|
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 |
$593.26
|
| Rate for Payer: Aetna American Axle |
$348.61
|
| Rate for Payer: Aetna Commercial |
$455.87
|
| Rate for Payer: Aetna Commercial |
$775.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$348.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$593.26
|
| 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 |
$775.80
|
| Rate for Payer: PHP Commercial |
$775.80
|
| 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 |
$593.26
|
| 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
|
|
|
BLEPHAROPLASTY, LOWER EYELID; WITH EXTENSIVE HERNIATED FAT PAD
|
Facility
|
OP
|
$5,632.99
|
|
|
Service Code
|
CPT 15821
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$517.92 |
| Max. Negotiated Rate |
$5,632.99 |
| Rate for Payer: Aetna Medicare |
$1,863.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,108.09
|
| Rate for Payer: BCN Commercial |
$2,108.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Nomi Health Commercial |
$3,763.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,632.99
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,506.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$569.71
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$517.92
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$960.64
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
BLEPHAROPLASTY, UPPER EYELID;
|
Facility
|
OP
|
$5,632.99
|
|
|
Service Code
|
CPT 15822
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$375.59 |
| Max. Negotiated Rate |
$5,632.99 |
| Rate for Payer: Aetna Medicare |
$1,863.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,401.99
|
| Rate for Payer: BCN Commercial |
$1,401.99
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Nomi Health Commercial |
$3,763.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,632.99
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,506.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$413.15
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$375.59
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$960.64
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
BLEPHAROPLASTY, UPPER EYELID; WITH EXCESSIVE SKIN WEIGHTING DOWN LID
|
Facility
|
OP
|
$5,632.99
|
|
|
Service Code
|
CPT 15823
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$517.70 |
| Max. Negotiated Rate |
$5,632.99 |
| Rate for Payer: Aetna Medicare |
$1,863.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,717.91
|
| Rate for Payer: BCN Commercial |
$1,717.91
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Nomi Health Commercial |
$3,763.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,632.99
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,506.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$569.47
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$517.70
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$960.64
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
BLEPHAROTOMY, DRAINAGE OF ABSCESS, EYELID
|
Facility
|
OP
|
$920.54
|
|
|
Service Code
|
CPT 67700
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$108.53 |
| Max. Negotiated Rate |
$920.54 |
| Rate for Payer: Aetna Medicare |
$304.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$366.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$366.11
|
| Rate for Payer: BCBS Complete |
$164.84
|
| Rate for Payer: BCBS MAPPO |
$292.89
|
| Rate for Payer: BCBS Trust/PPO |
$296.90
|
| Rate for Payer: BCN Commercial |
$296.90
|
| Rate for Payer: BCN Medicare Advantage |
$292.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$292.89
|
| Rate for Payer: Mclaren Medicaid |
$156.99
|
| Rate for Payer: Mclaren Medicare |
$292.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$307.53
|
| Rate for Payer: Meridian Medicaid |
$164.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$336.82
|
| Rate for Payer: Nomi Health Commercial |
$615.07
|
| Rate for Payer: PACE Medicare |
$278.25
|
| Rate for Payer: PACE SWMI |
$292.89
|
| Rate for Payer: PHP Medicare Advantage |
$292.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$156.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$920.54
|
| Rate for Payer: Priority Health Medicare |
$292.89
|
| Rate for Payer: Priority Health Narrow Network |
$736.43
|
| Rate for Payer: Railroad Medicare Medicare |
$292.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.38
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$292.89
|
| Rate for Payer: UHC Exchange |
$108.53
|
| Rate for Payer: UHC Medicare Advantage |
$292.89
|
| Rate for Payer: UHCCP Medicaid |
$156.99
|
| Rate for Payer: VA VA |
$292.89
|
|
|
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 KIT
|
Facility
|
OP
|
$24,947.41
|
|
|
Service Code
|
HCPCS J9039
|
| Hospital Charge Code |
173348
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$81.75 |
| 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 |
$158.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,215.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$190.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$190.64
|
| Rate for Payer: BCBS Complete |
