|
ROSUVASTATIN 5 MG TABLET
|
Facility
|
IP
|
$112.10
|
|
|
Service Code
|
NDC 68462026190
|
| Hospital Charge Code |
36612
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.32 |
| Max. Negotiated Rate |
$100.89 |
| Rate for Payer: Aetna American Axle |
$72.86
|
| Rate for Payer: Aetna Commercial |
$95.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.86
|
| Rate for Payer: Cash Price |
$89.68
|
| Rate for Payer: Cofinity Commercial |
$78.47
|
| Rate for Payer: Cofinity Commercial |
$96.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.68
|
| Rate for Payer: Healthscope Commercial |
$100.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.28
|
| Rate for Payer: PHP Commercial |
$95.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.86
|
| Rate for Payer: Priority Health SBD |
$70.62
|
| Rate for Payer: UMR Bronson Commercial |
$49.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.08
|
|
|
ROSUVASTATIN 5 MG TABLET
|
Facility
|
IP
|
$133.25
|
|
|
Service Code
|
NDC 65862029390
|
| Hospital Charge Code |
36612
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.63 |
| Max. Negotiated Rate |
$119.92 |
| Rate for Payer: Aetna American Axle |
$86.61
|
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.61
|
| Rate for Payer: Cash Price |
$106.60
|
| Rate for Payer: Cofinity Commercial |
$114.59
|
| Rate for Payer: Cofinity Commercial |
$93.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$93.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.60
|
| Rate for Payer: Healthscope Commercial |
$119.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.26
|
| Rate for Payer: PHP Commercial |
$113.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.61
|
| Rate for Payer: Priority Health SBD |
$83.95
|
| Rate for Payer: UMR Bronson Commercial |
$58.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.94
|
|
|
ROSUVASTATIN 5 MG TABLET
|
Facility
|
OP
|
$133.25
|
|
|
Service Code
|
NDC 65862029390
|
| Hospital Charge Code |
36612
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.30 |
| Max. Negotiated Rate |
$119.92 |
| Rate for Payer: Aetna American Axle |
$86.61
|
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Aetna Medicare |
$66.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.61
|
| Rate for Payer: BCBS Complete |
$53.30
|
| Rate for Payer: Cash Price |
$106.60
|
| Rate for Payer: Cofinity Commercial |
$114.59
|
| Rate for Payer: Cofinity Commercial |
$93.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$93.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.60
|
| Rate for Payer: Healthscope Commercial |
$119.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.26
|
| Rate for Payer: PHP Commercial |
$113.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.61
|
| Rate for Payer: Priority Health SBD |
$83.95
|
| Rate for Payer: UMR Bronson Commercial |
$49.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.94
|
|
|
ROSUVASTATIN 5 MG TABLET
|
Facility
|
OP
|
$112.10
|
|
|
Service Code
|
NDC 68462026190
|
| Hospital Charge Code |
36612
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.48 |
| Max. Negotiated Rate |
$100.89 |
| Rate for Payer: Aetna American Axle |
$72.86
|
| Rate for Payer: Aetna Commercial |
$95.28
|
| Rate for Payer: Aetna Medicare |
$56.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.86
|
| Rate for Payer: BCBS Complete |
$44.84
|
| Rate for Payer: Cash Price |
$89.68
|
| Rate for Payer: Cofinity Commercial |
$78.47
|
| Rate for Payer: Cofinity Commercial |
$96.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.68
|
| Rate for Payer: Healthscope Commercial |
$100.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.28
|
| Rate for Payer: PHP Commercial |
$95.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.86
|
| Rate for Payer: Priority Health SBD |
$70.62
|
| Rate for Payer: UMR Bronson Commercial |
$41.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.08
|
|
|
ROTAVIRUS VACCINE LIVE, PENTAVALENT 2 ML ORAL SOLUTION
|
Facility
|
IP
|
$292.99
|
|
|
Service Code
|
HCPCS 90680
|
| Hospital Charge Code |
70476
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$128.92 |
| Max. Negotiated Rate |
$263.69 |
| Rate for Payer: Aetna American Axle |
$190.44
|
| Rate for Payer: Aetna Commercial |
$249.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.44
|
| Rate for Payer: Cash Price |
$234.39
|
| Rate for Payer: Cofinity Commercial |
$205.09
|
| Rate for Payer: Cofinity Commercial |
$251.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$205.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.39
|
| Rate for Payer: Healthscope Commercial |
$263.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$205.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$219.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.04
|
| Rate for Payer: PHP Commercial |
$249.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.44
|
| Rate for Payer: Priority Health SBD |
$184.58
|
| Rate for Payer: UMR Bronson Commercial |
