|
SYNCOPE AND COLLAPSE
|
Facility
|
IP
|
$10,717.28
|
|
|
Service Code
|
APR-DRG 2044
|
| Min. Negotiated Rate |
$10,206.93 |
| Max. Negotiated Rate |
$10,717.28 |
| Rate for Payer: BCBS Complete |
$10,717.28
|
| Rate for Payer: Mclaren Medicaid |
$10,206.93
|
| Rate for Payer: Meridian Medicaid |
$10,717.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,206.93
|
| Rate for Payer: UHC Medicaid |
$10,206.93
|
| Rate for Payer: UHCCP Medicaid |
$10,206.93
|
|
|
SYNCOPE AND COLLAPSE
|
Facility
|
IP
|
$19,147.07
|
|
|
Service Code
|
MSDRG 312
|
| Min. Negotiated Rate |
$7,487.80 |
| Max. Negotiated Rate |
$19,147.07 |
| Rate for Payer: Aetna Medicare |
$8,197.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,852.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,852.36
|
| Rate for Payer: BCBS MAPPO |
$7,881.89
|
| Rate for Payer: BCBS Trust/PPO |
$19,147.07
|
| Rate for Payer: BCN Commercial |
$19,147.07
|
| Rate for Payer: BCN Medicare Advantage |
$7,881.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,881.89
|
| Rate for Payer: Mclaren Medicare |
$7,881.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,275.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,064.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,670.08
|
| Rate for Payer: Nomi Health Commercial |
$11,243.64
|
| Rate for Payer: PACE Medicare |
$7,487.80
|
| Rate for Payer: PACE SWMI |
$7,881.89
|
| Rate for Payer: PHP Medicare Advantage |
$7,881.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14,052.06
|
| Rate for Payer: Priority Health Medicare |
$7,881.89
|
| Rate for Payer: Priority Health Tiered Network |
$11,241.64
|
| Rate for Payer: Railroad Medicare Medicare |
$7,881.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,207.08
|
| Rate for Payer: UHC Core |
$11,886.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,881.89
|
| Rate for Payer: UHC Exchange |
$9,707.01
|
| Rate for Payer: VA VA |
$7,881.89
|
|
|
SYNCOPE AND COLLAPSE
|
Facility
|
IP
|
$4,341.39
|
|
|
Service Code
|
APR-DRG 2041
|
| Min. Negotiated Rate |
$4,134.66 |
| Max. Negotiated Rate |
$4,341.39 |
| Rate for Payer: BCBS Complete |
$4,341.39
|
| Rate for Payer: Mclaren Medicaid |
$4,134.66
|
| Rate for Payer: Meridian Medicaid |
$4,341.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,134.66
|
| Rate for Payer: UHC Medicaid |
$4,134.66
|
| Rate for Payer: UHCCP Medicaid |
$4,134.66
|
|
|
SYNOVECTOMY, EXTENSOR TENDON SHEATH, WRIST, SINGLE COMPARTMENT;
|
Facility
|
OP
|
$5,181.40
|
|
|
Service Code
|
CPT 25118
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$837.96 |
| Max. Negotiated Rate |
$5,181.40 |
| Rate for Payer: Aetna Medicare |
$1,666.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,002.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,002.76
|
| Rate for Payer: BCBS Complete |
$879.93
|
| Rate for Payer: BCBS MAPPO |
$1,602.21
|
| Rate for Payer: BCBS Trust/PPO |
$2,675.66
|
| Rate for Payer: BCN Commercial |
$2,675.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,602.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,602.21
|
| Rate for Payer: Mclaren Medicaid |
$1,602.21
|
| Rate for Payer: Mclaren Medicare |
$1,602.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,682.32
|
| Rate for Payer: Meridian Medicaid |
$1,682.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,842.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,762.43
|
| Rate for Payer: Nomi Health Commercial |
$4,806.63
|
| Rate for Payer: PACE Medicare |
$1,522.10
|
| Rate for Payer: PACE SWMI |
$1,602.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,602.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$837.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,181.40
|
| Rate for Payer: Priority Health Medicare |
$1,602.21
|
| Rate for Payer: Priority Health Tiered Network |
$4,145.12
|
| Rate for Payer: Railroad Medicare Medicare |
$1,602.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,602.21
|
| Rate for Payer: UHC Medicaid |
$837.96
|
| Rate for Payer: UHCCP Medicaid |
$837.96
|
| Rate for Payer: VA VA |
$1,602.21
|
|
|
SYNOVECTOMY, PROXIMAL INTERPHALANGEAL JOINT, INCLUDING EXTENSOR RECONSTRUCTION, EACH INTERPHALANGEAL JOINT
|
Facility
|
OP
|
$5,181.40
|
|
|
Service Code
|
CPT 26140
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$837.96 |
| Max. Negotiated Rate |
$5,181.40 |
| Rate for Payer: Aetna Medicare |
$1,666.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,002.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,002.76
|
| Rate for Payer: BCBS Complete |
$879.93
|
| Rate for Payer: BCBS MAPPO |
$1,602.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,744.87
|
| Rate for Payer: BCN Commercial |
$1,744.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,602.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,602.21
|
| Rate for Payer: Mclaren Medicaid |
$1,602.21
|
| Rate for Payer: Mclaren Medicare |
$1,602.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,682.32
|
| Rate for Payer: Meridian Medicaid |
$1,682.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,842.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,762.43
|
| Rate for Payer: Nomi Health Commercial |
$4,806.63
|
| Rate for Payer: PACE Medicare |
$1,522.10
|
| Rate for Payer: PACE SWMI |
$1,602.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,602.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$837.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,181.40
|
| Rate for Payer: Priority Health Medicare |
$1,602.21
|
| Rate for Payer: Priority Health Tiered Network |
$4,145.12
|
| Rate for Payer: Railroad Medicare Medicare |
$1,602.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,602.21
|
| Rate for Payer: UHC Medicaid |
$837.96
|
| Rate for Payer: UHCCP Medicaid |
$837.96
|
| Rate for Payer: VA VA |
$1,602.21
|
|
|
TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE
|
Facility
|
OP
|
$406.56
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
24914
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$365.90 |
| Rate for Payer: Aetna American Axle |
$264.26
|
| Rate for Payer: Aetna American Axle |
$827.56
|
| Rate for Payer: Aetna American Axle |
$290.78
|
| Rate for Payer: Aetna Commercial |
$345.58
|
| Rate for Payer: Aetna Commercial |
$380.26
|
| Rate for Payer: Aetna Commercial |
$1,082.19
|
| Rate for Payer: Aetna Medicare |
$203.28
|
| Rate for Payer: Aetna Medicare |
$636.59
|
| Rate for Payer: Aetna Medicare |
$223.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$827.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$264.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.78
|
