|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
IP
|
$75.81
|
|
|
Service Code
|
NDC 29300012613
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.36 |
| Max. Negotiated Rate |
$68.23 |
| Rate for Payer: Aetna American Axle |
$49.28
|
| Rate for Payer: Aetna Commercial |
$64.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.28
|
| Rate for Payer: Cash Price |
$60.65
|
| Rate for Payer: Cofinity Commercial |
$53.07
|
| Rate for Payer: Cofinity Commercial |
$65.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.65
|
| Rate for Payer: Healthscope Commercial |
$68.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.44
|
| Rate for Payer: PHP Commercial |
$64.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.28
|
| Rate for Payer: Priority Health SBD |
$47.76
|
| Rate for Payer: UMR Bronson Commercial |
$33.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.86
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
IP
|
$60.71
|
|
|
Service Code
|
NDC 70954045510
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.71 |
| Max. Negotiated Rate |
$54.64 |
| Rate for Payer: Aetna American Axle |
$39.46
|
| Rate for Payer: Aetna Commercial |
$51.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.46
|
| Rate for Payer: Cash Price |
$48.57
|
| Rate for Payer: Cofinity Commercial |
$42.50
|
| Rate for Payer: Cofinity Commercial |
$52.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.57
|
| Rate for Payer: Healthscope Commercial |
$54.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.60
|
| Rate for Payer: PHP Commercial |
$51.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.46
|
| Rate for Payer: Priority Health SBD |
$38.25
|
| Rate for Payer: UMR Bronson Commercial |
$26.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.53
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
OP
|
$60.71
|
|
|
Service Code
|
NDC 70954045510
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.46 |
| Max. Negotiated Rate |
$54.64 |
| Rate for Payer: Aetna American Axle |
$39.46
|
| Rate for Payer: Aetna Commercial |
$51.60
|
| Rate for Payer: Aetna Medicare |
$30.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.46
|
| Rate for Payer: BCBS Complete |
$24.28
|
| Rate for Payer: Cash Price |
$48.57
|
| Rate for Payer: Cofinity Commercial |
$42.50
|
| Rate for Payer: Cofinity Commercial |
$52.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.57
|
| Rate for Payer: Healthscope Commercial |
$54.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.60
|
| Rate for Payer: PHP Commercial |
$51.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.46
|
| Rate for Payer: Priority Health SBD |
$38.25
|
| Rate for Payer: UMR Bronson Commercial |
$22.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.53
|
|
|
BIVALIRUDIN 250 MG/50 ML (5 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$195.36
|
|
|
Service Code
|
HCPCS J0583
|
| Hospital Charge Code |
192876
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$72.28 |
| Max. Negotiated Rate |
$175.82 |
| Rate for Payer: Aetna American Axle |
$126.98
|
| Rate for Payer: Aetna American Axle |
$313.25
|
| Rate for Payer: Aetna Commercial |
$166.06
|
| Rate for Payer: Aetna Commercial |
$409.63
|
| Rate for Payer: Aetna Medicare |
$97.68
|
| Rate for Payer: Aetna Medicare |
$240.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.25
|
| Rate for Payer: BCBS Complete |
$192.77
|
| Rate for Payer: BCBS Complete |
$78.14
|
| Rate for Payer: Cash Price |
$156.29
|
| Rate for Payer: Cash Price |
$385.54
|
| Rate for Payer: Cofinity Commercial |
$168.01
|
| Rate for Payer: Cofinity Commercial |
$136.75
|
| Rate for Payer: Cofinity Commercial |
$337.34
|
| Rate for Payer: Cofinity Commercial |
$414.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$337.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$136.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.54
|
| Rate for Payer: Healthscope Commercial |
$433.73
|
| Rate for Payer: Healthscope Commercial |
$175.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$337.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$361.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$409.63
|
| Rate for Payer: PHP Commercial |
$409.63
|
| Rate for Payer: PHP Commercial |
$166.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.25
|
| Rate for Payer: Priority Health SBD |
$303.61
|
| Rate for Payer: Priority Health SBD |
$123.08
|
| Rate for Payer: UMR Bronson Commercial |
$72.28
|
| Rate for Payer: UMR Bronson Commercial |
$178.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$361.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.52
|
|
|
BIVALIRUDIN 250 MG/50 ML (5 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$195.36
|
|
|
Service Code
|
HCPCS J0583
|
| Hospital Charge Code |
192876
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$85.96 |
| Max. Negotiated Rate |
$175.82 |
| Rate for Payer: Aetna American Axle |
$126.98
|
| Rate for Payer: Aetna American Axle |
$313.25
|
| Rate for Payer: Aetna Commercial |
$166.06
|
| Rate for Payer: Aetna Commercial |
$409.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.25
|
| Rate for Payer: Cash Price |
$156.29
|
| Rate for Payer: Cash Price |
$385.54
|
| Rate for Payer: Cofinity Commercial |
$414.45
|
| Rate for Payer: Cofinity Commercial |
$337.34
|
| Rate for Payer: Cofinity Commercial |
$136.75
|
| Rate for Payer: Cofinity Commercial |
$168.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$136.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$337.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.54
