|
BONE GRAFT, ANY DONOR AREA; MAJOR OR LARGE
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 20902
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,734.39 |
| Max. Negotiated Rate |
$19,611.80 |
| Rate for Payer: Aetna Medicare |
$7,245.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,611.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Exchange |
$13,314.90
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,734.39
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
BONE GRAFT, ANY DONOR AREA; MINOR OR SMALL (EG, DOWEL OR BUTTON)
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 20900
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,734.39 |
| Max. Negotiated Rate |
$19,611.80 |
| Rate for Payer: Aetna Medicare |
$7,245.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,611.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Exchange |
$13,314.90
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,734.39
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
BORIC ACID (BULK) POWDER
|
Facility
|
IP
|
$73.44
|
|
|
Service Code
|
NDC 00395030396
|
| Hospital Charge Code |
1131
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.31 |
| Max. Negotiated Rate |
$66.10 |
| Rate for Payer: Aetna American Axle |
$47.74
|
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.74
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$51.41
|
| Rate for Payer: Cofinity Commercial |
$63.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Healthscope Commercial |
$66.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.74
|
| Rate for Payer: Priority Health SBD |
$46.27
|
| Rate for Payer: UMR Bronson Commercial |
$32.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.08
|
|
|
BORIC ACID (BULK) POWDER
|
Facility
|
OP
|
$73.44
|
|
|
Service Code
|
NDC 00395030396
|
| Hospital Charge Code |
1131
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.17 |
| Max. Negotiated Rate |
$66.10 |
| Rate for Payer: Aetna American Axle |
$47.74
|
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna Medicare |
$36.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.74
|
| Rate for Payer: BCBS Complete |
$29.38
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$51.41
|
| Rate for Payer: Cofinity Commercial |
$63.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Healthscope Commercial |
$66.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.74
|
| Rate for Payer: Priority Health SBD |
$46.27
|
| Rate for Payer: UMR Bronson Commercial |
$27.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.08
|
|
|
BORTEZOMIB 3.5 MG INJECTION POWDER FOR SOLUTION
|
Facility
|
IP
|
$333.64
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
35839
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$146.80 |
| Max. Negotiated Rate |
$300.28 |
| Rate for Payer: Aetna American Axle |
$216.87
|
| Rate for Payer: Aetna American Axle |
$143.97
|
| Rate for Payer: Aetna American Axle |
$130.00
|
| Rate for Payer: Aetna American Axle |
$4,678.36
|
| Rate for Payer: Aetna Commercial |
$283.59
|
| Rate for Payer: Aetna Commercial |
$6,117.85
|
| Rate for Payer: Aetna Commercial |
$188.28
|
| Rate for Payer: Aetna Commercial |
$170.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,678.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.87
|
| Rate for Payer: Cash Price |
$177.20
|
| Rate for Payer: Cash Price |
$266.91
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$5,757.98
|
| Rate for Payer: Cofinity Commercial |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$6,189.82
|
| Rate for Payer: Cofinity Commercial |
$5,038.23
|
| Rate for Payer: Cofinity Commercial |
$233.55
|
| Rate for Payer: Cofinity Commercial |
$155.05
|
| Rate for Payer: Cofinity Commercial |
$190.49
|
| Rate for Payer: Cofinity Commercial |
$286.93
|
| Rate for Payer: Cofinity Commercial |
$172.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$155.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$233.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,038.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,757.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.20
|
| Rate for Payer: Healthscope Commercial |
$300.28
|
| Rate for Payer: Healthscope Commercial |
$180.00
|
| Rate for Payer: Healthscope Commercial |
$199.35
|
| Rate for Payer: Healthscope Commercial |
$6,477.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$155.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,038.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,398.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,117.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.59
|
| Rate for Payer: PHP Commercial |
