|
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
|
|
|
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 |
$367.51
|
| 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 |
$21.35 |
| 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 |
$41.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,421.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.79
|
| Rate for Payer: BCBS Complete |
$22.42
|
| Rate for Payer: BCBS MAPPO |
$39.83
|
| Rate for Payer: BCN Medicare Advantage |
$39.83
|
| Rate for Payer: Cash Price |
$7,903.92
|
| 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: Health Alliance Plan Medicare Advantage |
$39.83
|
| 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 |
$7,409.93
|
| Rate for Payer: Mclaren Medicaid |
$21.35
|
| Rate for Payer: Mclaren Medicare |
$39.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.82
|
| Rate for Payer: Meridian Medicaid |
$22.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,397.92
|
| Rate for Payer: PACE Medicare |
$37.84
|
| Rate for Payer: PACE SWMI |
$39.83
|
| Rate for Payer: PHP Commercial |
$8,397.92
|
| Rate for Payer: PHP Medicare Advantage |
$39.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,421.94
|
| Rate for Payer: Priority Health Medicare |
$39.83
|
| Rate for Payer: Priority Health SBD |
$6,224.34
|
| Rate for Payer: Railroad Medicare Medicare |
$39.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.83
|
| Rate for Payer: UHC Exchange |
$76.12
|
| Rate for Payer: UHC Medicare Advantage |
$39.83
|
| Rate for Payer: UHCCP Medicaid |
$21.35
|
| Rate for Payer: UMR Bronson Commercial |
$3,655.56
|
| Rate for Payer: VA VA |
$39.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,409.93
|
|
|
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 |
$7,409.93
|
| 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 |
$7,409.93
|
|
|
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
|
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 |
$53.87
|
| 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
|
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
|
$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
|
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
|
|
|
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
|
|
|
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
|
|
|
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 HEMODIALYSIS SOLN WITHOUT CALCIUM 8 POT 2 MEQ-MAG 1 MEQ/L
|
Facility
|
IP
|
$394.40
|
|
|
Service Code
|
NDC 24571010206
|
| Hospital Charge Code |
118523
|
|
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 HEMODIALYSIS SOLN WITHOUT CALCIUM 8 POT 2 MEQ-MAG 1 MEQ/L
|
Facility
|
OP
|
$394.40
|
|
|
Service Code
|
NDC 24571010206
|
| Hospital Charge Code |
118523
|
|
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
|
|
|
BICARBONATE HEMODIALYSIS SOLUTION NO.9 K 4 MEQ-CA 2.5 MEQ-MG 1.5 MEQ/L
|
Facility
|
OP
|
$394.40
|
|
|
Service Code
|
NDC 24571010506
|
| Hospital Charge Code |
100176
|
|
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
|
|
|
BICARBONATE HEMODIALYSIS SOLUTION NO.9 K 4 MEQ-CA 2.5 MEQ-MG 1.5 MEQ/L
|
Facility
|
IP
|
$394.40
|
|
|
Service Code
|
NDC 24571010506
|
| Hospital Charge Code |
100176
|
|
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
|
|
|
BICTEGRAVIR 50 MG-EMTRICITABINE 200 MG-TENOFOVIR ALAFENAM 25 MG TABLET
|
Facility
|
OP
|
$15,209.56
|
|
|
Service Code
|
NDC 61958250101
|
| Hospital Charge Code |
185933
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5,627.54 |
| Max. Negotiated Rate |
$13,688.60 |
| Rate for Payer: Aetna American Axle |
$9,886.21
|
| Rate for Payer: Aetna Commercial |
$12,928.13
|
| Rate for Payer: Aetna Medicare |
$7,604.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,886.21
|
| Rate for Payer: BCBS Complete |
$6,083.82
|
| Rate for Payer: Cash Price |
$12,167.65
|
| Rate for Payer: Cofinity Commercial |
$10,646.69
|
| Rate for Payer: Cofinity Commercial |
$13,080.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,646.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,167.65
|
| Rate for Payer: Healthscope Commercial |
$13,688.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,646.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,407.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,928.13
|
| Rate for Payer: PHP Commercial |
$12,928.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,886.21
|
| Rate for Payer: Priority Health SBD |
$9,582.02
|
| Rate for Payer: UMR Bronson Commercial |
$5,627.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,407.17
|
|
|
BICTEGRAVIR 50 MG-EMTRICITABINE 200 MG-TENOFOVIR ALAFENAM 25 MG TABLET
|
Facility
|
IP
|
$15,209.56
|
|
|
Service Code
|
NDC 61958250101
|
| Hospital Charge Code |
185933
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6,692.21 |
| Max. Negotiated Rate |
$13,688.60 |
| Rate for Payer: Aetna American Axle |
$9,886.21
|
| Rate for Payer: Aetna Commercial |
$12,928.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,886.21
|
| Rate for Payer: Cash Price |
$12,167.65
|
| Rate for Payer: Cofinity Commercial |
$10,646.69
|
| Rate for Payer: Cofinity Commercial |
$13,080.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,646.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,167.65
|
| Rate for Payer: Healthscope Commercial |
$13,688.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,646.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,407.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,928.13
|
| Rate for Payer: PHP Commercial |
$12,928.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,886.21
