|
TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE
|
Facility
|
IP
|
$353.76
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
24914
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$155.65 |
| Max. Negotiated Rate |
$318.38 |
| Rate for Payer: Aetna American Axle |
$229.94
|
| Rate for Payer: Aetna American Axle |
$803.51
|
| Rate for Payer: Aetna American Axle |
$282.36
|
| Rate for Payer: Aetna Commercial |
$300.70
|
| Rate for Payer: Aetna Commercial |
$1,050.74
|
| Rate for Payer: Aetna Commercial |
$369.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$282.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$803.51
|
| Rate for Payer: Cash Price |
$347.52
|
| Rate for Payer: Cash Price |
$283.01
|
| Rate for Payer: Cash Price |
$988.94
|
| Rate for Payer: Cofinity Commercial |
$865.32
|
| Rate for Payer: Cofinity Commercial |
$1,063.11
|
| Rate for Payer: Cofinity Commercial |
$247.63
|
| Rate for Payer: Cofinity Commercial |
$304.23
|
| Rate for Payer: Cofinity Commercial |
$304.08
|
| Rate for Payer: Cofinity Commercial |
$373.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$865.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$304.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$247.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$988.94
|
| Rate for Payer: Healthscope Commercial |
$390.96
|
| Rate for Payer: Healthscope Commercial |
$1,112.55
|
| Rate for Payer: Healthscope Commercial |
$318.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$247.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$865.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$304.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$325.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$927.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,050.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$369.24
|
| Rate for Payer: PHP Commercial |
$1,050.74
|
| Rate for Payer: PHP Commercial |
$369.24
|
| Rate for Payer: PHP Commercial |
$300.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$803.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.36
|
| Rate for Payer: Priority Health SBD |
$222.87
|
| Rate for Payer: Priority Health SBD |
$778.79
|
| Rate for Payer: Priority Health SBD |
$273.67
|
| Rate for Payer: UMR Bronson Commercial |
$191.14
|
| Rate for Payer: UMR Bronson Commercial |
$155.65
|
| Rate for Payer: UMR Bronson Commercial |
$543.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$927.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$325.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.32
|
|
|
TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE
|
Facility
|
OP
|
$434.40
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
24914
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$160.73 |
| Max. Negotiated Rate |
$390.96 |
| Rate for Payer: Aetna American Axle |
$282.36
|
| Rate for Payer: Aetna American Axle |
$803.51
|
| Rate for Payer: Aetna American Axle |
$229.94
|
| Rate for Payer: Aetna Commercial |
$369.24
|
| Rate for Payer: Aetna Commercial |
$300.70
|
| Rate for Payer: Aetna Commercial |
$1,050.74
|
| Rate for Payer: Aetna Medicare |
$217.20
|
| Rate for Payer: Aetna Medicare |
$176.88
|
| Rate for Payer: Aetna Medicare |
$618.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$282.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$803.51
|
| Rate for Payer: BCBS Complete |
$494.47
|
| Rate for Payer: BCBS Complete |
$141.50
|
| Rate for Payer: BCBS Complete |
$173.76
|
| Rate for Payer: Cash Price |
$347.52
|
| Rate for Payer: Cash Price |
$283.01
|
| Rate for Payer: Cash Price |
$988.94
|
| Rate for Payer: Cofinity Commercial |
$304.23
|
| Rate for Payer: Cofinity Commercial |
$1,063.11
|
| Rate for Payer: Cofinity Commercial |
$865.32
|
| Rate for Payer: Cofinity Commercial |
$373.58
|
| Rate for Payer: Cofinity Commercial |
$304.08
|
| Rate for Payer: Cofinity Commercial |
$247.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$865.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$247.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$304.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$988.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.52
|
| Rate for Payer: Healthscope Commercial |
$1,112.55
|
| Rate for Payer: Healthscope Commercial |
$318.38
|
| Rate for Payer: Healthscope Commercial |
$390.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$247.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$865.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$304.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$927.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$325.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,050.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$369.24
|
| Rate for Payer: PHP Commercial |
$1,050.74
|
| Rate for Payer: PHP Commercial |
$300.70
|
| Rate for Payer: PHP Commercial |
$369.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$803.51
|
| Rate for Payer: Priority Health SBD |
$222.87
