|
BETHANECHOL CHLORIDE 10 MG TABLET
|
Facility
|
OP
|
$193.80
|
|
|
Service Code
|
NDC 00832051100
|
| Hospital Charge Code |
1043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.71 |
| Max. Negotiated Rate |
$174.42 |
| Rate for Payer: Aetna American Axle |
$125.97
|
| Rate for Payer: Aetna Commercial |
$164.73
|
| Rate for Payer: Aetna Medicare |
$96.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.97
|
| Rate for Payer: BCBS Complete |
$77.52
|
| Rate for Payer: Cash Price |
$155.04
|
| Rate for Payer: Cofinity Commercial |
$135.66
|
| Rate for Payer: Cofinity Commercial |
$166.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$135.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.04
|
| Rate for Payer: Healthscope Commercial |
$174.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.73
|
| Rate for Payer: PHP Commercial |
$164.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.97
|
| Rate for Payer: Priority Health SBD |
$122.09
|
| Rate for Payer: UMR Bronson Commercial |
$71.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.35
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET
|
Facility
|
IP
|
$315.40
|
|
|
Service Code
|
NDC 00832051101
|
| Hospital Charge Code |
1043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.78 |
| Max. Negotiated Rate |
$283.86 |
| Rate for Payer: Aetna American Axle |
$205.01
|
| Rate for Payer: Aetna Commercial |
$268.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.01
|
| Rate for Payer: Cash Price |
$252.32
|
| Rate for Payer: Cofinity Commercial |
$220.78
|
| Rate for Payer: Cofinity Commercial |
$271.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$220.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.32
|
| Rate for Payer: Healthscope Commercial |
$283.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$220.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.09
|
| Rate for Payer: PHP Commercial |
$268.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.01
|
| Rate for Payer: Priority Health SBD |
$198.70
|
| Rate for Payer: UMR Bronson Commercial |
$138.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.55
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET
|
Facility
|
IP
|
$3.16
|
|
|
Service Code
|
NDC 00832051189
|
| Hospital Charge Code |
1043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$2.84 |
| Rate for Payer: Aetna American Axle |
$2.05
|
| Rate for Payer: Aetna Commercial |
$2.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.05
|
| Rate for Payer: Cash Price |
$2.53
|
| Rate for Payer: Cofinity Commercial |
$2.21
|
| Rate for Payer: Cofinity Commercial |
$2.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.53
|
| Rate for Payer: Healthscope Commercial |
$2.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.69
|
| Rate for Payer: PHP Commercial |
$2.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.05
|
| Rate for Payer: Priority Health SBD |
$1.99
|
| Rate for Payer: UMR Bronson Commercial |
$1.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.37
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET
|
Facility
|
OP
|
$315.40
|
|
|
Service Code
|
NDC 00832051101
|
| Hospital Charge Code |
1043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.70 |
| Max. Negotiated Rate |
$283.86 |
| Rate for Payer: Aetna American Axle |
$205.01
|
| Rate for Payer: Aetna Commercial |
$268.09
|
| Rate for Payer: Aetna Medicare |
$157.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.01
|
| Rate for Payer: BCBS Complete |
$126.16
|
| Rate for Payer: Cash Price |
$252.32
|
| Rate for Payer: Cofinity Commercial |
$220.78
|
| Rate for Payer: Cofinity Commercial |
$271.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$220.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.32
|
| Rate for Payer: Healthscope Commercial |
$283.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$220.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.09
|
| Rate for Payer: PHP Commercial |
$268.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.01
|
| Rate for Payer: Priority Health SBD |
$198.70
|
| Rate for Payer: UMR Bronson Commercial |
$116.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.55
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET
|
Facility
|
OP
|
$279.30
|
|
|
Service Code
|
NDC 65162057210
|
| Hospital Charge Code |
1043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.34 |
| Max. Negotiated Rate |
$251.37 |
| Rate for Payer: Aetna American Axle |
$181.54
|
| Rate for Payer: Aetna Commercial |
$237.40
|
| Rate for Payer: Aetna Medicare |
$139.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.54
|
| Rate for Payer: BCBS Complete |
$111.72
|
| Rate for Payer: Cash Price |
$223.44
|
| Rate for Payer: Cofinity Commercial |
$195.51
|
| Rate for Payer: Cofinity Commercial |
$240.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$195.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.44
|
| Rate for Payer: Healthscope Commercial |