|
| Rate for Payer: Priority Health SBD |
$9,582.02
|
| Rate for Payer: UMR Bronson Commercial |
$6,692.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,407.17
|
|
|
BIMATOPROST 0.01 % EYE DROPS
|
Facility
|
IP
|
$858.76
|
|
|
Service Code
|
NDC 00023320503
|
| Hospital Charge Code |
105410
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$377.85 |
| Max. Negotiated Rate |
$772.88 |
| Rate for Payer: Aetna American Axle |
$558.19
|
| Rate for Payer: Aetna Commercial |
$729.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$558.19
|
| Rate for Payer: Cash Price |
$687.01
|
| Rate for Payer: Cofinity Commercial |
$601.13
|
| Rate for Payer: Cofinity Commercial |
$738.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$601.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$687.01
|
| Rate for Payer: Healthscope Commercial |
$772.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$601.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$644.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$729.95
|
| Rate for Payer: PHP Commercial |
$729.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$558.19
|
| Rate for Payer: Priority Health SBD |
$541.02
|
| Rate for Payer: UMR Bronson Commercial |
$377.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$644.07
|
|
|
BIMATOPROST 0.01 % EYE DROPS
|
Facility
|
OP
|
$858.76
|
|
|
Service Code
|
NDC 00023320503
|
| Hospital Charge Code |
105410
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$317.74 |
| Max. Negotiated Rate |
$772.88 |
| Rate for Payer: Aetna American Axle |
$558.19
|
| Rate for Payer: Aetna Commercial |
$729.95
|
| Rate for Payer: Aetna Medicare |
$429.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$558.19
|
| Rate for Payer: BCBS Complete |
$343.50
|
| Rate for Payer: Cash Price |
$687.01
|
| Rate for Payer: Cofinity Commercial |
$601.13
|
| Rate for Payer: Cofinity Commercial |
$738.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$601.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$687.01
|
| Rate for Payer: Healthscope Commercial |
$772.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$601.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$644.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$729.95
|
| Rate for Payer: PHP Commercial |
$729.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$558.19
|
| Rate for Payer: Priority Health SBD |
$541.02
|
| Rate for Payer: UMR Bronson Commercial |
$317.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$644.07
|
|
|
BIOPSY, BONE, OPEN; DEEP (EG, HUMERAL SHAFT, ISCHIUM, FEMORAL SHAFT)
|
Facility
|
OP
|
$7,857.23
|
|
|
Service Code
|
CPT 20245
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,496.14 |
| Max. Negotiated Rate |
$7,857.23 |
| Rate for Payer: Aetna Medicare |
$2,902.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,489.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,489.12
|
| Rate for Payer: BCBS Complete |
$1,570.94
|
| Rate for Payer: BCBS MAPPO |
$2,791.30
|
| Rate for Payer: BCN Medicare Advantage |
$2,791.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,791.30
|
| Rate for Payer: Mclaren Medicaid |
$1,496.14
|
| Rate for Payer: Mclaren Medicare |
$2,791.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,930.86
|
| Rate for Payer: Meridian Medicaid |
$1,570.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,209.99
|
| Rate for Payer: PACE Medicare |
$2,651.74
|
| Rate for Payer: PACE SWMI |
$2,791.30
|
| Rate for Payer: PHP Medicare Advantage |
$2,791.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,496.14
|
| Rate for Payer: Priority Health Medicare |
$2,791.30
|
| Rate for Payer: Railroad Medicare Medicare |
$2,791.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,857.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,791.30
|
| Rate for Payer: UHC Exchange |
$5,334.45
|
| Rate for Payer: UHC Medicare Advantage |
$2,791.30
|
| Rate for Payer: UHCCP Medicaid |
$1,496.14
|
| Rate for Payer: VA VA |
$2,791.30
|
|
|
BIOPSY, BONE, OPEN; SUPERFICIAL (EG, STERNUM, SPINOUS PROCESS, RIB, PATELLA, OLECRANON PROCESS, CALCANEUS, TARSAL, METATARSAL, CARPAL, METACARPAL, PHALANX)
|
Facility
|
OP
|
$7,857.23
|
|
|
Service Code
|
CPT 20240
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,496.14 |
| Max. Negotiated Rate |
$7,857.23 |
| Rate for Payer: Aetna Medicare |
$2,902.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,489.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,489.12
|
| Rate for Payer: BCBS Complete |
$1,570.94
|
| Rate for Payer: BCBS MAPPO |
$2,791.30
|
| Rate for Payer: BCN Medicare Advantage |
$2,791.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,791.30
|
| Rate for Payer: Mclaren Medicaid |
$1,496.14
|
| Rate for Payer: Mclaren Medicare |
$2,791.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,930.86
|
| Rate for Payer: Meridian Medicaid |
$1,570.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,209.99
|
| Rate for Payer: PACE Medicare |
$2,651.74
|
| Rate for Payer: PACE SWMI |
$2,791.30
|
| Rate for Payer: PHP Medicare Advantage |
$2,791.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,496.14
|
| Rate for Payer: Priority Health Medicare |
$2,791.30
|
| Rate for Payer: Railroad Medicare Medicare |
$2,791.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,857.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,791.30
|
| Rate for Payer: UHC Exchange |
$5,334.45
|
| Rate for Payer: UHC Medicare Advantage |
$2,791.30
|
| Rate for Payer: UHCCP Medicaid |
$1,496.14
|
| Rate for Payer: VA VA |
$2,791.30
|
|