| Rate for Payer: BCBS Complete |
$509.27
|
| Rate for Payer: BCBS Complete |
$162.62
|
| Rate for Payer: BCBS Complete |
$178.94
|
| Rate for Payer: BCBS Trust/PPO |
$0.64
|
| Rate for Payer: BCBS Trust/PPO |
$0.64
|
| Rate for Payer: BCBS Trust/PPO |
$0.64
|
| Rate for Payer: BCN Commercial |
$0.64
|
| Rate for Payer: BCN Commercial |
$0.64
|
| Rate for Payer: BCN Commercial |
$0.64
|
| Rate for Payer: Cash Price |
$1,018.54
|
| Rate for Payer: Cash Price |
$1,018.54
|
| Rate for Payer: Cash Price |
$357.89
|
| Rate for Payer: Cash Price |
$357.89
|
| Rate for Payer: Cash Price |
$325.25
|
| Rate for Payer: Cash Price |
$325.25
|
| Rate for Payer: Cofinity Advantage |
$313.15
|
| Rate for Payer: Cofinity Advantage |
$284.59
|
| Rate for Payer: Cofinity Advantage |
$891.22
|
| Rate for Payer: Cofinity Commercial |
$1,094.93
|
| Rate for Payer: Cofinity Commercial |
$349.64
|
| Rate for Payer: Cofinity Commercial |
$384.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,018.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.25
|
| Rate for Payer: Healthscope Commercial |
$1,145.85
|
| Rate for Payer: Healthscope Commercial |
$365.90
|
| Rate for Payer: Healthscope Commercial |
$402.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$891.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$313.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$284.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$954.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$335.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$304.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$325.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,018.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$357.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,082.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$954.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.52
|
| Rate for Payer: PHP Commercial |
$345.58
|
| Rate for Payer: PHP Commercial |
$1,082.19
|
| Rate for Payer: PHP Commercial |
$380.26
|
| Rate for Payer: Priority Health SBD |
$802.10
|
| Rate for Payer: Priority Health SBD |
$281.84
|
| Rate for Payer: Priority Health SBD |
$256.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.33
|
| Rate for Payer: UHC Core |
$0.33
|
| Rate for Payer: UHC Core |
$0.33
|
| Rate for Payer: UHC Core |
$0.33
|
| Rate for Payer: UHC Exchange |
$0.33
|
| Rate for Payer: UHC Exchange |
$0.33
|
| Rate for Payer: UHC Exchange |
$0.33
|
| Rate for Payer: UMR Bronson Commercial |
$165.52
|
| Rate for Payer: UMR Bronson Commercial |
$471.07
|
| Rate for Payer: UMR Bronson Commercial |
$150.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$304.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$954.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$335.52
|
|
|
TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE
|
Facility
|
IP
|
$1,273.17
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
24914
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$560.19 |
| Max. Negotiated Rate |
$1,145.85 |
| Rate for Payer: Aetna American Axle |
$827.56
|
| Rate for Payer: Aetna American Axle |
$290.78
|
| Rate for Payer: Aetna American Axle |
$264.26
|
| Rate for Payer: Aetna Commercial |
$345.58
|
| Rate for Payer: Aetna Commercial |
$1,082.19
|
| Rate for Payer: Aetna Commercial |
$380.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$827.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$264.26
|
| Rate for Payer: Cash Price |
$325.25
|
| Rate for Payer: Cash Price |
$1,018.54
|
| Rate for Payer: Cash Price |
$357.89
|
| Rate for Payer: Cofinity Advantage |
$313.15
|
| Rate for Payer: Cofinity Advantage |
$891.22
|
| Rate for Payer: Cofinity Advantage |
$284.59
|
| Rate for Payer: Cofinity Commercial |
$384.73
|
| Rate for Payer: Cofinity Commercial |
$1,094.93
|
| Rate for Payer: Cofinity Commercial |
$349.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,018.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.89
|
| Rate for Payer: Healthscope Commercial |
$365.90
|
| Rate for Payer: Healthscope Commercial |
$402.62
|
| Rate for Payer: Healthscope Commercial |
$1,145.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$284.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$891.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$313.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$335.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$954.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$304.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,082.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$954.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.52
|
| Rate for Payer: PHP Commercial |
$345.58
|
| Rate for Payer: PHP Commercial |
$1,082.19
|
| Rate for Payer: PHP Commercial |
$380.26
|
| Rate for Payer: Priority Health SBD |
$802.10
|
| Rate for Payer: Priority Health SBD |
$256.13
|
| Rate for Payer: Priority Health SBD |
$281.84
|
| Rate for Payer: UMR Bronson Commercial |
$560.19
|
| Rate for Payer: UMR Bronson Commercial |
$196.84
|
| Rate for Payer: UMR Bronson Commercial |
$178.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$304.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$954.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$335.52
|
|
|
TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE
|
Facility
|
IP
|
$519.36
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
12933
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$228.52 |
| Max. Negotiated Rate |
$467.42 |
| Rate for Payer: Aetna American Axle |
$337.58
|
| Rate for Payer: Aetna American Axle |
$169.42
|
| Rate for Payer: Aetna American Axle |
$372.22
|
| Rate for Payer: Aetna American Axle |
$1,655.12
|
| Rate for Payer: Aetna American Axle |
$135.23
|
| Rate for Payer: Aetna Commercial |
$176.84
|
| Rate for Payer: Aetna Commercial |
$221.54
|
| Rate for Payer: Aetna Commercial |
$441.46
|
| Rate for Payer: Aetna Commercial |
$486.74
|
| Rate for Payer: Aetna Commercial |
$2,164.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$337.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,655.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.22
|
| Rate for Payer: Cash Price |
$208.51
|
| Rate for Payer: Cash Price |
$2,037.07
|
| Rate for Payer: Cash Price |
$458.11
|
| Rate for Payer: Cash Price |
$415.49
|
| Rate for Payer: Cash Price |
$166.44
|
| Rate for Payer: Cofinity Advantage |
$145.63
|
| Rate for Payer: Cofinity Advantage |
$400.85
|
| Rate for Payer: Cofinity Advantage |
$1,782.44
|
| Rate for Payer: Cofinity Advantage |
$363.55
|
| Rate for Payer: Cofinity Advantage |
$182.45
|
