|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
OP
|
$288.80
|
|
|
Service Code
|
NDC 51079029420
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.86 |
| Max. Negotiated Rate |
$259.92 |
| Rate for Payer: Aetna American Axle |
$187.72
|
| Rate for Payer: Aetna Commercial |
$245.48
|
| Rate for Payer: Aetna Medicare |
$144.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.72
|
| Rate for Payer: BCBS Complete |
$115.52
|
| Rate for Payer: Cash Price |
$231.04
|
| Rate for Payer: Cofinity Advantage |
$202.16
|
| Rate for Payer: Cofinity Commercial |
$248.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.04
|
| Rate for Payer: Healthscope Commercial |
$259.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$202.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.60
|
| Rate for Payer: PHP Commercial |
$245.48
|
| Rate for Payer: Priority Health SBD |
$181.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.72
|
| Rate for Payer: UHC Core |
$150.46
|
| Rate for Payer: UHC Exchange |
$113.50
|
| Rate for Payer: UMR Bronson Commercial |
$106.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.60
|
|
|
TARLATAMAB-DLLE 10 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$69,370.50
|
|
|
Service Code
|
HCPCS J9026
|
| Hospital Charge Code |
207439
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$819.92 |
| Max. Negotiated Rate |
$62,433.45 |
| Rate for Payer: Aetna American Axle |
$45,090.82
|
| Rate for Payer: Aetna Commercial |
$58,964.93
|
| Rate for Payer: Aetna Medicare |
$1,630.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45,090.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,959.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,959.65
|
| Rate for Payer: BCBS Complete |
$860.99
|
| Rate for Payer: BCBS MAPPO |
$1,567.72
|
| Rate for Payer: BCBS Trust/PPO |
$5,079.88
|
| Rate for Payer: BCN Commercial |
$5,079.88
|
| Rate for Payer: BCN Medicare Advantage |
$1,567.72
|
| Rate for Payer: Cash Price |
$55,496.40
|
| Rate for Payer: Cash Price |
$55,496.40
|
| Rate for Payer: Cofinity Advantage |
$48,559.35
|
| Rate for Payer: Cofinity Commercial |
$59,658.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55,496.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,567.72
|
| Rate for Payer: Healthscope Commercial |
$62,433.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48,559.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52,027.88
|
| Rate for Payer: Mclaren Medicaid |
$1,567.72
|
| Rate for Payer: Mclaren Medicare |
$1,567.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.11
|
| Rate for Payer: Meridian Medicaid |
$1,646.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,802.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,724.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58,964.93
|
| Rate for Payer: Nomi Health Commercial |
$4,703.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52,027.88
|
| Rate for Payer: PACE Medicare |
$1,489.33
|
| Rate for Payer: PACE SWMI |
$1,567.72
|
| Rate for Payer: PHP Commercial |
$58,964.93
|
| Rate for Payer: PHP Medicare Advantage |
$1,567.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$819.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,934.80
|
| Rate for Payer: Priority Health Medicare |
$1,567.72
|
| Rate for Payer: Priority Health SBD |
$43,703.42
|
| Rate for Payer: Priority Health Tiered Network |
$3,947.84
|
| Rate for Payer: Railroad Medicare Medicare |
$1,567.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,584.87
|
| Rate for Payer: UHC Core |
$2,584.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,567.72
|
| Rate for Payer: UHC Exchange |
$2,584.87
|
| Rate for Payer: UHC Medicaid |
$819.92
|
| Rate for Payer: UHCCP Medicaid |
$819.92
|
| Rate for Payer: UMR Bronson Commercial |
$25,667.08
|
| Rate for Payer: VA VA |
$1,567.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52,027.88
|
|
|
TARLATAMAB-DLLE 10 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$69,370.50
|
|
|
Service Code
|
HCPCS J9026
|
| Hospital Charge Code |
207439
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30,523.02 |
| Max. Negotiated Rate |
$62,433.45 |
| Rate for Payer: Aetna American Axle |
$45,090.82
|
| Rate for Payer: Aetna Commercial |
$58,964.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45,090.82
|
| Rate for Payer: Cash Price |
$55,496.40
|
| Rate for Payer: Cofinity Advantage |
$48,559.35
|
| Rate for Payer: Cofinity Commercial |
$59,658.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55,496.40
|
| Rate for Payer: Healthscope Commercial |
$62,433.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48,559.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52,027.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58,964.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52,027.88
|
| Rate for Payer: PHP Commercial |
$58,964.93
|
| Rate for Payer: Priority Health SBD |
$43,703.42
|
| Rate for Payer: UMR Bronson Commercial |
