|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
IP
|
$964.86
|
|
|
Service Code
|
NDC 00406996001
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$424.54 |
| Max. Negotiated Rate |
$868.37 |
| Rate for Payer: Aetna American Axle |
$627.16
|
| Rate for Payer: Aetna Commercial |
$820.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$627.16
|
| 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: 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: UMR Bronson Commercial |
$424.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$723.64
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
IP
|
$9,078.96
|
|
|
Service Code
|
NDC 00406991501
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,994.74 |
| Max. Negotiated Rate |
$8,171.06 |
| Rate for Payer: Aetna American Axle |
$5,901.32
|
| Rate for Payer: Aetna Commercial |
$7,717.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,901.32
|
| Rate for Payer: Cash Price |
$7,263.17
|
| Rate for Payer: Cofinity Advantage |
$6,355.27
|
| Rate for Payer: Cofinity Commercial |
$7,807.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,263.17
|
| Rate for Payer: Healthscope Commercial |
$8,171.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,355.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,809.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,717.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,809.22
|
| Rate for Payer: PHP Commercial |
$7,717.12
|
| Rate for Payer: Priority Health SBD |
$5,719.74
|
| Rate for Payer: UMR Bronson Commercial |
$3,994.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,809.22
|
|
|
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
|
IP
|
$12.43
|
|
|
Service Code
|
NDC 68084054911
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.47 |
| Max. Negotiated Rate |
$11.19 |
| Rate for Payer: Aetna American Axle |
$8.08
|
| Rate for Payer: Aetna Commercial |
$10.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.08
|
| Rate for Payer: Cash Price |
$9.94
|
| Rate for Payer: Cofinity Advantage |
$8.70
|
| Rate for Payer: Cofinity Commercial |
$10.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.94
|
| Rate for Payer: Healthscope Commercial |
$11.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.32
|
| Rate for Payer: PHP Commercial |
$10.57
|
| Rate for Payer: Priority Health SBD |
$7.83
|
| Rate for Payer: UMR Bronson Commercial |
$5.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.32
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
OP
|
$2,127.84
|
|
|
Service Code
|
NDC 00378311001
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$787.30 |
| Max. Negotiated Rate |
$1,915.06 |
| Rate for Payer: Aetna American Axle |
$1,383.10
|
| Rate for Payer: Aetna Commercial |
$1,808.66
|
| Rate for Payer: Aetna Medicare |
$1,063.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,383.10
|
| Rate for Payer: BCBS Complete |
$851.14
|
| Rate for Payer: Cash Price |
$1,702.27
|
| Rate for Payer: Cofinity Advantage |
$1,489.49
|
| Rate for Payer: Cofinity Commercial |
$1,829.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,702.27
|
| Rate for Payer: Healthscope Commercial |
$1,915.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,489.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,595.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,702.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,808.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,595.88
|
| Rate for Payer: PHP Commercial |
$1,808.66
|
| Rate for Payer: Priority Health SBD |
$1,340.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,383.10
|
| Rate for Payer: UHC Core |
$1,108.60
|
| Rate for Payer: UHC Exchange |
$836.24
|
| Rate for Payer: UMR Bronson Commercial |
$787.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,595.88
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
IP
|
$2,127.84
|
|
|
Service Code
|
NDC 00378311001
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$936.25 |
| Max. Negotiated Rate |
$1,915.06 |
| Rate for Payer: Aetna American Axle |
$1,383.10
|
| Rate for Payer: Aetna Commercial |
$1,808.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,383.10
|
| Rate for Payer: Cash Price |
$1,702.27
|
| Rate for Payer: Cofinity Advantage |
$1,489.49
|
| Rate for Payer: Cofinity Commercial |
$1,829.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,702.27
|
| Rate for Payer: Healthscope Commercial |
$1,915.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,489.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,595.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,808.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,595.88
|
| Rate for Payer: PHP Commercial |
$1,808.66
|
| Rate for Payer: Priority Health SBD |
$1,340.54
|
| Rate for Payer: UMR Bronson Commercial |