$85.83
|
| Rate for Payer: BCBS MAPPO |
$152.51
|
| Rate for Payer: BCBS Trust/PPO |
$411.20
|
| Rate for Payer: BCN Commercial |
$411.20
|
| Rate for Payer: BCN Medicare Advantage |
$152.51
|
| 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 |
$152.51
|
| 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 |
$81.75
|
| Rate for Payer: Mclaren Medicare |
$152.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.14
|
| Rate for Payer: Meridian Medicaid |
$85.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21,205.30
|
| Rate for Payer: Nomi Health Commercial |
$457.53
|
| Rate for Payer: PACE Medicare |
$144.88
|
| Rate for Payer: PACE SWMI |
$152.51
|
| Rate for Payer: PHP Commercial |
$21,205.30
|
| Rate for Payer: PHP Medicare Advantage |
$152.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16,215.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$437.96
|
| Rate for Payer: Priority Health Medicare |
$152.51
|
| Rate for Payer: Priority Health Narrow Network |
$350.37
|
| Rate for Payer: Priority Health SBD |
$15,716.87
|
| Rate for Payer: Railroad Medicare Medicare |
$152.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$429.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.51
|
| Rate for Payer: UHC Exchange |
$291.46
|
| Rate for Payer: UHC Medicare Advantage |
$152.51
|
| Rate for Payer: UHCCP Medicaid |
$81.75
|
| Rate for Payer: UMR Bronson Commercial |
$9,230.54
|
| Rate for Payer: VA VA |
$152.51
|
| 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 |
$81.75 |
| 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 |
$158.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,109.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$190.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$190.64
|
| Rate for Payer: BCBS Complete |
$85.83
|
| Rate for Payer: BCBS MAPPO |
$152.51
|
| Rate for Payer: BCBS Trust/PPO |
$411.20
|
| Rate for Payer: BCN Commercial |
$411.20
|
| Rate for Payer: BCN Medicare Advantage |
$152.51
|
| 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 |
$152.51
|
| 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 |
$81.75
|
| Rate for Payer: Mclaren Medicare |
$152.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.14
|
| Rate for Payer: Meridian Medicaid |
$85.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17,143.45
|
| Rate for Payer: Nomi Health Commercial |
$457.53
|
| Rate for Payer: PACE Medicare |
$144.88
|
| Rate for Payer: PACE SWMI |
$152.51
|
| Rate for Payer: PHP Commercial |
$17,143.45
|
| Rate for Payer: PHP Medicare Advantage |
$152.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,109.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$437.96
|
| Rate for Payer: Priority Health Medicare |
$152.51
|
| Rate for Payer: Priority Health Narrow Network |
$350.37
|
| Rate for Payer: Priority Health SBD |
$12,706.33
|
| Rate for Payer: Railroad Medicare Medicare |
$152.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$429.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.51
|
| Rate for Payer: UHC Exchange |
$291.46
|
| Rate for Payer: UHC Medicare Advantage |
$152.51
|
| Rate for Payer: UHCCP Medicaid |
$81.75
|
| Rate for Payer: UMR Bronson Commercial |
$7,462.44
|
| Rate for Payer: VA VA |
$152.51
|
| 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 |
$3.32
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.32
|
| 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 |
$3.32
|
| 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 |
$3.32
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.32
|
| 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 |
$3.32
|
| 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
|
|
|
BONE GRAFT, ANY DONOR AREA; MAJOR OR LARGE
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 20902
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$265.84 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$4,814.60
|
| Rate for Payer: BCN Commercial |
$4,814.60
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$292.42
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$265.84
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
BONE GRAFT, ANY DONOR AREA; MINOR OR SMALL (EG, DOWEL OR BUTTON)
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 20900
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$173.82 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$4,738.65
|
| Rate for Payer: BCN Commercial |
$4,738.65
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.20
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$173.82
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
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
|
|
|
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
|
|
|
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 |
$143.98
|
| 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) |
$143.98
|
| 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 |
$143.98
|
| 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 |
$4.15 |
| Max. Negotiated Rate |
$199.35 |
| Rate for Payer: Aetna American Axle |
$143.98
|
| Rate for Payer: Aetna American Axle |