| Rate for Payer: Cofinity Commercial |
$492.47
|
| Rate for Payer: Cofinity Commercial |
$178.92
|
| Rate for Payer: Cofinity Commercial |
$2,189.85
|
| Rate for Payer: Cofinity Commercial |
$224.15
|
| Rate for Payer: Cofinity Commercial |
$446.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$415.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,037.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.11
|
| Rate for Payer: Healthscope Commercial |
$187.25
|
| Rate for Payer: Healthscope Commercial |
$2,291.71
|
| Rate for Payer: Healthscope Commercial |
$234.58
|
| Rate for Payer: Healthscope Commercial |
$467.42
|
| Rate for Payer: Healthscope Commercial |
$515.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,782.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$400.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$145.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$363.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,909.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$389.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$429.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$441.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,164.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$486.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,909.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$429.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$389.52
|
| Rate for Payer: PHP Commercial |
$221.54
|
| Rate for Payer: PHP Commercial |
$176.84
|
| Rate for Payer: PHP Commercial |
$441.46
|
| Rate for Payer: PHP Commercial |
$486.74
|
| Rate for Payer: PHP Commercial |
$2,164.39
|
| Rate for Payer: Priority Health SBD |
$327.20
|
| Rate for Payer: Priority Health SBD |
$360.76
|
| Rate for Payer: Priority Health SBD |
$1,604.19
|
| Rate for Payer: Priority Health SBD |
$131.07
|
| Rate for Payer: Priority Health SBD |
$164.20
|
| Rate for Payer: UMR Bronson Commercial |
$1,120.39
|
| Rate for Payer: UMR Bronson Commercial |
$251.96
|
| Rate for Payer: UMR Bronson Commercial |
$114.68
|
| Rate for Payer: UMR Bronson Commercial |
$91.54
|
| Rate for Payer: UMR Bronson Commercial |
$228.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$389.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$429.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,909.76
|
|
|
TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE
|
Facility
|
OP
|
$208.05
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
12933
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$187.25 |
| Rate for Payer: Aetna American Axle |
$135.23
|
| Rate for Payer: Aetna American Axle |
$337.58
|
| Rate for Payer: Aetna American Axle |
$169.42
|
| Rate for Payer: Aetna American Axle |
$1,655.12
|
| Rate for Payer: Aetna American Axle |
$372.22
|
| Rate for Payer: Aetna Commercial |
$176.84
|
| Rate for Payer: Aetna Commercial |
$2,164.39
|
| Rate for Payer: Aetna Commercial |
$486.74
|
| Rate for Payer: Aetna Commercial |
$441.46
|
| Rate for Payer: Aetna Commercial |
$221.54
|
| Rate for Payer: Aetna Medicare |
$286.32
|
| Rate for Payer: Aetna Medicare |
$1,273.17
|
| Rate for Payer: Aetna Medicare |
$104.03
|
| Rate for Payer: Aetna Medicare |
$130.32
|
| Rate for Payer: Aetna Medicare |
$259.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$337.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,655.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.22
|
| Rate for Payer: BCBS Complete |
$207.74
|
| Rate for Payer: BCBS Complete |
$83.22
|
| Rate for Payer: BCBS Complete |
$1,018.54
|
| Rate for Payer: BCBS Complete |
$104.26
|
| Rate for Payer: BCBS Complete |
$229.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.64
|
| Rate for Payer: BCBS Trust/PPO |
$0.64
|
| Rate for Payer: BCBS Trust/PPO |
$0.64
|
| Rate for Payer: BCBS Trust/PPO |
$0.64
|
| Rate for Payer: BCBS Trust/PPO |
$0.64
|
| Rate for Payer: BCN Commercial |
$0.64
|
| Rate for Payer: BCN Commercial |
$0.64
|
| Rate for Payer: BCN Commercial |
$0.64
|
| Rate for Payer: BCN Commercial |
$0.64
|
| Rate for Payer: BCN Commercial |
$0.64
|
| Rate for Payer: Cash Price |
$415.49
|
| Rate for Payer: Cash Price |
$458.11
|
| Rate for Payer: Cash Price |
$2,037.07
|
| Rate for Payer: Cash Price |
$166.44
|
| Rate for Payer: Cash Price |
$208.51
|
| Rate for Payer: Cash Price |
$166.44
|
| Rate for Payer: Cash Price |
$208.51
|
| Rate for Payer: Cash Price |
$415.49
|
| Rate for Payer: Cash Price |
$2,037.07
|
| Rate for Payer: Cash Price |
$458.11
|
| Rate for Payer: Cofinity Advantage |
$363.55
|
| Rate for Payer: Cofinity Advantage |
$1,782.44
|
| Rate for Payer: Cofinity Advantage |
$182.45
|
| Rate for Payer: Cofinity Advantage |
$400.85
|
| Rate for Payer: Cofinity Advantage |
$145.63
|
| Rate for Payer: Cofinity Commercial |
$446.65
|
| Rate for Payer: Cofinity Commercial |
$178.92
|
| Rate for Payer: Cofinity Commercial |
$2,189.85
|
| Rate for Payer: Cofinity Commercial |
$224.15
|
| Rate for Payer: Cofinity Commercial |
$492.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$415.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,037.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.51
|
| Rate for Payer: Healthscope Commercial |
$234.58
|
| Rate for Payer: Healthscope Commercial |
$515.38
|
| Rate for Payer: Healthscope Commercial |
$467.42
|
| Rate for Payer: Healthscope Commercial |
$187.25
|
| Rate for Payer: Healthscope Commercial |
$2,291.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,782.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$400.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$363.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$145.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$429.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$389.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,909.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,037.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$415.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$208.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$166.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$441.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,164.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$486.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$389.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,909.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$429.48
|
| Rate for Payer: PHP Commercial |
$2,164.39
|
| Rate for Payer: PHP Commercial |
$221.54
|
| Rate for Payer: PHP Commercial |
$486.74
|
| Rate for Payer: PHP Commercial |
$441.46
|
| Rate for Payer: PHP Commercial |