$936.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,595.88
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
IP
|
$338.95
|
|
|
Service Code
|
NDC 00904643604
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.14 |
| Max. Negotiated Rate |
$305.06 |
| Rate for Payer: Aetna American Axle |
$220.32
|
| Rate for Payer: Aetna Commercial |
$288.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.32
|
| 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: 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: UMR Bronson Commercial |
$149.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$254.21
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
IP
|
$372.88
|
|
|
Service Code
|
NDC 68084054921
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.07 |
| Max. Negotiated Rate |
$335.59 |
| Rate for Payer: Aetna American Axle |
$242.37
|
| Rate for Payer: Aetna Commercial |
$316.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.37
|
| Rate for Payer: Cash Price |
$298.30
|
| Rate for Payer: Cofinity Advantage |
$261.02
|
| Rate for Payer: Cofinity Commercial |
$320.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.30
|
| Rate for Payer: Healthscope Commercial |
$335.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$261.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$279.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$279.66
|
| Rate for Payer: PHP Commercial |
$316.95
|
| Rate for Payer: Priority Health SBD |
$234.91
|
| Rate for Payer: UMR Bronson Commercial |
$164.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$279.66
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
OP
|
$9,078.96
|
|
|
Service Code
|
NDC 00406991501
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,359.22 |
| Max. Negotiated Rate |
$8,171.06 |
| Rate for Payer: Aetna American Axle |
$5,901.32
|
| Rate for Payer: Aetna Commercial |
$7,717.12
|
| Rate for Payer: Aetna Medicare |
$4,539.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,901.32
|
| Rate for Payer: BCBS Complete |
$3,631.58
|
| Rate for Payer: Cash Price |
$7,263.17
|
| Rate for Payer: Cofinity Advantage |
$6,355.27
|
| Rate for Payer: Cofinity Commercial |
$7,807.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,263.17
|
| Rate for Payer: Healthscope Commercial |
$8,171.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,355.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,809.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,263.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,717.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,809.22
|
| Rate for Payer: PHP Commercial |
$7,717.12
|
| Rate for Payer: Priority Health SBD |
$5,719.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,901.32
|
| Rate for Payer: UHC Core |
$4,730.14
|
| Rate for Payer: UHC Exchange |
$3,568.03
|
| Rate for Payer: UMR Bronson Commercial |
$3,359.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,809.22
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
OP
|
$12.43
|
|
|
Service Code
|
NDC 68084054911
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$11.19 |
| Rate for Payer: Aetna American Axle |
$8.08
|
| Rate for Payer: Aetna Commercial |
$10.57
|
| Rate for Payer: Aetna Medicare |
$6.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.08
|
| Rate for Payer: BCBS Complete |
$4.97
|
| Rate for Payer: Cash Price |
$9.94
|
| Rate for Payer: Cofinity Advantage |
$8.70
|
| Rate for Payer: Cofinity Commercial |
$10.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.94
|
| Rate for Payer: Healthscope Commercial |
$11.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.32
|
| Rate for Payer: PHP Commercial |
$10.57
|
| Rate for Payer: Priority Health SBD |
$7.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.08
|
| Rate for Payer: UHC Core |
$6.48
|
| Rate for Payer: UHC Exchange |
$4.88
|
| Rate for Payer: UMR Bronson Commercial |
$4.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.32
|
|
|
TEMOZOLOMIDE 100 MG CAPSULE
|
Facility
|
IP
|
$224.41
|
|
|
Service Code
|
HCPCS J8700
|
| Hospital Charge Code |
25894
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$98.74 |
| Max. Negotiated Rate |
$201.97 |
| Rate for Payer: Aetna American Axle |
$145.87
|
| Rate for Payer: Aetna American Axle |
$196.61
|
| Rate for Payer: Aetna Commercial |
$190.75
|
| Rate for Payer: Aetna Commercial |
$257.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.61
|
| Rate for Payer: Cash Price |
$179.53
|
| Rate for Payer: Cash Price |
$241.98
|
| Rate for Payer: Cofinity Advantage |
$211.73
|
| Rate for Payer: Cofinity Advantage |
$157.09
|
| Rate for Payer: Cofinity Commercial |
$260.12
|
| Rate for Payer: Cofinity Commercial |
$192.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.98
|
| Rate for Payer: Healthscope Commercial |
$201.97
|
| Rate for Payer: Healthscope Commercial |