$251.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$195.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.40
|
| Rate for Payer: PHP Commercial |
$237.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.54
|
| Rate for Payer: Priority Health SBD |
$175.96
|
| Rate for Payer: UMR Bronson Commercial |
$103.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.48
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET
|
Facility
|
IP
|
$279.30
|
|
|
Service Code
|
NDC 65162057210
|
| Hospital Charge Code |
1043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.89 |
| Max. Negotiated Rate |
$251.37 |
| Rate for Payer: Aetna American Axle |
$181.54
|
| Rate for Payer: Aetna Commercial |
$237.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.54
|
| Rate for Payer: Cash Price |
$223.44
|
| Rate for Payer: Cofinity Commercial |
$195.51
|
| Rate for Payer: Cofinity Commercial |
$240.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$195.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.44
|
| Rate for Payer: Healthscope Commercial |
$251.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$195.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.40
|
| Rate for Payer: PHP Commercial |
$237.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.54
|
| Rate for Payer: Priority Health SBD |
$175.96
|
| Rate for Payer: UMR Bronson Commercial |
$122.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.48
|
|
|
BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$14,313.05
|
|
|
Service Code
|
HCPCS J9035
|
| Hospital Charge Code |
38022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,297.74 |
| Max. Negotiated Rate |
$12,881.74 |
| Rate for Payer: Aetna American Axle |
$9,303.48
|
| Rate for Payer: Aetna American Axle |
$2,325.88
|
| Rate for Payer: Aetna Commercial |
$12,166.09
|
| Rate for Payer: Aetna Commercial |
$3,041.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,303.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,325.88
|
| Rate for Payer: Cash Price |
$11,450.44
|
| Rate for Payer: Cash Price |
$2,862.62
|
| Rate for Payer: Cofinity Commercial |
$3,077.31
|
| Rate for Payer: Cofinity Commercial |
$2,504.79
|
| Rate for Payer: Cofinity Commercial |
$10,019.14
|
| Rate for Payer: Cofinity Commercial |
$12,309.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,019.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,504.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,450.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,862.62
|
| Rate for Payer: Healthscope Commercial |
$12,881.74
|
| Rate for Payer: Healthscope Commercial |
$3,220.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,019.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,504.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,734.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,683.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,041.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,166.09
|
| Rate for Payer: PHP Commercial |
$3,041.53
|
| Rate for Payer: PHP Commercial |
$12,166.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,303.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,325.88
|
| Rate for Payer: Priority Health SBD |
$9,017.22
|
| Rate for Payer: Priority Health SBD |
$2,254.31
|
| Rate for Payer: UMR Bronson Commercial |
$6,297.74
|
| Rate for Payer: UMR Bronson Commercial |
$1,574.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,734.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,683.70
|
|
|
BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$14,313.05
|
|
|
Service Code
|
HCPCS J9035
|
| Hospital Charge Code |
38022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.23 |
| Max. Negotiated Rate |
$12,881.74 |
| Rate for Payer: Aetna American Axle |
$9,303.48
|
| Rate for Payer: Aetna American Axle |
$2,325.88
|
| Rate for Payer: Aetna Commercial |
$3,041.53
|
| Rate for Payer: Aetna Commercial |
$12,166.09
|
| Rate for Payer: Aetna Medicare |
$76.12
|
| Rate for Payer: Aetna Medicare |
$76.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,303.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,325.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$91.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$91.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$91.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$91.49
|
| Rate for Payer: BCBS Complete |
$41.19
|
| Rate for Payer: BCBS Complete |
$41.19
|
| Rate for Payer: BCBS MAPPO |
$73.19
|
| Rate for Payer: BCBS MAPPO |
$73.19
|
| Rate for Payer: BCBS Trust/PPO |
$196.02
|
| Rate for Payer: BCBS Trust/PPO |
$196.02
|
| Rate for Payer: BCN Commercial |
$196.02
|
| Rate for Payer: BCN Commercial |
$196.02
|
| Rate for Payer: BCN Medicare Advantage |
$73.19
|
| Rate for Payer: BCN Medicare Advantage |
$73.19
|
| Rate for Payer: Cash Price |
$2,862.62
|
| Rate for Payer: Cash Price |
$11,450.44
|
| Rate for Payer: Cash Price |
$2,862.62
|
| Rate for Payer: Cash Price |
$11,450.44
|
| Rate for Payer: Cofinity Commercial |