$176.84
|
| Rate for Payer: Priority Health SBD |
$164.20
|
| Rate for Payer: Priority Health SBD |
$131.07
|
| Rate for Payer: Priority Health SBD |
$327.20
|
| Rate for Payer: Priority Health SBD |
$360.76
|
| Rate for Payer: Priority Health SBD |
$1,604.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.33
|
| Rate for Payer: UHC Core |
$0.33
|
| Rate for Payer: UHC Core |
$0.33
|
| Rate for Payer: UHC Core |
$0.33
|
| Rate for Payer: UHC Core |
$0.33
|
| Rate for Payer: UHC Core |
$0.33
|
| Rate for Payer: UHC Exchange |
$0.33
|
| Rate for Payer: UHC Exchange |
$0.33
|
| Rate for Payer: UHC Exchange |
$0.33
|
| Rate for Payer: UHC Exchange |
$0.33
|
| Rate for Payer: UHC Exchange |
$0.33
|
| Rate for Payer: UMR Bronson Commercial |
$76.98
|
| Rate for Payer: UMR Bronson Commercial |
$192.16
|
| Rate for Payer: UMR Bronson Commercial |
$96.44
|
| Rate for Payer: UMR Bronson Commercial |
$211.88
|
| Rate for Payer: UMR Bronson Commercial |
$942.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$389.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$429.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,909.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.04
|
|
|
TACROLIMUS 5 MG CAPSULE, IMMEDIATE-RELEASE
|
Facility
|
OP
|
$2,485.29
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
12934
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$2,236.76 |
| Rate for Payer: Aetna American Axle |
$1,615.44
|
| Rate for Payer: Aetna American Axle |
$17.34
|
| Rate for Payer: Aetna American Axle |
$1,777.05
|
| Rate for Payer: Aetna American Axle |
$652.24
|
| Rate for Payer: Aetna American Axle |
$290.16
|
| Rate for Payer: Aetna American Axle |
$1,733.28
|
| Rate for Payer: Aetna Commercial |
$379.44
|
| Rate for Payer: Aetna Commercial |
$2,323.84
|
| Rate for Payer: Aetna Commercial |
$2,266.60
|
| Rate for Payer: Aetna Commercial |
$852.92
|
| Rate for Payer: Aetna Commercial |
$22.67
|
| Rate for Payer: Aetna Commercial |
$2,112.50
|
| Rate for Payer: Aetna Medicare |
$501.72
|
| Rate for Payer: Aetna Medicare |
$1,242.64
|
| Rate for Payer: Aetna Medicare |
$1,333.30
|
| Rate for Payer: Aetna Medicare |
$223.20
|
| Rate for Payer: Aetna Medicare |
$1,366.96
|
| Rate for Payer: Aetna Medicare |
$13.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,777.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$652.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,615.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,733.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.34
|
| Rate for Payer: BCBS Complete |
$1,066.64
|
| Rate for Payer: BCBS Complete |
$994.12
|
| Rate for Payer: BCBS Complete |
$401.38
|
| Rate for Payer: BCBS Complete |
$10.67
|
| Rate for Payer: BCBS Complete |
$1,093.57
|
| Rate for Payer: BCBS Complete |
$178.56
|
| Rate for Payer: BCBS Trust/PPO |
$0.64
|
| Rate for Payer: BCBS Trust/PPO |
$0.64
|
| Rate for Payer: BCBS Trust/PPO |
$0.64
|
| Rate for Payer: BCBS Trust/PPO |
$0.64
|
| Rate for Payer: BCBS Trust/PPO |
$0.64
|
| Rate for Payer: BCBS Trust/PPO |
$0.64
|
| Rate for Payer: BCN Commercial |
$0.64
|
| Rate for Payer: BCN Commercial |
$0.64
|
| Rate for Payer: BCN Commercial |
$0.64
|
| Rate for Payer: BCN Commercial |
$0.64
|
| Rate for Payer: BCN Commercial |
$0.64
|
| Rate for Payer: BCN Commercial |
$0.64
|
| Rate for Payer: Cash Price |
$357.12
|
| Rate for Payer: Cash Price |
$802.75
|
| Rate for Payer: Cash Price |
$802.75
|
| Rate for Payer: Cash Price |
$2,133.27
|
| Rate for Payer: Cash Price |
$2,133.27
|
| Rate for Payer: Cash Price |
$1,988.23
|
| Rate for Payer: Cash Price |
$1,988.23
|
| Rate for Payer: Cash Price |
$357.12
|
| Rate for Payer: Cash Price |
$2,187.14
|
| Rate for Payer: Cash Price |
$21.34
|
| Rate for Payer: Cash Price |
$2,187.14
|
| Rate for Payer: Cash Price |
$21.34
|
| Rate for Payer: Cofinity Advantage |
$18.67
|
| Rate for Payer: Cofinity Advantage |
$1,866.61
|
| Rate for Payer: Cofinity Advantage |
$312.48
|
| Rate for Payer: Cofinity Advantage |
$702.41
|
| Rate for Payer: Cofinity Advantage |
$1,739.70
|
| Rate for Payer: Cofinity Advantage |
$1,913.75
|
| Rate for Payer: Cofinity Commercial |
$2,351.18
|
| Rate for Payer: Cofinity Commercial |
$862.96
|
| Rate for Payer: Cofinity Commercial |
$2,137.35
|
| Rate for Payer: Cofinity Commercial |
$2,293.27
|
| Rate for Payer: Cofinity Commercial |
$22.94
|
| Rate for Payer: Cofinity Commercial |
$383.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,988.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$802.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,133.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,187.14
|
| Rate for Payer: Healthscope Commercial |
$903.10
|
| Rate for Payer: Healthscope Commercial |
$2,460.54
|
| Rate for Payer: Healthscope Commercial |
$2,399.93
|
| Rate for Payer: Healthscope Commercial |
$24.00
|
| Rate for Payer: Healthscope Commercial |
$401.76
|
| Rate for Payer: Healthscope Commercial |
$2,236.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,739.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$702.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,913.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,866.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$312.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$334.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,999.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$752.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,863.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,050.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,133.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,988.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,187.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$802.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$357.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$852.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,323.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,266.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,112.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,863.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$752.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,050.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,999.94
|
| Rate for Payer: PHP Commercial |
$2,112.50
|
| Rate for Payer: PHP Commercial |
$2,266.60
|
| Rate for Payer: PHP Commercial |
$22.67
|
| Rate for Payer: PHP Commercial |
$852.92
|
| Rate for Payer: PHP Commercial |
$2,323.84
|
| Rate for Payer: PHP Commercial |
$379.44
|
| Rate for Payer: Priority Health SBD |
$16.80