$272.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$211.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.85
|
| Rate for Payer: PHP Commercial |
$190.75
|
| Rate for Payer: PHP Commercial |
$257.10
|
| Rate for Payer: Priority Health SBD |
$190.56
|
| Rate for Payer: Priority Health SBD |
$141.38
|
| Rate for Payer: UMR Bronson Commercial |
$98.74
|
| Rate for Payer: UMR Bronson Commercial |
$133.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.85
|
|
|
TEMOZOLOMIDE 100 MG CAPSULE
|
Facility
|
OP
|
$224.41
|
|
|
Service Code
|
HCPCS J8700
|
| Hospital Charge Code |
25894
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$201.97 |
| Rate for Payer: Aetna American Axle |
$145.87
|
| Rate for Payer: Aetna American Axle |
$196.61
|
| Rate for Payer: Aetna Commercial |
$190.75
|
| Rate for Payer: Aetna Commercial |
$257.10
|
| Rate for Payer: Aetna Medicare |
$112.20
|
| Rate for Payer: Aetna Medicare |
$151.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.61
|
| Rate for Payer: BCBS Complete |
$120.99
|
| Rate for Payer: BCBS Complete |
$89.76
|
| Rate for Payer: BCBS Trust/PPO |
$1.75
|
| Rate for Payer: BCBS Trust/PPO |
$1.75
|
| Rate for Payer: BCN Commercial |
$1.75
|
| Rate for Payer: BCN Commercial |
$1.75
|
| Rate for Payer: Cash Price |
$179.53
|
| Rate for Payer: Cash Price |
$241.98
|
| Rate for Payer: Cash Price |
$179.53
|
| Rate for Payer: Cash Price |
$241.98
|
| Rate for Payer: Cofinity Advantage |
$157.09
|
| Rate for Payer: Cofinity Advantage |
$211.73
|
| Rate for Payer: Cofinity Commercial |
$192.99
|
| Rate for Payer: Cofinity Commercial |
$260.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.98
|
| Rate for Payer: Healthscope Commercial |
$201.97
|
| Rate for Payer: Healthscope Commercial |
$272.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$211.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$179.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.31
|
| Rate for Payer: PHP Commercial |
$190.75
|
| Rate for Payer: PHP Commercial |
$257.10
|
| Rate for Payer: Priority Health SBD |
$141.38
|
| Rate for Payer: Priority Health SBD |
$190.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.89
|
| Rate for Payer: UHC Core |
$0.89
|
| Rate for Payer: UHC Core |
$0.89
|
| Rate for Payer: UHC Exchange |
$0.89
|
| Rate for Payer: UHC Exchange |
$0.89
|
| Rate for Payer: UMR Bronson Commercial |
$83.03
|
| Rate for Payer: UMR Bronson Commercial |
$111.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.85
|
|
|
TEMOZOLOMIDE 140 MG CAPSULE
|
Facility
|
IP
|
$76.30
|
|
|
Service Code
|
HCPCS J8700
|
| Hospital Charge Code |
81461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.57 |
| Max. Negotiated Rate |
$68.67 |
| Rate for Payer: Aetna American Axle |
$49.59
|
| Rate for Payer: Aetna American Axle |
$174.20
|
| Rate for Payer: Aetna American Axle |
$568.33
|
| Rate for Payer: Aetna American Axle |
$1,214.51
|
| Rate for Payer: Aetna American Axle |
$80.97
|
| Rate for Payer: Aetna Commercial |
$105.88
|
| Rate for Payer: Aetna Commercial |
$227.80
|
| Rate for Payer: Aetna Commercial |
$64.86
|
| Rate for Payer: Aetna Commercial |
$743.20
|
| Rate for Payer: Aetna Commercial |
$1,588.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,214.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$568.33
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Cash Price |
$1,494.78
|
| Rate for Payer: Cash Price |
$699.48
|
| Rate for Payer: Cash Price |
$61.04
|
| Rate for Payer: Cash Price |
$99.66
|
| Rate for Payer: Cofinity Advantage |
$87.20
|
| Rate for Payer: Cofinity Advantage |
$612.04
|
| Rate for Payer: Cofinity Advantage |
$1,307.93
|
| Rate for Payer: Cofinity Advantage |
$53.41
|
| Rate for Payer: Cofinity Advantage |
$187.60
|
| Rate for Payer: Cofinity Commercial |
$751.94
|
| Rate for Payer: Cofinity Commercial |
$107.13
|
| Rate for Payer: Cofinity Commercial |
$1,606.88
|
| Rate for Payer: Cofinity Commercial |
$230.48
|
| Rate for Payer: Cofinity Commercial |
$65.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,494.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$699.48
|
| Rate for Payer: Healthscope Commercial |
$112.11
|
| Rate for Payer: Healthscope Commercial |
$1,681.62
|
| Rate for Payer: Healthscope Commercial |
$241.20
|
| Rate for Payer: Healthscope Commercial |
$68.67
|
| Rate for Payer: Healthscope Commercial |
$786.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,307.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$612.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,401.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$655.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,588.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$743.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$201.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,401.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$655.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.23