$2,504.79
|
| Rate for Payer: Cofinity Commercial |
$10,019.14
|
| Rate for Payer: Cofinity Commercial |
$12,309.22
|
| Rate for Payer: Cofinity Commercial |
$3,077.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,019.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,504.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,450.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,862.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.19
|
| Rate for Payer: Healthscope Commercial |
$12,881.74
|
| Rate for Payer: Healthscope Commercial |
$3,220.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,504.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,019.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,734.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,683.70
|
| Rate for Payer: Mclaren Medicaid |
$39.23
|
| Rate for Payer: Mclaren Medicaid |
$39.23
|
| Rate for Payer: Mclaren Medicare |
$73.19
|
| Rate for Payer: Mclaren Medicare |
$73.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.85
|
| Rate for Payer: Meridian Medicaid |
$41.19
|
| Rate for Payer: Meridian Medicaid |
$41.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,166.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,041.53
|
| Rate for Payer: Nomi Health Commercial |
$219.57
|
| Rate for Payer: Nomi Health Commercial |
$219.57
|
| Rate for Payer: PACE Medicare |
$69.53
|
| Rate for Payer: PACE Medicare |
$69.53
|
| Rate for Payer: PACE SWMI |
$73.19
|
| Rate for Payer: PACE SWMI |
$73.19
|
| Rate for Payer: PHP Commercial |
$12,166.09
|
| Rate for Payer: PHP Commercial |
$3,041.53
|
| Rate for Payer: PHP Medicare Advantage |
$73.19
|
| Rate for Payer: PHP Medicare Advantage |
$73.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,303.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,325.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$209.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$209.26
|
| Rate for Payer: Priority Health Medicare |
$73.19
|
| Rate for Payer: Priority Health Medicare |
$73.19
|
| Rate for Payer: Priority Health Narrow Network |
$167.41
|
| Rate for Payer: Priority Health Narrow Network |
$167.41
|
| Rate for Payer: Priority Health SBD |
$9,017.22
|
| Rate for Payer: Priority Health SBD |
$2,254.31
|
| Rate for Payer: Railroad Medicare Medicare |
$73.19
|
| Rate for Payer: Railroad Medicare Medicare |
$73.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.19
|
| Rate for Payer: UHC Exchange |
$139.87
|
| Rate for Payer: UHC Exchange |
$139.87
|
| Rate for Payer: UHC Medicare Advantage |
$73.19
|
| Rate for Payer: UHC Medicare Advantage |
$73.19
|
| Rate for Payer: UHCCP Medicaid |
$39.23
|
| Rate for Payer: UHCCP Medicaid |
$39.23
|
| Rate for Payer: UMR Bronson Commercial |
$5,295.83
|
| Rate for Payer: UMR Bronson Commercial |
$1,323.96
|
| Rate for Payer: VA VA |
$73.19
|
| Rate for Payer: VA VA |
$73.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,734.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,683.70
|
|
|
BEVACIZUMAB-AWWB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$11,973.43
|
|
|
Service Code
|
HCPCS Q5107
|
| Hospital Charge Code |
190598
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$10,776.09 |
| Rate for Payer: Aetna American Axle |
$7,782.73
|
| Rate for Payer: Aetna American Axle |
$1,945.74
|
| Rate for Payer: Aetna Commercial |
$10,177.42
|
| Rate for Payer: Aetna Commercial |
$2,544.43
|
| Rate for Payer: Aetna Medicare |
$29.88
|
| Rate for Payer: Aetna Medicare |
$29.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,945.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,782.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.91
|
| Rate for Payer: BCBS Complete |
$16.17
|
| Rate for Payer: BCBS Complete |
$16.17
|
| Rate for Payer: BCBS MAPPO |
$28.73
|
| Rate for Payer: BCBS MAPPO |
$28.73
|
| Rate for Payer: BCBS Trust/PPO |
$68.67
|
| Rate for Payer: BCBS Trust/PPO |
$68.67
|
| Rate for Payer: BCN Commercial |
$68.67
|
| Rate for Payer: BCN Commercial |
$68.67
|
| Rate for Payer: BCN Medicare Advantage |
$28.73
|
| Rate for Payer: BCN Medicare Advantage |
$28.73
|
| Rate for Payer: Cash Price |
$9,578.74
|
| Rate for Payer: Cash Price |
$2,394.76
|
| Rate for Payer: Cash Price |
$2,394.76
|
| Rate for Payer: Cash Price |
$9,578.74
|
| Rate for Payer: Cofinity Commercial |
$10,297.15
|
| Rate for Payer: Cofinity Commercial |
$8,381.40
|
| Rate for Payer: Cofinity Commercial |
$2,574.37
|
| Rate for Payer: Cofinity Commercial |
$2,095.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,095.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,381.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,578.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,394.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.73
|
| Rate for Payer: Healthscope Commercial |
$2,694.10
|
| Rate for Payer: Healthscope Commercial |