|
| Rate for Payer: Priority Health SBD |
$632.17
|
| Rate for Payer: Priority Health SBD |
$1,565.73
|
| Rate for Payer: Priority Health SBD |
$281.23
|
| Rate for Payer: Priority Health SBD |
$1,679.95
|
| Rate for Payer: Priority Health SBD |
$1,722.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.33
|
| Rate for Payer: UHC Core |
$0.33
|
| Rate for Payer: UHC Core |
$0.33
|
| Rate for Payer: UHC Core |
$0.33
|
| Rate for Payer: UHC Core |
$0.33
|
| Rate for Payer: UHC Core |
$0.33
|
| Rate for Payer: UHC Core |
$0.33
|
| Rate for Payer: UHC Exchange |
$0.33
|
| Rate for Payer: UHC Exchange |
$0.33
|
| Rate for Payer: UHC Exchange |
$0.33
|
| Rate for Payer: UHC Exchange |
$0.33
|
| Rate for Payer: UHC Exchange |
$0.33
|
| Rate for Payer: UHC Exchange |
$0.33
|
| Rate for Payer: UMR Bronson Commercial |
$9.87
|
| Rate for Payer: UMR Bronson Commercial |
$1,011.55
|
| Rate for Payer: UMR Bronson Commercial |
$919.56
|
| Rate for Payer: UMR Bronson Commercial |
$371.27
|
| Rate for Payer: UMR Bronson Commercial |
$165.17
|
| Rate for Payer: UMR Bronson Commercial |
$986.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,999.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,050.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$752.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,863.97
|
|
|
TACROLIMUS 5 MG CAPSULE, IMMEDIATE-RELEASE
|
Facility
|
IP
|
$446.40
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
12934
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$196.42 |
| Max. Negotiated Rate |
$401.76 |
| Rate for Payer: Aetna American Axle |
$290.16
|
| Rate for Payer: Aetna American Axle |
$1,777.05
|
| Rate for Payer: Aetna American Axle |
$17.34
|
| Rate for Payer: Aetna American Axle |
$652.24
|
| Rate for Payer: Aetna American Axle |
$1,733.28
|
| Rate for Payer: Aetna American Axle |
$1,615.44
|
| Rate for Payer: Aetna Commercial |
$379.44
|
| Rate for Payer: Aetna Commercial |
$2,266.60
|
| Rate for Payer: Aetna Commercial |
$22.67
|
| Rate for Payer: Aetna Commercial |
$2,112.50
|
| Rate for Payer: Aetna Commercial |
$2,323.84
|
| Rate for Payer: Aetna Commercial |
$852.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,733.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,777.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,615.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$652.24
|
| Rate for Payer: Cash Price |
$357.12
|
| Rate for Payer: Cash Price |
$2,187.14
|
| Rate for Payer: Cash Price |
$21.34
|
| Rate for Payer: Cash Price |
$802.75
|
| Rate for Payer: Cash Price |
$2,133.27
|
| Rate for Payer: Cash Price |
$1,988.23
|
| Rate for Payer: Cofinity Advantage |
$18.67
|
| Rate for Payer: Cofinity Advantage |
$1,739.70
|
| Rate for Payer: Cofinity Advantage |
$702.41
|
| Rate for Payer: Cofinity Advantage |
$1,913.75
|
| Rate for Payer: Cofinity Advantage |
$1,866.61
|
| Rate for Payer: Cofinity Advantage |
$312.48
|
| Rate for Payer: Cofinity Commercial |
$2,137.35
|
| Rate for Payer: Cofinity Commercial |
$22.94
|
| Rate for Payer: Cofinity Commercial |
$2,351.18
|
| Rate for Payer: Cofinity Commercial |
$862.96
|
| Rate for Payer: Cofinity Commercial |
$2,293.27
|
| Rate for Payer: Cofinity Commercial |
$383.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,187.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,133.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$802.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,988.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.12
|
| Rate for Payer: Healthscope Commercial |
$2,460.54
|
| Rate for Payer: Healthscope Commercial |
$903.10
|
| Rate for Payer: Healthscope Commercial |
$24.00
|
| Rate for Payer: Healthscope Commercial |
$2,236.76
|
| Rate for Payer: Healthscope Commercial |
$2,399.93
|
| Rate for Payer: Healthscope Commercial |
$401.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,739.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,913.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$312.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$702.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,866.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$334.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,863.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,999.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,050.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$752.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,266.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,112.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$852.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,323.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$752.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,863.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,050.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,999.94
|
| Rate for Payer: PHP Commercial |
$2,266.60
|
| Rate for Payer: PHP Commercial |
$379.44
|
| Rate for Payer: PHP Commercial |
$2,323.84
|
| Rate for Payer: PHP Commercial |
$22.67
|
| Rate for Payer: PHP Commercial |
$852.92
|
| Rate for Payer: PHP Commercial |
$2,112.50
|
| Rate for Payer: Priority Health SBD |
$1,722.38
|
| Rate for Payer: Priority Health SBD |
$1,565.73
|
| Rate for Payer: Priority Health SBD |
$632.17
|
| Rate for Payer: Priority Health SBD |
$1,679.95
|
| Rate for Payer: Priority Health SBD |
$16.80
|
| Rate for Payer: Priority Health SBD |
$281.23
|
| Rate for Payer: UMR Bronson Commercial |
$1,202.93
|
| Rate for Payer: UMR Bronson Commercial |
$1,173.30
|
| Rate for Payer: UMR Bronson Commercial |
$11.73
|
| Rate for Payer: UMR Bronson Commercial |
$1,093.53
|
| Rate for Payer: UMR Bronson Commercial |
$196.42
|
| Rate for Payer: UMR Bronson Commercial |
$441.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,863.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,050.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$752.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,999.94
|
|
|
TACROLIMUS 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$841.98
|
|
|
Service Code
|
HCPCS J7525
|
| Hospital Charge Code |
12935
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$135.96 |
| Max. Negotiated Rate |
$851.03 |
| Rate for Payer: Aetna American Axle |
$547.29
|
| Rate for Payer: Aetna Commercial |
$715.68
|
| Rate for Payer: Aetna Medicare |
$270.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$547.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$324.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$324.95
|
| Rate for Payer: BCBS Complete |
$142.77
|
| Rate for Payer: BCBS MAPPO |