|
| Rate for Payer: PHP Commercial |
$227.80
|
| Rate for Payer: PHP Commercial |
$105.88
|
| Rate for Payer: PHP Commercial |
$64.86
|
| Rate for Payer: PHP Commercial |
$743.20
|
| Rate for Payer: PHP Commercial |
$1,588.20
|
| Rate for Payer: Priority Health SBD |
$48.07
|
| Rate for Payer: Priority Health SBD |
$550.84
|
| Rate for Payer: Priority Health SBD |
$1,177.14
|
| Rate for Payer: Priority Health SBD |
$78.48
|
| Rate for Payer: Priority Health SBD |
$168.84
|
| Rate for Payer: UMR Bronson Commercial |
$822.13
|
| Rate for Payer: UMR Bronson Commercial |
$384.71
|
| Rate for Payer: UMR Bronson Commercial |
$117.92
|
| Rate for Payer: UMR Bronson Commercial |
$54.81
|
| Rate for Payer: UMR Bronson Commercial |
$33.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$655.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,401.35
|
|
|
TEMOZOLOMIDE 140 MG CAPSULE
|
Facility
|
OP
|
$124.57
|
|
|
Service Code
|
HCPCS J8700
|
| Hospital Charge Code |
81461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$112.11 |
| Rate for Payer: Aetna American Axle |
$80.97
|
| Rate for Payer: Aetna American Axle |
$49.59
|
| Rate for Payer: Aetna American Axle |
$174.20
|
| Rate for Payer: Aetna American Axle |
$1,214.51
|
| Rate for Payer: Aetna American Axle |
$568.33
|
| Rate for Payer: Aetna Commercial |
$105.88
|
| Rate for Payer: Aetna Commercial |
$1,588.20
|
| Rate for Payer: Aetna Commercial |
$743.20
|
| Rate for Payer: Aetna Commercial |
$64.86
|
| Rate for Payer: Aetna Commercial |
$227.80
|
| Rate for Payer: Aetna Medicare |
$437.18
|
| Rate for Payer: Aetna Medicare |
$934.24
|
| Rate for Payer: Aetna Medicare |
$62.28
|
| Rate for Payer: Aetna Medicare |
$134.00
|
| Rate for Payer: Aetna Medicare |
$38.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,214.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$568.33
|
| Rate for Payer: BCBS Complete |
$30.52
|
| Rate for Payer: BCBS Complete |
$49.83
|
| Rate for Payer: BCBS Complete |
$747.39
|
| Rate for Payer: BCBS Complete |
$107.20
|
| Rate for Payer: BCBS Complete |
$349.74
|
| Rate for Payer: BCBS Trust/PPO |
$1.75
|
| Rate for Payer: BCBS Trust/PPO |
$1.75
|
| Rate for Payer: BCBS Trust/PPO |
$1.75
|
| Rate for Payer: BCBS Trust/PPO |
$1.75
|
| Rate for Payer: BCBS Trust/PPO |
$1.75
|
| Rate for Payer: BCN Commercial |
$1.75
|
| Rate for Payer: BCN Commercial |
$1.75
|
| Rate for Payer: BCN Commercial |
$1.75
|
| Rate for Payer: BCN Commercial |
$1.75
|
| Rate for Payer: BCN Commercial |
$1.75
|
| Rate for Payer: Cash Price |
$61.04
|
| Rate for Payer: Cash Price |
$699.48
|
| Rate for Payer: Cash Price |
$1,494.78
|
| Rate for Payer: Cash Price |
$99.66
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Cash Price |
$99.66
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Cash Price |
$61.04
|
| Rate for Payer: Cash Price |
$1,494.78
|
| Rate for Payer: Cash Price |
$699.48
|
| Rate for Payer: Cofinity Advantage |
$53.41
|
| Rate for Payer: Cofinity Advantage |
$1,307.93
|
| Rate for Payer: Cofinity Advantage |
$187.60
|
| Rate for Payer: Cofinity Advantage |
$612.04
|
| Rate for Payer: Cofinity Advantage |
$87.20
|
| Rate for Payer: Cofinity Commercial |
$65.62
|
| Rate for Payer: Cofinity Commercial |
$107.13
|
| Rate for Payer: Cofinity Commercial |
$1,606.88
|
| Rate for Payer: Cofinity Commercial |
$230.48
|
| Rate for Payer: Cofinity Commercial |
$751.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$699.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,494.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.40
|
| Rate for Payer: Healthscope Commercial |
$241.20
|
| Rate for Payer: Healthscope Commercial |
$786.91
|
| Rate for Payer: Healthscope Commercial |
$68.67
|
| Rate for Payer: Healthscope Commercial |
$112.11
|
| Rate for Payer: Healthscope Commercial |
$1,681.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,307.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$612.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$655.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,401.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$699.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,494.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$214.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,588.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$743.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$201.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,401.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$655.76
|
| Rate for Payer: PHP Commercial |
$1,588.20
|
| Rate for Payer: PHP Commercial |
$227.80
|
| Rate for Payer: PHP Commercial |
$743.20
|
| Rate for Payer: PHP Commercial |
$64.86
|
| Rate for Payer: PHP Commercial |