$128.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$219.74
|
|
|
ROTAVIRUS VACCINE LIVE, PENTAVALENT 2 ML ORAL SOLUTION
|
Facility
|
OP
|
$292.99
|
|
|
Service Code
|
HCPCS 90680
|
| Hospital Charge Code |
70476
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.41 |
| Max. Negotiated Rate |
$263.69 |
| Rate for Payer: Aetna American Axle |
$190.44
|
| Rate for Payer: Aetna Commercial |
$249.04
|
| Rate for Payer: Aetna Medicare |
$146.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.44
|
| Rate for Payer: BCBS Complete |
$117.20
|
| Rate for Payer: Cash Price |
$234.39
|
| Rate for Payer: Cofinity Commercial |
$205.09
|
| Rate for Payer: Cofinity Commercial |
$251.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$205.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.39
|
| Rate for Payer: Healthscope Commercial |
$263.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$205.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$219.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.04
|
| Rate for Payer: PHP Commercial |
$249.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.44
|
| Rate for Payer: Priority Health SBD |
$184.58
|
| Rate for Payer: UMR Bronson Commercial |
$108.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$219.74
|
|
|
RUFINAMIDE 200 MG TABLET
|
Facility
|
IP
|
$5,450.55
|
|
|
Service Code
|
NDC 62856058252
|
| Hospital Charge Code |
95691
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,398.24 |
| Max. Negotiated Rate |
$4,905.49 |
| Rate for Payer: Aetna American Axle |
$3,542.86
|
| Rate for Payer: Aetna Commercial |
$4,632.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,542.86
|
| Rate for Payer: Cash Price |
$4,360.44
|
| Rate for Payer: Cofinity Commercial |
$3,815.39
|
| Rate for Payer: Cofinity Commercial |
$4,687.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,815.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,360.44
|
| Rate for Payer: Healthscope Commercial |
$4,905.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,815.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,087.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,632.97
|
| Rate for Payer: PHP Commercial |
$4,632.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,542.86
|
| Rate for Payer: Priority Health SBD |
$3,433.85
|
| Rate for Payer: UMR Bronson Commercial |
$2,398.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,087.91
|
|
|
RUFINAMIDE 200 MG TABLET
|
Facility
|
OP
|
$5,450.55
|
|
|
Service Code
|
NDC 62856058252
|
| Hospital Charge Code |
95691
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,016.70 |
| Max. Negotiated Rate |
$4,905.49 |
| Rate for Payer: Aetna American Axle |
$3,542.86
|
| Rate for Payer: Aetna Commercial |
$4,632.97
|
| Rate for Payer: Aetna Medicare |
$2,725.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,542.86
|
| Rate for Payer: BCBS Complete |
$2,180.22
|
| Rate for Payer: Cash Price |
$4,360.44
|
| Rate for Payer: Cofinity Commercial |
$3,815.39
|
| Rate for Payer: Cofinity Commercial |
$4,687.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,815.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,360.44
|
| Rate for Payer: Healthscope Commercial |
$4,905.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,815.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,087.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,632.97
|
| Rate for Payer: PHP Commercial |
$4,632.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,542.86
|
| Rate for Payer: Priority Health SBD |
$3,433.85
|
| Rate for Payer: UMR Bronson Commercial |
$2,016.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,087.91
|
|
|
RUFINAMIDE 400 MG TABLET
|
Facility
|
OP
|
$2,536.13
|
|
|
Service Code
|
NDC 00054042623
|
| Hospital Charge Code |
95692
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$938.37 |
| Max. Negotiated Rate |
$2,282.52 |
| Rate for Payer: Aetna American Axle |
$1,648.48
|
| Rate for Payer: Aetna Commercial |
$2,155.71
|
| Rate for Payer: Aetna Medicare |
$1,268.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,648.48
|
| Rate for Payer: BCBS Complete |
$1,014.45
|
| Rate for Payer: Cash Price |
$2,028.90
|
| Rate for Payer: Cofinity Commercial |
$1,775.29
|
| Rate for Payer: Cofinity Commercial |
$2,181.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,775.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,028.90
|
| Rate for Payer: Healthscope Commercial |
$2,282.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,775.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,902.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,155.71
|
| Rate for Payer: PHP Commercial |
$2,155.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,648.48
|
| Rate for Payer: Priority Health SBD |
$1,597.76
|
| Rate for Payer: UMR Bronson Commercial |
$938.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,902.10
|
|
|
RUFINAMIDE 400 MG TABLET
|
Facility
|
IP
|
$1,617.05