|
| Rate for Payer: Healthscope Commercial |
$175.82
|
| Rate for Payer: Healthscope Commercial |
$433.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$337.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$361.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$409.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.06
|
| Rate for Payer: PHP Commercial |
$409.63
|
| Rate for Payer: PHP Commercial |
$166.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.25
|
| Rate for Payer: Priority Health SBD |
$123.08
|
| Rate for Payer: Priority Health SBD |
$303.61
|
| Rate for Payer: UMR Bronson Commercial |
$85.96
|
| Rate for Payer: UMR Bronson Commercial |
$212.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$361.44
|
|
|
BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$247.62
|
|
|
Service Code
|
HCPCS J0583
|
| Hospital Charge Code |
29396
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.95 |
| Max. Negotiated Rate |
$222.86 |
| Rate for Payer: Aetna American Axle |
$160.95
|
| Rate for Payer: Aetna American Axle |
$118.83
|
| Rate for Payer: Aetna American Axle |
$125.44
|
| Rate for Payer: Aetna American Axle |
$289.87
|
| Rate for Payer: Aetna American Axle |
$133.08
|
| Rate for Payer: Aetna Commercial |
$210.48
|
| Rate for Payer: Aetna Commercial |
$164.03
|
| Rate for Payer: Aetna Commercial |
$155.40
|
| Rate for Payer: Aetna Commercial |
$379.06
|
| Rate for Payer: Aetna Commercial |
$174.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.44
|
| Rate for Payer: Cash Price |
$198.10
|
| Rate for Payer: Cash Price |
$356.76
|
| Rate for Payer: Cash Price |
$154.38
|
| Rate for Payer: Cash Price |
$163.79
|
| Rate for Payer: Cash Price |
$146.26
|
| Rate for Payer: Cofinity Commercial |
$312.17
|
| Rate for Payer: Cofinity Commercial |
$127.97
|
| Rate for Payer: Cofinity Commercial |
$212.95
|
| Rate for Payer: Cofinity Commercial |
$173.33
|
| Rate for Payer: Cofinity Commercial |
$143.32
|
| Rate for Payer: Cofinity Commercial |
$135.09
|
| Rate for Payer: Cofinity Commercial |
$165.96
|
| Rate for Payer: Cofinity Commercial |
$176.08
|
| Rate for Payer: Cofinity Commercial |
$157.23
|
| Rate for Payer: Cofinity Commercial |
$383.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$173.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$127.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$135.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$312.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$143.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.79
|
| Rate for Payer: Healthscope Commercial |
$173.68
|
| Rate for Payer: Healthscope Commercial |
$222.86
|
| Rate for Payer: Healthscope Commercial |
$184.27
|
| Rate for Payer: Healthscope Commercial |
$401.36
|
| Rate for Payer: Healthscope Commercial |
$164.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$143.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$312.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$334.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.40
|
| Rate for Payer: PHP Commercial |
$155.40
|
| Rate for Payer: PHP Commercial |
$379.06
|
| Rate for Payer: PHP Commercial |
$174.03
|
| Rate for Payer: PHP Commercial |
$210.48
|
| Rate for Payer: PHP Commercial |
$164.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.83
|
| Rate for Payer: Priority Health SBD |
$280.95
|
| Rate for Payer: Priority Health SBD |
$128.99
|
| Rate for Payer: Priority Health SBD |
$121.58
|
| Rate for Payer: Priority Health SBD |
$115.18
|
| Rate for Payer: Priority Health SBD |
$156.00
|
| Rate for Payer: UMR Bronson Commercial |
$80.44
|
| Rate for Payer: UMR Bronson Commercial |
$84.91
|
| Rate for Payer: UMR Bronson Commercial |
$108.95
|
| Rate for Payer: UMR Bronson Commercial |
$196.22
|
| Rate for Payer: UMR Bronson Commercial |
$90.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.72
|
|
|
BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$192.98
|
|
|
Service Code
|
HCPCS J0583
|
| Hospital Charge Code |
29396
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.40 |
| Max. Negotiated Rate |
$173.68 |
| Rate for Payer: Aetna American Axle |
$125.44
|
| Rate for Payer: Aetna American Axle |
$160.95
|
| Rate for Payer: Aetna American Axle |
$289.87
|
| Rate for Payer: Aetna American Axle |
$118.83
|
| Rate for Payer: Aetna American Axle |
$133.08
|
| Rate for Payer: Aetna Commercial |
$155.40
|
| Rate for Payer: Aetna Commercial |
$379.06
|
| Rate for Payer: Aetna Commercial |
$174.03
|
| Rate for Payer: Aetna Commercial |
$210.48
|
| Rate for Payer: Aetna Commercial |
$164.03
|
| Rate for Payer: Aetna Medicare |
$123.81
|
| Rate for Payer: Aetna Medicare |
$96.49
|
| Rate for Payer: Aetna Medicare |
$222.97
|
| Rate for Payer: Aetna Medicare |
$102.37
|
| Rate for Payer: Aetna Medicare |
$91.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.95
|
| Rate for Payer: BCBS Complete |
$178.38
|
| Rate for Payer: BCBS Complete |
$73.13
|
| Rate for Payer: BCBS Complete |
$99.05
|
| Rate for Payer: BCBS Complete |
$81.90
|
| Rate for Payer: BCBS Complete |
$77.19
|
| Rate for Payer: Cash Price |
$356.76
|
| Rate for Payer: Cash Price |
$146.26
|
| Rate for Payer: Cash Price |
$154.38
|
| Rate for Payer: Cash Price |
$198.10
|
| Rate for Payer: Cash Price |
$163.79
|
| Rate for Payer: Cofinity Commercial |
$312.17
|
| Rate for Payer: Cofinity Commercial |
$165.96
|
| Rate for Payer: Cofinity Commercial |
$212.95
|
| Rate for Payer: Cofinity Commercial |