$105.88
|
| Rate for Payer: Priority Health SBD |
$168.84
|
| Rate for Payer: Priority Health SBD |
$78.48
|
| Rate for Payer: Priority Health SBD |
$48.07
|
| Rate for Payer: Priority Health SBD |
$550.84
|
| Rate for Payer: Priority Health SBD |
$1,177.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.89
|
| Rate for Payer: UHC Core |
$0.89
|
| Rate for Payer: UHC Core |
$0.89
|
| Rate for Payer: UHC Core |
$0.89
|
| Rate for Payer: UHC Core |
$0.89
|
| Rate for Payer: UHC Core |
$0.89
|
| Rate for Payer: UHC Exchange |
$0.89
|
| Rate for Payer: UHC Exchange |
$0.89
|
| Rate for Payer: UHC Exchange |
$0.89
|
| Rate for Payer: UHC Exchange |
$0.89
|
| Rate for Payer: UHC Exchange |
$0.89
|
| Rate for Payer: UMR Bronson Commercial |
$46.09
|
| Rate for Payer: UMR Bronson Commercial |
$28.23
|
| Rate for Payer: UMR Bronson Commercial |
$99.16
|
| Rate for Payer: UMR Bronson Commercial |
$323.51
|
| Rate for Payer: UMR Bronson Commercial |
$691.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$655.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,401.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.43
|
|
|
TEMSIROLIMUS 30 MG/3 ML (10 MG/ML) (FIRST DILUTION) INTRAVENOUS SOLN
|
Facility
|
OP
|
$7,785.57
|
|
|
Service Code
|
HCPCS J9330
|
| Hospital Charge Code |
82228
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.73 |
| Max. Negotiated Rate |
$7,007.01 |
| Rate for Payer: Aetna American Axle |
$5,060.62
|
| Rate for Payer: Aetna American Axle |
$1,791.29
|
| Rate for Payer: Aetna American Axle |
$1,980.23
|
| Rate for Payer: Aetna Commercial |
$6,617.73
|
| Rate for Payer: Aetna Commercial |
$2,589.53
|
| Rate for Payer: Aetna Commercial |
$2,342.46
|
| Rate for Payer: Aetna Medicare |
$31.28
|
| Rate for Payer: Aetna Medicare |
$31.28
|
| Rate for Payer: Aetna Medicare |
$31.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,060.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,791.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,980.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.60
|
| Rate for Payer: BCBS Complete |
$16.52
|
| Rate for Payer: BCBS Complete |
$16.52
|
| Rate for Payer: BCBS Complete |
$16.52
|
| Rate for Payer: BCBS MAPPO |
$30.08
|
| Rate for Payer: BCBS MAPPO |
$30.08
|
| Rate for Payer: BCBS MAPPO |
$30.08
|
| Rate for Payer: BCBS Trust/PPO |
$65.85
|
| Rate for Payer: BCBS Trust/PPO |
$65.85
|
| Rate for Payer: BCBS Trust/PPO |
$65.85
|
| Rate for Payer: BCN Commercial |
$65.85
|
| Rate for Payer: BCN Commercial |
$65.85
|
| Rate for Payer: BCN Commercial |
$65.85
|
| Rate for Payer: BCN Medicare Advantage |
$30.08
|
| Rate for Payer: BCN Medicare Advantage |
$30.08
|
| Rate for Payer: BCN Medicare Advantage |
$30.08
|
| Rate for Payer: Cash Price |
$2,437.21
|
| Rate for Payer: Cash Price |
$6,228.46
|
| Rate for Payer: Cash Price |
$2,204.66
|
| Rate for Payer: Cash Price |
$6,228.46
|
| Rate for Payer: Cash Price |
$2,437.21
|
| Rate for Payer: Cash Price |
$2,204.66
|
| Rate for Payer: Cofinity Advantage |
$1,929.08
|
| Rate for Payer: Cofinity Advantage |
$2,132.56
|
| Rate for Payer: Cofinity Advantage |
$5,449.90
|
| Rate for Payer: Cofinity Commercial |
$2,620.00
|
| Rate for Payer: Cofinity Commercial |
$6,695.59
|
| Rate for Payer: Cofinity Commercial |
$2,370.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,204.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,437.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,228.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.08
|
| Rate for Payer: Healthscope Commercial |
$2,480.25
|
| Rate for Payer: Healthscope Commercial |
$2,741.86
|
| Rate for Payer: Healthscope Commercial |
$7,007.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,132.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,929.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,449.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,284.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,839.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,066.87
|
| Rate for Payer: Mclaren Medicaid |
$30.08
|
| Rate for Payer: Mclaren Medicaid |
$30.08
|
| Rate for Payer: Mclaren Medicaid |
$30.08
|
| Rate for Payer: Mclaren Medicare |
$30.08
|
| Rate for Payer: Mclaren Medicare |
$30.08
|
| Rate for Payer: Mclaren Medicare |
$30.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.58
|
| Rate for Payer: Meridian Medicaid |
$31.58
|
| Rate for Payer: Meridian Medicaid |
$31.58
|
| Rate for Payer: Meridian Medicaid |
$31.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$33.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$33.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$33.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,342.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,589.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,617.73