|
|
|
Service Code
|
NDC 59651061708
|
| Hospital Charge Code |
95692
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$711.50 |
| Max. Negotiated Rate |
$1,455.35 |
| Rate for Payer: Aetna American Axle |
$1,051.08
|
| Rate for Payer: Aetna Commercial |
$1,374.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,051.08
|
| Rate for Payer: Cash Price |
$1,293.64
|
| Rate for Payer: Cofinity Commercial |
$1,131.93
|
| Rate for Payer: Cofinity Commercial |
$1,390.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,131.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,293.64
|
| Rate for Payer: Healthscope Commercial |
$1,455.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,131.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,212.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,374.49
|
| Rate for Payer: PHP Commercial |
$1,374.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,051.08
|
| Rate for Payer: Priority Health SBD |
$1,018.74
|
| Rate for Payer: UMR Bronson Commercial |
$711.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,212.79
|
|
|
RUFINAMIDE 400 MG TABLET
|
Facility
|
IP
|
$2,536.13
|
|
|
Service Code
|
NDC 00054042623
|
| Hospital Charge Code |
95692
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,115.90 |
| Max. Negotiated Rate |
$2,282.52 |
| Rate for Payer: Aetna American Axle |
$1,648.48
|
| Rate for Payer: Aetna Commercial |
$2,155.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,648.48
|
| Rate for Payer: Cash Price |
$2,028.90
|
| Rate for Payer: Cofinity Commercial |
$1,775.29
|
| Rate for Payer: Cofinity Commercial |
$2,181.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,775.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,028.90
|
| Rate for Payer: Healthscope Commercial |
$2,282.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,775.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,902.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,155.71
|
| Rate for Payer: PHP Commercial |
$2,155.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,648.48
|
| Rate for Payer: Priority Health SBD |
$1,597.76
|
| Rate for Payer: UMR Bronson Commercial |
$1,115.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,902.10
|
|
|
RUFINAMIDE 400 MG TABLET
|
Facility
|
OP
|
$1,617.05
|
|
|
Service Code
|
NDC 59651061708
|
| Hospital Charge Code |
95692
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$598.31 |
| Max. Negotiated Rate |
$1,455.35 |
| Rate for Payer: Aetna American Axle |
$1,051.08
|
| Rate for Payer: Aetna Commercial |
$1,374.49
|
| Rate for Payer: Aetna Medicare |
$808.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,051.08
|
| Rate for Payer: BCBS Complete |
$646.82
|
| Rate for Payer: Cash Price |
$1,293.64
|
| Rate for Payer: Cofinity Commercial |
$1,131.93
|
| Rate for Payer: Cofinity Commercial |
$1,390.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,131.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,293.64
|
| Rate for Payer: Healthscope Commercial |
$1,455.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,131.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,212.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,374.49
|
| Rate for Payer: PHP Commercial |
$1,374.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,051.08
|
| Rate for Payer: Priority Health SBD |
$1,018.74
|
| Rate for Payer: UMR Bronson Commercial |
$598.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,212.79
|
|
|
RUFINAMIDE 400 MG TABLET
|
Facility
|
IP
|
$10,901.09
|
|
|
Service Code
|
NDC 62856058352
|
| Hospital Charge Code |
95692
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,796.48 |
| Max. Negotiated Rate |
$9,810.98 |
| Rate for Payer: Aetna American Axle |
$7,085.71
|
| Rate for Payer: Aetna Commercial |
$9,265.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,085.71
|
| Rate for Payer: Cash Price |
$8,720.87
|
| Rate for Payer: Cofinity Commercial |
$7,630.76
|
| Rate for Payer: Cofinity Commercial |
$9,374.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,630.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,720.87
|
| Rate for Payer: Healthscope Commercial |
$9,810.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,630.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,175.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,265.93
|
| Rate for Payer: PHP Commercial |
$9,265.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,085.71
|
| Rate for Payer: Priority Health SBD |
$6,867.69
|
| Rate for Payer: UMR Bronson Commercial |
$4,796.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,175.82
|
|
|
RUFINAMIDE 400 MG TABLET
|
Facility
|
OP
|
$10,901.09
|
|
|
Service Code
|
NDC 62856058352
|
| Hospital Charge Code |
95692
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,033.40 |
| Max. Negotiated Rate |
$9,810.98 |
| Rate for Payer: Aetna American Axle |
$7,085.71
|
| Rate for Payer: Aetna Commercial |
$9,265.93
|
| Rate for Payer: Aetna Medicare |