$259.96
|
| Rate for Payer: BCBS Trust/PPO |
$851.03
|
| Rate for Payer: BCN Commercial |
$851.03
|
| Rate for Payer: BCN Medicare Advantage |
$259.96
|
| Rate for Payer: Cash Price |
$673.58
|
| Rate for Payer: Cash Price |
$673.58
|
| Rate for Payer: Cofinity Advantage |
$589.39
|
| Rate for Payer: Cofinity Commercial |
$724.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$673.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$259.96
|
| Rate for Payer: Healthscope Commercial |
$757.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$589.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$631.49
|
| Rate for Payer: Mclaren Medicaid |
$259.96
|
| Rate for Payer: Mclaren Medicare |
$259.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$272.96
|
| Rate for Payer: Meridian Medicaid |
$272.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$298.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$285.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$715.68
|
| Rate for Payer: Nomi Health Commercial |
$779.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$631.49
|
| Rate for Payer: PACE Medicare |
$246.96
|
| Rate for Payer: PACE SWMI |
$259.96
|
| Rate for Payer: PHP Commercial |
$715.68
|
| Rate for Payer: PHP Medicare Advantage |
$259.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$135.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$829.96
|
| Rate for Payer: Priority Health Medicare |
$259.96
|
| Rate for Payer: Priority Health SBD |
$530.45
|
| Rate for Payer: Priority Health Tiered Network |
$663.97
|
| Rate for Payer: Railroad Medicare Medicare |
$259.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$547.29
|
| Rate for Payer: UHC Core |
$438.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$259.96
|
| Rate for Payer: UHC Exchange |
$330.90
|
| Rate for Payer: UHC Medicaid |
$135.96
|
| Rate for Payer: UHCCP Medicaid |
$135.96
|
| Rate for Payer: UMR Bronson Commercial |
$311.53
|
| Rate for Payer: VA VA |
$259.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$631.49
|
|
|
TACROLIMUS 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$841.98
|
|
|
Service Code
|
HCPCS J7525
|
| Hospital Charge Code |
12935
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$370.47 |
| Max. Negotiated Rate |
$757.78 |
| Rate for Payer: Aetna American Axle |
$547.29
|
| Rate for Payer: Aetna Commercial |
$715.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$547.29
|
| Rate for Payer: Cash Price |
$673.58
|
| Rate for Payer: Cofinity Advantage |
$589.39
|
| Rate for Payer: Cofinity Commercial |
$724.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$673.58
|
| Rate for Payer: Healthscope Commercial |
$757.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$589.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$631.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$715.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$631.49
|
| Rate for Payer: PHP Commercial |
$715.68
|
| Rate for Payer: Priority Health SBD |
$530.45
|
| Rate for Payer: UMR Bronson Commercial |
$370.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$631.49
|
|
|
TACROLIMUS XR 0.75 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$77.19
|
|
|
Service Code
|
HCPCS J7503
|
| Hospital Charge Code |
175521
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$69.47 |
| Rate for Payer: Aetna American Axle |
$50.17
|
| Rate for Payer: Aetna Commercial |
$65.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.17
|
| Rate for Payer: Cash Price |
$61.75
|
| Rate for Payer: Cofinity Advantage |
$54.03
|
| Rate for Payer: Cofinity Commercial |
$66.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.75
|
| Rate for Payer: Healthscope Commercial |
$69.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.89
|
| Rate for Payer: PHP Commercial |
$65.61
|
| Rate for Payer: Priority Health SBD |
$48.63
|
| Rate for Payer: UMR Bronson Commercial |
$33.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.89
|
|
|
TACROLIMUS XR 0.75 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$77.19
|
|
|
Service Code
|
HCPCS J7503
|
| Hospital Charge Code |
175521
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$69.47 |
| Rate for Payer: Aetna American Axle |
$50.17
|
| Rate for Payer: Aetna Commercial |
$65.61
|
| Rate for Payer: Aetna Medicare |
$38.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.17
|
| Rate for Payer: BCBS Complete |
$30.88
|
| Rate for Payer: BCBS Trust/PPO |
$6.05
|
| Rate for Payer: BCN Commercial |
$6.05
|
| Rate for Payer: Cash Price |
$61.75
|
| Rate for Payer: Cash Price |
$61.75
|
| Rate for Payer: Cofinity Advantage |
$54.03
|
| Rate for Payer: Cofinity Commercial |
$66.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.75
|
| Rate for Payer: Healthscope Commercial |
$69.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.89
|
| Rate for Payer: PHP Commercial |
$65.61
|
| Rate for Payer: Priority Health SBD |
$48.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.09
|
| Rate for Payer: UHC Core |
$3.09
|
| Rate for Payer: UHC Exchange |
$3.09
|
| Rate for Payer: UMR Bronson Commercial |
$28.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.89
|
|
|
TACROLIMUS XR 1 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$102.82
|
|
|
Service Code
|
HCPCS J7503
|
| Hospital Charge Code |
175522
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.24 |
| Max. Negotiated Rate |
$92.54 |
| Rate for Payer: Aetna American Axle |
$66.83
|
| Rate for Payer: Aetna American Axle |
$223.08
|
| Rate for Payer: Aetna Commercial |
$87.40
|
| Rate for Payer: Aetna Commercial |
$291.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.08
|
| Rate for Payer: Cash Price |
$82.26
|
| Rate for Payer: Cash Price |
$274.56
|
| Rate for Payer: Cofinity Advantage |
$240.24
|
| Rate for Payer: Cofinity Advantage |
$71.97
|
| Rate for Payer: Cofinity Commercial |
$295.15
|
| Rate for Payer: Cofinity Commercial |
$88.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.56
|
| Rate for Payer: Healthscope Commercial |
$92.54
|
| Rate for Payer: Healthscope Commercial |
$308.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$240.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$257.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$257.40
|
| Rate for Payer: PHP Commercial |
$87.40
|
| Rate for Payer: PHP Commercial |
$291.72
|
| Rate for Payer: Priority Health SBD |
$216.22
|
| Rate for Payer: Priority Health SBD |
$64.78
|
| Rate for Payer: UMR Bronson Commercial |
$45.24
|
| Rate for Payer: UMR Bronson Commercial |
$151.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$257.40
|