$30,523.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52,027.88
|
|
|
TARLATAMAB-DLLE 1 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$6,937.05
|
|
|
Service Code
|
HCPCS J9026
|
| Hospital Charge Code |
207440
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,052.30 |
| Max. Negotiated Rate |
$6,243.35 |
| Rate for Payer: Aetna American Axle |
$4,509.08
|
| Rate for Payer: Aetna Commercial |
$5,896.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,509.08
|
| Rate for Payer: Cash Price |
$5,549.64
|
| Rate for Payer: Cofinity Advantage |
$4,855.94
|
| Rate for Payer: Cofinity Commercial |
$5,965.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,549.64
|
| Rate for Payer: Healthscope Commercial |
$6,243.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,855.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,202.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,896.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,202.79
|
| Rate for Payer: PHP Commercial |
$5,896.49
|
| Rate for Payer: Priority Health SBD |
$4,370.34
|
| Rate for Payer: UMR Bronson Commercial |
$3,052.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,202.79
|
|
|
TARLATAMAB-DLLE 1 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,937.05
|
|
|
Service Code
|
HCPCS J9026
|
| Hospital Charge Code |
207440
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$819.92 |
| Max. Negotiated Rate |
$6,243.35 |
| Rate for Payer: Aetna American Axle |
$4,509.08
|
| Rate for Payer: Aetna Commercial |
$5,896.49
|
| Rate for Payer: Aetna Medicare |
$1,630.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,509.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,959.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,959.65
|
| Rate for Payer: BCBS Complete |
$860.99
|
| Rate for Payer: BCBS MAPPO |
$1,567.72
|
| Rate for Payer: BCBS Trust/PPO |
$5,079.88
|
| Rate for Payer: BCN Commercial |
$5,079.88
|
| Rate for Payer: BCN Medicare Advantage |
$1,567.72
|
| Rate for Payer: Cash Price |
$5,549.64
|
| Rate for Payer: Cash Price |
$5,549.64
|
| Rate for Payer: Cofinity Advantage |
$4,855.94
|
| Rate for Payer: Cofinity Commercial |
$5,965.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,549.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,567.72
|
| Rate for Payer: Healthscope Commercial |
$6,243.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,855.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,202.79
|
| Rate for Payer: Mclaren Medicaid |
$1,567.72
|
| Rate for Payer: Mclaren Medicare |
$1,567.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.11
|
| Rate for Payer: Meridian Medicaid |
$1,646.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,802.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,724.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,896.49
|
| Rate for Payer: Nomi Health Commercial |
$4,703.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,202.79
|
| Rate for Payer: PACE Medicare |
$1,489.33
|
| Rate for Payer: PACE SWMI |
$1,567.72
|
| Rate for Payer: PHP Commercial |
$5,896.49
|
| Rate for Payer: PHP Medicare Advantage |
$1,567.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$819.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,934.80
|
| Rate for Payer: Priority Health Medicare |
$1,567.72
|
| Rate for Payer: Priority Health SBD |
$4,370.34
|
| Rate for Payer: Priority Health Tiered Network |
$3,947.84
|
| Rate for Payer: Railroad Medicare Medicare |
$1,567.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,584.87
|
| Rate for Payer: UHC Core |
$2,584.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,567.72
|
| Rate for Payer: UHC Exchange |
$2,584.87
|
| Rate for Payer: UHC Medicaid |
$819.92
|
| Rate for Payer: UHCCP Medicaid |
$819.92
|
| Rate for Payer: UMR Bronson Commercial |
$2,566.71
|
| Rate for Payer: VA VA |
$1,567.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,202.79
|
|
|
TBO-FILGRASTIM 300 MCG/0.5 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$572.34
|
|
|
Service Code
|
HCPCS J1447
|
| Hospital Charge Code |
168855
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$515.11 |
| Rate for Payer: Aetna American Axle |
$372.02
|
| Rate for Payer: Aetna Commercial |
$486.49
|
| Rate for Payer: Aetna Medicare |
$0.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.31
|
| Rate for Payer: BCBS Complete |
$0.14
|
| Rate for Payer: BCBS MAPPO |
$0.25
|
| Rate for Payer: BCBS Trust/PPO |
$0.76
|
| Rate for Payer: BCN Commercial |
$0.76
|
| Rate for Payer: BCN Medicare Advantage |
$0.25
|
| Rate for Payer: Cash Price |
$457.87
|
| Rate for Payer: Cash Price |
$457.87
|
| Rate for Payer: Cofinity Advantage |
$400.64
|
| Rate for Payer: Cofinity Commercial |
$492.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$457.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.25
|
| Rate for Payer: Healthscope Commercial |