$10,776.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,381.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,095.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,980.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,245.09
|
| Rate for Payer: Mclaren Medicaid |
$15.40
|
| Rate for Payer: Mclaren Medicaid |
$15.40
|
| Rate for Payer: Mclaren Medicare |
$28.73
|
| Rate for Payer: Mclaren Medicare |
$28.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.17
|
| Rate for Payer: Meridian Medicaid |
$16.17
|
| Rate for Payer: Meridian Medicaid |
$16.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,544.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,177.42
|
| Rate for Payer: Nomi Health Commercial |
$86.19
|
| Rate for Payer: Nomi Health Commercial |
$86.19
|
| Rate for Payer: PACE Medicare |
$27.29
|
| Rate for Payer: PACE Medicare |
$27.29
|
| Rate for Payer: PACE SWMI |
$28.73
|
| Rate for Payer: PACE SWMI |
$28.73
|
| Rate for Payer: PHP Commercial |
$2,544.43
|
| Rate for Payer: PHP Commercial |
$10,177.42
|
| Rate for Payer: PHP Medicare Advantage |
$28.73
|
| Rate for Payer: PHP Medicare Advantage |
$28.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,782.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,945.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.50
|
| Rate for Payer: Priority Health Medicare |
$28.73
|
| Rate for Payer: Priority Health Medicare |
$28.73
|
| Rate for Payer: Priority Health Narrow Network |
$61.20
|
| Rate for Payer: Priority Health Narrow Network |
$61.20
|
| Rate for Payer: Priority Health SBD |
$1,885.87
|
| Rate for Payer: Priority Health SBD |
$7,543.26
|
| Rate for Payer: Railroad Medicare Medicare |
$28.73
|
| Rate for Payer: Railroad Medicare Medicare |
$28.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.73
|
| Rate for Payer: UHC Exchange |
$54.91
|
| Rate for Payer: UHC Exchange |
$54.91
|
| Rate for Payer: UHC Medicare Advantage |
$28.73
|
| Rate for Payer: UHC Medicare Advantage |
$28.73
|
| Rate for Payer: UHCCP Medicaid |
$15.40
|
| Rate for Payer: UHCCP Medicaid |
$15.40
|
| Rate for Payer: UMR Bronson Commercial |
$1,107.58
|
| Rate for Payer: UMR Bronson Commercial |
$4,430.17
|
| Rate for Payer: VA VA |
$28.73
|
| Rate for Payer: VA VA |
$28.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,980.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,245.09
|
|
|
BEVACIZUMAB-BVZR 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,427.53
|
|
|
Service Code
|
HCPCS Q5118
|
| Hospital Charge Code |
192559
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,068.11 |
| Max. Negotiated Rate |
$2,184.78 |
| Rate for Payer: Aetna American Axle |
$1,577.89
|
| Rate for Payer: Aetna American Axle |
$6,311.57
|
| Rate for Payer: Aetna Commercial |
$2,063.40
|
| Rate for Payer: Aetna Commercial |
$8,253.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,577.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,311.57
|
| Rate for Payer: Cash Price |
$1,942.02
|
| Rate for Payer: Cash Price |
$7,768.09
|
| Rate for Payer: Cofinity Commercial |
$8,350.69
|
| Rate for Payer: Cofinity Commercial |
$6,797.08
|
| Rate for Payer: Cofinity Commercial |
$1,699.27
|
| Rate for Payer: Cofinity Commercial |
$2,087.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,699.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,797.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,942.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,768.09
|
| Rate for Payer: Healthscope Commercial |
$2,184.78
|
| Rate for Payer: Healthscope Commercial |
$8,739.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,699.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,797.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,820.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,282.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,253.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,063.40
|
| Rate for Payer: PHP Commercial |
$8,253.59
|
| Rate for Payer: PHP Commercial |
$2,063.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,577.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,311.57
|
| Rate for Payer: Priority Health SBD |
$1,529.34
|
| Rate for Payer: Priority Health SBD |
$6,117.37
|
| Rate for Payer: UMR Bronson Commercial |
$1,068.11
|
| Rate for Payer: UMR Bronson Commercial |
$4,272.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,820.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,282.58
|
|
|
BEVACIZUMAB-BVZR 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,427.53
|
|
|
Service Code
|
HCPCS Q5118
|
| Hospital Charge Code |
192559
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.33 |
| Max. Negotiated Rate |
$2,184.78 |
| Rate for Payer: Aetna American Axle |
$1,577.89
|
| Rate for Payer: Aetna American Axle |
$6,311.57
|
| Rate for Payer: Aetna Commercial |
$8,253.59
|
| Rate for Payer: Aetna Commercial |
$2,063.40
|
| Rate for Payer: Aetna Medicare |
$23.92
|
| Rate for Payer: Aetna Medicare |
$23.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,577.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,311.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.75