|
| Rate for Payer: Nomi Health Commercial |
$90.24
|
| Rate for Payer: Nomi Health Commercial |
$90.24
|
| Rate for Payer: Nomi Health Commercial |
$90.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,066.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,284.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,839.18
|
| Rate for Payer: PACE Medicare |
$28.58
|
| Rate for Payer: PACE Medicare |
$28.58
|
| Rate for Payer: PACE Medicare |
$28.58
|
| Rate for Payer: PACE SWMI |
$30.08
|
| Rate for Payer: PACE SWMI |
$30.08
|
| Rate for Payer: PACE SWMI |
$30.08
|
| Rate for Payer: PHP Commercial |
$6,617.73
|
| Rate for Payer: PHP Commercial |
$2,342.46
|
| Rate for Payer: PHP Commercial |
$2,589.53
|
| Rate for Payer: PHP Medicare Advantage |
$30.08
|
| Rate for Payer: PHP Medicare Advantage |
$30.08
|
| Rate for Payer: PHP Medicare Advantage |
$30.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$84.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$84.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$84.25
|
| Rate for Payer: Priority Health Medicare |
$30.08
|
| Rate for Payer: Priority Health Medicare |
$30.08
|
| Rate for Payer: Priority Health Medicare |
$30.08
|
| Rate for Payer: Priority Health SBD |
$4,904.91
|
| Rate for Payer: Priority Health SBD |
$1,919.30
|
| Rate for Payer: Priority Health SBD |
$1,736.17
|
| Rate for Payer: Priority Health Tiered Network |
$67.40
|
| Rate for Payer: Priority Health Tiered Network |
$67.40
|
| Rate for Payer: Priority Health Tiered Network |
$67.40
|
| Rate for Payer: Railroad Medicare Medicare |
$30.08
|
| Rate for Payer: Railroad Medicare Medicare |
$30.08
|
| Rate for Payer: Railroad Medicare Medicare |
$30.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.53
|
| Rate for Payer: UHC Core |
$33.53
|
| Rate for Payer: UHC Core |
$33.53
|
| Rate for Payer: UHC Core |
$33.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$30.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$30.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$30.08
|
| Rate for Payer: UHC Exchange |
$33.53
|
| Rate for Payer: UHC Exchange |
$33.53
|
| Rate for Payer: UHC Exchange |
$33.53
|
| Rate for Payer: UHC Medicaid |
$15.73
|
| Rate for Payer: UHC Medicaid |
$15.73
|
| Rate for Payer: UHC Medicaid |
$15.73
|
| Rate for Payer: UHCCP Medicaid |
$15.73
|
| Rate for Payer: UHCCP Medicaid |
$15.73
|
| Rate for Payer: UHCCP Medicaid |
$15.73
|
| Rate for Payer: UMR Bronson Commercial |
$1,127.21
|
| Rate for Payer: UMR Bronson Commercial |
$1,019.66
|
| Rate for Payer: UMR Bronson Commercial |
$2,880.66
|
| Rate for Payer: VA VA |
$30.08
|
| Rate for Payer: VA VA |
$30.08
|
| Rate for Payer: VA VA |
$30.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,066.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,839.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,284.88
|
|
|
TEMSIROLIMUS 30 MG/3 ML (10 MG/ML) (FIRST DILUTION) INTRAVENOUS SOLN
|
Facility
|
IP
|
$7,785.57
|
|
|
Service Code
|
HCPCS J9330
|
| Hospital Charge Code |
82228
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,425.65 |
| Max. Negotiated Rate |
$7,007.01 |
| Rate for Payer: Aetna American Axle |
$5,060.62
|
| Rate for Payer: Aetna American Axle |
$1,791.29
|
| Rate for Payer: Aetna American Axle |
$1,980.23
|
| Rate for Payer: Aetna Commercial |
$6,617.73
|
| Rate for Payer: Aetna Commercial |
$2,589.53
|
| Rate for Payer: Aetna Commercial |
$2,342.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,060.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,791.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,980.23
|
| Rate for Payer: Cash Price |
$2,437.21
|
| Rate for Payer: Cash Price |
$2,204.66
|
| Rate for Payer: Cash Price |
$6,228.46
|
| Rate for Payer: Cofinity Advantage |
$2,132.56
|
| Rate for Payer: Cofinity Advantage |
$1,929.08
|
| Rate for Payer: Cofinity Advantage |
$5,449.90
|
| Rate for Payer: Cofinity Commercial |
$6,695.59
|
| Rate for Payer: Cofinity Commercial |
$2,620.00
|
| Rate for Payer: Cofinity Commercial |
$2,370.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,437.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,228.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,204.66
|
| Rate for Payer: Healthscope Commercial |
$2,741.86
|
| Rate for Payer: Healthscope Commercial |
$2,480.25
|
| Rate for Payer: Healthscope Commercial |
$7,007.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,929.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,132.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,449.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,066.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,839.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,284.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,342.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,617.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,589.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,284.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,066.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,839.18