|
|
TACROLIMUS XR 1 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$102.82
|
|
|
Service Code
|
HCPCS J7503
|
| Hospital Charge Code |
175522
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$92.54 |
| Rate for Payer: Aetna American Axle |
$66.83
|
| Rate for Payer: Aetna American Axle |
$223.08
|
| Rate for Payer: Aetna Commercial |
$291.72
|
| Rate for Payer: Aetna Commercial |
$87.40
|
| Rate for Payer: Aetna Medicare |
$51.41
|
| Rate for Payer: Aetna Medicare |
$171.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.08
|
| Rate for Payer: BCBS Complete |
$137.28
|
| Rate for Payer: BCBS Complete |
$41.13
|
| Rate for Payer: BCBS Trust/PPO |
$6.05
|
| Rate for Payer: BCBS Trust/PPO |
$6.05
|
| Rate for Payer: BCN Commercial |
$6.05
|
| Rate for Payer: BCN Commercial |
$6.05
|
| Rate for Payer: Cash Price |
$274.56
|
| Rate for Payer: Cash Price |
$274.56
|
| Rate for Payer: Cash Price |
$82.26
|
| Rate for Payer: Cash Price |
$82.26
|
| Rate for Payer: Cofinity Advantage |
$71.97
|
| Rate for Payer: Cofinity Advantage |
$240.24
|
| Rate for Payer: Cofinity Commercial |
$295.15
|
| Rate for Payer: Cofinity Commercial |
$88.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.56
|
| Rate for Payer: Healthscope Commercial |
$308.88
|
| Rate for Payer: Healthscope Commercial |
$92.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$240.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$257.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$257.40
|
| Rate for Payer: PHP Commercial |
$87.40
|
| Rate for Payer: PHP Commercial |
$291.72
|
| Rate for Payer: Priority Health SBD |
$216.22
|
| Rate for Payer: Priority Health SBD |
$64.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.83
|
| Rate for Payer: UHC Core |
$53.57
|
| Rate for Payer: UHC Core |
$178.81
|
| Rate for Payer: UHC Exchange |
$40.41
|
| Rate for Payer: UHC Exchange |
$134.88
|
| Rate for Payer: UMR Bronson Commercial |
$38.04
|
| Rate for Payer: UMR Bronson Commercial |
$126.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$257.40
|
|
|
TALQUETAMAB-TGVS 2 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$2,722.78
|
|
|
Service Code
|
HCPCS J3055
|
| Hospital Charge Code |
204984
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,198.02 |
| Max. Negotiated Rate |
$2,450.50 |
| Rate for Payer: Aetna American Axle |
$1,769.81
|
| Rate for Payer: Aetna Commercial |
$2,314.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,769.81
|
| Rate for Payer: Cash Price |
$2,178.22
|
| Rate for Payer: Cofinity Advantage |
$1,905.95
|
| Rate for Payer: Cofinity Commercial |
$2,341.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,178.22
|
| Rate for Payer: Healthscope Commercial |
$2,450.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,905.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,042.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,314.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,042.09
|
| Rate for Payer: PHP Commercial |
$2,314.36
|
| Rate for Payer: Priority Health SBD |
$1,715.35
|
| Rate for Payer: UMR Bronson Commercial |
$1,198.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,042.09
|
|
|
TALQUETAMAB-TGVS 2 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$2,722.78
|
|
|
Service Code
|
HCPCS J3055
|
| Hospital Charge Code |
204984
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.16 |
| Max. Negotiated Rate |
$2,450.50 |
| Rate for Payer: Aetna American Axle |
$1,769.81
|
| Rate for Payer: Aetna Commercial |
$2,314.36
|
| Rate for Payer: Aetna Medicare |
$77.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,769.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.60
|
| Rate for Payer: BCBS Complete |
$41.12
|
| Rate for Payer: BCBS MAPPO |
$74.88
|
| Rate for Payer: BCBS Trust/PPO |
$242.90
|
| Rate for Payer: BCN Commercial |
$242.90
|
| Rate for Payer: BCN Medicare Advantage |
$74.88
|
| Rate for Payer: Cash Price |
$2,178.22
|
| Rate for Payer: Cash Price |
$2,178.22
|
| Rate for Payer: Cofinity Advantage |
$1,905.95
|
| Rate for Payer: Cofinity Commercial |
$2,341.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,178.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.88
|
| Rate for Payer: Healthscope Commercial |
$2,450.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,905.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,042.09
|
| Rate for Payer: Mclaren Medicaid |
$74.88
|
| Rate for Payer: Mclaren Medicare |
$74.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.62
|
| Rate for Payer: Meridian Medicaid |
$78.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$82.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,314.36
|
| Rate for Payer: Nomi Health Commercial |
$224.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,042.09
|
| Rate for Payer: PACE Medicare |
$71.14
|
| Rate for Payer: PACE SWMI |
$74.88
|
| Rate for Payer: PHP Commercial |
$2,314.36
|
| Rate for Payer: PHP Medicare Advantage |
$74.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$229.04
|
| Rate for Payer: Priority Health Medicare |
$74.88
|
| Rate for Payer: Priority Health SBD |
$1,715.35
|
| Rate for Payer: Priority Health Tiered Network |
$183.23
|
| Rate for Payer: Railroad Medicare Medicare |
$74.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.62
|
| Rate for Payer: UHC Core |
$123.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$74.88
|
| Rate for Payer: UHC Exchange |
$123.62
|
| Rate for Payer: UHC Medicaid |
$39.16
|
| Rate for Payer: UHCCP Medicaid |
$39.16
|
| Rate for Payer: UMR Bronson Commercial |
$1,007.43
|
| Rate for Payer: VA VA |
$74.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,042.09
|
|
|
TALQUETAMAB-TGVS 40 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$36,384.63
|
|
|
Service Code
|
HCPCS J3055
|
| Hospital Charge Code |
204983
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16,009.24 |
| Max. Negotiated Rate |
$32,746.17 |
| Rate for Payer: Aetna American Axle |
$23,650.01
|
| Rate for Payer: Aetna Commercial |
$30,926.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23,650.01
|
| Rate for Payer: Cash Price |
$29,107.70
|
| Rate for Payer: Cofinity Advantage |
$25,469.24
|
| Rate for Payer: Cofinity Commercial |
$31,290.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29,107.70
|
| Rate for Payer: Healthscope Commercial |
$32,746.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25,469.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27,288.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30,926.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27,288.47
|
| Rate for Payer: PHP Commercial |
$30,926.94