$283.59
|
| Rate for Payer: PHP Commercial |
$6,117.85
|
| Rate for Payer: PHP Commercial |
$170.00
|
| Rate for Payer: PHP Commercial |
$188.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,678.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.00
|
| Rate for Payer: Priority Health SBD |
$4,534.41
|
| Rate for Payer: Priority Health SBD |
$126.00
|
| Rate for Payer: Priority Health SBD |
$139.54
|
| Rate for Payer: Priority Health SBD |
$210.19
|
| Rate for Payer: UMR Bronson Commercial |
$146.80
|
| Rate for Payer: UMR Bronson Commercial |
$3,166.89
|
| Rate for Payer: UMR Bronson Commercial |
$97.46
|
| Rate for Payer: UMR Bronson Commercial |
$88.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,398.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.23
|
|
|
BORTEZOMIB 3.5 MG INJECTION POWDER FOR SOLUTION
|
Facility
|
OP
|
$221.50
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
35839
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$81.95 |
| Max. Negotiated Rate |
$199.35 |
| Rate for Payer: Aetna American Axle |
$143.97
|
| Rate for Payer: Aetna American Axle |
$4,678.36
|
| Rate for Payer: Aetna American Axle |
$604.50
|
| Rate for Payer: Aetna American Axle |
$130.00
|
| Rate for Payer: Aetna American Axle |
$216.87
|
| Rate for Payer: Aetna Commercial |
$170.00
|
| Rate for Payer: Aetna Commercial |
$790.50
|
| Rate for Payer: Aetna Commercial |
$283.59
|
| Rate for Payer: Aetna Commercial |
$6,117.85
|
| Rate for Payer: Aetna Commercial |
$188.28
|
| Rate for Payer: Aetna Medicare |
$3,598.74
|
| Rate for Payer: Aetna Medicare |
$110.75
|
| Rate for Payer: Aetna Medicare |
$465.00
|
| Rate for Payer: Aetna Medicare |
$166.82
|
| Rate for Payer: Aetna Medicare |
$100.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$604.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,678.36
|
| Rate for Payer: BCBS Complete |
$372.00
|
| Rate for Payer: BCBS Complete |
$80.00
|
| Rate for Payer: BCBS Complete |
$2,878.99
|
| Rate for Payer: BCBS Complete |
$133.46
|
| Rate for Payer: BCBS Complete |
$88.60
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$177.20
|
| Rate for Payer: Cash Price |
$5,757.98
|
| Rate for Payer: Cash Price |
$266.91
|
| Rate for Payer: Cofinity Commercial |
$651.00
|
| Rate for Payer: Cofinity Commercial |
$190.49
|
| Rate for Payer: Cofinity Commercial |
$6,189.82
|
| Rate for Payer: Cofinity Commercial |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$286.93
|
| Rate for Payer: Cofinity Commercial |
$233.55
|
| Rate for Payer: Cofinity Commercial |
$5,038.23
|
| Rate for Payer: Cofinity Commercial |
$172.00
|
| Rate for Payer: Cofinity Commercial |
$155.05
|
| Rate for Payer: Cofinity Commercial |
$799.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,038.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$155.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$233.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$651.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$744.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,757.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.91
|
| Rate for Payer: Healthscope Commercial |
$180.00
|
| Rate for Payer: Healthscope Commercial |
$300.28
|
| Rate for Payer: Healthscope Commercial |
$837.00
|
| Rate for Payer: Healthscope Commercial |
$6,477.72
|
| Rate for Payer: Healthscope Commercial |
$199.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,038.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$155.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$651.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$697.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,398.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,117.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$790.50
|
| Rate for Payer: PHP Commercial |
$6,117.85
|
| Rate for Payer: PHP Commercial |
$283.59
|
| Rate for Payer: PHP Commercial |
$170.00
|
| Rate for Payer: PHP Commercial |
$188.28
|
| Rate for Payer: PHP Commercial |
$790.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$604.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,678.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.97
|
| Rate for Payer: Priority Health SBD |
$139.54
|
| Rate for Payer: Priority Health SBD |
$126.00
|
| Rate for Payer: Priority Health SBD |
$210.19
|
| Rate for Payer: Priority Health SBD |
$4,534.41
|
| Rate for Payer: Priority Health SBD |
$585.90
|
| Rate for Payer: UMR Bronson Commercial |
$344.10
|
| Rate for Payer: UMR Bronson Commercial |
$2,663.06
|
| Rate for Payer: UMR Bronson Commercial |
$81.95
|
| Rate for Payer: UMR Bronson Commercial |
$74.00
|
