|
SORAFENIB 200 MG TABLET
|
Facility
|
OP
|
$94,398.84
|
|
|
Service Code
|
NDC 50419048858
|
| Hospital Charge Code |
43675
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34,927.57 |
| Max. Negotiated Rate |
$84,958.96 |
| Rate for Payer: Aetna American Axle |
$61,359.25
|
| Rate for Payer: Aetna Commercial |
$80,239.01
|
| Rate for Payer: Aetna Medicare |
$47,199.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61,359.25
|
| Rate for Payer: BCBS Complete |
$37,759.54
|
| Rate for Payer: Cash Price |
$75,519.07
|
| Rate for Payer: Cofinity Advantage |
$66,079.19
|
| Rate for Payer: Cofinity Commercial |
$81,183.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75,519.07
|
| Rate for Payer: Healthscope Commercial |
$84,958.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66,079.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70,799.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75,519.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80,239.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70,799.13
|
| Rate for Payer: PHP Commercial |
$80,239.01
|
| Rate for Payer: Priority Health SBD |
$59,471.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61,359.25
|
| Rate for Payer: UHC Core |
$49,181.80
|
| Rate for Payer: UHC Exchange |
$37,098.74
|
| Rate for Payer: UMR Bronson Commercial |
$34,927.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70,799.13
|
|
|
SORAFENIB 200 MG TABLET
|
Facility
|
IP
|
$41,326.64
|
|
|
Service Code
|
NDC 00378120178
|
| Hospital Charge Code |
43675
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18,183.72 |
| Max. Negotiated Rate |
$37,193.98 |
| Rate for Payer: Aetna American Axle |
$26,862.32
|
| Rate for Payer: Aetna Commercial |
$35,127.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26,862.32
|
| Rate for Payer: Cash Price |
$33,061.31
|
| Rate for Payer: Cofinity Advantage |
$28,928.65
|
| Rate for Payer: Cofinity Commercial |
$35,540.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33,061.31
|
| Rate for Payer: Healthscope Commercial |
$37,193.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28,928.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30,994.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35,127.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30,994.98
|
| Rate for Payer: PHP Commercial |
$35,127.64
|
| Rate for Payer: Priority Health SBD |
$26,035.78
|
| Rate for Payer: UMR Bronson Commercial |
$18,183.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30,994.98
|
|
|
SORBITOL 70 % SOLUTION
|
Facility
|
IP
|
$45.51
|
|
|
Service Code
|
NDC 46287050001
|
| Hospital Charge Code |
7413
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.02 |
| Max. Negotiated Rate |
$40.96 |
| Rate for Payer: Aetna American Axle |
$29.58
|
| Rate for Payer: Aetna Commercial |
$38.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.58
|
| Rate for Payer: Cash Price |
$36.41
|
| Rate for Payer: Cofinity Advantage |
$31.86
|
| Rate for Payer: Cofinity Commercial |
$39.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.41
|
| Rate for Payer: Healthscope Commercial |
$40.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.13
|
| Rate for Payer: PHP Commercial |
$38.68
|
| Rate for Payer: Priority Health SBD |
$28.67
|
| Rate for Payer: UMR Bronson Commercial |
$20.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.13
|
|
|
SORBITOL 70 % SOLUTION
|
Facility
|
OP
|
$29.76
|
|
|
Service Code
|
NDC 00802391316
|
| Hospital Charge Code |
7413
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.01 |
| Max. Negotiated Rate |
$26.78 |
| Rate for Payer: Aetna American Axle |
$19.34
|
| Rate for Payer: Aetna Commercial |
$25.30
|
| Rate for Payer: Aetna Medicare |
$14.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.34
|
| Rate for Payer: BCBS Complete |
$11.90
|
| Rate for Payer: Cash Price |
$23.81
|
| Rate for Payer: Cofinity Advantage |
$20.83
|
| Rate for Payer: Cofinity Commercial |
$25.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.81
|
| Rate for Payer: Healthscope Commercial |