$127.97
|
| Rate for Payer: Cofinity Commercial |
$176.08
|
| Rate for Payer: Cofinity Commercial |
$143.32
|
| Rate for Payer: Cofinity Commercial |
$173.33
|
| Rate for Payer: Cofinity Commercial |
$157.23
|
| Rate for Payer: Cofinity Commercial |
$135.09
|
| Rate for Payer: Cofinity Commercial |
$383.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$127.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$173.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$135.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$143.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$312.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.79
|
| Rate for Payer: Healthscope Commercial |
$164.54
|
| Rate for Payer: Healthscope Commercial |
$184.27
|
| Rate for Payer: Healthscope Commercial |
$401.36
|
| Rate for Payer: Healthscope Commercial |
$222.86
|
| Rate for Payer: Healthscope Commercial |
$173.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$143.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$312.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$334.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.06
|
| Rate for Payer: PHP Commercial |
$210.48
|
| Rate for Payer: PHP Commercial |
$174.03
|
| Rate for Payer: PHP Commercial |
$155.40
|
| Rate for Payer: PHP Commercial |
$164.03
|
| Rate for Payer: PHP Commercial |
$379.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.44
|
| Rate for Payer: Priority Health SBD |
$121.58
|
| Rate for Payer: Priority Health SBD |
$115.18
|
| Rate for Payer: Priority Health SBD |
$128.99
|
| Rate for Payer: Priority Health SBD |
$156.00
|
| Rate for Payer: Priority Health SBD |
$280.95
|
| Rate for Payer: UMR Bronson Commercial |
$165.00
|
| Rate for Payer: UMR Bronson Commercial |
$91.62
|
| Rate for Payer: UMR Bronson Commercial |
$71.40
|
| Rate for Payer: UMR Bronson Commercial |
$67.64
|
| Rate for Payer: UMR Bronson Commercial |
$75.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.56
|
|
|
BLADDER INSTILLATION OF ANTICARCINOGENIC AGENT (INCLUDING RETENTION TIME)
|
Facility
|
OP
|
$1,832.42
|
|
|
Service Code
|
CPT 51720
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$348.92 |
| Max. Negotiated Rate |
$1,832.42 |
| Rate for Payer: Aetna Medicare |
$677.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$813.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$813.71
|
| Rate for Payer: BCBS Complete |
$366.37
|
| Rate for Payer: BCBS MAPPO |
$650.97
|
| Rate for Payer: BCN Medicare Advantage |
$650.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$650.97
|
| Rate for Payer: Mclaren Medicaid |
$348.92
|
| Rate for Payer: Mclaren Medicare |
$650.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$683.52
|
| Rate for Payer: Meridian Medicaid |
$366.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$748.62
|
| Rate for Payer: PACE Medicare |
$618.42
|
| Rate for Payer: PACE SWMI |
$650.97
|
| Rate for Payer: PHP Medicare Advantage |
$650.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$348.92
|
| Rate for Payer: Priority Health Medicare |
$650.97
|
| Rate for Payer: Railroad Medicare Medicare |
$650.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,832.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$650.97
|
| Rate for Payer: UHC Exchange |
$1,244.07
|
| Rate for Payer: UHC Medicare Advantage |
$650.97
|
| Rate for Payer: UHCCP Medicaid |
$348.92
|
| Rate for Payer: VA VA |
$650.97
|
|
|
BLADDER INSTILLATION OF ANTICARCINOGENIC AGENT (INCLUDING RETENTION TIME)
|
Facility
|
OP
|
$1,832.42
|
|
|
Service Code
|
CPT 51720
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$348.92 |
| Max. Negotiated Rate |
$1,832.42 |
| Rate for Payer: Aetna Medicare |
$677.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$813.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$813.71
|
| Rate for Payer: BCBS Complete |
$366.37
|
| Rate for Payer: BCBS MAPPO |
$650.97
|
| Rate for Payer: BCN Medicare Advantage |
$650.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$650.97
|
| Rate for Payer: Mclaren Medicaid |
$348.92
|
| Rate for Payer: Mclaren Medicare |
$650.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$683.52
|
| Rate for Payer: Meridian Medicaid |
$366.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$748.62
|
| Rate for Payer: PACE Medicare |
$618.42
|
| Rate for Payer: PACE SWMI |
$650.97
|
| Rate for Payer: PHP Medicare Advantage |
$650.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$348.92
|
| Rate for Payer: Priority Health Medicare |
$650.97
|
| Rate for Payer: Railroad Medicare Medicare |
$650.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,832.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$650.97
|
| Rate for Payer: UHC Exchange |
$1,244.07
|
| Rate for Payer: UHC Medicare Advantage |
$650.97
|
| Rate for Payer: UHCCP Medicaid |
$348.92
|
| Rate for Payer: VA VA |
$650.97
|
|
|
BLADDER IRRIGATION, SIMPLE, LAVAGE AND/OR INSTILLATION
|
Facility
|
OP
|
$667.69
|
|
|
Service Code
|
CPT 51700
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$127.14 |
| Max. Negotiated Rate |
$667.69 |
| Rate for Payer: Aetna Medicare |
$246.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.50
|
| Rate for Payer: BCBS Complete |
$133.50
|
| Rate for Payer: BCBS MAPPO |
$237.20
|
| Rate for Payer: BCN Medicare Advantage |
$237.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.20
|
| Rate for Payer: Mclaren Medicaid |
$127.14
|
| Rate for Payer: Mclaren Medicare |
$237.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.06