|
| Rate for Payer: Priority Health SBD |
$778.79
|
| Rate for Payer: Priority Health SBD |
$273.67
|
| Rate for Payer: UMR Bronson Commercial |
$160.73
|
| Rate for Payer: UMR Bronson Commercial |
$457.38
|
| Rate for Payer: UMR Bronson Commercial |
$130.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$927.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$325.80
|
|
|
TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE
|
Facility
|
IP
|
$509.28
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
12933
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$224.08 |
| Max. Negotiated Rate |
$458.35 |
| Rate for Payer: Aetna American Axle |
$331.03
|
| Rate for Payer: Aetna American Axle |
$169.42
|
| Rate for Payer: Aetna American Axle |
$1,606.78
|
| Rate for Payer: Aetna American Axle |
$378.14
|
| Rate for Payer: Aetna Commercial |
$432.89
|
| Rate for Payer: Aetna Commercial |
$494.50
|
| Rate for Payer: Aetna Commercial |
$221.54
|
| Rate for Payer: Aetna Commercial |
$2,101.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,606.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$378.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.03
|
| Rate for Payer: Cash Price |
$208.51
|
| Rate for Payer: Cash Price |
$407.42
|
| Rate for Payer: Cash Price |
$1,977.58
|
| Rate for Payer: Cash Price |
$465.41
|
| Rate for Payer: Cofinity Commercial |
$1,730.38
|
| Rate for Payer: Cofinity Commercial |
$500.31
|
| Rate for Payer: Cofinity Commercial |
$407.23
|
| Rate for Payer: Cofinity Commercial |
$356.50
|
| Rate for Payer: Cofinity Commercial |
$182.45
|
| Rate for Payer: Cofinity Commercial |
$224.15
|
| Rate for Payer: Cofinity Commercial |
$437.98
|
| Rate for Payer: Cofinity Commercial |
$2,125.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$182.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$356.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$407.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,730.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,977.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$465.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$407.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.51
|
| Rate for Payer: Healthscope Commercial |
$458.35
|
| Rate for Payer: Healthscope Commercial |
$2,224.77
|
| Rate for Payer: Healthscope Commercial |
$234.58
|
| Rate for Payer: Healthscope Commercial |
$523.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,730.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$407.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$356.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,853.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$381.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$436.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$494.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,101.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$432.89
|
| Rate for Payer: PHP Commercial |
$432.89
|
| Rate for Payer: PHP Commercial |
$494.50
|
| Rate for Payer: PHP Commercial |
$2,101.17
|
| Rate for Payer: PHP Commercial |
$221.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$378.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,606.78
|
| Rate for Payer: Priority Health SBD |
$366.51
|
| Rate for Payer: Priority Health SBD |
$1,557.34
|
| Rate for Payer: Priority Health SBD |
$164.20
|
| Rate for Payer: Priority Health SBD |
$320.85
|
| Rate for Payer: UMR Bronson Commercial |
$224.08
|
| Rate for Payer: UMR Bronson Commercial |
$255.97
|
| Rate for Payer: UMR Bronson Commercial |
$114.68
|
| Rate for Payer: UMR Bronson Commercial |
$1,087.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$436.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,853.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$381.96
|
|
|
TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE
|
Facility
|
OP
|
$260.64
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
12933
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$96.44 |
| Max. Negotiated Rate |
$234.58 |
| Rate for Payer: Aetna American Axle |
$169.42
|
| Rate for Payer: Aetna American Axle |
$378.14
|
| Rate for Payer: Aetna American Axle |
$1,606.78
|
| Rate for Payer: Aetna American Axle |
$331.03
|
| Rate for Payer: Aetna Commercial |
$494.50
|
| Rate for Payer: Aetna Commercial |
$221.54
|
| Rate for Payer: Aetna Commercial |
$432.89
|
| Rate for Payer: Aetna Commercial |
$2,101.17
|
| Rate for Payer: Aetna Medicare |
$254.64
|
| Rate for Payer: Aetna Medicare |
$1,235.98
|
| Rate for Payer: Aetna Medicare |
$290.88
|
| Rate for Payer: Aetna Medicare |
$130.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$378.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,606.78
|
| Rate for Payer: BCBS Complete |
$988.79
|
| Rate for Payer: BCBS Complete |
$232.70
|
| Rate for Payer: BCBS Complete |
$203.71
|
| Rate for Payer: BCBS Complete |
$104.26
|
| Rate for Payer: Cash Price |
$208.51
|
| Rate for Payer: Cash Price |
$407.42
|
| Rate for Payer: Cash Price |