$26.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.32
|
| Rate for Payer: PHP Commercial |
$25.30
|
| Rate for Payer: Priority Health SBD |
$18.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.34
|
| Rate for Payer: UHC Core |
$15.50
|
| Rate for Payer: UHC Exchange |
$11.70
|
| Rate for Payer: UMR Bronson Commercial |
$11.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.32
|
|
|
SORBITOL 70 % SOLUTION
|
Facility
|
OP
|
$45.51
|
|
|
Service Code
|
NDC 46287050001
|
| Hospital Charge Code |
7413
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.84 |
| Max. Negotiated Rate |
$40.96 |
| Rate for Payer: Aetna American Axle |
$29.58
|
| Rate for Payer: Aetna Commercial |
$38.68
|
| Rate for Payer: Aetna Medicare |
$22.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.58
|
| Rate for Payer: BCBS Complete |
$18.20
|
| Rate for Payer: Cash Price |
$36.41
|
| Rate for Payer: Cofinity Advantage |
$31.86
|
| Rate for Payer: Cofinity Commercial |
$39.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.41
|
| Rate for Payer: Healthscope Commercial |
$40.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.13
|
| Rate for Payer: PHP Commercial |
$38.68
|
| Rate for Payer: Priority Health SBD |
$28.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.58
|
| Rate for Payer: UHC Core |
$23.71
|
| Rate for Payer: UHC Exchange |
$17.89
|
| Rate for Payer: UMR Bronson Commercial |
$16.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.13
|
|
|
SORBITOL 70 % SOLUTION
|
Facility
|
IP
|
$29.76
|
|
|
Service Code
|
NDC 00802391316
|
| Hospital Charge Code |
7413
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.09 |
| Max. Negotiated Rate |
$26.78 |
| Rate for Payer: Aetna American Axle |
$19.34
|
| Rate for Payer: Aetna Commercial |
$25.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.34
|
| Rate for Payer: Cash Price |
$23.81
|
| Rate for Payer: Cofinity Advantage |
$20.83
|
| Rate for Payer: Cofinity Commercial |
$25.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.81
|
| Rate for Payer: Healthscope Commercial |
$26.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.32
|
| Rate for Payer: PHP Commercial |
$25.30
|
| Rate for Payer: Priority Health SBD |
$18.75
|
| Rate for Payer: UMR Bronson Commercial |
$13.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.32
|
|
|
SOTALOL 120 MG TABLET
|
Facility
|
OP
|
$223.25
|
|
|
Service Code
|
NDC 60505015900
|
| Hospital Charge Code |
15723
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.60 |
| Max. Negotiated Rate |
$200.93 |
| Rate for Payer: Aetna American Axle |
$145.11
|
| Rate for Payer: Aetna Commercial |
$189.76
|
| Rate for Payer: Aetna Medicare |
$111.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.11
|
| Rate for Payer: BCBS Complete |
$89.30
|
| Rate for Payer: Cash Price |
$178.60
|
| Rate for Payer: Cofinity Advantage |
$156.28
|
| Rate for Payer: Cofinity Commercial |
$192.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.60
|
| Rate for Payer: Healthscope Commercial |
$200.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$178.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$167.44
|
| Rate for Payer: PHP Commercial |
$189.76
|
| Rate for Payer: Priority Health SBD |
$140.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.11
|
| Rate for Payer: UHC Core |
$116.31
|
| Rate for Payer: UHC Exchange |
$87.74
|
| Rate for Payer: UMR Bronson Commercial |
$82.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.44
|
|
|
SOTALOL 120 MG TABLET
|
Facility
|
IP
|
$331.55
|
|
|
Service Code
|
NDC 00093106001
|
| Hospital Charge Code |
15723
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.88 |
| Max. Negotiated Rate |
$298.39 |
| Rate for Payer: Aetna American Axle |
$215.51
|
| Rate for Payer: Aetna Commercial |
$281.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.51
|
| Rate for Payer: Cash Price |
$265.24
|
| Rate for Payer: Cofinity Advantage |
$232.09
|
| Rate for Payer: Cofinity Commercial |
$285.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.24
|
| Rate for Payer: Healthscope Commercial |