|
| Rate for Payer: BCBS Complete |
$12.94
|
| Rate for Payer: BCBS Complete |
$12.94
|
| Rate for Payer: BCBS MAPPO |
$23.00
|
| Rate for Payer: BCBS MAPPO |
$23.00
|
| Rate for Payer: BCBS Trust/PPO |
$51.71
|
| Rate for Payer: BCBS Trust/PPO |
$51.71
|
| Rate for Payer: BCN Commercial |
$51.71
|
| Rate for Payer: BCN Commercial |
$51.71
|
| Rate for Payer: BCN Medicare Advantage |
$23.00
|
| Rate for Payer: BCN Medicare Advantage |
$23.00
|
| Rate for Payer: Cash Price |
$7,768.09
|
| Rate for Payer: Cash Price |
$1,942.02
|
| Rate for Payer: Cash Price |
$7,768.09
|
| Rate for Payer: Cash Price |
$1,942.02
|
| Rate for Payer: Cofinity Commercial |
$6,797.08
|
| Rate for Payer: Cofinity Commercial |
$1,699.27
|
| Rate for Payer: Cofinity Commercial |
$2,087.68
|
| Rate for Payer: Cofinity Commercial |
$8,350.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,699.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,797.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,942.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,768.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.00
|
| Rate for Payer: Healthscope Commercial |
$2,184.78
|
| Rate for Payer: Healthscope Commercial |
$8,739.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,797.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,699.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,820.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,282.58
|
| Rate for Payer: Mclaren Medicaid |
$12.33
|
| Rate for Payer: Mclaren Medicaid |
$12.33
|
| Rate for Payer: Mclaren Medicare |
$23.00
|
| Rate for Payer: Mclaren Medicare |
$23.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.15
|
| Rate for Payer: Meridian Medicaid |
$12.94
|
| Rate for Payer: Meridian Medicaid |
$12.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,063.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,253.59
|
| Rate for Payer: Nomi Health Commercial |
$69.00
|
| Rate for Payer: Nomi Health Commercial |
$69.00
|
| Rate for Payer: PACE Medicare |
$21.85
|
| Rate for Payer: PACE Medicare |
$21.85
|
| Rate for Payer: PACE SWMI |
$23.00
|
| Rate for Payer: PACE SWMI |
$23.00
|
| Rate for Payer: PHP Commercial |
$2,063.40
|
| Rate for Payer: PHP Commercial |
$8,253.59
|
| Rate for Payer: PHP Medicare Advantage |
$23.00
|
| Rate for Payer: PHP Medicare Advantage |
$23.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,577.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,311.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.88
|
| Rate for Payer: Priority Health Medicare |
$23.00
|
| Rate for Payer: Priority Health Medicare |
$23.00
|
| Rate for Payer: Priority Health Narrow Network |
$54.30
|
| Rate for Payer: Priority Health Narrow Network |
$54.30
|
| Rate for Payer: Priority Health SBD |
$1,529.34
|
| Rate for Payer: Priority Health SBD |
$6,117.37
|
| Rate for Payer: Railroad Medicare Medicare |
$23.00
|
| Rate for Payer: Railroad Medicare Medicare |
$23.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.00
|
| Rate for Payer: UHC Exchange |
$43.96
|
| Rate for Payer: UHC Exchange |
$43.96
|
| Rate for Payer: UHC Medicare Advantage |
$23.00
|
| Rate for Payer: UHC Medicare Advantage |
$23.00
|
| Rate for Payer: UHCCP Medicaid |
$12.33
|
| Rate for Payer: UHCCP Medicaid |
$12.33
|
| Rate for Payer: UMR Bronson Commercial |
$898.19
|
| Rate for Payer: UMR Bronson Commercial |
$3,592.74
|
| Rate for Payer: VA VA |
$23.00
|
| Rate for Payer: VA VA |
$23.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,820.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,282.58
|
|
|
BEXAROTENE 75 MG CAPSULE
|
Facility
|
IP
|
$735.03
|
|
|
Service Code
|
NDC 42292000701
|
| Hospital Charge Code |
27027
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$323.41 |
| Max. Negotiated Rate |
$661.53 |
| Rate for Payer: Aetna American Axle |
$477.77
|
| Rate for Payer: Aetna Commercial |
$624.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$477.77
|
| Rate for Payer: Cash Price |
$588.02
|
| Rate for Payer: Cofinity Commercial |
$514.52
|
| Rate for Payer: Cofinity Commercial |
$632.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$514.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$588.02
|
| Rate for Payer: Healthscope Commercial |
$661.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$514.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$551.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$624.78
|
| Rate for Payer: PHP Commercial |
$624.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$477.77
|
| Rate for Payer: Priority Health SBD |
$463.07
|
| Rate for Payer: UMR Bronson Commercial |
$323.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$551.27
|
|
|
BEXAROTENE 75 MG CAPSULE
|
Facility
|
IP
|
$7,350.24
|
|
|
Service Code
|
NDC 42292000710
|
| Hospital Charge Code |
27027
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,234.11 |