$1,977.58
|
| Rate for Payer: Cash Price |
$465.41
|
| Rate for Payer: Cofinity Commercial |
$224.15
|
| Rate for Payer: Cofinity Commercial |
$500.31
|
| Rate for Payer: Cofinity Commercial |
$1,730.38
|
| Rate for Payer: Cofinity Commercial |
$437.98
|
| Rate for Payer: Cofinity Commercial |
$356.50
|
| Rate for Payer: Cofinity Commercial |
$407.23
|
| Rate for Payer: Cofinity Commercial |
$2,125.89
|
| Rate for Payer: Cofinity Commercial |
$182.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,730.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$182.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$356.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$407.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,977.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$465.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$407.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.51
|
| Rate for Payer: Healthscope Commercial |
$458.35
|
| Rate for Payer: Healthscope Commercial |
$2,224.77
|
| Rate for Payer: Healthscope Commercial |
$234.58
|
| Rate for Payer: Healthscope Commercial |
$523.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$407.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$356.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,730.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,853.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$381.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$436.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,101.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$494.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$432.89
|
| Rate for Payer: PHP Commercial |
$432.89
|
| Rate for Payer: PHP Commercial |
$221.54
|
| Rate for Payer: PHP Commercial |
$494.50
|
| Rate for Payer: PHP Commercial |
$2,101.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$378.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,606.78
|
| Rate for Payer: Priority Health SBD |
$320.85
|
| Rate for Payer: Priority Health SBD |
$366.51
|
| Rate for Payer: Priority Health SBD |
$164.20
|
| Rate for Payer: Priority Health SBD |
$1,557.34
|
| Rate for Payer: UMR Bronson Commercial |
$188.43
|
| Rate for Payer: UMR Bronson Commercial |
$96.44
|
| Rate for Payer: UMR Bronson Commercial |
$215.25
|
| Rate for Payer: UMR Bronson Commercial |
$914.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,853.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$381.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$436.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.48
|
|
|
TACROLIMUS 5 MG CAPSULE, IMMEDIATE-RELEASE
|
Facility
|
IP
|
$1,003.44
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
12934
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$441.51 |
| Max. Negotiated Rate |
$903.10 |
| Rate for Payer: Aetna American Axle |
$652.24
|
| Rate for Payer: Aetna American Axle |
$1,811.93
|
| Rate for Payer: Aetna American Axle |
$17.34
|
| Rate for Payer: Aetna American Axle |
$1,647.18
|
| Rate for Payer: Aetna American Axle |
$1,733.28
|
| Rate for Payer: Aetna American Axle |
$497.95
|
| Rate for Payer: Aetna Commercial |
$852.92
|
| Rate for Payer: Aetna Commercial |
$2,154.01
|
| Rate for Payer: Aetna Commercial |
$22.67
|
| Rate for Payer: Aetna Commercial |
$651.17
|
| Rate for Payer: Aetna Commercial |
$2,369.44
|
| Rate for Payer: Aetna Commercial |
$2,266.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$652.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$497.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,647.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,733.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,811.93
|
| Rate for Payer: Cash Price |
$2,230.06
|
| Rate for Payer: Cash Price |
$21.34
|
| Rate for Payer: Cash Price |
$802.75
|
| Rate for Payer: Cash Price |
$2,133.27
|
| Rate for Payer: Cash Price |
$2,027.30
|
| Rate for Payer: Cash Price |
$612.86
|
| Rate for Payer: Cofinity Commercial |
$2,397.32
|
| Rate for Payer: Cofinity Commercial |
$702.41
|
| Rate for Payer: Cofinity Commercial |
$22.94
|
| Rate for Payer: Cofinity Commercial |
$18.67
|
| Rate for Payer: Cofinity Commercial |
$1,866.61
|
| Rate for Payer: Cofinity Commercial |
$1,773.89
|
| Rate for Payer: Cofinity Commercial |
$2,179.35
|
| Rate for Payer: Cofinity Commercial |
$2,293.27
|
| Rate for Payer: Cofinity Commercial |
$862.96
|
| Rate for Payer: Cofinity Commercial |
$658.83
|
| Rate for Payer: Cofinity Commercial |
$536.26
|
| Rate for Payer: Cofinity Commercial |
$1,951.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,773.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$536.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,951.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$702.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,866.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$802.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,230.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,133.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,027.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$612.86