$298.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$232.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$281.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$248.66
|
| Rate for Payer: PHP Commercial |
$281.82
|
| Rate for Payer: Priority Health SBD |
$208.88
|
| Rate for Payer: UMR Bronson Commercial |
$145.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.66
|
|
|
SOTALOL 120 MG TABLET
|
Facility
|
IP
|
$223.25
|
|
|
Service Code
|
NDC 60505015900
|
| Hospital Charge Code |
15723
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.23 |
| Max. Negotiated Rate |
$200.93 |
| Rate for Payer: Aetna American Axle |
$145.11
|
| Rate for Payer: Aetna Commercial |
$189.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.11
|
| Rate for Payer: Cash Price |
$178.60
|
| Rate for Payer: Cofinity Advantage |
$156.28
|
| Rate for Payer: Cofinity Commercial |
$192.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.60
|
| Rate for Payer: Healthscope Commercial |
$200.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$167.44
|
| Rate for Payer: PHP Commercial |
$189.76
|
| Rate for Payer: Priority Health SBD |
$140.65
|
| Rate for Payer: UMR Bronson Commercial |
$98.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.44
|
|
|
SOTALOL 120 MG TABLET
|
Facility
|
OP
|
$331.55
|
|
|
Service Code
|
NDC 00093106001
|
| Hospital Charge Code |
15723
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.67 |
| Max. Negotiated Rate |
$298.39 |
| Rate for Payer: Aetna American Axle |
$215.51
|
| Rate for Payer: Aetna Commercial |
$281.82
|
| Rate for Payer: Aetna Medicare |
$165.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.51
|
| Rate for Payer: BCBS Complete |
$132.62
|
| Rate for Payer: Cash Price |
$265.24
|
| Rate for Payer: Cofinity Advantage |
$232.09
|
| Rate for Payer: Cofinity Commercial |
$285.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.24
|
| Rate for Payer: Healthscope Commercial |
$298.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$232.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$265.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$281.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$248.66
|
| Rate for Payer: PHP Commercial |
$281.82
|
| Rate for Payer: Priority Health SBD |
$208.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.51
|
| Rate for Payer: UHC Core |
$172.74
|
| Rate for Payer: UHC Exchange |
$130.30
|
| Rate for Payer: UMR Bronson Commercial |
$122.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.66
|
|
|
SOTALOL 150 MG/10 ML (15 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$10,353.20
|
|
|
Service Code
|
HCPCS C9482
|
| Hospital Charge Code |
103935
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,555.41 |
| Max. Negotiated Rate |
$9,317.88 |
| Rate for Payer: Aetna American Axle |
$6,729.58
|
| Rate for Payer: Aetna Commercial |
$8,800.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,729.58
|
| Rate for Payer: Cash Price |
$8,282.56
|
| Rate for Payer: Cofinity Advantage |
$7,247.24
|
| Rate for Payer: Cofinity Commercial |
$8,903.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,282.56
|
| Rate for Payer: Healthscope Commercial |
$9,317.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,247.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,764.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,800.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,764.90
|
| Rate for Payer: PHP Commercial |
$8,800.22
|
| Rate for Payer: Priority Health SBD |
$6,522.52
|
| Rate for Payer: UMR Bronson Commercial |
$4,555.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,764.90
|
|
|
SOTALOL 150 MG/10 ML (15 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$10,353.20
|
|
|
Service Code
|
HCPCS C9482
|
| Hospital Charge Code |
103935
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.40 |
| Max. Negotiated Rate |
$9,317.88 |
| Rate for Payer: Aetna American Axle |
$6,729.58
|
| Rate for Payer: Aetna Commercial |
$8,800.22
|
| Rate for Payer: Aetna Medicare |
$5,176.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,729.58