$515.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$400.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$429.25
|
| Rate for Payer: Mclaren Medicaid |
$0.25
|
| Rate for Payer: Mclaren Medicare |
$0.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.26
|
| Rate for Payer: Meridian Medicaid |
$0.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$486.49
|
| Rate for Payer: Nomi Health Commercial |
$0.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$429.25
|
| Rate for Payer: PACE Medicare |
$0.24
|
| Rate for Payer: PACE SWMI |
$0.25
|
| Rate for Payer: PHP Commercial |
$486.49
|
| Rate for Payer: PHP Medicare Advantage |
$0.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$0.89
|
| Rate for Payer: Priority Health Medicare |
$0.25
|
| Rate for Payer: Priority Health SBD |
$360.57
|
| Rate for Payer: Priority Health Tiered Network |
$0.71
|
| Rate for Payer: Railroad Medicare Medicare |
$0.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.41
|
| Rate for Payer: UHC Core |
$0.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.41
|
| Rate for Payer: UHC Medicaid |
$0.13
|
| Rate for Payer: UHCCP Medicaid |
$0.13
|
| Rate for Payer: UMR Bronson Commercial |
$211.77
|
| Rate for Payer: VA VA |
$0.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$429.25
|
|
|
TBO-FILGRASTIM 300 MCG/0.5 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$572.34
|
|
|
Service Code
|
HCPCS J1447
|
| Hospital Charge Code |
168855
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$251.83 |
| Max. Negotiated Rate |
$515.11 |
| Rate for Payer: Aetna American Axle |
$372.02
|
| Rate for Payer: Aetna Commercial |
$486.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.02
|
| Rate for Payer: Cash Price |
$457.87
|
| Rate for Payer: Cofinity Advantage |
$400.64
|
| Rate for Payer: Cofinity Commercial |
$492.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$457.87
|
| Rate for Payer: Healthscope Commercial |
$515.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$400.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$429.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$486.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$429.25
|
| Rate for Payer: PHP Commercial |
$486.49
|
| Rate for Payer: Priority Health SBD |
$360.57
|
| Rate for Payer: UMR Bronson Commercial |
$251.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$429.25
|
|
|
TBO-FILGRASTIM 480 MCG/0.8 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$911.50
|
|
|
Service Code
|
HCPCS J1447
|
| Hospital Charge Code |
168856
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$820.35 |
| Rate for Payer: Aetna American Axle |
$592.48
|
| Rate for Payer: Aetna American Axle |
$592.47
|
| Rate for Payer: Aetna Commercial |
$774.77
|
| Rate for Payer: Aetna Commercial |
$774.77
|
| Rate for Payer: Aetna Medicare |
$0.26
|
| Rate for Payer: Aetna Medicare |
$0.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$592.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$592.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.31
|
| Rate for Payer: BCBS Complete |
$0.14
|
| Rate for Payer: BCBS Complete |
$0.14
|
| Rate for Payer: BCBS MAPPO |
$0.25
|
| Rate for Payer: BCBS MAPPO |
$0.25
|
| Rate for Payer: BCBS Trust/PPO |
$0.76
|
| Rate for Payer: BCBS Trust/PPO |
$0.76
|
| Rate for Payer: BCN Commercial |
$0.76
|
| Rate for Payer: BCN Commercial |
$0.76
|
| Rate for Payer: BCN Medicare Advantage |
$0.25
|
| Rate for Payer: BCN Medicare Advantage |
$0.25
|
| Rate for Payer: Cash Price |
$729.19
|
| Rate for Payer: Cash Price |
$729.20
|
| Rate for Payer: Cash Price |
$729.20
|
| Rate for Payer: Cash Price |
$729.19
|
| Rate for Payer: Cofinity Advantage |
$638.05
|
| Rate for Payer: Cofinity Advantage |
$638.04
|
| Rate for Payer: Cofinity Commercial |
$783.88
|
| Rate for Payer: Cofinity Commercial |
$783.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$729.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$729.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.25
|
| Rate for Payer: Healthscope Commercial |
$820.34
|
| Rate for Payer: Healthscope Commercial |
$820.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$638.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$638.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$683.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$683.62
|
| Rate for Payer: Mclaren Medicaid |
$0.25
|
| Rate for Payer: Mclaren Medicaid |
$0.25
|
| Rate for Payer: Mclaren Medicare |
$0.25
|
| Rate for Payer: Mclaren Medicare |
$0.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.26
|
| Rate for Payer: Meridian Medicaid |
$0.26
|
| Rate for Payer: Meridian Medicaid |
$0.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$774.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$774.77
|
| Rate for Payer: Nomi Health Commercial |
$0.75
|
| Rate for Payer: Nomi Health Commercial |
$0.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$683.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$683.62