| Rate for Payer: UMR Bronson Commercial |
$123.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$697.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,398.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.23
|
|
|
BORTEZOMIB 3.5 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$333.64
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
185652
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$123.45 |
| Max. Negotiated Rate |
$300.28 |
| Rate for Payer: Aetna American Axle |
$216.87
|
| Rate for Payer: Aetna American Axle |
$272.63
|
| Rate for Payer: Aetna Commercial |
$283.59
|
| Rate for Payer: Aetna Commercial |
$356.52
|
| Rate for Payer: Aetna Medicare |
$166.82
|
| Rate for Payer: Aetna Medicare |
$209.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.63
|
| Rate for Payer: BCBS Complete |
$167.77
|
| Rate for Payer: BCBS Complete |
$133.46
|
| Rate for Payer: Cash Price |
$266.91
|
| Rate for Payer: Cash Price |
$335.54
|
| Rate for Payer: Cofinity Commercial |
$286.93
|
| Rate for Payer: Cofinity Commercial |
$233.55
|
| Rate for Payer: Cofinity Commercial |
$293.60
|
| Rate for Payer: Cofinity Commercial |
$360.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$293.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$233.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$335.54
|
| Rate for Payer: Healthscope Commercial |
$377.49
|
| Rate for Payer: Healthscope Commercial |
$300.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$293.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$314.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$356.52
|
| Rate for Payer: PHP Commercial |
$356.52
|
| Rate for Payer: PHP Commercial |
$283.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.63
|
| Rate for Payer: Priority Health SBD |
$264.24
|
| Rate for Payer: Priority Health SBD |
$210.19
|
| Rate for Payer: UMR Bronson Commercial |
$123.45
|
| Rate for Payer: UMR Bronson Commercial |
$155.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$314.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.23
|
|
|
BORTEZOMIB 3.5 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$6,907.69
|
|
|
Service Code
|
HCPCS J9048
|
| Hospital Charge Code |
185652
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$6,216.92 |
| Rate for Payer: Aetna American Axle |
$4,490.00
|
| Rate for Payer: Aetna Commercial |
$5,871.54
|
| Rate for Payer: Aetna Medicare |
$17.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,490.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.62
|
| Rate for Payer: BCBS Complete |
$9.29
|
| Rate for Payer: BCBS MAPPO |
$16.50
|
| Rate for Payer: BCN Medicare Advantage |
$16.50
|
| Rate for Payer: Cash Price |
$5,526.15
|
| Rate for Payer: Cash Price |
$5,526.15
|
| Rate for Payer: Cofinity Commercial |
$4,835.38
|
| Rate for Payer: Cofinity Commercial |
$5,940.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,835.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,526.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.50
|
| Rate for Payer: Healthscope Commercial |
$6,216.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,835.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,180.77
|
| Rate for Payer: Mclaren Medicaid |
$8.84
|
| Rate for Payer: Mclaren Medicare |
$16.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.32
|
| Rate for Payer: Meridian Medicaid |
$9.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,871.54
|
| Rate for Payer: PACE Medicare |
$15.68
|
| Rate for Payer: PACE SWMI |
$16.50
|
| Rate for Payer: PHP Commercial |
$5,871.54
|
| Rate for Payer: PHP Medicare Advantage |
$16.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,490.00
|
| Rate for Payer: Priority Health Medicare |
$16.50
|
| Rate for Payer: Priority Health SBD |
$4,351.84
|
| Rate for Payer: Railroad Medicare Medicare |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.50
|
| Rate for Payer: UHC Exchange |
$31.53
|
| Rate for Payer: UHC Medicare Advantage |
$16.50
|
| Rate for Payer: UHCCP Medicaid |
$8.84
|
| Rate for Payer: UMR Bronson Commercial |
$2,555.85
|
| Rate for Payer: VA VA |
$16.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,180.77
|
|
|
BORTEZOMIB 3.5 MG SUBCUTANEOUS INJECTION
|
Facility
|
OP
|
$192.88
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
151057
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.37 |
| Max. Negotiated Rate |
$173.59 |
| Rate for Payer: Aetna American Axle |
$125.37
|
| Rate for Payer: Aetna American Axle |
$4,678.36
|
| Rate for Payer: Aetna American Axle |
$130.00
|
| Rate for Payer: Aetna American Axle |
$272.63
|
| Rate for Payer: Aetna Commercial |
$163.95