|
| Rate for Payer: Priority Health SBD |
$22,922.32
|
| Rate for Payer: UMR Bronson Commercial |
$16,009.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27,288.47
|
|
|
TALQUETAMAB-TGVS 40 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$36,384.63
|
|
|
Service Code
|
HCPCS J3055
|
| Hospital Charge Code |
204983
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.16 |
| Max. Negotiated Rate |
$32,746.17 |
| Rate for Payer: Aetna American Axle |
$23,650.01
|
| Rate for Payer: Aetna Commercial |
$30,926.94
|
| Rate for Payer: Aetna Medicare |
$77.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23,650.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.60
|
| Rate for Payer: BCBS Complete |
$41.12
|
| Rate for Payer: BCBS MAPPO |
$74.88
|
| Rate for Payer: BCBS Trust/PPO |
$242.90
|
| Rate for Payer: BCN Commercial |
$242.90
|
| Rate for Payer: BCN Medicare Advantage |
$74.88
|
| Rate for Payer: Cash Price |
$29,107.70
|
| Rate for Payer: Cash Price |
$29,107.70
|
| Rate for Payer: Cofinity Advantage |
$25,469.24
|
| Rate for Payer: Cofinity Commercial |
$31,290.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29,107.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.88
|
| Rate for Payer: Healthscope Commercial |
$32,746.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25,469.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27,288.47
|
| Rate for Payer: Mclaren Medicaid |
$74.88
|
| Rate for Payer: Mclaren Medicare |
$74.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.62
|
| Rate for Payer: Meridian Medicaid |
$78.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$82.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30,926.94
|
| Rate for Payer: Nomi Health Commercial |
$224.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27,288.47
|
| Rate for Payer: PACE Medicare |
$71.14
|
| Rate for Payer: PACE SWMI |
$74.88
|
| Rate for Payer: PHP Commercial |
$30,926.94
|
| Rate for Payer: PHP Medicare Advantage |
$74.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$229.04
|
| Rate for Payer: Priority Health Medicare |
$74.88
|
| Rate for Payer: Priority Health SBD |
$22,922.32
|
| Rate for Payer: Priority Health Tiered Network |
$183.23
|
| Rate for Payer: Railroad Medicare Medicare |
$74.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.62
|
| Rate for Payer: UHC Core |
$123.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$74.88
|
| Rate for Payer: UHC Exchange |
$123.62
|
| Rate for Payer: UHC Medicaid |
$39.16
|
| Rate for Payer: UHCCP Medicaid |
$39.16
|
| Rate for Payer: UMR Bronson Commercial |
$13,462.31
|
| Rate for Payer: VA VA |
$74.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27,288.47
|
|
|
TAMOXIFEN 10 MG TABLET
|
Facility
|
IP
|
$387.60
|
|
|
Service Code
|
NDC 63739014310
|
| Hospital Charge Code |
7711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.54 |
| Max. Negotiated Rate |
$348.84 |
| Rate for Payer: Aetna American Axle |
$251.94
|
| Rate for Payer: Aetna Commercial |
$329.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.94
|
| Rate for Payer: Cash Price |
$310.08
|
| Rate for Payer: Cofinity Advantage |
$271.32
|
| Rate for Payer: Cofinity Commercial |
$333.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.08
|
| Rate for Payer: Healthscope Commercial |
$348.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$271.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$290.70
|
| Rate for Payer: PHP Commercial |
$329.46
|
| Rate for Payer: Priority Health SBD |
$244.19
|
| Rate for Payer: UMR Bronson Commercial |
$170.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.70
|
|
|
TAMOXIFEN 10 MG TABLET
|
Facility
|
IP
|
$249.57
|
|
|
Service Code
|
NDC 59651029960
|
| Hospital Charge Code |
7711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.81 |
| Max. Negotiated Rate |
$224.61 |
| Rate for Payer: Aetna American Axle |
$162.22
|
| Rate for Payer: Aetna Commercial |
$212.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.22
|
| Rate for Payer: Cash Price |
$199.66
|
| Rate for Payer: Cofinity Advantage |
$174.70
|
| Rate for Payer: Cofinity Commercial |
$214.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.66
|
| Rate for Payer: Healthscope Commercial |
$224.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.18
|
| Rate for Payer: PHP Commercial |
$212.13
|
| Rate for Payer: Priority Health SBD |
$157.23
|
| Rate for Payer: UMR Bronson Commercial |
$109.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.18
|
|
|
TAMOXIFEN 10 MG TABLET
|
Facility
|
IP
|
$201.78
|
|
|
Service Code
|
NDC 00378014491
|
| Hospital Charge Code |
7711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.78 |
| Max. Negotiated Rate |
$181.60 |
| Rate for Payer: Aetna American Axle |
$131.16
|
| Rate for Payer: Aetna Commercial |
$171.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.16
|
| Rate for Payer: Cash Price |
$161.42
|
| Rate for Payer: Cofinity Advantage |
$141.25
|
| Rate for Payer: Cofinity Commercial |
$173.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.42
|
| Rate for Payer: Healthscope Commercial |
$181.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$141.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$151.34
|
| Rate for Payer: PHP Commercial |
$171.51
|
| Rate for Payer: Priority Health SBD |
$127.12
|
| Rate for Payer: UMR Bronson Commercial |
$88.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.34
|
|
|
TAMOXIFEN 10 MG TABLET
|
Facility
|
OP
|
$201.78
|
|
|
Service Code
|
NDC 00378014491
|
| Hospital Charge Code |
7711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.66 |
| Max. Negotiated Rate |
$181.60 |
| Rate for Payer: Aetna American Axle |
$131.16
|
| Rate for Payer: Aetna Commercial |
$171.51
|
| Rate for Payer: Aetna Medicare |
$100.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.16
|
| Rate for Payer: BCBS Complete |
$80.71
|
| Rate for Payer: Cash Price |
$161.42
|
| Rate for Payer: Cofinity Advantage |
$141.25
|
| Rate for Payer: Cofinity Commercial |
$173.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.42
|
| Rate for Payer: Healthscope Commercial |
$181.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$141.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$161.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$151.34
|
| Rate for Payer: PHP Commercial |
$171.51
|
| Rate for Payer: Priority Health SBD |
$127.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.16
|
| Rate for Payer: UHC Core |
$105.13
|
| Rate for Payer: UHC Exchange |
$79.30
|
| Rate for Payer: UMR Bronson Commercial |
$74.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.34
|
|