|
| Rate for Payer: PACE Medicare |
$0.24
|
| Rate for Payer: PACE Medicare |
$0.24
|
| Rate for Payer: PACE SWMI |
$0.25
|
| Rate for Payer: PACE SWMI |
$0.25
|
| Rate for Payer: PHP Commercial |
$774.77
|
| Rate for Payer: PHP Commercial |
$774.77
|
| Rate for Payer: PHP Medicare Advantage |
$0.25
|
| Rate for Payer: PHP Medicare Advantage |
$0.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$0.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$0.89
|
| Rate for Payer: Priority Health Medicare |
$0.25
|
| Rate for Payer: Priority Health Medicare |
$0.25
|
| Rate for Payer: Priority Health SBD |
$574.24
|
| Rate for Payer: Priority Health SBD |
$574.25
|
| Rate for Payer: Priority Health Tiered Network |
$0.71
|
| Rate for Payer: Priority Health Tiered Network |
$0.71
|
| Rate for Payer: Railroad Medicare Medicare |
$0.25
|
| Rate for Payer: Railroad Medicare Medicare |
$0.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.41
|
| Rate for Payer: UHC Core |
$0.41
|
| Rate for Payer: UHC Core |
$0.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.41
|
| Rate for Payer: UHC Exchange |
$0.41
|
| Rate for Payer: UHC Medicaid |
$0.13
|
| Rate for Payer: UHC Medicaid |
$0.13
|
| Rate for Payer: UHCCP Medicaid |
$0.13
|
| Rate for Payer: UHCCP Medicaid |
$0.13
|
| Rate for Payer: UMR Bronson Commercial |
$337.25
|
| Rate for Payer: UMR Bronson Commercial |
$337.25
|
| Rate for Payer: VA VA |
$0.25
|
| Rate for Payer: VA VA |
$0.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$683.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$683.62
|
|
|
TBO-FILGRASTIM 480 MCG/0.8 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$911.49
|
|
|
Service Code
|
HCPCS J1447
|
| Hospital Charge Code |
168856
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$401.06 |
| Max. Negotiated Rate |
$820.34 |
| Rate for Payer: Aetna American Axle |
$592.47
|
| Rate for Payer: Aetna American Axle |
$592.48
|
| Rate for Payer: Aetna Commercial |
$774.77
|
| Rate for Payer: Aetna Commercial |
$774.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$592.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$592.48
|
| Rate for Payer: Cash Price |
$729.19
|
| Rate for Payer: Cash Price |
$729.20
|
| Rate for Payer: Cofinity Advantage |
$638.05
|
| Rate for Payer: Cofinity Advantage |
$638.04
|
| Rate for Payer: Cofinity Commercial |
$783.89
|
| Rate for Payer: Cofinity Commercial |
$783.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$729.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$729.20
|
| Rate for Payer: Healthscope Commercial |
$820.34
|
| Rate for Payer: Healthscope Commercial |
$820.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$638.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$638.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$683.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$683.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$774.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$774.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$683.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$683.62
|
| Rate for Payer: PHP Commercial |
$774.77
|
| Rate for Payer: PHP Commercial |
$774.77
|
| Rate for Payer: Priority Health SBD |
$574.25
|
| Rate for Payer: Priority Health SBD |
$574.24
|
| Rate for Payer: UMR Bronson Commercial |
$401.06
|
| Rate for Payer: UMR Bronson Commercial |
$401.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$683.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$683.62
|
|
|
TEBENTAFUSP-TEBN 100 MCG/0.5 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$96,579.90
|
|
|
Service Code
|
HCPCS J9274
|
| Hospital Charge Code |
199147
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$116.36 |
| Max. Negotiated Rate |
$86,921.91 |
| Rate for Payer: Aetna American Axle |
$62,776.93
|
| Rate for Payer: Aetna Commercial |
$82,092.91
|
| Rate for Payer: Aetna Medicare |
$231.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62,776.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$278.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$278.11
|
| Rate for Payer: BCBS Complete |
$122.19
|
| Rate for Payer: BCBS MAPPO |
$222.49
|
| Rate for Payer: BCBS Trust/PPO |
$720.54
|
| Rate for Payer: BCN Commercial |
$720.54
|
| Rate for Payer: BCN Medicare Advantage |
$222.49
|
| Rate for Payer: Cash Price |
$77,263.92
|
| Rate for Payer: Cash Price |
$77,263.92
|
| Rate for Payer: Cofinity Advantage |
$67,605.93
|
| Rate for Payer: Cofinity Commercial |
$83,058.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77,263.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$222.49
|
| Rate for Payer: Healthscope Commercial |
$86,921.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67,605.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72,434.93
|
| Rate for Payer: Mclaren Medicaid |
$222.49
|
| Rate for Payer: Mclaren Medicare |
$222.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$233.61