|
| Rate for Payer: Aetna Commercial |
$356.52
|
| Rate for Payer: Aetna Commercial |
$6,117.85
|
| Rate for Payer: Aetna Commercial |
$170.00
|
| Rate for Payer: Aetna Medicare |
$209.72
|
| Rate for Payer: Aetna Medicare |
$100.00
|
| Rate for Payer: Aetna Medicare |
$96.44
|
| Rate for Payer: Aetna Medicare |
$3,598.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,678.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.63
|
| Rate for Payer: BCBS Complete |
$2,878.99
|
| Rate for Payer: BCBS Complete |
$77.15
|
| Rate for Payer: BCBS Complete |
$167.77
|
| Rate for Payer: BCBS Complete |
$80.00
|
| Rate for Payer: Cash Price |
$335.54
|
| Rate for Payer: Cash Price |
$154.30
|
| Rate for Payer: Cash Price |
$5,757.98
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Commercial |
$135.02
|
| Rate for Payer: Cofinity Commercial |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$165.88
|
| Rate for Payer: Cofinity Commercial |
$172.00
|
| Rate for Payer: Cofinity Commercial |
$293.60
|
| Rate for Payer: Cofinity Commercial |
$360.71
|
| Rate for Payer: Cofinity Commercial |
$6,189.82
|
| Rate for Payer: Cofinity Commercial |
$5,038.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$135.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$293.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,038.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,757.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$335.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.00
|
| Rate for Payer: Healthscope Commercial |
$173.59
|
| Rate for Payer: Healthscope Commercial |
$180.00
|
| Rate for Payer: Healthscope Commercial |
$6,477.72
|
| Rate for Payer: Healthscope Commercial |
$377.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,038.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$293.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$314.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,398.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,117.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$356.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.95
|
| Rate for Payer: PHP Commercial |
$356.52
|
| Rate for Payer: PHP Commercial |
$170.00
|
| Rate for Payer: PHP Commercial |
$163.95
|
| Rate for Payer: PHP Commercial |
$6,117.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,678.36
|
| Rate for Payer: Priority Health SBD |
$264.24
|
| Rate for Payer: Priority Health SBD |
$4,534.41
|
| Rate for Payer: Priority Health SBD |
$126.00
|
| Rate for Payer: Priority Health SBD |
$121.51
|
| Rate for Payer: UMR Bronson Commercial |
$155.19
|
| Rate for Payer: UMR Bronson Commercial |
$71.37
|
| Rate for Payer: UMR Bronson Commercial |
$74.00
|
| Rate for Payer: UMR Bronson Commercial |
$2,663.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,398.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$314.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.00
|
|
|
BORTEZOMIB 3.5 MG SUBCUTANEOUS INJECTION
|
Facility
|
IP
|
$7,197.47
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
151057
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,166.89 |
| Max. Negotiated Rate |
$6,477.72 |
| Rate for Payer: Aetna American Axle |
$4,678.36
|
| Rate for Payer: Aetna Commercial |
$6,117.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,678.36
|
| Rate for Payer: Cash Price |
$5,757.98
|
| Rate for Payer: Cofinity Commercial |
$5,038.23
|
| Rate for Payer: Cofinity Commercial |
$6,189.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,038.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,757.98
|
| Rate for Payer: Healthscope Commercial |
$6,477.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,038.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,398.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,117.85
|
| Rate for Payer: PHP Commercial |
$6,117.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,678.36
|
| Rate for Payer: Priority Health SBD |
$4,534.41
|
| Rate for Payer: UMR Bronson Commercial |
$3,166.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,398.10
|
|
|
BREAST AUGMENTATION WITH IMPLANT
|
Facility
|
OP
|
$26,270.05
|
|
|
Service Code
|
CPT 19325
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,002.22 |
| Max. Negotiated Rate |
$26,270.05 |
| Rate for Payer: Aetna Medicare |
$9,705.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,665.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,665.62
|
| Rate for Payer: BCBS Complete |
$5,252.33
|
| Rate for Payer: BCBS MAPPO |
$9,332.50
|
| Rate for Payer: BCN Medicare Advantage |
$9,332.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,332.50
|