$4,678.36
|
| Rate for Payer: Aetna American Axle |
$216.87
|
| Rate for Payer: Aetna American Axle |
$130.00
|
| Rate for Payer: Aetna American Axle |
$604.50
|
| Rate for Payer: Aetna Commercial |
$188.28
|
| 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 Medicare |
$166.82
|
| Rate for Payer: Aetna Medicare |
$3,598.74
|
| Rate for Payer: Aetna Medicare |
$110.75
|
| Rate for Payer: Aetna Medicare |
$100.00
|
| Rate for Payer: Aetna Medicare |
$465.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,678.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$604.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.87
|
| Rate for Payer: BCBS Complete |
$88.60
|
| Rate for Payer: BCBS Complete |
$80.00
|
| Rate for Payer: BCBS Complete |
$2,878.99
|
| Rate for Payer: BCBS Complete |
$372.00
|
| Rate for Payer: BCBS Complete |
$133.46
|
| Rate for Payer: BCBS Trust/PPO |
$4.15
|
| Rate for Payer: BCBS Trust/PPO |
$4.15
|
| Rate for Payer: BCBS Trust/PPO |
$4.15
|
| Rate for Payer: BCBS Trust/PPO |
$4.15
|
| Rate for Payer: BCBS Trust/PPO |
$4.15
|
| Rate for Payer: BCN Commercial |
$4.15
|
| Rate for Payer: BCN Commercial |
$4.15
|
| Rate for Payer: BCN Commercial |
$4.15
|
| Rate for Payer: BCN Commercial |
$4.15
|
| Rate for Payer: BCN Commercial |
$4.15
|
| 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 |
$177.20
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$266.91
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Cash Price |
$5,757.98
|
| Rate for Payer: Cash Price |
$5,757.98
|
| Rate for Payer: Cofinity Commercial |
$155.05
|
| Rate for Payer: Cofinity Commercial |
$799.80
|
| 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 |
$651.00
|
| Rate for Payer: Cofinity Commercial |
$6,189.82
|
| Rate for Payer: Cofinity Commercial |
$5,038.23
|
| Rate for Payer: Cofinity Commercial |
$190.49
|
| Rate for Payer: Cofinity Commercial |
$172.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,038.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$651.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$233.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$155.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.91
|
| 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 |
$160.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,757.98
|
| Rate for Payer: Healthscope Commercial |
$6,477.72
|
| Rate for Payer: Healthscope Commercial |
$180.00
|
| Rate for Payer: Healthscope Commercial |
$199.35
|
| Rate for Payer: Healthscope Commercial |
$300.28
|
| Rate for Payer: Healthscope Commercial |
$837.00
|
| 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 |
$5,038.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$651.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,398.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$697.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.23
|
| 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 |
$6,117.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$790.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.00
|
| Rate for Payer: PHP Commercial |
$790.50
|
| Rate for Payer: PHP Commercial |
$6,117.85
|
| Rate for Payer: PHP Commercial |
$188.28
|
| Rate for Payer: PHP Commercial |
$170.00
|
| Rate for Payer: PHP Commercial |
$283.59
|
| 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 |
$216.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.98
|
| Rate for Payer: Priority Health SBD |
$139.54
|
| Rate for Payer: Priority Health SBD |
$585.90
|
| Rate for Payer: Priority Health SBD |
$4,534.41
|
| Rate for Payer: Priority Health SBD |
$126.00
|
| Rate for Payer: Priority Health SBD |
$210.19
|
| Rate for Payer: UMR Bronson Commercial |
$74.00
|
| Rate for Payer: UMR Bronson Commercial |
$123.45
|
| Rate for Payer: UMR Bronson Commercial |
$81.96
|
| Rate for Payer: UMR Bronson Commercial |
$2,663.06
|
| Rate for Payer: UMR Bronson Commercial |
$344.10
|
| 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 |
$697.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.00
|
|
|
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 |
$7.20 |
| 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: BCBS Trust/PPO |
$7.20
|
| Rate for Payer: BCN Commercial |
$7.20
|
| 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 |
$5,940.61
|
| Rate for Payer: Cofinity Commercial |
$4,835.38
|
| 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: Nomi Health Commercial |
$49.50
|
| 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 HMO/PPO/Tiered Network |
$47.48
|
| Rate for Payer: Priority Health Medicare |
$16.50
|
| Rate for Payer: Priority Health Narrow Network |
$37.98
|
| 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 INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$333.64
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
185652
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.15 |
| 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 |
$356.52
|
| Rate for Payer: Aetna Commercial |
$283.59
|
| 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: BCBS Trust/PPO |
$4.15
|