|
| Rate for Payer: Meridian Medicaid |
$233.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$255.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$244.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82,092.91
|
| Rate for Payer: Nomi Health Commercial |
$667.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72,434.93
|
| Rate for Payer: PACE Medicare |
$211.37
|
| Rate for Payer: PACE SWMI |
$222.49
|
| Rate for Payer: PHP Commercial |
$82,092.91
|
| Rate for Payer: PHP Medicare Advantage |
$222.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$684.70
|
| Rate for Payer: Priority Health Medicare |
$222.49
|
| Rate for Payer: Priority Health SBD |
$60,845.34
|
| Rate for Payer: Priority Health Tiered Network |
$547.76
|
| Rate for Payer: Railroad Medicare Medicare |
$222.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$366.65
|
| Rate for Payer: UHC Core |
$366.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$222.49
|
| Rate for Payer: UHC Exchange |
$366.65
|
| Rate for Payer: UHC Medicaid |
$116.36
|
| Rate for Payer: UHCCP Medicaid |
$116.36
|
| Rate for Payer: UMR Bronson Commercial |
$35,734.56
|
| Rate for Payer: VA VA |
$222.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72,434.93
|
|
|
TEBENTAFUSP-TEBN 100 MCG/0.5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$96,579.90
|
|
|
Service Code
|
HCPCS J9274
|
| Hospital Charge Code |
199147
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42,495.16 |
| Max. Negotiated Rate |
$86,921.91 |
| Rate for Payer: Aetna American Axle |
$62,776.93
|
| Rate for Payer: Aetna Commercial |
$82,092.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62,776.93
|
| Rate for Payer: Cash Price |
$77,263.92
|
| Rate for Payer: Cofinity Advantage |
$67,605.93
|
| Rate for Payer: Cofinity Commercial |
$83,058.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77,263.92
|
| Rate for Payer: Healthscope Commercial |
$86,921.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67,605.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72,434.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82,092.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72,434.93
|
| Rate for Payer: PHP Commercial |
$82,092.91
|
| Rate for Payer: Priority Health SBD |
$60,845.34
|
| Rate for Payer: UMR Bronson Commercial |
$42,495.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72,434.93
|
|
|
TECLISTAMAB-CQYV 10 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$6,470.09
|
|
|
Service Code
|
HCPCS J9380
|
| Hospital Charge Code |
201912
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,846.84 |
| Max. Negotiated Rate |
$5,823.08 |
| Rate for Payer: Aetna American Axle |
$4,205.56
|
| Rate for Payer: Aetna Commercial |
$5,499.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,205.56
|
| Rate for Payer: Cash Price |
$5,176.07
|
| Rate for Payer: Cofinity Advantage |
$4,529.06
|
| Rate for Payer: Cofinity Commercial |
$5,564.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,176.07
|
| Rate for Payer: Healthscope Commercial |
$5,823.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,529.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,852.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,499.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,852.57
|
| Rate for Payer: PHP Commercial |
$5,499.58
|
| Rate for Payer: Priority Health SBD |
$4,076.16
|
| Rate for Payer: UMR Bronson Commercial |
$2,846.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,852.57
|
|
|
TECLISTAMAB-CQYV 10 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$6,470.09
|
|
|
Service Code
|
HCPCS J9380
|
| Hospital Charge Code |
201912
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.04 |
| Max. Negotiated Rate |
$5,823.08 |
| Rate for Payer: Aetna American Axle |
$4,205.56
|
| Rate for Payer: Aetna Commercial |
$5,499.58
|
| Rate for Payer: Aetna Medicare |
$35.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,205.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.12
|
| Rate for Payer: BCBS Complete |
$18.95
|
| Rate for Payer: BCBS MAPPO |
$34.50
|
| Rate for Payer: BCBS Trust/PPO |
$112.09
|
| Rate for Payer: BCN Commercial |
$112.09
|
| Rate for Payer: BCN Medicare Advantage |
$34.50
|
| Rate for Payer: Cash Price |
$5,176.07
|
| Rate for Payer: Cash Price |
$5,176.07
|
| Rate for Payer: Cofinity Advantage |
$4,529.06
|
| Rate for Payer: Cofinity Commercial |
$5,564.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,176.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.50
|
| Rate for Payer: Healthscope Commercial |
$5,823.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,529.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,852.57
|
| Rate for Payer: Mclaren Medicaid |
$34.50
|
| Rate for Payer: Mclaren Medicare |
$34.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.23
|
| Rate for Payer: Meridian Medicaid |
$36.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$37.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,499.58