|
| Rate for Payer: BCBS Complete |
$4,141.28
|
| Rate for Payer: BCBS Trust/PPO |
$64.89
|
| Rate for Payer: BCN Commercial |
$64.89
|
| Rate for Payer: Cash Price |
$8,282.56
|
| Rate for Payer: Cash Price |
$8,282.56
|
| Rate for Payer: Cofinity Advantage |
$7,247.24
|
| Rate for Payer: Cofinity Commercial |
$8,903.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,282.56
|
| Rate for Payer: Healthscope Commercial |
$9,317.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,247.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,764.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,282.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,800.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,764.90
|
| Rate for Payer: PHP Commercial |
$8,800.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$79.00
|
| Rate for Payer: Priority Health SBD |
$6,522.52
|
| Rate for Payer: Priority Health Tiered Network |
$63.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.40
|
| Rate for Payer: UHC Core |
$41.40
|
| Rate for Payer: UHC Exchange |
$41.40
|
| Rate for Payer: UMR Bronson Commercial |
$3,830.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,764.90
|
|
|
SOTALOL 80 MG TABLET
|
Facility
|
IP
|
$4.44
|
|
|
Service Code
|
NDC 00245001289
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna American Axle |
$2.89
|
| Rate for Payer: Aetna Commercial |
$3.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.89
|
| Rate for Payer: Cash Price |
$3.55
|
| Rate for Payer: Cofinity Advantage |
$3.11
|
| Rate for Payer: Cofinity Commercial |
$3.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.55
|
| Rate for Payer: Healthscope Commercial |
$4.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.33
|
| Rate for Payer: PHP Commercial |
$3.77
|
| Rate for Payer: Priority Health SBD |
$2.80
|
| Rate for Payer: UMR Bronson Commercial |
$1.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.33
|
|
|
SOTALOL 80 MG TABLET
|
Facility
|
OP
|
$444.00
|
|
|
Service Code
|
NDC 00245001201
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.28 |
| Max. Negotiated Rate |
$399.60 |
| Rate for Payer: Aetna American Axle |
$288.60
|
| Rate for Payer: Aetna Commercial |
$377.40
|
| Rate for Payer: Aetna Medicare |
$222.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.60
|
| Rate for Payer: BCBS Complete |
$177.60
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cofinity Advantage |
$310.80
|
| Rate for Payer: Cofinity Commercial |
$381.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.20
|
| Rate for Payer: Healthscope Commercial |
$399.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$310.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$333.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$355.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$377.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$333.00
|
| Rate for Payer: PHP Commercial |
$377.40
|
| Rate for Payer: Priority Health SBD |
$279.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$288.60
|
| Rate for Payer: UHC Core |
$231.32
|
| Rate for Payer: UHC Exchange |
$174.49
|
| Rate for Payer: UMR Bronson Commercial |
$164.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$333.00
|
|
|
SOTALOL 80 MG TABLET
|
Facility
|
OP
|
$4.44
|
|
|
Service Code
|
NDC 00245001289
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna American Axle |
$2.89
|
| Rate for Payer: Aetna Commercial |
$3.77
|
| Rate for Payer: Aetna Medicare |
$2.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.89
|
| Rate for Payer: BCBS Complete |
$1.78
|
| Rate for Payer: Cash Price |
$3.55
|
| Rate for Payer: Cofinity Advantage |
$3.11
|
| Rate for Payer: Cofinity Commercial |
$3.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.55
|
| Rate for Payer: Healthscope Commercial |
$4.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.33
|
| Rate for Payer: PHP Commercial |
$3.77
|
| Rate for Payer: Priority Health SBD |
$2.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.89
|
| Rate for Payer: UHC Core |