|
| Rate for Payer: Meridian Medicaid |
$133.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.78
|
| Rate for Payer: PACE Medicare |
$225.34
|
| Rate for Payer: PACE SWMI |
$237.20
|
| Rate for Payer: PHP Medicare Advantage |
$237.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.14
|
| Rate for Payer: Priority Health Medicare |
$237.20
|
| Rate for Payer: Railroad Medicare Medicare |
$237.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$667.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$237.20
|
| Rate for Payer: UHC Exchange |
$453.31
|
| Rate for Payer: UHC Medicare Advantage |
$237.20
|
| Rate for Payer: UHCCP Medicaid |
$127.14
|
| Rate for Payer: VA VA |
$237.20
|
|
|
BLADDER IRRIGATION, SIMPLE, LAVAGE AND/OR INSTILLATION
|
Facility
|
OP
|
$667.69
|
|
|
Service Code
|
CPT 51700
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$127.14 |
| Max. Negotiated Rate |
$667.69 |
| Rate for Payer: Aetna Medicare |
$246.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.50
|
| Rate for Payer: BCBS Complete |
$133.50
|
| Rate for Payer: BCBS MAPPO |
$237.20
|
| Rate for Payer: BCN Medicare Advantage |
$237.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.20
|
| Rate for Payer: Mclaren Medicaid |
$127.14
|
| Rate for Payer: Mclaren Medicare |
$237.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.06
|
| Rate for Payer: Meridian Medicaid |
$133.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.78
|
| Rate for Payer: PACE Medicare |
$225.34
|
| Rate for Payer: PACE SWMI |
$237.20
|
| Rate for Payer: PHP Medicare Advantage |
$237.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.14
|
| Rate for Payer: Priority Health Medicare |
$237.20
|
| Rate for Payer: Railroad Medicare Medicare |
$237.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$667.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$237.20
|
| Rate for Payer: UHC Exchange |
$453.31
|
| Rate for Payer: UHC Medicare Advantage |
$237.20
|
| Rate for Payer: UHCCP Medicaid |
$127.14
|
| Rate for Payer: VA VA |
$237.20
|
|
|
BLEOMYCIN 15 UNIT SOLUTION FOR INJECTION
|
Facility
|
IP
|
$274.29
|
|
|
Service Code
|
HCPCS J9040
|
| Hospital Charge Code |
9289
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$120.69 |
| Max. Negotiated Rate |
$246.86 |
| Rate for Payer: Aetna American Axle |
$178.29
|
| Rate for Payer: Aetna American Axle |
$312.34
|
| Rate for Payer: Aetna American Axle |
$319.87
|
| Rate for Payer: Aetna Commercial |
$408.44
|
| Rate for Payer: Aetna Commercial |
$233.15
|
| Rate for Payer: Aetna Commercial |
$418.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$319.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$312.34
|
| Rate for Payer: Cash Price |
$393.68
|
| Rate for Payer: Cash Price |
$384.42
|
| Rate for Payer: Cash Price |
$219.43
|
| Rate for Payer: Cofinity Commercial |
$235.89
|
| Rate for Payer: Cofinity Commercial |
$413.25
|
| Rate for Payer: Cofinity Commercial |
$336.36
|
| Rate for Payer: Cofinity Commercial |
$423.21
|
| Rate for Payer: Cofinity Commercial |
$344.47
|
| Rate for Payer: Cofinity Commercial |
$192.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$336.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$192.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$344.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$393.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$384.42
|
| Rate for Payer: Healthscope Commercial |
$432.47
|
| Rate for Payer: Healthscope Commercial |
$246.86
|
| Rate for Payer: Healthscope Commercial |
$442.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$336.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$344.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$360.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$369.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$418.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$408.44
|
| Rate for Payer: PHP Commercial |
$418.29
|
| Rate for Payer: PHP Commercial |
$408.44
|
| Rate for Payer: PHP Commercial |
$233.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$312.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.29
|
| Rate for Payer: Priority Health SBD |
$310.02
|
| Rate for Payer: Priority Health SBD |
$302.73
|
| Rate for Payer: Priority Health SBD |
$172.80
|
| Rate for Payer: UMR Bronson Commercial |
$120.69
|
| Rate for Payer: UMR Bronson Commercial |
$216.52
|
| Rate for Payer: UMR Bronson Commercial |
$211.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$369.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$360.39
|
|
|
BLEOMYCIN 15 UNIT SOLUTION FOR INJECTION
|
Facility
|
OP
|
$492.10
|
|
|
Service Code
|
HCPCS J9040
|
| Hospital Charge Code |
9289
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$182.08 |
| Max. Negotiated Rate |
$442.89 |
| Rate for Payer: Aetna American Axle |
$319.87
|
| Rate for Payer: Aetna American Axle |
$178.29
|
| Rate for Payer: Aetna American Axle |
$312.34
|
| Rate for Payer: Aetna Commercial |
$418.29
|
| Rate for Payer: Aetna Commercial |
$408.44
|
| Rate for Payer: Aetna Commercial |
$233.15
|
| Rate for Payer: Aetna Medicare |
$246.05
|
| Rate for Payer: Aetna Medicare |
$240.26
|
| Rate for Payer: Aetna Medicare |
$137.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$312.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$319.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.29
|
| Rate for Payer: BCBS Complete |
$109.72
|
| Rate for Payer: BCBS Complete |
$192.21
|
| Rate for Payer: BCBS Complete |