| Rate for Payer: Mclaren Medicaid |
$5,002.22
|
| Rate for Payer: Mclaren Medicare |
$9,332.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,799.12
|
| Rate for Payer: Meridian Medicaid |
$5,252.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,732.38
|
| Rate for Payer: PACE Medicare |
$8,865.88
|
| Rate for Payer: PACE SWMI |
$9,332.50
|
| Rate for Payer: PHP Medicare Advantage |
$9,332.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,002.22
|
| Rate for Payer: Priority Health Medicare |
$9,332.50
|
| Rate for Payer: Railroad Medicare Medicare |
$9,332.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,270.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,332.50
|
| Rate for Payer: UHC Exchange |
$17,835.34
|
| Rate for Payer: UHC Medicare Advantage |
$9,332.50
|
| Rate for Payer: UHCCP Medicaid |
$5,002.22
|
| Rate for Payer: VA VA |
$9,332.50
|
|
|
BREAST REDUCTION
|
Facility
|
OP
|
$17,903.47
|
|
|
Service Code
|
CPT 19318
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,409.09 |
| Max. Negotiated Rate |
$17,903.47 |
| Rate for Payer: Aetna Medicare |
$6,614.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,950.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,950.31
|
| Rate for Payer: BCBS Complete |
$3,579.55
|
| Rate for Payer: BCBS MAPPO |
$6,360.25
|
| Rate for Payer: BCN Medicare Advantage |
$6,360.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,360.25
|
| Rate for Payer: Mclaren Medicaid |
$3,409.09
|
| Rate for Payer: Mclaren Medicare |
$6,360.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,678.26
|
| Rate for Payer: Meridian Medicaid |
$3,579.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,314.29
|
| Rate for Payer: PACE Medicare |
$6,042.24
|
| Rate for Payer: PACE SWMI |
$6,360.25
|
| Rate for Payer: PHP Medicare Advantage |
$6,360.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,409.09
|
| Rate for Payer: Priority Health Medicare |
$6,360.25
|
| Rate for Payer: Railroad Medicare Medicare |
$6,360.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,903.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,360.25
|
| Rate for Payer: UHC Exchange |
$12,155.07
|
| Rate for Payer: UHC Medicare Advantage |
$6,360.25
|
| Rate for Payer: UHCCP Medicaid |
$3,409.09
|
| Rate for Payer: VA VA |
$6,360.25
|
|
|
BRENTUXIMAB VEDOTIN 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$54,778.00
|
|
|
Service Code
|
HCPCS J9042
|
| Hospital Charge Code |
153416
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24,102.32 |
| Max. Negotiated Rate |
$49,300.20 |
| Rate for Payer: Aetna American Axle |
$35,605.70
|
| Rate for Payer: Aetna Commercial |
$46,561.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35,605.70
|
| Rate for Payer: Cash Price |
$43,822.40
|
| Rate for Payer: Cofinity Commercial |
$38,344.60
|
| Rate for Payer: Cofinity Commercial |
$47,109.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$38,344.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43,822.40
|
| Rate for Payer: Healthscope Commercial |
$49,300.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38,344.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41,083.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46,561.30
|
| Rate for Payer: PHP Commercial |
$46,561.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35,605.70
|
| Rate for Payer: Priority Health SBD |
$34,510.14
|
| Rate for Payer: UMR Bronson Commercial |
$24,102.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41,083.50
|
|
|
BRENTUXIMAB VEDOTIN 50 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$54,778.00
|
|
|
Service Code
|
HCPCS J9042
|
| Hospital Charge Code |
153416
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$138.63 |
| Max. Negotiated Rate |
$49,300.20 |
| Rate for Payer: Aetna American Axle |
$35,605.70
|
| Rate for Payer: Aetna Commercial |
$46,561.30
|
| Rate for Payer: Aetna Medicare |
$268.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35,605.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$323.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$323.30
|
| Rate for Payer: BCBS Complete |
$145.56
|
| Rate for Payer: BCBS MAPPO |
$258.64
|
| Rate for Payer: BCN Medicare Advantage |
$258.64
|
| Rate for Payer: Cash Price |
$43,822.40
|
| Rate for Payer: Cash Price |
$43,822.40
|
| Rate for Payer: Cofinity Commercial |
$47,109.08
|
| Rate for Payer: Cofinity Commercial |
$38,344.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$38,344.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43,822.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$258.64
|
| Rate for Payer: Healthscope Commercial |