|
| Rate for Payer: Healthscope Commercial |
$24.00
|
| Rate for Payer: Healthscope Commercial |
$689.47
|
| Rate for Payer: Healthscope Commercial |
$2,508.82
|
| Rate for Payer: Healthscope Commercial |
$2,280.72
|
| Rate for Payer: Healthscope Commercial |
$2,399.93
|
| Rate for Payer: Healthscope Commercial |
$903.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,951.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$702.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,773.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,866.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$536.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,090.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$574.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,900.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$752.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,999.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,369.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$651.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$852.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,154.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,266.60
|
| Rate for Payer: PHP Commercial |
$852.92
|
| Rate for Payer: PHP Commercial |
$2,154.01
|
| Rate for Payer: PHP Commercial |
$22.67
|
| Rate for Payer: PHP Commercial |
$2,369.44
|
| Rate for Payer: PHP Commercial |
$2,266.60
|
| Rate for Payer: PHP Commercial |
$651.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,647.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$652.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,811.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,733.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.95
|
| Rate for Payer: Priority Health SBD |
$1,756.18
|
| Rate for Payer: Priority Health SBD |
$16.80
|
| Rate for Payer: Priority Health SBD |
$632.17
|
| Rate for Payer: Priority Health SBD |
$1,596.50
|
| Rate for Payer: Priority Health SBD |
$1,679.95
|
| Rate for Payer: Priority Health SBD |
$482.63
|
| Rate for Payer: UMR Bronson Commercial |
$337.08
|
| Rate for Payer: UMR Bronson Commercial |
$1,115.02
|
| Rate for Payer: UMR Bronson Commercial |
$1,173.30
|
| Rate for Payer: UMR Bronson Commercial |
$1,226.54
|
| Rate for Payer: UMR Bronson Commercial |
$11.73
|
| Rate for Payer: UMR Bronson Commercial |
$441.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,900.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,999.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,090.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$574.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$752.58
|
|
|
TACROLIMUS 5 MG CAPSULE, IMMEDIATE-RELEASE
|
Facility
|
OP
|
$26.67
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
12934
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.87 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna American Axle |
$17.34
|
| Rate for Payer: Aetna American Axle |
$1,647.18
|
| Rate for Payer: Aetna American Axle |
$652.24
|
| Rate for Payer: Aetna American Axle |
$1,811.93
|
| Rate for Payer: Aetna American Axle |
$1,733.28
|
| Rate for Payer: Aetna American Axle |
$497.95
|
| Rate for Payer: Aetna Commercial |
$651.17
|
| Rate for Payer: Aetna Commercial |
$22.67
|
| Rate for Payer: Aetna Commercial |
$2,154.01
|
| Rate for Payer: Aetna Commercial |
$852.92
|
| Rate for Payer: Aetna Commercial |
$2,369.44
|
| Rate for Payer: Aetna Commercial |
$2,266.60
|
| Rate for Payer: Aetna Medicare |
$1,333.30
|
| Rate for Payer: Aetna Medicare |
$501.72
|
| Rate for Payer: Aetna Medicare |
$1,393.79
|
| Rate for Payer: Aetna Medicare |
$383.04
|
| Rate for Payer: Aetna Medicare |
$13.34
|
| Rate for Payer: Aetna Medicare |
$1,267.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,811.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,647.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,733.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$652.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$497.95
|
| Rate for Payer: BCBS Complete |
$306.43
|
| Rate for Payer: BCBS Complete |
$10.67
|
| Rate for Payer: BCBS Complete |
$1,013.65
|
| Rate for Payer: BCBS Complete |
$1,066.64
|
| Rate for Payer: BCBS Complete |
$1,115.03
|
| Rate for Payer: BCBS Complete |
$401.38
|
| Rate for Payer: Cash Price |
$2,027.30
|
| Rate for Payer: Cash Price |
$2,133.27
|
| Rate for Payer: Cash Price |
$21.34
|
| Rate for Payer: Cash Price |
$612.86
|
| Rate for Payer: Cash Price |
$2,230.06
|
| Rate for Payer: Cash Price |
$802.75
|
| Rate for Payer: Cofinity Commercial |
$658.83
|
| Rate for Payer: Cofinity Commercial |
$22.94
|
| Rate for Payer: Cofinity Commercial |
$702.41
|
| Rate for Payer: Cofinity Commercial |
$2,293.27
|
| Rate for Payer: Cofinity Commercial |
$1,866.61
|
| Rate for Payer: Cofinity Commercial |
$18.67
|
| Rate for Payer: Cofinity Commercial |
$862.96
|