$5,450.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,085.71
|
| Rate for Payer: BCBS Complete |
$4,360.44
|
| Rate for Payer: Cash Price |
$8,720.87
|
| Rate for Payer: Cofinity Commercial |
$7,630.76
|
| Rate for Payer: Cofinity Commercial |
$9,374.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,630.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,720.87
|
| Rate for Payer: Healthscope Commercial |
$9,810.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,630.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,175.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,265.93
|
| Rate for Payer: PHP Commercial |
$9,265.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,085.71
|
| Rate for Payer: Priority Health SBD |
$6,867.69
|
| Rate for Payer: UMR Bronson Commercial |
$4,033.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,175.82
|
|
|
SACITUZUMAB GOVITECAN-HZIY 180 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$11,284.45
|
|
|
Service Code
|
HCPCS J9317
|
| Hospital Charge Code |
193479
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,965.16 |
| Max. Negotiated Rate |
$10,156.00 |
| Rate for Payer: Aetna American Axle |
$7,334.89
|
| Rate for Payer: Aetna Commercial |
$9,591.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,334.89
|
| Rate for Payer: Cash Price |
$9,027.56
|
| Rate for Payer: Cofinity Commercial |
$7,899.11
|
| Rate for Payer: Cofinity Commercial |
$9,704.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,899.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,027.56
|
| Rate for Payer: Healthscope Commercial |
$10,156.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,899.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,463.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,591.78
|
| Rate for Payer: PHP Commercial |
$9,591.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,334.89
|
| Rate for Payer: Priority Health SBD |
$7,109.20
|
| Rate for Payer: UMR Bronson Commercial |
$4,965.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,463.34
|
|
|
SACITUZUMAB GOVITECAN-HZIY 180 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$11,284.45
|
|
|
Service Code
|
HCPCS J9317
|
| Hospital Charge Code |
193479
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.45 |
| Max. Negotiated Rate |
$10,156.00 |
| Rate for Payer: Aetna American Axle |
$7,334.89
|
| Rate for Payer: Aetna Commercial |
$9,591.78
|
| Rate for Payer: Aetna Medicare |
$37.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,334.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.35
|
| Rate for Payer: BCBS Complete |
$20.42
|
| Rate for Payer: BCBS MAPPO |
$36.28
|
| Rate for Payer: BCN Medicare Advantage |
$36.28
|
| Rate for Payer: Cash Price |
$9,027.56
|
| Rate for Payer: Cash Price |
$9,027.56
|
| Rate for Payer: Cofinity Commercial |
$9,704.63
|
| Rate for Payer: Cofinity Commercial |
$7,899.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,899.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,027.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.28
|
| Rate for Payer: Healthscope Commercial |
$10,156.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,899.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,463.34
|
| Rate for Payer: Mclaren Medicaid |
$19.45
|
| Rate for Payer: Mclaren Medicare |
$36.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.09
|
| Rate for Payer: Meridian Medicaid |
$20.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,591.78
|
| Rate for Payer: PACE Medicare |
$34.47
|
| Rate for Payer: PACE SWMI |
$36.28
|
| Rate for Payer: PHP Commercial |
$9,591.78
|
| Rate for Payer: PHP Medicare Advantage |
$36.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,334.89
|
| Rate for Payer: Priority Health Medicare |
$36.28
|
| Rate for Payer: Priority Health SBD |
$7,109.20
|
| Rate for Payer: Railroad Medicare Medicare |
$36.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.28
|
| Rate for Payer: UHC Exchange |
$69.33
|
| Rate for Payer: UHC Medicare Advantage |
$36.28
|
| Rate for Payer: UHCCP Medicaid |
$19.45
|
| Rate for Payer: UMR Bronson Commercial |
$4,175.25
|
| Rate for Payer: VA VA |
$36.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,463.34
|
|
|
SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET
|
Facility
|
OP
|
$7,031.63
|
|
|
Service Code
|
NDC 00078065967
|
| Hospital Charge Code |
174639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,601.70 |
| Max. Negotiated Rate |
$6,328.47 |
| Rate for Payer: Aetna American Axle |
$4,570.56
|
| Rate for Payer: Aetna Commercial |
$5,976.89
|
| Rate for Payer: Aetna Medicare |
$3,515.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,570.56
|
| Rate for Payer: BCBS Complete |
$2,812.65
|
| Rate for Payer: Cash Price |
$5,625.30
|
| Rate for Payer: Cofinity Commercial |
$4,922.14
|
| Rate for Payer: Cofinity Commercial |
$6,047.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,922.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,625.30