$196.84
|
| Rate for Payer: Cash Price |
$393.68
|
| Rate for Payer: Cash Price |
$384.42
|
| Rate for Payer: Cash Price |
$219.43
|
| Rate for Payer: Cofinity Commercial |
$413.25
|
| Rate for Payer: Cofinity Commercial |
$192.00
|
| Rate for Payer: Cofinity Commercial |
$235.89
|
| Rate for Payer: Cofinity Commercial |
$423.21
|
| Rate for Payer: Cofinity Commercial |
$344.47
|
| Rate for Payer: Cofinity Commercial |
$336.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$192.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$336.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$344.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$384.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$393.68
|
| Rate for Payer: Healthscope Commercial |
$246.86
|
| Rate for Payer: Healthscope Commercial |
$432.47
|
| Rate for Payer: Healthscope Commercial |
$442.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$336.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$344.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$360.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$369.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$408.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$418.29
|
| Rate for Payer: PHP Commercial |
$233.15
|
| Rate for Payer: PHP Commercial |
$408.44
|
| Rate for Payer: PHP Commercial |
$418.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$312.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.29
|
| Rate for Payer: Priority Health SBD |
$302.73
|
| Rate for Payer: Priority Health SBD |
$172.80
|
| Rate for Payer: Priority Health SBD |
$310.02
|
| Rate for Payer: UMR Bronson Commercial |
$182.08
|
| Rate for Payer: UMR Bronson Commercial |
$101.49
|
| Rate for Payer: UMR Bronson Commercial |
$177.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$360.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$369.07
|
|
|
BLEOMYCIN 30 UNIT SOLUTION FOR INJECTION
|
Facility
|
IP
|
$912.70
|
|
|
Service Code
|
HCPCS J9040
|
| Hospital Charge Code |
17012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$401.59 |
| Max. Negotiated Rate |
$821.43 |
| Rate for Payer: Aetna American Axle |
$593.25
|
| Rate for Payer: Aetna American Axle |
$348.61
|
| Rate for Payer: Aetna Commercial |
$455.87
|
| Rate for Payer: Aetna Commercial |
$775.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$348.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$593.25
|
| Rate for Payer: Cash Price |
$429.06
|
| Rate for Payer: Cash Price |
$730.16
|
| Rate for Payer: Cofinity Commercial |
$784.92
|
| Rate for Payer: Cofinity Commercial |
$638.89
|
| Rate for Payer: Cofinity Commercial |
$461.24
|
| Rate for Payer: Cofinity Commercial |
$375.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$638.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$375.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$429.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$730.16
|
| Rate for Payer: Healthscope Commercial |
$482.69
|
| Rate for Payer: Healthscope Commercial |
$821.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$638.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$375.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$402.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$684.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$455.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$775.79
|
| Rate for Payer: PHP Commercial |
$775.79
|
| Rate for Payer: PHP Commercial |
$455.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$593.25
|
| Rate for Payer: Priority Health SBD |
$575.00
|
| Rate for Payer: Priority Health SBD |
$337.88
|
| Rate for Payer: UMR Bronson Commercial |
$235.98
|
| Rate for Payer: UMR Bronson Commercial |
$401.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$402.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$684.52
|
|
|
BLEOMYCIN 30 UNIT SOLUTION FOR INJECTION
|
Facility
|
OP
|
$362.24
|
|
|
Service Code
|
HCPCS J9040
|
| Hospital Charge Code |
17012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$134.03 |
| Max. Negotiated Rate |
$326.02 |
| Rate for Payer: Aetna American Axle |
$235.46
|
| Rate for Payer: Aetna American Axle |
$523.21
|
| Rate for Payer: Aetna American Axle |
$593.25
|
| Rate for Payer: Aetna American Axle |
$203.21
|
| Rate for Payer: Aetna American Axle |
$348.61
|
| Rate for Payer: Aetna Commercial |
$265.74
|
| Rate for Payer: Aetna Commercial |
$775.79
|
| Rate for Payer: Aetna Commercial |
$455.87
|
| Rate for Payer: Aetna Commercial |
$684.20
|
| Rate for Payer: Aetna Commercial |
$307.90
|
| Rate for Payer: Aetna Medicare |
$402.47
|
| Rate for Payer: Aetna Medicare |
$181.12
|
| Rate for Payer: Aetna Medicare |
$456.35
|
| Rate for Payer: Aetna Medicare |
$268.16
|
| Rate for Payer: Aetna Medicare |
$156.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$593.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$348.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$523.21
|
| Rate for Payer: BCBS Complete |
$365.08
|
| Rate for Payer: BCBS Complete |
$125.05
|
| Rate for Payer: BCBS Complete |
$321.98
|
| Rate for Payer: BCBS Complete |
$214.53
|
| Rate for Payer: BCBS Complete |
$144.90
|
| Rate for Payer: Cash Price |
$730.16
|
| Rate for Payer: Cash Price |
$250.10
|
| Rate for Payer: Cash Price |
$289.79
|
| Rate for Payer: Cash Price |
$643.95
|
| Rate for Payer: Cash Price |
$429.06
|
| Rate for Payer: Cofinity Commercial |
$638.89
|
| Rate for Payer: Cofinity Commercial |
$311.53
|