|
| Rate for Payer: Nomi Health Commercial |
$103.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,852.57
|
| Rate for Payer: PACE Medicare |
$32.77
|
| Rate for Payer: PACE SWMI |
$34.50
|
| Rate for Payer: PHP Commercial |
$5,499.58
|
| Rate for Payer: PHP Medicare Advantage |
$34.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$105.90
|
| Rate for Payer: Priority Health Medicare |
$34.50
|
| Rate for Payer: Priority Health SBD |
$4,076.16
|
| Rate for Payer: Priority Health Tiered Network |
$84.72
|
| Rate for Payer: Railroad Medicare Medicare |
$34.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.06
|
| Rate for Payer: UHC Core |
$57.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$34.50
|
| Rate for Payer: UHC Exchange |
$57.06
|
| Rate for Payer: UHC Medicaid |
$18.04
|
| Rate for Payer: UHCCP Medicaid |
$18.04
|
| Rate for Payer: UMR Bronson Commercial |
$2,393.93
|
| Rate for Payer: VA VA |
$34.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,852.57
|
|
|
TECLISTAMAB-CQYV 90 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$33,217.39
|
|
|
Service Code
|
HCPCS J9380
|
| Hospital Charge Code |
201911
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.04 |
| Max. Negotiated Rate |
$29,895.65 |
| Rate for Payer: Aetna American Axle |
$21,591.30
|
| Rate for Payer: Aetna Commercial |
$28,234.78
|
| Rate for Payer: Aetna Medicare |
$35.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21,591.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.12
|
| Rate for Payer: BCBS Complete |
$18.95
|
| Rate for Payer: BCBS MAPPO |
$34.50
|
| Rate for Payer: BCBS Trust/PPO |
$112.09
|
| Rate for Payer: BCN Commercial |
$112.09
|
| Rate for Payer: BCN Medicare Advantage |
$34.50
|
| Rate for Payer: Cash Price |
$26,573.91
|
| Rate for Payer: Cash Price |
$26,573.91
|
| Rate for Payer: Cofinity Advantage |
$23,252.17
|
| Rate for Payer: Cofinity Commercial |
$28,566.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26,573.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.50
|
| Rate for Payer: Healthscope Commercial |
$29,895.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23,252.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24,913.04
|
| Rate for Payer: Mclaren Medicaid |
$34.50
|
| Rate for Payer: Mclaren Medicare |
$34.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.23
|
| Rate for Payer: Meridian Medicaid |
$36.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$37.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28,234.78
|
| Rate for Payer: Nomi Health Commercial |
$103.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24,913.04
|
| Rate for Payer: PACE Medicare |
$32.77
|
| Rate for Payer: PACE SWMI |
$34.50
|
| Rate for Payer: PHP Commercial |
$28,234.78
|
| Rate for Payer: PHP Medicare Advantage |
$34.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$105.90
|
| Rate for Payer: Priority Health Medicare |
$34.50
|
| Rate for Payer: Priority Health SBD |
$20,926.96
|
| Rate for Payer: Priority Health Tiered Network |
$84.72
|
| Rate for Payer: Railroad Medicare Medicare |
$34.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.06
|
| Rate for Payer: UHC Core |
$57.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$34.50
|
| Rate for Payer: UHC Exchange |
$57.06
|
| Rate for Payer: UHC Medicaid |
$18.04
|
| Rate for Payer: UHCCP Medicaid |
$18.04
|
| Rate for Payer: UMR Bronson Commercial |
$12,290.43
|
| Rate for Payer: VA VA |
$34.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24,913.04
|
|
|
TECLISTAMAB-CQYV 90 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$33,217.39
|
|
|
Service Code
|
HCPCS J9380
|
| Hospital Charge Code |
201911
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14,615.65 |
| Max. Negotiated Rate |
$29,895.65 |
| Rate for Payer: Aetna American Axle |
$21,591.30
|
| Rate for Payer: Aetna Commercial |
$28,234.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21,591.30
|
| Rate for Payer: Cash Price |
$26,573.91
|
| Rate for Payer: Cofinity Advantage |
$23,252.17
|
| Rate for Payer: Cofinity Commercial |
$28,566.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26,573.91
|
| Rate for Payer: Healthscope Commercial |
$29,895.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23,252.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24,913.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28,234.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24,913.04
|
| Rate for Payer: PHP Commercial |
$28,234.78
|
| Rate for Payer: Priority Health SBD |
$20,926.96
|
| Rate for Payer: UMR Bronson Commercial |
$14,615.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24,913.04
|
|
|
TEMAZEPAM 15 MG CAPSULE
|
Facility
|
IP
|
$152.25
|
|
|
Service Code
|
NDC 00378401001
|
| Hospital Charge Code |
7753
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.99 |
| Max. Negotiated Rate |
$137.03 |
| Rate for Payer: Aetna American Axle |