| Rate for Payer: Cofinity Commercial |
$1,773.89
|
| Rate for Payer: Cofinity Commercial |
$2,179.35
|
| Rate for Payer: Cofinity Commercial |
$536.26
|
| Rate for Payer: Cofinity Commercial |
$2,397.32
|
| Rate for Payer: Cofinity Commercial |
$1,951.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,951.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,773.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$702.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,866.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$536.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,230.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,027.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$802.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,133.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$612.86
|
| Rate for Payer: Healthscope Commercial |
$2,280.72
|
| Rate for Payer: Healthscope Commercial |
$2,399.93
|
| Rate for Payer: Healthscope Commercial |
$903.10
|
| Rate for Payer: Healthscope Commercial |
$24.00
|
| Rate for Payer: Healthscope Commercial |
$689.47
|
| Rate for Payer: Healthscope Commercial |
$2,508.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,866.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,773.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$702.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$536.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,951.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,900.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$574.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,090.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$752.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,999.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$852.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,154.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$651.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,369.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,266.60
|
| Rate for Payer: PHP Commercial |
$852.92
|
| Rate for Payer: PHP Commercial |
$22.67
|
| Rate for Payer: PHP Commercial |
$2,266.60
|
| Rate for Payer: PHP Commercial |
$2,154.01
|
| Rate for Payer: PHP Commercial |
$2,369.44
|
| Rate for Payer: PHP Commercial |
$651.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$652.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,811.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,647.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,733.28
|
| Rate for Payer: Priority Health SBD |
$1,596.50
|
| Rate for Payer: Priority Health SBD |
$1,756.18
|
| Rate for Payer: Priority Health SBD |
$1,679.95
|
| Rate for Payer: Priority Health SBD |
$16.80
|
| Rate for Payer: Priority Health SBD |
$632.17
|
| Rate for Payer: Priority Health SBD |
$482.63
|
| Rate for Payer: UMR Bronson Commercial |
$283.45
|
| Rate for Payer: UMR Bronson Commercial |
$371.27
|
| Rate for Payer: UMR Bronson Commercial |
$937.63
|
| Rate for Payer: UMR Bronson Commercial |
$986.64
|
| Rate for Payer: UMR Bronson Commercial |
$9.87
|
| Rate for Payer: UMR Bronson Commercial |
$1,031.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,090.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$574.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$752.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,999.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,900.60
|
|
|
TACROLIMUS 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$817.46
|
|
|
Service Code
|
HCPCS J7525
|
| Hospital Charge Code |
12935
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$359.68 |
| Max. Negotiated Rate |
$735.71 |
| Rate for Payer: Aetna American Axle |
$531.35
|
| Rate for Payer: Aetna Commercial |
$694.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$531.35
|
| Rate for Payer: Cash Price |
$653.97
|
| Rate for Payer: Cofinity Commercial |
$572.22
|
| Rate for Payer: Cofinity Commercial |
$703.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$572.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$653.97
|
| Rate for Payer: Healthscope Commercial |
$735.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$572.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$613.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$694.84
|
| Rate for Payer: PHP Commercial |
$694.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$531.35
|
| Rate for Payer: Priority Health SBD |
$515.00
|
| Rate for Payer: UMR Bronson Commercial |
$359.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$613.10
|
|
|
TACROLIMUS 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$817.46
|
|
|
Service Code
|
HCPCS J7525
|
| Hospital Charge Code |
12935
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$141.05 |
| Max. Negotiated Rate |
$740.74 |
| Rate for Payer: Aetna American Axle |
$531.35
|
| Rate for Payer: Aetna Commercial |
$694.84
|
| Rate for Payer: Aetna Medicare |