$2.31
|
| Rate for Payer: UHC Exchange |
$1.74
|
| Rate for Payer: UMR Bronson Commercial |
$1.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.33
|
|
|
SOTALOL 80 MG TABLET
|
Facility
|
IP
|
$143.35
|
|
|
Service Code
|
NDC 60505008000
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.07 |
| Max. Negotiated Rate |
$129.01 |
| Rate for Payer: Aetna American Axle |
$93.18
|
| Rate for Payer: Aetna Commercial |
$121.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.18
|
| Rate for Payer: Cash Price |
$114.68
|
| Rate for Payer: Cofinity Advantage |
$100.34
|
| Rate for Payer: Cofinity Commercial |
$123.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.68
|
| Rate for Payer: Healthscope Commercial |
$129.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.51
|
| Rate for Payer: PHP Commercial |
$121.85
|
| Rate for Payer: Priority Health SBD |
$90.31
|
| Rate for Payer: UMR Bronson Commercial |
$63.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.51
|
|
|
SOTALOL 80 MG TABLET
|
Facility
|
OP
|
$442.56
|
|
|
Service Code
|
NDC 00904714361
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.75 |
| Max. Negotiated Rate |
$398.30 |
| Rate for Payer: Aetna American Axle |
$287.66
|
| Rate for Payer: Aetna Commercial |
$376.18
|
| Rate for Payer: Aetna Medicare |
$221.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.66
|
| Rate for Payer: BCBS Complete |
$177.02
|
| Rate for Payer: Cash Price |
$354.05
|
| Rate for Payer: Cofinity Advantage |
$309.79
|
| Rate for Payer: Cofinity Commercial |
$380.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.05
|
| Rate for Payer: Healthscope Commercial |
$398.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$309.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$331.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$354.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$331.92
|
| Rate for Payer: PHP Commercial |
$376.18
|
| Rate for Payer: Priority Health SBD |
$278.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$287.66
|
| Rate for Payer: UHC Core |
$230.57
|
| Rate for Payer: UHC Exchange |
$173.93
|
| Rate for Payer: UMR Bronson Commercial |
$163.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$331.92
|
|
|
SOTALOL 80 MG TABLET
|
Facility
|
IP
|
$442.56
|
|
|
Service Code
|
NDC 00904714361
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.73 |
| Max. Negotiated Rate |
$398.30 |
| Rate for Payer: Aetna American Axle |
$287.66
|
| Rate for Payer: Aetna Commercial |
$376.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.66
|
| Rate for Payer: Cash Price |
$354.05
|
| Rate for Payer: Cofinity Advantage |
$309.79
|
| Rate for Payer: Cofinity Commercial |
$380.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.05
|
| Rate for Payer: Healthscope Commercial |
$398.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$309.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$331.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$331.92
|
| Rate for Payer: PHP Commercial |
$376.18
|
| Rate for Payer: Priority Health SBD |
$278.81
|
| Rate for Payer: UMR Bronson Commercial |
$194.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$331.92
|
|
|
SOTALOL 80 MG TABLET
|
Facility
|
IP
|
$444.00
|
|
|
Service Code
|
NDC 00245001201
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$195.36 |
| Max. Negotiated Rate |
$399.60 |
| Rate for Payer: Aetna American Axle |
$288.60
|
| Rate for Payer: Aetna Commercial |
$377.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.60
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cofinity Advantage |
$310.80
|
| Rate for Payer: Cofinity Commercial |
$381.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.20
|
| Rate for Payer: Healthscope Commercial |
$399.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$310.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$333.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$377.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$333.00
|
| Rate for Payer: PHP Commercial |
$377.40
|
| Rate for Payer: Priority Health SBD |