$49,300.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38,344.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41,083.50
|
| Rate for Payer: Mclaren Medicaid |
$138.63
|
| Rate for Payer: Mclaren Medicare |
$258.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$271.57
|
| Rate for Payer: Meridian Medicaid |
$145.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$297.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46,561.30
|
| Rate for Payer: PACE Medicare |
$245.71
|
| Rate for Payer: PACE SWMI |
$258.64
|
| Rate for Payer: PHP Commercial |
$46,561.30
|
| Rate for Payer: PHP Medicare Advantage |
$258.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35,605.70
|
| Rate for Payer: Priority Health Medicare |
$258.64
|
| Rate for Payer: Priority Health SBD |
$34,510.14
|
| Rate for Payer: Railroad Medicare Medicare |
$258.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$728.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$258.64
|
| Rate for Payer: UHC Exchange |
$494.29
|
| Rate for Payer: UHC Medicare Advantage |
$258.64
|
| Rate for Payer: UHCCP Medicaid |
$138.63
|
| Rate for Payer: UMR Bronson Commercial |
$20,267.86
|
| Rate for Payer: VA VA |
$258.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41,083.50
|
|
|
BREXPIPRAZOLE 0.25 MG TABLET
|
Facility
|
IP
|
$5,215.45
|
|
|
Service Code
|
NDC 59148003513
|
| Hospital Charge Code |
174663
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,294.80 |
| Max. Negotiated Rate |
$4,693.90 |
| Rate for Payer: Aetna American Axle |
$3,390.04
|
| Rate for Payer: Aetna Commercial |
$4,433.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,390.04
|
| Rate for Payer: Cash Price |
$4,172.36
|
| Rate for Payer: Cofinity Commercial |
$3,650.82
|
| Rate for Payer: Cofinity Commercial |
$4,485.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,650.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,172.36
|
| Rate for Payer: Healthscope Commercial |
$4,693.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,650.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,911.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,433.13
|
| Rate for Payer: PHP Commercial |
$4,433.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,390.04
|
| Rate for Payer: Priority Health SBD |
$3,285.73
|
| Rate for Payer: UMR Bronson Commercial |
$2,294.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,911.59
|
|
|
BREXPIPRAZOLE 0.25 MG TABLET
|
Facility
|
OP
|
$5,215.45
|
|
|
Service Code
|
NDC 59148003513
|
| Hospital Charge Code |
174663
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,929.72 |
| Max. Negotiated Rate |
$4,693.90 |
| Rate for Payer: Aetna American Axle |
$3,390.04
|
| Rate for Payer: Aetna Commercial |
$4,433.13
|
| Rate for Payer: Aetna Medicare |
$2,607.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,390.04
|
| Rate for Payer: BCBS Complete |
$2,086.18
|
| Rate for Payer: Cash Price |
$4,172.36
|
| Rate for Payer: Cofinity Commercial |
$3,650.82
|
| Rate for Payer: Cofinity Commercial |
$4,485.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,650.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,172.36
|
| Rate for Payer: Healthscope Commercial |
$4,693.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,650.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,911.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,433.13
|
| Rate for Payer: PHP Commercial |
$4,433.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,390.04
|
| Rate for Payer: Priority Health SBD |
$3,285.73
|
| Rate for Payer: UMR Bronson Commercial |
$1,929.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,911.59
|
|
|
BREXPIPRAZOLE 1 MG TABLET
|
Facility
|
IP
|
$5,215.45
|
|
|
Service Code
|
NDC 59148003713
|
| Hospital Charge Code |
174666
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,294.80 |
| Max. Negotiated Rate |
$4,693.90 |
| Rate for Payer: Aetna American Axle |
$3,390.04
|
| Rate for Payer: Aetna Commercial |
$4,433.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,390.04
|
| Rate for Payer: Cash Price |
$4,172.36
|
| Rate for Payer: Cofinity Commercial |
$3,650.82
|
| Rate for Payer: Cofinity Commercial |
$4,485.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,650.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,172.36
|
| Rate for Payer: Healthscope Commercial |
$4,693.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,650.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,911.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,433.13
|
| Rate for Payer: PHP Commercial |
$4,433.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,390.04
|
| Rate for Payer: Priority Health SBD |