$273.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$531.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$328.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$328.94
|
| Rate for Payer: BCBS Complete |
$148.10
|
| Rate for Payer: BCBS MAPPO |
$263.15
|
| Rate for Payer: BCN Medicare Advantage |
$263.15
|
| Rate for Payer: Cash Price |
$653.97
|
| Rate for Payer: Cash Price |
$653.97
|
| Rate for Payer: Cofinity Commercial |
$703.02
|
| Rate for Payer: Cofinity Commercial |
$572.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$572.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$653.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.15
|
| Rate for Payer: Healthscope Commercial |
$735.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$572.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$613.10
|
| Rate for Payer: Mclaren Medicaid |
$141.05
|
| Rate for Payer: Mclaren Medicare |
$263.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$276.31
|
| Rate for Payer: Meridian Medicaid |
$148.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$302.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$694.84
|
| Rate for Payer: PACE Medicare |
$249.99
|
| Rate for Payer: PACE SWMI |
$263.15
|
| Rate for Payer: PHP Commercial |
$694.84
|
| Rate for Payer: PHP Medicare Advantage |
$263.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$141.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$531.35
|
| Rate for Payer: Priority Health Medicare |
$263.15
|
| Rate for Payer: Priority Health SBD |
$515.00
|
| Rate for Payer: Railroad Medicare Medicare |
$263.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$740.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.15
|
| Rate for Payer: UHC Exchange |
$502.91
|
| Rate for Payer: UHC Medicare Advantage |
$263.15
|
| Rate for Payer: UHCCP Medicaid |
$141.05
|
| Rate for Payer: UMR Bronson Commercial |
$302.46
|
| Rate for Payer: VA VA |
$263.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$613.10
|
|
|
TACROLIMUS XR 0.75 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$462.99
|
|
|
Service Code
|
HCPCS J7503
|
| Hospital Charge Code |
175521
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$203.72 |
| Max. Negotiated Rate |
$416.69 |
| Rate for Payer: Aetna American Axle |
$300.94
|
| Rate for Payer: Aetna Commercial |
$393.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$300.94
|
| Rate for Payer: Cash Price |
$370.39
|
| Rate for Payer: Cofinity Commercial |
$324.09
|
| Rate for Payer: Cofinity Commercial |
$398.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$324.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.39
|
| Rate for Payer: Healthscope Commercial |
$416.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$324.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$347.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$393.54
|
| Rate for Payer: PHP Commercial |
$393.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.94
|
| Rate for Payer: Priority Health SBD |
$291.68
|
| Rate for Payer: UMR Bronson Commercial |
$203.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$347.24
|
|
|
TACROLIMUS XR 0.75 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$462.99
|
|
|
Service Code
|
HCPCS J7503
|
| Hospital Charge Code |
175521
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$171.31 |
| Max. Negotiated Rate |
$416.69 |
| Rate for Payer: Aetna American Axle |
$300.94
|
| Rate for Payer: Aetna Commercial |
$393.54
|
| Rate for Payer: Aetna Medicare |
$231.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$300.94
|
| Rate for Payer: BCBS Complete |
$185.20
|
| Rate for Payer: Cash Price |
$370.39
|
| Rate for Payer: Cofinity Commercial |
$324.09
|
| Rate for Payer: Cofinity Commercial |
$398.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$324.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.39
|
| Rate for Payer: Healthscope Commercial |
$416.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$324.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$347.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$393.54
|
| Rate for Payer: PHP Commercial |
$393.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.94
|
| Rate for Payer: Priority Health SBD |
$291.68
|
| Rate for Payer: UMR Bronson Commercial |
$171.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$347.24
|
|
|
TACROLIMUS XR 1 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$2,057.94
|
|
|
Service Code
|
HCPCS J7503
|
| Hospital Charge Code |
175522
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$905.49 |
| Max. Negotiated Rate |
$1,852.15 |
| Rate for Payer: Aetna American Axle |
$1,337.66
|
| Rate for Payer: Aetna American Axle |
$401.30
|
| Rate for Payer: Aetna Commercial |
$1,749.25
|
| Rate for Payer: Aetna Commercial |
$524.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,337.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$401.30
|
| Rate for Payer: Cash Price |
$1,646.35
|
| Rate for Payer: Cash Price |
$493.91
|
| Rate for Payer: Cofinity Commercial |
$530.96
|
| Rate for Payer: Cofinity Commercial |