| Max. Negotiated Rate |
$6,615.22 |
| Rate for Payer: Aetna American Axle |
$4,777.66
|
| Rate for Payer: Aetna Commercial |
$6,247.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,777.66
|
| Rate for Payer: Cash Price |
$5,880.19
|
| Rate for Payer: Cofinity Commercial |
$5,145.17
|
| Rate for Payer: Cofinity Commercial |
$6,321.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,145.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,880.19
|
| Rate for Payer: Healthscope Commercial |
$6,615.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,145.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,512.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,247.70
|
| Rate for Payer: PHP Commercial |
$6,247.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,777.66
|
| Rate for Payer: Priority Health SBD |
$4,630.65
|
| Rate for Payer: UMR Bronson Commercial |
$3,234.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,512.68
|
|
|
BEXAROTENE 75 MG CAPSULE
|
Facility
|
OP
|
$735.03
|
|
|
Service Code
|
NDC 42292000701
|
| Hospital Charge Code |
27027
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$271.96 |
| Max. Negotiated Rate |
$661.53 |
| Rate for Payer: Aetna American Axle |
$477.77
|
| Rate for Payer: Aetna Commercial |
$624.78
|
| Rate for Payer: Aetna Medicare |
$367.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$477.77
|
| Rate for Payer: BCBS Complete |
$294.01
|
| Rate for Payer: Cash Price |
$588.02
|
| Rate for Payer: Cofinity Commercial |
$514.52
|
| Rate for Payer: Cofinity Commercial |
$632.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$514.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$588.02
|
| Rate for Payer: Healthscope Commercial |
$661.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$514.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$551.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$624.78
|
| Rate for Payer: PHP Commercial |
$624.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$477.77
|
| Rate for Payer: Priority Health SBD |
$463.07
|
| Rate for Payer: UMR Bronson Commercial |
$271.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$551.27
|
|
|
BEXAROTENE 75 MG CAPSULE
|
Facility
|
OP
|
$7,350.24
|
|
|
Service Code
|
NDC 42292000710
|
| Hospital Charge Code |
27027
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,719.59 |
| Max. Negotiated Rate |
$6,615.22 |
| Rate for Payer: Aetna American Axle |
$4,777.66
|
| Rate for Payer: Aetna Commercial |
$6,247.70
|
| Rate for Payer: Aetna Medicare |
$3,675.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,777.66
|
| Rate for Payer: BCBS Complete |
$2,940.10
|
| Rate for Payer: Cash Price |
$5,880.19
|
| Rate for Payer: Cofinity Commercial |
$5,145.17
|
| Rate for Payer: Cofinity Commercial |
$6,321.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,145.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,880.19
|
| Rate for Payer: Healthscope Commercial |
$6,615.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,145.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,512.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,247.70
|
| Rate for Payer: PHP Commercial |
$6,247.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,777.66
|
| Rate for Payer: Priority Health SBD |
$4,630.65
|
| Rate for Payer: UMR Bronson Commercial |
$2,719.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,512.68
|
|
|
BEZLOTOXUMAB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$9,879.90
|
|
|
Service Code
|
HCPCS J0565
|
| Hospital Charge Code |
181631
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.37 |
| Max. Negotiated Rate |
$8,891.91 |
| Rate for Payer: Aetna American Axle |
$6,421.94
|
| Rate for Payer: Aetna Commercial |
$8,397.92
|
| Rate for Payer: Aetna Medicare |
$41.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,421.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.84
|
| Rate for Payer: BCBS Complete |
$22.44
|
| Rate for Payer: BCBS MAPPO |
$39.87
|
| Rate for Payer: BCBS Trust/PPO |
$107.47
|
| Rate for Payer: BCN Commercial |
$107.47
|
| Rate for Payer: BCN Medicare Advantage |
$39.87
|
| Rate for Payer: Cash Price |
$7,903.92
|
| Rate for Payer: Cash Price |
$7,903.92
|
| Rate for Payer: Cofinity Commercial |
$8,496.71
|
| Rate for Payer: Cofinity Commercial |
$6,915.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,915.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,903.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.87
|
| Rate for Payer: Healthscope Commercial |
$8,891.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,915.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,409.92
|
| Rate for Payer: Mclaren Medicaid |
$21.37
|
| Rate for Payer: Mclaren Medicare |
$39.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.86
|
| Rate for Payer: Meridian Medicaid |
$22.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,397.92
|
| Rate for Payer: Nomi Health Commercial |
$119.61
|
| Rate for Payer: PACE Medicare |
$37.88
|