$3,285.73
|
| Rate for Payer: UMR Bronson Commercial |
$2,294.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,911.59
|
|
|
BREXPIPRAZOLE 1 MG TABLET
|
Facility
|
OP
|
$5,215.45
|
|
|
Service Code
|
NDC 59148003713
|
| Hospital Charge Code |
174666
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,929.72 |
| Max. Negotiated Rate |
$4,693.90 |
| Rate for Payer: Aetna American Axle |
$3,390.04
|
| Rate for Payer: Aetna Commercial |
$4,433.13
|
| Rate for Payer: Aetna Medicare |
$2,607.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,390.04
|
| Rate for Payer: BCBS Complete |
$2,086.18
|
| Rate for Payer: Cash Price |
$4,172.36
|
| Rate for Payer: Cofinity Commercial |
$3,650.82
|
| Rate for Payer: Cofinity Commercial |
$4,485.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,650.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,172.36
|
| Rate for Payer: Healthscope Commercial |
$4,693.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,650.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,911.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,433.13
|
| Rate for Payer: PHP Commercial |
$4,433.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,390.04
|
| Rate for Payer: Priority Health SBD |
$3,285.73
|
| Rate for Payer: UMR Bronson Commercial |
$1,929.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,911.59
|
|
|
BRIMONIDINE 0.15 % EYE DROPS
|
Facility
|
IP
|
$674.73
|
|
|
Service Code
|
NDC 00023917705
|
| Hospital Charge Code |
31158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$296.88 |
| Max. Negotiated Rate |
$607.26 |
| Rate for Payer: Aetna American Axle |
$438.57
|
| Rate for Payer: Aetna Commercial |
$573.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$438.57
|
| Rate for Payer: Cash Price |
$539.78
|
| Rate for Payer: Cofinity Commercial |
$472.31
|
| Rate for Payer: Cofinity Commercial |
$580.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$472.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$539.78
|
| Rate for Payer: Healthscope Commercial |
$607.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$472.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$506.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$573.52
|
| Rate for Payer: PHP Commercial |
$573.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$438.57
|
| Rate for Payer: Priority Health SBD |
$425.08
|
| Rate for Payer: UMR Bronson Commercial |
$296.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$506.05
|
|
|
BRIMONIDINE 0.15 % EYE DROPS
|
Facility
|
OP
|
$674.73
|
|
|
Service Code
|
NDC 00023917705
|
| Hospital Charge Code |
31158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$249.65 |
| Max. Negotiated Rate |
$607.26 |
| Rate for Payer: Aetna American Axle |
$438.57
|
| Rate for Payer: Aetna Commercial |
$573.52
|
| Rate for Payer: Aetna Medicare |
$337.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$438.57
|
| Rate for Payer: BCBS Complete |
$269.89
|
| Rate for Payer: Cash Price |
$539.78
|
| Rate for Payer: Cofinity Commercial |
$472.31
|
| Rate for Payer: Cofinity Commercial |
$580.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$472.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$539.78
|
| Rate for Payer: Healthscope Commercial |
$607.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$472.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$506.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$573.52
|
| Rate for Payer: PHP Commercial |
$573.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$438.57
|
| Rate for Payer: Priority Health SBD |
$425.08
|
| Rate for Payer: UMR Bronson Commercial |
$249.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$506.05
|
|
|
BRIMONIDINE 0.15 % EYE DROPS
|
Facility
|
IP
|
$499.17
|
|
|
Service Code
|
NDC 61314014405
|
| Hospital Charge Code |
31158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$219.63 |
| Max. Negotiated Rate |
$449.25 |
| Rate for Payer: Aetna American Axle |
$324.46
|
| Rate for Payer: Aetna Commercial |
$424.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.46
|
| Rate for Payer: Cash Price |
$399.34
|
| Rate for Payer: Cofinity Commercial |
$349.42
|
| Rate for Payer: Cofinity Commercial |
$429.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$349.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.34
|
| Rate for Payer: Healthscope Commercial |
$449.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$349.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$374.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$424.29
|
| Rate for Payer: PHP Commercial |
$424.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.46
|