| Rate for Payer: BCBS Trust/PPO |
$4.15
|
| Rate for Payer: BCN Commercial |
$4.15
|
| Rate for Payer: BCN Commercial |
$4.15
|
| Rate for Payer: Cash Price |
$335.54
|
| Rate for Payer: Cash Price |
$335.54
|
| Rate for Payer: Cash Price |
$266.91
|
| Rate for Payer: Cash Price |
$266.91
|
| Rate for Payer: Cofinity Commercial |
$360.71
|
| Rate for Payer: Cofinity Commercial |
$233.55
|
| Rate for Payer: Cofinity Commercial |
$293.60
|
| Rate for Payer: Cofinity Commercial |
$286.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$233.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$293.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$335.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.91
|
| Rate for Payer: Healthscope Commercial |
$377.49
|
| Rate for Payer: Healthscope Commercial |
$300.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$293.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$314.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.23
|
| 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 |
$283.59
|
| Rate for Payer: PHP Commercial |
$356.52
|
| 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 SUBCUTANEOUS INJECTION
|
Facility
|
OP
|
$192.88
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
151057
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.15 |
| Max. Negotiated Rate |
$173.59 |
| Rate for Payer: Aetna American Axle |
$125.37
|
| Rate for Payer: Aetna American Axle |
$272.63
|
| Rate for Payer: Aetna American Axle |
$130.00
|
| Rate for Payer: Aetna American Axle |
$4,678.36
|
| Rate for Payer: Aetna Commercial |
$163.95
|
| Rate for Payer: Aetna Commercial |
$356.52
|
| Rate for Payer: Aetna Commercial |
$170.00
|
| Rate for Payer: Aetna Commercial |
$6,117.85
|
| Rate for Payer: Aetna Medicare |
$3,598.74
|
| 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 New Business (MI Preferred) |
$130.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,678.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.37
|
| Rate for Payer: BCBS Complete |
$2,878.99
|
| Rate for Payer: BCBS Complete |
$80.00
|
| Rate for Payer: BCBS Complete |
$77.15
|
| Rate for Payer: BCBS Complete |
$167.77
|
| Rate for Payer: BCBS Trust/PPO |
$4.15
|
| Rate for Payer: BCBS Trust/PPO |
$4.15
|
| Rate for Payer: BCBS Trust/PPO |
$4.15
|
| Rate for Payer: BCBS Trust/PPO |
$4.15
|
| Rate for Payer: BCN Commercial |
$4.15
|
| Rate for Payer: BCN Commercial |
$4.15
|
| Rate for Payer: BCN Commercial |
$4.15
|
| Rate for Payer: BCN Commercial |
$4.15
|
| Rate for Payer: Cash Price |
$154.30
|
| Rate for Payer: Cash Price |
$5,757.98
|
| Rate for Payer: Cash Price |
$335.54
|
| Rate for Payer: Cash Price |
$160.00
|
| 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 |
$293.60
|
| Rate for Payer: Cofinity Commercial |
$6,189.82
|
| Rate for Payer: Cofinity Commercial |
$5,038.23
|
| Rate for Payer: Cofinity Commercial |
$135.02
|
| Rate for Payer: Cofinity Commercial |
$360.71
|
| Rate for Payer: Cofinity Commercial |
$165.88
|
| Rate for Payer: Cofinity Commercial |
$172.00
|
| Rate for Payer: Cofinity Commercial |
$140.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$135.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,038.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$293.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,757.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$335.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.30
|
| Rate for Payer: Healthscope Commercial |
$173.59
|
| Rate for Payer: Healthscope Commercial |
$6,477.72
|
| Rate for Payer: Healthscope Commercial |
$180.00
|
| Rate for Payer: Healthscope Commercial |
$377.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$293.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,038.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$314.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,398.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$356.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,117.85
|
| Rate for Payer: PHP Commercial |
$356.52
|
| Rate for Payer: PHP Commercial |
$6,117.85
|
| Rate for Payer: PHP Commercial |
$163.95
|
| Rate for Payer: PHP Commercial |
$170.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,678.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.37
|
| 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: Priority Health SBD |
$264.24
|
| Rate for Payer: UMR Bronson Commercial |
$74.00
|
| Rate for Payer: UMR Bronson Commercial |
$71.37
|
| Rate for Payer: UMR Bronson Commercial |
$2,663.06
|
| Rate for Payer: UMR Bronson Commercial |
$155.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,398.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$314.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.66
|
|
|
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
|
$29,467.24
|
|
|
Service Code
|
CPT 19325
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$590.26 |
| Max. Negotiated Rate |
$29,467.24 |
| Rate for Payer: Aetna Medicare |
$9,750.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,719.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,719.45