| Rate for Payer: PACE SWMI |
$39.87
|
| Rate for Payer: PHP Commercial |
$8,397.92
|
| Rate for Payer: PHP Medicare Advantage |
$39.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,421.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$114.71
|
| Rate for Payer: Priority Health Medicare |
$39.87
|
| Rate for Payer: Priority Health Narrow Network |
$91.77
|
| Rate for Payer: Priority Health SBD |
$6,224.34
|
| Rate for Payer: Railroad Medicare Medicare |
$39.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.87
|
| Rate for Payer: UHC Exchange |
$76.20
|
| Rate for Payer: UHC Medicare Advantage |
$39.87
|
| Rate for Payer: UHCCP Medicaid |
$21.37
|
| Rate for Payer: UMR Bronson Commercial |
$3,655.56
|
| Rate for Payer: VA VA |
$39.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,409.92
|
|
|
BEZLOTOXUMAB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$9,879.90
|
|
|
Service Code
|
HCPCS J0565
|
| Hospital Charge Code |
181631
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,347.16 |
| Max. Negotiated Rate |
$8,891.91 |
| Rate for Payer: Aetna American Axle |
$6,421.94
|
| Rate for Payer: Aetna Commercial |
$8,397.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,421.94
|
| Rate for Payer: Cash Price |
$7,903.92
|
| Rate for Payer: Cofinity Commercial |
$6,915.93
|
| Rate for Payer: Cofinity Commercial |
$8,496.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,915.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,903.92
|
| Rate for Payer: Healthscope Commercial |
$8,891.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,915.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,409.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,397.92
|
| Rate for Payer: PHP Commercial |
$8,397.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,421.94
|
| Rate for Payer: Priority Health SBD |
$6,224.34
|
| Rate for Payer: UMR Bronson Commercial |
$4,347.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,409.92
|
|
|
BICALUTAMIDE 50 MG TABLET
|
Facility
|
OP
|
$107.73
|
|
|
Service Code
|
NDC 47335048583
|
| Hospital Charge Code |
15746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.86 |
| Max. Negotiated Rate |
$96.96 |
| Rate for Payer: Aetna American Axle |
$70.02
|
| Rate for Payer: Aetna Commercial |
$91.57
|
| Rate for Payer: Aetna Medicare |
$53.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.02
|
| Rate for Payer: BCBS Complete |
$43.09
|
| Rate for Payer: Cash Price |
$86.18
|
| Rate for Payer: Cofinity Commercial |
$75.41
|
| Rate for Payer: Cofinity Commercial |
$92.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.18
|
| Rate for Payer: Healthscope Commercial |
$96.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.57
|
| Rate for Payer: PHP Commercial |
$91.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.02
|
| Rate for Payer: Priority Health SBD |
$67.87
|
| Rate for Payer: UMR Bronson Commercial |
$39.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.80
|
|
|
BICALUTAMIDE 50 MG TABLET
|
Facility
|
OP
|
$76.38
|
|
|
Service Code
|
NDC 00904601946
|
| Hospital Charge Code |
15746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.26 |
| Max. Negotiated Rate |
$68.74 |
| Rate for Payer: Aetna American Axle |
$49.65
|
| Rate for Payer: Aetna Commercial |
$64.92
|
| Rate for Payer: Aetna Medicare |
$38.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.65
|
| Rate for Payer: BCBS Complete |
$30.55
|
| Rate for Payer: Cash Price |
$61.10
|
| Rate for Payer: Cofinity Commercial |
$53.47
|
| Rate for Payer: Cofinity Commercial |
$65.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.10
|
| Rate for Payer: Healthscope Commercial |
$68.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.92
|
| Rate for Payer: PHP Commercial |
$64.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.65
|
| Rate for Payer: Priority Health SBD |
$48.12
|
| Rate for Payer: UMR Bronson Commercial |
$28.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.28
|
|
|
BICALUTAMIDE 50 MG TABLET
|
Facility
|
IP
|
$76.38
|
|
|
Service Code
|
NDC 00904601946
|
| Hospital Charge Code |
15746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.61 |
| Max. Negotiated Rate |
$68.74 |
| Rate for Payer: Aetna American Axle |
$49.65
|
| Rate for Payer: Aetna Commercial |
$64.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.65
|
| Rate for Payer: Cash Price |
$61.10
|
| Rate for Payer: Cofinity Commercial |
$53.47
|
| Rate for Payer: Cofinity Commercial |
$65.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.10
|
| Rate for Payer: Healthscope Commercial |
$68.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.92
|
| Rate for Payer: PHP Commercial |
$64.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.65
|
| Rate for Payer: Priority Health SBD |
$48.12
|
| Rate for Payer: UMR Bronson Commercial |
$33.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.28
|
|
|
BICALUTAMIDE 50 MG TABLET
|
Facility
|
IP
|
$107.73
|
|
|
Service Code
|
NDC 47335048583
|
| Hospital Charge Code |