| Rate for Payer: Cofinity Commercial |
$692.25
|
| Rate for Payer: Cofinity Commercial |
$218.84
|
| Rate for Payer: Cofinity Commercial |
$461.24
|
| Rate for Payer: Cofinity Commercial |
$375.42
|
| Rate for Payer: Cofinity Commercial |
$563.46
|
| Rate for Payer: Cofinity Commercial |
$268.86
|
| Rate for Payer: Cofinity Commercial |
$253.57
|
| Rate for Payer: Cofinity Commercial |
$784.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$218.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$563.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$253.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$375.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$638.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$730.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$643.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$429.06
|
| Rate for Payer: Healthscope Commercial |
$281.37
|
| Rate for Payer: Healthscope Commercial |
$482.69
|
| Rate for Payer: Healthscope Commercial |
$821.43
|
| Rate for Payer: Healthscope Commercial |
$724.45
|
| Rate for Payer: Healthscope Commercial |
$326.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$563.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$218.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$253.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$375.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$638.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$684.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$402.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$603.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$455.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$684.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$775.79
|
| Rate for Payer: PHP Commercial |
$684.20
|
| Rate for Payer: PHP Commercial |
$455.87
|
| Rate for Payer: PHP Commercial |
$265.74
|
| Rate for Payer: PHP Commercial |
$307.90
|
| Rate for Payer: PHP Commercial |
$775.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$593.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$523.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.46
|
| Rate for Payer: Priority Health SBD |
$228.21
|
| Rate for Payer: Priority Health SBD |
$196.96
|
| Rate for Payer: Priority Health SBD |
$337.88
|
| Rate for Payer: Priority Health SBD |
$507.11
|
| Rate for Payer: Priority Health SBD |
$575.00
|
| Rate for Payer: UMR Bronson Commercial |
$337.70
|
| Rate for Payer: UMR Bronson Commercial |
$297.83
|
| Rate for Payer: UMR Bronson Commercial |
$134.03
|
| Rate for Payer: UMR Bronson Commercial |
$115.67
|
| Rate for Payer: UMR Bronson Commercial |
$198.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$684.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$603.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$402.24
|
|
|
BLEPHAROPLASTY, LOWER EYELID; WITH EXTENSIVE HERNIATED FAT PAD
|
Facility
|
OP
|
$5,021.81
|
|
|
Service Code
|
CPT 15821
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$956.23 |
| Max. Negotiated Rate |
$5,021.81 |
| Rate for Payer: Aetna Medicare |
$1,855.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,230.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,230.01
|
| Rate for Payer: BCBS Complete |
$1,004.04
|
| Rate for Payer: BCBS MAPPO |
$1,784.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,784.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,784.01
|
| Rate for Payer: Mclaren Medicaid |
$956.23
|
| Rate for Payer: Mclaren Medicare |
$1,784.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,873.21
|
| Rate for Payer: Meridian Medicaid |
$1,004.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,051.61
|
| Rate for Payer: PACE Medicare |
$1,694.81
|
| Rate for Payer: PACE SWMI |
$1,784.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,784.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$956.23
|
| Rate for Payer: Priority Health Medicare |
$1,784.01
|
| Rate for Payer: Railroad Medicare Medicare |
$1,784.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,021.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,784.01
|
| Rate for Payer: UHC Exchange |
$3,409.42
|
| Rate for Payer: UHC Medicare Advantage |
$1,784.01
|
| Rate for Payer: UHCCP Medicaid |
$956.23
|
| Rate for Payer: VA VA |
$1,784.01
|
|
|
BLEPHAROPLASTY, UPPER EYELID;
|
Facility
|
OP
|
$5,021.81
|
|
|
Service Code
|
CPT 15822
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$956.23 |
| Max. Negotiated Rate |
$5,021.81 |
| Rate for Payer: Aetna Medicare |
$1,855.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,230.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,230.01
|
| Rate for Payer: BCBS Complete |
$1,004.04
|
| Rate for Payer: BCBS MAPPO |
$1,784.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,784.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,784.01
|
| Rate for Payer: Mclaren Medicaid |
$956.23
|
| Rate for Payer: Mclaren Medicare |
$1,784.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,873.21
|
| Rate for Payer: Meridian Medicaid |
$1,004.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,051.61
|
| Rate for Payer: PACE Medicare |
$1,694.81
|
| Rate for Payer: PACE SWMI |
$1,784.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,784.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$956.23
|
| Rate for Payer: Priority Health Medicare |
$1,784.01
|
| Rate for Payer: Railroad Medicare Medicare |
$1,784.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,021.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,784.01