|
| Rate for Payer: PHP Commercial |
$2,589.53
|
| Rate for Payer: PHP Commercial |
$2,342.46
|
| Rate for Payer: PHP Commercial |
$6,617.73
|
| Rate for Payer: Priority Health SBD |
$1,736.17
|
| Rate for Payer: Priority Health SBD |
$1,919.30
|
| Rate for Payer: Priority Health SBD |
$4,904.91
|
| Rate for Payer: UMR Bronson Commercial |
$1,340.46
|
| Rate for Payer: UMR Bronson Commercial |
$1,212.57
|
| Rate for Payer: UMR Bronson Commercial |
$3,425.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,066.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,284.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,839.18
|
|
|
TENDONITIS, MYOSITIS AND BURSITIS WITH MCC
|
Facility
|
IP
|
$35,628.65
|
|
|
Service Code
|
MSDRG 557
|
| Min. Negotiated Rate |
$12,376.09 |
| Max. Negotiated Rate |
$35,628.65 |
| Rate for Payer: Aetna Medicare |
$13,548.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,284.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,284.33
|
| Rate for Payer: BCBS MAPPO |
$13,027.46
|
| Rate for Payer: BCBS Trust/PPO |
$35,628.65
|
| Rate for Payer: BCN Commercial |
$35,628.65
|
| Rate for Payer: BCN Medicare Advantage |
$13,027.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,027.46
|
| Rate for Payer: Mclaren Medicare |
$13,027.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,678.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,981.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,330.21
|
| Rate for Payer: Nomi Health Commercial |
$19,181.01
|
| Rate for Payer: PACE Medicare |
$12,376.09
|
| Rate for Payer: PACE SWMI |
$13,027.46
|
| Rate for Payer: PHP Medicare Advantage |
$13,027.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,972.01
|
| Rate for Payer: Priority Health Medicare |
$13,027.46
|
| Rate for Payer: Priority Health Tiered Network |
$19,177.60
|
| Rate for Payer: Railroad Medicare Medicare |
$13,027.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,236.47
|
| Rate for Payer: UHC Core |
$20,276.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,027.46
|
| Rate for Payer: UHC Exchange |
$16,559.61
|
| Rate for Payer: VA VA |
$13,027.46
|
|
|
TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC
|
Facility
|
IP
|
$14,559.16
|
|
|
Service Code
|
MSDRG 558
|
| Min. Negotiated Rate |
$7,659.39 |
| Max. Negotiated Rate |
$14,559.16 |
| Rate for Payer: Aetna Medicare |
$8,385.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,078.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,078.15
|
| Rate for Payer: BCBS MAPPO |
$8,062.52
|
| Rate for Payer: BCBS Trust/PPO |
$11,650.20
|
| Rate for Payer: BCN Commercial |
$11,650.20
|
| Rate for Payer: BCN Medicare Advantage |
$8,062.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,062.52
|
| Rate for Payer: Mclaren Medicare |
$8,062.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,465.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,271.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,868.77
|
| Rate for Payer: Nomi Health Commercial |
$11,522.28
|
| Rate for Payer: PACE Medicare |
$7,659.39
|
| Rate for Payer: PACE SWMI |
$8,062.52
|
| Rate for Payer: PHP Medicare Advantage |
$8,062.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14,400.30
|
| Rate for Payer: Priority Health Medicare |
$8,062.52
|
| Rate for Payer: Priority Health Tiered Network |
$11,520.23
|
| Rate for Payer: Railroad Medicare Medicare |
$8,062.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,559.16
|
| Rate for Payer: UHC Core |
$12,180.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,062.52
|
| Rate for Payer: UHC Exchange |
$9,947.57
|
| Rate for Payer: VA VA |
$8,062.52
|
|
|
TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES
|
Facility
|
IP
|
$19,849.82
|
|
|
Service Code
|
APR-DRG 3174
|
| Min. Negotiated Rate |
$18,904.59 |
| Max. Negotiated Rate |
$19,849.82 |
| Rate for Payer: BCBS Complete |
$19,849.82
|
| Rate for Payer: Mclaren Medicaid |
$18,904.59
|
| Rate for Payer: Meridian Medicaid |
$19,849.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$18,904.59
|
| Rate for Payer: UHC Medicaid |
$18,904.59
|
| Rate for Payer: UHCCP Medicaid |
$18,904.59
|
|
|
TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES
|
Facility
|
IP
|
$8,279.03
|
|
|
Service Code
|
APR-DRG 3171
|
| Min. Negotiated Rate |
$7,884.79 |
| Max. Negotiated Rate |
$8,279.03 |
| Rate for Payer: BCBS Complete |
$8,279.03
|
| Rate for Payer: Mclaren Medicaid |
$7,884.79
|
| Rate for Payer: Meridian Medicaid |
$8,279.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,884.79
|
| Rate for Payer: UHC Medicaid |
$7,884.79