15746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.40 |
| Max. Negotiated Rate |
$96.96 |
| Rate for Payer: Aetna American Axle |
$70.02
|
| Rate for Payer: Aetna Commercial |
$91.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.02
|
| Rate for Payer: Cash Price |
$86.18
|
| Rate for Payer: Cofinity Commercial |
$75.41
|
| Rate for Payer: Cofinity Commercial |
$92.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.18
|
| Rate for Payer: Healthscope Commercial |
$96.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.57
|
| Rate for Payer: PHP Commercial |
$91.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.02
|
| Rate for Payer: Priority Health SBD |
$67.87
|
| Rate for Payer: UMR Bronson Commercial |
$47.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.80
|
|
|
BICALUTAMIDE 50 MG TABLET
|
Facility
|
IP
|
$101.52
|
|
|
Service Code
|
NDC 16729002310
|
| Hospital Charge Code |
15746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.67 |
| Max. Negotiated Rate |
$91.37 |
| Rate for Payer: Aetna American Axle |
$65.99
|
| Rate for Payer: Aetna Commercial |
$86.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.99
|
| Rate for Payer: Cash Price |
$81.22
|
| Rate for Payer: Cofinity Commercial |
$71.06
|
| Rate for Payer: Cofinity Commercial |
$87.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.22
|
| Rate for Payer: Healthscope Commercial |
$91.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.29
|
| Rate for Payer: PHP Commercial |
$86.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.99
|
| Rate for Payer: Priority Health SBD |
$63.96
|
| Rate for Payer: UMR Bronson Commercial |
$44.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.14
|
|
|
BICALUTAMIDE 50 MG TABLET
|
Facility
|
OP
|
$101.52
|
|
|
Service Code
|
NDC 16729002310
|
| Hospital Charge Code |
15746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.56 |
| Max. Negotiated Rate |
$91.37 |
| Rate for Payer: Aetna American Axle |
$65.99
|
| Rate for Payer: Aetna Commercial |
$86.29
|
| Rate for Payer: Aetna Medicare |
$50.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.99
|
| Rate for Payer: BCBS Complete |
$40.61
|
| Rate for Payer: Cash Price |
$81.22
|
| Rate for Payer: Cofinity Commercial |
$71.06
|
| Rate for Payer: Cofinity Commercial |
$87.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.22
|
| Rate for Payer: Healthscope Commercial |
$91.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.29
|
| Rate for Payer: PHP Commercial |
$86.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.99
|
| Rate for Payer: Priority Health SBD |
$63.96
|
| Rate for Payer: UMR Bronson Commercial |
$37.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.14
|
|
|
BICARBONATE DIALYSIS SOLN WITHOUT CALCIUM NO15 POT 4 MEQ-MAG 1.2 MEQ/L
|
Facility
|
IP
|
$394.40
|
|
|
Service Code
|
NDC 24571011406
|
| Hospital Charge Code |
119755
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$173.54 |
| Max. Negotiated Rate |
$354.96 |
| Rate for Payer: Aetna American Axle |
$256.36
|
| Rate for Payer: Aetna Commercial |
$335.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.36
|
| Rate for Payer: Cash Price |
$315.52
|
| Rate for Payer: Cofinity Commercial |
$276.08
|
| Rate for Payer: Cofinity Commercial |
$339.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$276.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.52
|
| Rate for Payer: Healthscope Commercial |
$354.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$276.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.24
|
| Rate for Payer: PHP Commercial |
$335.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.36
|
| Rate for Payer: Priority Health SBD |
$248.47
|
| Rate for Payer: UMR Bronson Commercial |
$173.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.80
|
|
|
BICARBONATE DIALYSIS SOLN WITHOUT CALCIUM NO15 POT 4 MEQ-MAG 1.2 MEQ/L
|
Facility
|
OP
|
$394.40
|
|
|
Service Code
|
NDC 24571011406
|
| Hospital Charge Code |
119755
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$145.93 |
| Max. Negotiated Rate |
$354.96 |
| Rate for Payer: Aetna American Axle |
$256.36
|
| Rate for Payer: Aetna Commercial |
$335.24
|
| Rate for Payer: Aetna Medicare |
$197.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.36
|
| Rate for Payer: BCBS Complete |
$157.76
|
| Rate for Payer: Cash Price |
$315.52
|
| Rate for Payer: Cofinity Commercial |
$276.08
|
| Rate for Payer: Cofinity Commercial |
$339.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$276.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.52
|
| Rate for Payer: Healthscope Commercial |
$354.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$276.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.24
|
| Rate for Payer: PHP Commercial |
$335.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.36
|
| Rate for Payer: Priority Health SBD |
$248.47
|
| Rate for Payer: UMR Bronson Commercial |
$145.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.80
|
|