|
| Rate for Payer: BCBS Complete |
$5,276.57
|
| Rate for Payer: BCBS MAPPO |
$9,375.56
|
| Rate for Payer: BCBS Trust/PPO |
$5,787.04
|
| Rate for Payer: BCN Commercial |
$5,787.04
|
| Rate for Payer: BCN Medicare Advantage |
$9,375.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,375.56
|
| Rate for Payer: Mclaren Medicaid |
$5,025.30
|
| Rate for Payer: Mclaren Medicare |
$9,375.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,844.34
|
| Rate for Payer: Meridian Medicaid |
$5,276.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,781.89
|
| Rate for Payer: Nomi Health Commercial |
$19,688.68
|
| Rate for Payer: PACE Medicare |
$8,906.78
|
| Rate for Payer: PACE SWMI |
$9,375.56
|
| Rate for Payer: PHP Medicare Advantage |
$9,375.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,025.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29,467.24
|
| Rate for Payer: Priority Health Medicare |
$9,375.56
|
| Rate for Payer: Priority Health Narrow Network |
$23,573.79
|
| Rate for Payer: Railroad Medicare Medicare |
$9,375.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$649.29
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,375.56
|
| Rate for Payer: UHC Exchange |
$590.26
|
| Rate for Payer: UHC Medicare Advantage |
$9,375.56
|
| Rate for Payer: UHCCP Medicaid |
$5,025.30
|
| Rate for Payer: VA VA |
$9,375.56
|
|
|
BREAST REDUCTION
|
Facility
|
OP
|
$20,082.39
|
|
|
Service Code
|
CPT 19318
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,051.77 |
| Max. Negotiated Rate |
$20,082.39 |
| Rate for Payer: Aetna Medicare |
$6,645.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,987.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,987.00
|
| Rate for Payer: BCBS Complete |
$3,596.07
|
| Rate for Payer: BCBS MAPPO |
$6,389.60
|
| Rate for Payer: BCBS Trust/PPO |
$6,817.13
|
| Rate for Payer: BCN Commercial |
$6,817.13
|
| Rate for Payer: BCN Medicare Advantage |
$6,389.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,389.60
|
| Rate for Payer: Mclaren Medicaid |
$3,424.83
|
| Rate for Payer: Mclaren Medicare |
$6,389.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,709.08
|
| Rate for Payer: Meridian Medicaid |
$3,596.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,348.04
|
| Rate for Payer: Nomi Health Commercial |
$13,418.16
|
| Rate for Payer: PACE Medicare |
$6,070.12
|
| Rate for Payer: PACE SWMI |
$6,389.60
|
| Rate for Payer: PHP Medicare Advantage |
$6,389.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,424.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,082.39
|
| Rate for Payer: Priority Health Medicare |
$6,389.60
|
| Rate for Payer: Priority Health Narrow Network |
$16,065.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,389.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,156.95
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,389.60
|
| Rate for Payer: UHC Exchange |
$1,051.77
|
| Rate for Payer: UHC Medicare Advantage |
$6,389.60
|
| Rate for Payer: UHCCP Medicaid |
$3,424.83
|
| Rate for Payer: VA VA |
$6,389.60
|
|
|
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 |
$133.43 |
| 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 |
$258.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35,605.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$311.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$311.16
|
| Rate for Payer: BCBS Complete |
$140.10
|
| Rate for Payer: BCBS MAPPO |
$248.93
|
| Rate for Payer: BCBS Trust/PPO |
$634.74
|
| Rate for Payer: BCN Commercial |
$634.74
|
| Rate for Payer: BCN Medicare Advantage |
$248.93
|
| 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 |
$248.93
|
| 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 |
$133.43
|
| Rate for Payer: Mclaren Medicare |
$248.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.38
|
| Rate for Payer: Meridian Medicaid |
$140.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$286.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46,561.30
|
| Rate for Payer: Nomi Health Commercial |
$746.79
|
| Rate for Payer: PACE Medicare |
$236.48
|
| Rate for Payer: PACE SWMI |
$248.93
|
| Rate for Payer: PHP Commercial |
$46,561.30
|
| Rate for Payer: PHP Medicare Advantage |
$248.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$133.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35,605.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$690.31
|
| Rate for Payer: Priority Health Medicare |
$248.93
|
| Rate for Payer: Priority Health Narrow Network |
$552.25
|
| Rate for Payer: Priority Health SBD |
$34,510.14
|
| Rate for Payer: Railroad Medicare Medicare |
$248.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$700.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$248.93
|
| Rate for Payer: UHC Exchange |
$475.73
|
| Rate for Payer: UHC Medicare Advantage |
$248.93
|
| Rate for Payer: UHCCP Medicaid |
$133.43
|
| Rate for Payer: UMR Bronson Commercial |
$20,267.86
|
| Rate for Payer: VA VA |
$248.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41,083.50
|
|
|
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
|
|