$98.96
|
| Rate for Payer: Aetna Commercial |
$129.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.96
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cofinity Advantage |
$106.58
|
| Rate for Payer: Cofinity Commercial |
$130.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.80
|
| Rate for Payer: Healthscope Commercial |
$137.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.19
|
| Rate for Payer: PHP Commercial |
$129.41
|
| Rate for Payer: Priority Health SBD |
$95.92
|
| Rate for Payer: UMR Bronson Commercial |
$66.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.19
|
|
|
TEMAZEPAM 15 MG CAPSULE
|
Facility
|
IP
|
$1.49
|
|
|
Service Code
|
NDC 51079041801
|
| Hospital Charge Code |
7753
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Aetna American Axle |
$0.97
|
| Rate for Payer: Aetna Commercial |
$1.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.97
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Cofinity Advantage |
$1.04
|
| Rate for Payer: Cofinity Commercial |
$1.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.19
|
| Rate for Payer: Healthscope Commercial |
$1.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.12
|
| Rate for Payer: PHP Commercial |
$1.27
|
| Rate for Payer: Priority Health SBD |
$0.94
|
| Rate for Payer: UMR Bronson Commercial |
$0.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.12
|
|
|
TEMAZEPAM 15 MG CAPSULE
|
Facility
|
IP
|
$148.75
|
|
|
Service Code
|
NDC 51079041820
|
| Hospital Charge Code |
7753
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.45 |
| Max. Negotiated Rate |
$133.88 |
| Rate for Payer: Aetna American Axle |
$96.69
|
| Rate for Payer: Aetna Commercial |
$126.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.69
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: Cofinity Advantage |
$104.12
|
| Rate for Payer: Cofinity Commercial |
$127.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.00
|
| Rate for Payer: Healthscope Commercial |
$133.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.56
|
| Rate for Payer: PHP Commercial |
$126.44
|
| Rate for Payer: Priority Health SBD |
$93.71
|
| Rate for Payer: UMR Bronson Commercial |
$65.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.56
|
|
|
TEMAZEPAM 15 MG CAPSULE
|
Facility
|
OP
|
$148.75
|
|
|
Service Code
|
NDC 51079041820
|
| Hospital Charge Code |
7753
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.04 |
| Max. Negotiated Rate |
$133.88 |
| Rate for Payer: Aetna American Axle |
$96.69
|
| Rate for Payer: Aetna Commercial |
$126.44
|
| Rate for Payer: Aetna Medicare |
$74.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.69
|
| Rate for Payer: BCBS Complete |
$59.50
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: Cofinity Advantage |
$104.12
|
| Rate for Payer: Cofinity Commercial |
$127.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.00
|
| Rate for Payer: Healthscope Commercial |
$133.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.56
|
| Rate for Payer: PHP Commercial |
$126.44
|
| Rate for Payer: Priority Health SBD |
$93.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.69
|
| Rate for Payer: UHC Core |
$77.50
|
| Rate for Payer: UHC Exchange |
$58.46
|
| Rate for Payer: UMR Bronson Commercial |
$55.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.56
|
|
|
TEMAZEPAM 15 MG CAPSULE
|
Facility
|
OP
|
$138.25
|
|
|
Service Code
|
NDC 00228207610
|
| Hospital Charge Code |
7753
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.15 |
| Max. Negotiated Rate |
$124.42 |
| Rate for Payer: Aetna American Axle |
$89.86
|
| Rate for Payer: Aetna Commercial |
$117.51
|
| Rate for Payer: Aetna Medicare |
$69.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.86
|
| Rate for Payer: BCBS Complete |
$55.30
|
| Rate for Payer: Cash Price |
$110.60
|
| Rate for Payer: Cofinity Advantage |
$96.78
|
| Rate for Payer: Cofinity Commercial |
$118.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.60
|
| Rate for Payer: Healthscope Commercial |
$124.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.69
|
| Rate for Payer: PHP Commercial |
$117.51
|
| Rate for Payer: Priority Health SBD |
$87.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.86
|
| Rate for Payer: UHC Core |
$72.03
|
| Rate for Payer: UHC Exchange |
$54.33
|
| Rate for Payer: UMR Bronson Commercial |
$51.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.69
|
|
|
TEMAZEPAM 15 MG CAPSULE
|
Facility
|
OP
|
$1.49
|
|
|
Service Code
|
NDC 51079041801
|
| Hospital Charge Code |
7753
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Aetna American Axle |
$0.97
|
| Rate for Payer: Aetna Commercial |
$1.27
|
| Rate for Payer: Aetna Medicare |
$0.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.97
|
| Rate for Payer: BCBS Complete |
$0.60
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Cofinity Advantage |
$1.04
|
| Rate for Payer: Cofinity Commercial |
$1.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.19