|
| Rate for Payer: Healthscope Commercial |
$6,328.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,922.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,273.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,976.89
|
| Rate for Payer: PHP Commercial |
$5,976.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,570.56
|
| Rate for Payer: Priority Health SBD |
$4,429.93
|
| Rate for Payer: UMR Bronson Commercial |
$2,601.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,273.72
|
|
|
SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET
|
Facility
|
IP
|
$2,343.88
|
|
|
Service Code
|
NDC 00078065920
|
| Hospital Charge Code |
174639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,031.31 |
| Max. Negotiated Rate |
$2,109.49 |
| Rate for Payer: Aetna American Axle |
$1,523.52
|
| Rate for Payer: Aetna Commercial |
$1,992.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,523.52
|
| Rate for Payer: Cash Price |
$1,875.10
|
| Rate for Payer: Cofinity Commercial |
$1,640.72
|
| Rate for Payer: Cofinity Commercial |
$2,015.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,640.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,875.10
|
| Rate for Payer: Healthscope Commercial |
$2,109.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,640.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,757.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,992.30
|
| Rate for Payer: PHP Commercial |
$1,992.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,523.52
|
| Rate for Payer: Priority Health SBD |
$1,476.64
|
| Rate for Payer: UMR Bronson Commercial |
$1,031.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,757.91
|
|
|
SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET
|
Facility
|
IP
|
$7,031.63
|
|
|
Service Code
|
NDC 00078065967
|
| Hospital Charge Code |
174639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,093.92 |
| Max. Negotiated Rate |
$6,328.47 |
| Rate for Payer: Aetna American Axle |
$4,570.56
|
| Rate for Payer: Aetna Commercial |
$5,976.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,570.56
|
| Rate for Payer: Cash Price |
$5,625.30
|
| Rate for Payer: Cofinity Commercial |
$4,922.14
|
| Rate for Payer: Cofinity Commercial |
$6,047.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,922.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,625.30
|
| Rate for Payer: Healthscope Commercial |
$6,328.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,922.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,273.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,976.89
|
| Rate for Payer: PHP Commercial |
$5,976.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,570.56
|
| Rate for Payer: Priority Health SBD |
$4,429.93
|
| Rate for Payer: UMR Bronson Commercial |
$3,093.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,273.72
|
|
|
SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET
|
Facility
|
OP
|
$2,343.88
|
|
|
Service Code
|
NDC 00078065920
|
| Hospital Charge Code |
174639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$867.24 |
| Max. Negotiated Rate |
$2,109.49 |
| Rate for Payer: Aetna American Axle |
$1,523.52
|
| Rate for Payer: Aetna Commercial |
$1,992.30
|
| Rate for Payer: Aetna Medicare |
$1,171.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,523.52
|
| Rate for Payer: BCBS Complete |
$937.55
|
| Rate for Payer: Cash Price |
$1,875.10
|
| Rate for Payer: Cofinity Commercial |
$1,640.72
|
| Rate for Payer: Cofinity Commercial |
$2,015.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,640.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,875.10
|
| Rate for Payer: Healthscope Commercial |
$2,109.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,640.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,757.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,992.30
|
| Rate for Payer: PHP Commercial |
$1,992.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,523.52
|
| Rate for Payer: Priority Health SBD |
$1,476.64
|
| Rate for Payer: UMR Bronson Commercial |
$867.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,757.91
|
|
|
SACUBITRIL 49 MG-VALSARTAN 51 MG TABLET
|
Facility
|
IP
|
$2,343.88
|
|
|
Service Code
|
NDC 00078077720
|
| Hospital Charge Code |
174640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,031.31 |
| Max. Negotiated Rate |
$2,109.49 |
| Rate for Payer: Aetna American Axle |
$1,523.52
|
| Rate for Payer: Aetna Commercial |
$1,992.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,523.52
|
| Rate for Payer: Cash Price |
$1,875.10
|
| Rate for Payer: Cofinity Commercial |
$1,640.72
|
| Rate for Payer: Cofinity Commercial |
$2,015.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,640.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,875.10
|
| Rate for Payer: Healthscope Commercial |