$279.72
|
| Rate for Payer: UMR Bronson Commercial |
$195.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$333.00
|
|
|
SOTALOL 80 MG TABLET
|
Facility
|
OP
|
$143.35
|
|
|
Service Code
|
NDC 60505008000
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.04 |
| Max. Negotiated Rate |
$129.01 |
| Rate for Payer: Aetna American Axle |
$93.18
|
| Rate for Payer: Aetna Commercial |
$121.85
|
| Rate for Payer: Aetna Medicare |
$71.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.18
|
| Rate for Payer: BCBS Complete |
$57.34
|
| Rate for Payer: Cash Price |
$114.68
|
| Rate for Payer: Cofinity Advantage |
$100.34
|
| Rate for Payer: Cofinity Commercial |
$123.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.68
|
| Rate for Payer: Healthscope Commercial |
$129.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$114.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.51
|
| Rate for Payer: PHP Commercial |
$121.85
|
| Rate for Payer: Priority Health SBD |
$90.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.18
|
| Rate for Payer: UHC Core |
$74.69
|
| Rate for Payer: UHC Exchange |
$56.34
|
| Rate for Payer: UMR Bronson Commercial |
$53.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.51
|
|
|
SPESOLIMAB-SBZO 60 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$72,548.53
|
|
|
Service Code
|
HCPCS J1747
|
| Hospital Charge Code |
201556
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.38 |
| Max. Negotiated Rate |
$65,293.68 |
| Rate for Payer: Aetna American Axle |
$47,156.54
|
| Rate for Payer: Aetna Commercial |
$61,666.25
|
| Rate for Payer: Aetna Medicare |
$68.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47,156.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$82.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$82.16
|
| Rate for Payer: BCBS Complete |
$36.10
|
| Rate for Payer: BCBS MAPPO |
$65.73
|
| Rate for Payer: BCBS Trust/PPO |
$213.11
|
| Rate for Payer: BCN Commercial |
$213.11
|
| Rate for Payer: BCN Medicare Advantage |
$65.73
|
| Rate for Payer: Cash Price |
$58,038.82
|
| Rate for Payer: Cash Price |
$58,038.82
|
| Rate for Payer: Cofinity Advantage |
$50,783.97
|
| Rate for Payer: Cofinity Commercial |
$62,391.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58,038.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.73
|
| Rate for Payer: Healthscope Commercial |
$65,293.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50,783.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54,411.40
|
| Rate for Payer: Mclaren Medicaid |
$65.73
|
| Rate for Payer: Mclaren Medicare |
$65.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.02
|
| Rate for Payer: Meridian Medicaid |
$69.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$72.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61,666.25
|
| Rate for Payer: Nomi Health Commercial |
$197.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54,411.40
|
| Rate for Payer: PACE Medicare |
$62.44
|
| Rate for Payer: PACE SWMI |
$65.73
|
| Rate for Payer: PHP Commercial |
$61,666.25
|
| Rate for Payer: PHP Medicare Advantage |
$65.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$207.30
|
| Rate for Payer: Priority Health Medicare |
$65.73
|
| Rate for Payer: Priority Health SBD |
$45,705.57
|
| Rate for Payer: Priority Health Tiered Network |
$165.84
|
| Rate for Payer: Railroad Medicare Medicare |
$65.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.45
|
| Rate for Payer: UHC Core |
$108.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$65.73
|
| Rate for Payer: UHC Exchange |
$108.45
|
| Rate for Payer: UHC Medicaid |
$34.38
|
| Rate for Payer: UHCCP Medicaid |
$34.38
|
| Rate for Payer: UMR Bronson Commercial |
$26,842.96
|
| Rate for Payer: VA VA |
$65.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54,411.40
|
|
|
SPHINCTEROPLASTY, ANAL, FOR INCONTINENCE OR PROLAPSE; ADULT
|
Facility
|
OP
|
$8,943.95
|
|
|
Service Code
|
CPT 46750
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,446.45 |
| Max. Negotiated Rate |
$8,943.95 |
| Rate for Payer: Aetna Medicare |