|
| Rate for Payer: UHC Exchange |
$3,409.42
|
| Rate for Payer: UHC Medicare Advantage |
$1,784.01
|
| Rate for Payer: UHCCP Medicaid |
$956.23
|
| Rate for Payer: VA VA |
$1,784.01
|
|
|
BLEPHAROPLASTY, UPPER EYELID; WITH EXCESSIVE SKIN WEIGHTING DOWN LID
|
Facility
|
OP
|
$5,021.81
|
|
|
Service Code
|
CPT 15823
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$956.23 |
| Max. Negotiated Rate |
$5,021.81 |
| Rate for Payer: Aetna Medicare |
$1,855.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,230.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,230.01
|
| Rate for Payer: BCBS Complete |
$1,004.04
|
| Rate for Payer: BCBS MAPPO |
$1,784.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,784.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,784.01
|
| Rate for Payer: Mclaren Medicaid |
$956.23
|
| Rate for Payer: Mclaren Medicare |
$1,784.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,873.21
|
| Rate for Payer: Meridian Medicaid |
$1,004.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,051.61
|
| Rate for Payer: PACE Medicare |
$1,694.81
|
| Rate for Payer: PACE SWMI |
$1,784.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,784.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$956.23
|
| Rate for Payer: Priority Health Medicare |
$1,784.01
|
| Rate for Payer: Railroad Medicare Medicare |
$1,784.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,021.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,784.01
|
| Rate for Payer: UHC Exchange |
$3,409.42
|
| Rate for Payer: UHC Medicare Advantage |
$1,784.01
|
| Rate for Payer: UHCCP Medicaid |
$956.23
|
| Rate for Payer: VA VA |
$1,784.01
|
|
|
BLEPHAROTOMY, DRAINAGE OF ABSCESS, EYELID
|
Facility
|
OP
|
$820.66
|
|
|
Service Code
|
CPT 67700
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$156.27 |
| Max. Negotiated Rate |
$820.66 |
| Rate for Payer: Aetna Medicare |
$303.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$364.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$364.43
|
| Rate for Payer: BCBS Complete |
$164.08
|
| Rate for Payer: BCBS MAPPO |
$291.54
|
| Rate for Payer: BCN Medicare Advantage |
$291.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$291.54
|
| Rate for Payer: Mclaren Medicaid |
$156.27
|
| Rate for Payer: Mclaren Medicare |
$291.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$306.12
|
| Rate for Payer: Meridian Medicaid |
$164.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$335.27
|
| Rate for Payer: PACE Medicare |
$276.96
|
| Rate for Payer: PACE SWMI |
$291.54
|
| Rate for Payer: PHP Medicare Advantage |
$291.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$156.27
|
| Rate for Payer: Priority Health Medicare |
$291.54
|
| Rate for Payer: Railroad Medicare Medicare |
$291.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$820.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$291.54
|
| Rate for Payer: UHC Exchange |
$557.16
|
| Rate for Payer: UHC Medicare Advantage |
$291.54
|
| Rate for Payer: UHCCP Medicaid |
$156.27
|
| Rate for Payer: VA VA |
$291.54
|
|
|
BLINATUMOMAB 35 MCG INTRAVENOUS KIT
|
Facility
|
OP
|
$24,947.41
|
|
|
Service Code
|
HCPCS J9039
|
| Hospital Charge Code |
173348
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$88.04 |
| Max. Negotiated Rate |
$22,452.67 |
| Rate for Payer: Aetna American Axle |
$16,215.82
|
| Rate for Payer: Aetna Commercial |
$21,205.30
|
| Rate for Payer: Aetna Medicare |
$170.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,215.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$205.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$205.31
|
| Rate for Payer: BCBS Complete |
$92.44
|
| Rate for Payer: BCBS MAPPO |
$164.25
|
| Rate for Payer: BCN Medicare Advantage |
$164.25
|
| Rate for Payer: Cash Price |
$19,957.93
|
| Rate for Payer: Cash Price |
$19,957.93
|
| Rate for Payer: Cofinity Commercial |
$21,454.77
|
| Rate for Payer: Cofinity Commercial |
$17,463.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$17,463.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,957.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$164.25
|
| Rate for Payer: Healthscope Commercial |
$22,452.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17,463.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18,710.56
|
| Rate for Payer: Mclaren Medicaid |
$88.04
|
| Rate for Payer: Mclaren Medicare |
$164.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$172.46
|
| Rate for Payer: Meridian Medicaid |
$92.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21,205.30
|
| Rate for Payer: PACE Medicare |
$156.04
|
| Rate for Payer: PACE SWMI |
$164.25
|
| Rate for Payer: PHP Commercial |
$21,205.30
|
| Rate for Payer: PHP Medicare Advantage |
$164.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$88.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16,215.82
|
| Rate for Payer: Priority Health Medicare |
$164.25
|
| Rate for Payer: Priority Health SBD |
$15,716.87
|
| Rate for Payer: Railroad Medicare Medicare |
$164.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$462.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$164.25
|
| Rate for Payer: UHC Exchange |
$313.90
|
| Rate for Payer: UHC Medicare Advantage |
$164.25
|
| Rate for Payer: UHCCP Medicaid |
$88.04
|
| Rate for Payer: UMR Bronson Commercial |
$9,230.54
|
| Rate for Payer: VA VA |
$164.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18,710.56
|
|
|
BLINATUMOMAB 35 MCG INTRAVENOUS KIT
|
Facility
|
IP
|
$24,947.41