| Rate for Payer: Priority Health SBD |
$314.48
|
| Rate for Payer: UMR Bronson Commercial |
$219.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$374.38
|
|
|
BRIMONIDINE 0.15 % EYE DROPS
|
Facility
|
OP
|
$499.17
|
|
|
Service Code
|
NDC 61314014405
|
| Hospital Charge Code |
31158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.69 |
| Max. Negotiated Rate |
$449.25 |
| Rate for Payer: Aetna American Axle |
$324.46
|
| Rate for Payer: Aetna Commercial |
$424.29
|
| Rate for Payer: Aetna Medicare |
$249.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.46
|
| Rate for Payer: BCBS Complete |
$199.67
|
| Rate for Payer: Cash Price |
$399.34
|
| Rate for Payer: Cofinity Commercial |
$349.42
|
| Rate for Payer: Cofinity Commercial |
$429.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$349.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.34
|
| Rate for Payer: Healthscope Commercial |
$449.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$349.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$374.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$424.29
|
| Rate for Payer: PHP Commercial |
$424.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.46
|
| Rate for Payer: Priority Health SBD |
$314.48
|
| Rate for Payer: UMR Bronson Commercial |
$184.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$374.38
|
|
|
BRIMONIDINE 0.1 % EYE DROPS
|
Facility
|
OP
|
$404.01
|
|
|
Service Code
|
NDC 82182032105
|
| Hospital Charge Code |
70262
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.48 |
| Max. Negotiated Rate |
$363.61 |
| Rate for Payer: Aetna American Axle |
$262.61
|
| Rate for Payer: Aetna Commercial |
$343.41
|
| Rate for Payer: Aetna Medicare |
$202.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.61
|
| Rate for Payer: BCBS Complete |
$161.60
|
| Rate for Payer: Cash Price |
$323.21
|
| Rate for Payer: Cofinity Commercial |
$282.81
|
| Rate for Payer: Cofinity Commercial |
$347.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$282.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.21
|
| Rate for Payer: Healthscope Commercial |
$363.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$282.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.41
|
| Rate for Payer: PHP Commercial |
$343.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.61
|
| Rate for Payer: Priority Health SBD |
$254.53
|
| Rate for Payer: UMR Bronson Commercial |
$149.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.01
|
|
|
BRIMONIDINE 0.1 % EYE DROPS
|
Facility
|
IP
|
$404.01
|
|
|
Service Code
|
NDC 82182032105
|
| Hospital Charge Code |
70262
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.76 |
| Max. Negotiated Rate |
$363.61 |
| Rate for Payer: Aetna American Axle |
$262.61
|
| Rate for Payer: Aetna Commercial |
$343.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.61
|
| Rate for Payer: Cash Price |
$323.21
|
| Rate for Payer: Cofinity Commercial |
$282.81
|
| Rate for Payer: Cofinity Commercial |
$347.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$282.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.21
|
| Rate for Payer: Healthscope Commercial |
$363.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$282.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.41
|
| Rate for Payer: PHP Commercial |
$343.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.61
|
| Rate for Payer: Priority Health SBD |
$254.53
|
| Rate for Payer: UMR Bronson Commercial |
$177.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.01
|
|
|
BRIMONIDINE 0.1 % EYE DROPS
|
Facility
|
IP
|
$632.59
|
|
|
Service Code
|
NDC 00023932105
|
| Hospital Charge Code |
70262
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$278.34 |
| Max. Negotiated Rate |
$569.33 |
| Rate for Payer: Aetna American Axle |
$411.18
|
| Rate for Payer: Aetna Commercial |
$537.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$411.18
|
| Rate for Payer: Cash Price |
$506.07
|
| Rate for Payer: Cofinity Commercial |
$442.81
|
| Rate for Payer: Cofinity Commercial |
$544.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$442.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$506.07
|
| Rate for Payer: Healthscope Commercial |
$569.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$442.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$474.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$537.70
|
| Rate for Payer: PHP Commercial |
$537.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$411.18
|
| Rate for Payer: Priority Health SBD |
$398.53
|
| Rate for Payer: UMR Bronson Commercial |
$278.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$474.44
|
|