|
| Rate for Payer: UHCCP Medicaid |
$7,884.79
|
|
|
TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES
|
Facility
|
IP
|
$12,913.40
|
|
|
Service Code
|
APR-DRG 3173
|
| Min. Negotiated Rate |
$12,298.47 |
| Max. Negotiated Rate |
$12,913.40 |
| Rate for Payer: BCBS Complete |
$12,913.40
|
| Rate for Payer: Mclaren Medicaid |
$12,298.47
|
| Rate for Payer: Meridian Medicaid |
$12,913.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,298.47
|
| Rate for Payer: UHC Medicaid |
$12,298.47
|
| Rate for Payer: UHCCP Medicaid |
$12,298.47
|
|
|
TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES
|
Facility
|
IP
|
$10,687.62
|
|
|
Service Code
|
APR-DRG 3172
|
| Min. Negotiated Rate |
$10,178.68 |
| Max. Negotiated Rate |
$10,687.62 |
| Rate for Payer: BCBS Complete |
$10,687.62
|
| Rate for Payer: Mclaren Medicaid |
$10,178.68
|
| Rate for Payer: Meridian Medicaid |
$10,687.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,178.68
|
| Rate for Payer: UHC Medicaid |
$10,178.68
|
| Rate for Payer: UHCCP Medicaid |
$10,178.68
|
|
|
TENDON SHEATH INCISION (EG, FOR TRIGGER FINGER)
|
Facility
|
OP
|
$5,181.40
|
|
|
Service Code
|
CPT 26055
|
|
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 |
$1,857.88
|
| Rate for Payer: BCN Commercial |
$1,857.88
|
| 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
|
|
|
TENDON TRANSPLANTATION OR TRANSFER, FLEXOR OR EXTENSOR, FOREARM AND/OR WRIST, SINGLE; EACH TENDON
|
Facility
|
OP
|
$10,543.31
|
|
|
Service Code
|
CPT 25310
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,705.10 |
| Max. Negotiated Rate |
$10,543.31 |
| Rate for Payer: Aetna Medicare |
$3,390.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$3,190.94
|
| Rate for Payer: BCN Commercial |
$3,190.94
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Mclaren Medicaid |
$3,260.23
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$3,423.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Nomi Health Commercial |
$9,780.69
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,543.31
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health Tiered Network |
$8,434.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
TENECTEPLASE 25 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$30,830.37
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
212669
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.26 |
| Max. Negotiated Rate |
$27,747.33 |
| Rate for Payer: Aetna American Axle |
$20,039.74
|
| Rate for Payer: Aetna Commercial |
$26,205.81
|
| Rate for Payer: Aetna Medicare |
$205.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20,039.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$246.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$246.80
|
| Rate for Payer: BCBS Complete |
$108.43
|
| Rate for Payer: BCBS MAPPO |
$197.44
|
| Rate for Payer: BCBS Trust/PPO |
$606.25
|
| Rate for Payer: BCN Commercial |
$606.25
|
| Rate for Payer: BCN Medicare Advantage |
$197.44
|
| Rate for Payer: Cash Price |
$24,664.30
|
| Rate for Payer: Cash Price |
$24,664.30
|
| Rate for Payer: Cofinity Advantage |
$21,581.26
|
| Rate for Payer: Cofinity Commercial |
$26,514.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,664.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.44
|
| Rate for Payer: Healthscope Commercial |
$27,747.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21,581.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23,122.78
|
| Rate for Payer: Mclaren Medicaid |
$197.44
|
| Rate for Payer: Mclaren Medicare |
$197.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$207.31
|
| Rate for Payer: Meridian Medicaid |
$207.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$227.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$217.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26,205.81
|
| Rate for Payer: Nomi Health Commercial |
$592.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23,122.78
|
| Rate for Payer: PACE Medicare |
$187.57
|
| Rate for Payer: PACE SWMI |
$197.44
|
| Rate for Payer: PHP Commercial |
$26,205.81
|
| Rate for Payer: PHP Medicare Advantage |
$197.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$543.17
|
| Rate for Payer: Priority Health Medicare |
$197.44
|
| Rate for Payer: Priority Health SBD |
$19,423.13
|
| Rate for Payer: Priority Health Tiered Network |
$434.54
|
| Rate for Payer: Railroad Medicare Medicare |
$197.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.50
|
| Rate for Payer: UHC Core |
$308.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$197.44
|
| Rate for Payer: UHC Exchange |
$308.50
|
| Rate for Payer: UHC Medicaid |
$103.26
|
| Rate for Payer: UHCCP Medicaid |
$103.26
|
| Rate for Payer: UMR Bronson Commercial |
$11,407.24
|
| Rate for Payer: VA VA |
$197.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23,122.78
|
|