$2,876.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,457.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,457.10
|
| Rate for Payer: BCBS Complete |
$1,518.91
|
| Rate for Payer: BCBS MAPPO |
$2,765.68
|
| Rate for Payer: BCBS Trust/PPO |
$2,707.66
|
| Rate for Payer: BCN Commercial |
$2,707.66
|
| Rate for Payer: BCN Medicare Advantage |
$2,765.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,765.68
|
| Rate for Payer: Mclaren Medicaid |
$2,765.68
|
| Rate for Payer: Mclaren Medicare |
$2,765.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,903.96
|
| Rate for Payer: Meridian Medicaid |
$2,903.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,180.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,042.25
|
| Rate for Payer: Nomi Health Commercial |
$8,297.04
|
| Rate for Payer: PACE Medicare |
$2,627.40
|
| Rate for Payer: PACE SWMI |
$2,765.68
|
| Rate for Payer: PHP Medicare Advantage |
$2,765.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,446.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8,943.95
|
| Rate for Payer: Priority Health Medicare |
$2,765.68
|
| Rate for Payer: Priority Health Tiered Network |
$7,155.16
|
| Rate for Payer: Railroad Medicare Medicare |
$2,765.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,765.68
|
| Rate for Payer: UHC Medicaid |
$1,446.45
|
| Rate for Payer: UHCCP Medicaid |
$1,446.45
|
| Rate for Payer: VA VA |
$2,765.68
|
|
|
SPHINCTEROTOMY, ANAL, DIVISION OF SPHINCTER (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$8,943.95
|
|
|
Service Code
|
CPT 46080
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,446.45 |
| Max. Negotiated Rate |
$8,943.95 |
| Rate for Payer: Aetna Medicare |
$2,876.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,457.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,457.10
|
| Rate for Payer: BCBS Complete |
$1,518.91
|
| Rate for Payer: BCBS MAPPO |
$2,765.68
|
| Rate for Payer: BCBS Trust/PPO |
$2,704.12
|
| Rate for Payer: BCN Commercial |
$2,704.12
|
| Rate for Payer: BCN Medicare Advantage |
$2,765.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,765.68
|
| Rate for Payer: Mclaren Medicaid |
$2,765.68
|
| Rate for Payer: Mclaren Medicare |
$2,765.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,903.96
|
| Rate for Payer: Meridian Medicaid |
$2,903.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,180.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,042.25
|
| Rate for Payer: Nomi Health Commercial |
$8,297.04
|
| Rate for Payer: PACE Medicare |
$2,627.40
|
| Rate for Payer: PACE SWMI |
$2,765.68
|
| Rate for Payer: PHP Medicare Advantage |
$2,765.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,446.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8,943.95
|
| Rate for Payer: Priority Health Medicare |
$2,765.68
|
| Rate for Payer: Priority Health Tiered Network |
$7,155.16
|
| Rate for Payer: Railroad Medicare Medicare |
$2,765.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,765.68
|
| Rate for Payer: UHC Medicaid |
$1,446.45
|
| Rate for Payer: UHCCP Medicaid |
$1,446.45
|
| Rate for Payer: VA VA |
$2,765.68
|
|
|
SPINAL DISORDERS AND INJURIES
|
Facility
|
IP
|
$7,618.62
|
|
|
Service Code
|
APR-DRG 0401
|
| Min. Negotiated Rate |
$7,255.83 |
| Max. Negotiated Rate |
$7,618.62 |
| Rate for Payer: BCBS Complete |
$7,618.62
|
| Rate for Payer: Mclaren Medicaid |
$7,255.83
|
| Rate for Payer: Meridian Medicaid |
$7,618.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,255.83
|
| Rate for Payer: UHC Medicaid |
$7,255.83
|
| Rate for Payer: UHCCP Medicaid |
$7,255.83
|
|
|
SPINAL DISORDERS AND INJURIES
|
Facility
|
IP
|
$9,891.62
|
|
|
Service Code
|
APR-DRG 0402
|
| Min. Negotiated Rate |
$9,420.59 |
| Max. Negotiated Rate |
$9,891.62 |
| Rate for Payer: BCBS Complete |
$9,891.62
|
| Rate for Payer: Mclaren Medicaid |
$9,420.59
|
| Rate for Payer: Meridian Medicaid |
$9,891.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,420.59
|
| Rate for Payer: UHC Medicaid |
$9,420.59
|
| Rate for Payer: UHCCP Medicaid |
$9,420.59
|
|