|
| Rate for Payer: Healthscope Commercial |
$1.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.12
|
| Rate for Payer: PHP Commercial |
$1.27
|
| Rate for Payer: Priority Health SBD |
$0.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC Core |
$0.78
|
| Rate for Payer: UHC Exchange |
$0.59
|
| Rate for Payer: UMR Bronson Commercial |
$0.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.12
|
|
|
TEMAZEPAM 15 MG CAPSULE
|
Facility
|
OP
|
$152.25
|
|
|
Service Code
|
NDC 00378401001
|
| Hospital Charge Code |
7753
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.33 |
| Max. Negotiated Rate |
$137.03 |
| Rate for Payer: Aetna American Axle |
$98.96
|
| Rate for Payer: Aetna Commercial |
$129.41
|
| Rate for Payer: Aetna Medicare |
$76.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.96
|
| Rate for Payer: BCBS Complete |
$60.90
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cofinity Advantage |
$106.58
|
| Rate for Payer: Cofinity Commercial |
$130.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.80
|
| Rate for Payer: Healthscope Commercial |
$137.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$121.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.19
|
| Rate for Payer: PHP Commercial |
$129.41
|
| Rate for Payer: Priority Health SBD |
$95.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.96
|
| Rate for Payer: UHC Core |
$79.32
|
| Rate for Payer: UHC Exchange |
$59.83
|
| Rate for Payer: UMR Bronson Commercial |
$56.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.19
|
|
|
TEMAZEPAM 15 MG CAPSULE
|
Facility
|
IP
|
$138.25
|
|
|
Service Code
|
NDC 00228207610
|
| Hospital Charge Code |
7753
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.83 |
| Max. Negotiated Rate |
$124.42 |
| Rate for Payer: Aetna American Axle |
$89.86
|
| Rate for Payer: Aetna Commercial |
$117.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.86
|
| Rate for Payer: Cash Price |
$110.60
|
| Rate for Payer: Cofinity Advantage |
$96.78
|
| Rate for Payer: Cofinity Commercial |
$118.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.60
|
| Rate for Payer: Healthscope Commercial |
$124.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.69
|
| Rate for Payer: PHP Commercial |
$117.51
|
| Rate for Payer: Priority Health SBD |
$87.10
|
| Rate for Payer: UMR Bronson Commercial |
$60.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.69
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
OP
|
$338.95
|
|
|
Service Code
|
NDC 00904643604
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.41 |
| Max. Negotiated Rate |
$305.06 |
| Rate for Payer: Aetna American Axle |
$220.32
|
| Rate for Payer: Aetna Commercial |
$288.11
|
| Rate for Payer: Aetna Medicare |
$169.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.32
|
| Rate for Payer: BCBS Complete |
$135.58
|
| Rate for Payer: Cash Price |
$271.16
|
| Rate for Payer: Cofinity Advantage |
$237.26
|
| Rate for Payer: Cofinity Commercial |
$291.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.16
|
| Rate for Payer: Healthscope Commercial |
$305.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$237.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$254.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$254.21
|
| Rate for Payer: PHP Commercial |
$288.11
|
| Rate for Payer: Priority Health SBD |
$213.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.32
|
| Rate for Payer: UHC Core |
$176.59
|
| Rate for Payer: UHC Exchange |
$133.21
|
| Rate for Payer: UMR Bronson Commercial |
$125.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$254.21
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
OP
|
$964.86
|
|
|
Service Code
|
NDC 00406996001
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$357.00 |
| Max. Negotiated Rate |
$868.37 |
| Rate for Payer: Aetna American Axle |
$627.16
|
| Rate for Payer: Aetna Commercial |
$820.13
|
| Rate for Payer: Aetna Medicare |
$482.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$627.16
|
| Rate for Payer: BCBS Complete |
$385.94
|
| Rate for Payer: Cash Price |
$771.89
|
| Rate for Payer: Cofinity Advantage |
$675.40
|
| Rate for Payer: Cofinity Commercial |
$829.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$771.89
|
| Rate for Payer: Healthscope Commercial |
$868.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$675.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$723.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$771.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$820.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$723.64
|
| Rate for Payer: PHP Commercial |
$820.13
|
| Rate for Payer: Priority Health SBD |
$607.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$627.16
|
| Rate for Payer: UHC Core |
$502.69
|
| Rate for Payer: UHC Exchange |
$379.19
|
| Rate for Payer: UMR Bronson Commercial |
$357.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$723.64
|
|