$2,109.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,640.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,757.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,992.30
|
| Rate for Payer: PHP Commercial |
$1,992.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,523.52
|
| Rate for Payer: Priority Health SBD |
$1,476.64
|
| Rate for Payer: UMR Bronson Commercial |
$1,031.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,757.91
|
|
|
SACUBITRIL 49 MG-VALSARTAN 51 MG TABLET
|
Facility
|
OP
|
$2,343.88
|
|
|
Service Code
|
NDC 00078077720
|
| Hospital Charge Code |
174640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$867.24 |
| Max. Negotiated Rate |
$2,109.49 |
| Rate for Payer: Aetna American Axle |
$1,523.52
|
| Rate for Payer: Aetna Commercial |
$1,992.30
|
| Rate for Payer: Aetna Medicare |
$1,171.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,523.52
|
| Rate for Payer: BCBS Complete |
$937.55
|
| Rate for Payer: Cash Price |
$1,875.10
|
| Rate for Payer: Cofinity Commercial |
$1,640.72
|
| Rate for Payer: Cofinity Commercial |
$2,015.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,640.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,875.10
|
| Rate for Payer: Healthscope Commercial |
$2,109.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,640.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,757.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,992.30
|
| Rate for Payer: PHP Commercial |
$1,992.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,523.52
|
| Rate for Payer: Priority Health SBD |
$1,476.64
|
| Rate for Payer: UMR Bronson Commercial |
$867.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,757.91
|
|
|
SACUBITRIL 97 MG-VALSARTAN 103 MG TABLET
|
Facility
|
IP
|
$2,343.88
|
|
|
Service Code
|
NDC 00078069620
|
| Hospital Charge Code |
174641
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,031.31 |
| Max. Negotiated Rate |
$2,109.49 |
| Rate for Payer: Aetna American Axle |
$1,523.52
|
| Rate for Payer: Aetna Commercial |
$1,992.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,523.52
|
| Rate for Payer: Cash Price |
$1,875.10
|
| Rate for Payer: Cofinity Commercial |
$1,640.72
|
| Rate for Payer: Cofinity Commercial |
$2,015.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,640.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,875.10
|
| Rate for Payer: Healthscope Commercial |
$2,109.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,640.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,757.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,992.30
|
| Rate for Payer: PHP Commercial |
$1,992.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,523.52
|
| Rate for Payer: Priority Health SBD |
$1,476.64
|
| Rate for Payer: UMR Bronson Commercial |
$1,031.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,757.91
|
|
|
SACUBITRIL 97 MG-VALSARTAN 103 MG TABLET
|
Facility
|
OP
|
$2,343.88
|
|
|
Service Code
|
NDC 00078069620
|
| Hospital Charge Code |
174641
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$867.24 |
| Max. Negotiated Rate |
$2,109.49 |
| Rate for Payer: Aetna American Axle |
$1,523.52
|
| Rate for Payer: Aetna Commercial |
$1,992.30
|
| Rate for Payer: Aetna Medicare |
$1,171.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,523.52
|
| Rate for Payer: BCBS Complete |
$937.55
|
| Rate for Payer: Cash Price |
$1,875.10
|
| Rate for Payer: Cofinity Commercial |
$1,640.72
|
| Rate for Payer: Cofinity Commercial |
$2,015.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,640.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,875.10
|
| Rate for Payer: Healthscope Commercial |
$2,109.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,640.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,757.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,992.30
|
| Rate for Payer: PHP Commercial |
$1,992.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,523.52
|
| Rate for Payer: Priority Health SBD |
$1,476.64
|
| Rate for Payer: UMR Bronson Commercial |
$867.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,757.91
|
|
|
SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY
|
Facility
|
IP
|
$24.97
|
|
|
Service Code
|
NDC 48582000155
|
| Hospital Charge Code |
118454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.99 |
| Max. Negotiated Rate |
$22.47 |
| Rate for Payer: Aetna American Axle |
$16.23
|
| Rate for Payer: Aetna Commercial |
$21.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.23
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cofinity Commercial |
$17.48
|
| Rate for Payer: Cofinity Commercial |
$21.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.98
|
| Rate for Payer: Healthscope Commercial |
$22.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.22
|
| Rate for Payer: PHP Commercial |
$21.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.23
|
| Rate for Payer: Priority Health SBD |
$15.73
|
| Rate for Payer: UMR Bronson Commercial |
$10.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.73
|
|