|
|
|
Service Code
|
HCPCS J9039
|
| Hospital Charge Code |
173348
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10,976.86 |
| Max. Negotiated Rate |
$22,452.67 |
| Rate for Payer: Aetna American Axle |
$16,215.82
|
| Rate for Payer: Aetna Commercial |
$21,205.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,215.82
|
| Rate for Payer: Cash Price |
$19,957.93
|
| Rate for Payer: Cofinity Commercial |
$17,463.19
|
| Rate for Payer: Cofinity Commercial |
$21,454.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17,463.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,957.93
|
| Rate for Payer: Healthscope Commercial |
$22,452.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17,463.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18,710.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21,205.30
|
| Rate for Payer: PHP Commercial |
$21,205.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16,215.82
|
| Rate for Payer: Priority Health SBD |
$15,716.87
|
| Rate for Payer: UMR Bronson Commercial |
$10,976.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18,710.56
|
|
|
BLINATUMOMAB 35 MCG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$20,168.77
|
|
|
Service Code
|
HCPCS J9039
|
| Hospital Charge Code |
183575
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8,874.26 |
| Max. Negotiated Rate |
$18,151.89 |
| Rate for Payer: Aetna American Axle |
$13,109.70
|
| Rate for Payer: Aetna Commercial |
$17,143.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,109.70
|
| Rate for Payer: Cash Price |
$16,135.02
|
| Rate for Payer: Cofinity Commercial |
$14,118.14
|
| Rate for Payer: Cofinity Commercial |
$17,345.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$14,118.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,135.02
|
| Rate for Payer: Healthscope Commercial |
$18,151.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14,118.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15,126.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17,143.45
|
| Rate for Payer: PHP Commercial |
$17,143.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,109.70
|
| Rate for Payer: Priority Health SBD |
$12,706.33
|
| Rate for Payer: UMR Bronson Commercial |
$8,874.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15,126.58
|
|
|
BLINATUMOMAB 35 MCG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$20,168.77
|
|
|
Service Code
|
HCPCS J9039
|
| Hospital Charge Code |
183575
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$88.04 |
| Max. Negotiated Rate |
$18,151.89 |
| Rate for Payer: Aetna American Axle |
$13,109.70
|
| Rate for Payer: Aetna Commercial |
$17,143.45
|
| Rate for Payer: Aetna Medicare |
$170.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,109.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$205.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$205.31
|
| Rate for Payer: BCBS Complete |
$92.44
|
| Rate for Payer: BCBS MAPPO |
$164.25
|
| Rate for Payer: BCN Medicare Advantage |
$164.25
|
| Rate for Payer: Cash Price |
$16,135.02
|
| Rate for Payer: Cash Price |
$16,135.02
|
| Rate for Payer: Cofinity Commercial |
$17,345.14
|
| Rate for Payer: Cofinity Commercial |
$14,118.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$14,118.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,135.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$164.25
|
| Rate for Payer: Healthscope Commercial |
$18,151.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14,118.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15,126.58
|
| Rate for Payer: Mclaren Medicaid |
$88.04
|
| Rate for Payer: Mclaren Medicare |
$164.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$172.46
|
| Rate for Payer: Meridian Medicaid |
$92.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17,143.45
|
| Rate for Payer: PACE Medicare |
$156.04
|
| Rate for Payer: PACE SWMI |
$164.25
|
| Rate for Payer: PHP Commercial |
$17,143.45
|
| Rate for Payer: PHP Medicare Advantage |
$164.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$88.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,109.70
|
| Rate for Payer: Priority Health Medicare |
$164.25
|
| Rate for Payer: Priority Health SBD |
$12,706.33
|
| Rate for Payer: Railroad Medicare Medicare |
$164.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$462.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$164.25
|
| Rate for Payer: UHC Exchange |
$313.90
|
| Rate for Payer: UHC Medicare Advantage |
$164.25
|
| Rate for Payer: UHCCP Medicaid |
$88.04
|
| Rate for Payer: UMR Bronson Commercial |
$7,462.44
|
| Rate for Payer: VA VA |
$164.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15,126.58
|
|
|
BLUE FOOD COLOR (BULK) LIQUID
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 51927100600
|
| Hospital Charge Code |
161587
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna American Axle |
$3.09
|
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health SBD |
$2.99
|
| Rate for Payer: UMR Bronson Commercial |
$2.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
|
BLUE FOOD COLOR (BULK) LIQUID
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 51927100600
|
| Hospital Charge Code |
161587
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna American Axle |
$3.09
|
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna Medicare |
$2.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health SBD |
$2.99
|
| Rate for Payer: UMR Bronson Commercial |
$1.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