$432.17
|
| Rate for Payer: Cofinity Commercial |
$1,440.56
|
| Rate for Payer: Cofinity Commercial |
$1,769.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,440.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$432.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,646.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$493.91
|
| Rate for Payer: Healthscope Commercial |
$1,852.15
|
| Rate for Payer: Healthscope Commercial |
$555.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,440.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$432.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,543.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$463.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$524.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,749.25
|
| Rate for Payer: PHP Commercial |
$524.78
|
| Rate for Payer: PHP Commercial |
$1,749.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,337.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.30
|
| Rate for Payer: Priority Health SBD |
$1,296.50
|
| Rate for Payer: Priority Health SBD |
$388.96
|
| Rate for Payer: UMR Bronson Commercial |
$905.49
|
| Rate for Payer: UMR Bronson Commercial |
$271.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,543.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$463.04
|
|
|
TACROLIMUS XR 1 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$2,057.94
|
|
|
Service Code
|
HCPCS J7503
|
| Hospital Charge Code |
175522
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$761.44 |
| Max. Negotiated Rate |
$1,852.15 |
| Rate for Payer: Aetna American Axle |
$1,337.66
|
| Rate for Payer: Aetna American Axle |
$401.30
|
| Rate for Payer: Aetna Commercial |
$1,749.25
|
| Rate for Payer: Aetna Commercial |
$524.78
|
| Rate for Payer: Aetna Medicare |
$1,028.97
|
| Rate for Payer: Aetna Medicare |
$308.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,337.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$401.30
|
| Rate for Payer: BCBS Complete |
$246.96
|
| Rate for Payer: BCBS Complete |
$823.18
|
| Rate for Payer: Cash Price |
$1,646.35
|
| Rate for Payer: Cash Price |
$493.91
|
| Rate for Payer: Cofinity Commercial |
$1,769.83
|
| Rate for Payer: Cofinity Commercial |
$1,440.56
|
| Rate for Payer: Cofinity Commercial |
$432.17
|
| Rate for Payer: Cofinity Commercial |
$530.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$432.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,440.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,646.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$493.91
|
| Rate for Payer: Healthscope Commercial |
$555.65
|
| Rate for Payer: Healthscope Commercial |
$1,852.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,440.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$432.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,543.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$463.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,749.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$524.78
|
| Rate for Payer: PHP Commercial |
$524.78
|
| Rate for Payer: PHP Commercial |
$1,749.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,337.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.30
|
| Rate for Payer: Priority Health SBD |
$388.96
|
| Rate for Payer: Priority Health SBD |
$1,296.50
|
| Rate for Payer: UMR Bronson Commercial |
$761.44
|
| Rate for Payer: UMR Bronson Commercial |
$228.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$463.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,543.45
|
|
|
TALQUETAMAB-TGVS 2 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$2,650.01
|
|
|
Service Code
|
HCPCS J3055
|
| Hospital Charge Code |
204984
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,166.00 |
| Max. Negotiated Rate |
$2,385.01 |
| Rate for Payer: Aetna American Axle |
$1,722.51
|
| Rate for Payer: Aetna Commercial |
$2,252.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,722.51
|
| Rate for Payer: Cash Price |
$2,120.01
|
| Rate for Payer: Cofinity Commercial |
$1,855.01
|
| Rate for Payer: Cofinity Commercial |
$2,279.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,855.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,120.01
|
| Rate for Payer: Healthscope Commercial |
$2,385.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,855.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,987.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,252.51
|
| Rate for Payer: PHP Commercial |
$2,252.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,722.51
|
| Rate for Payer: Priority Health SBD |
$1,669.51
|
| Rate for Payer: UMR Bronson Commercial |
$1,166.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,987.51
|
|
|
TALQUETAMAB-TGVS 2 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$2,650.01
|
|
|
Service Code
|
HCPCS J3055
|
| Hospital Charge Code |
204984
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.92 |
| Max. Negotiated Rate |
$2,385.01 |
| Rate for Payer: Aetna American Axle |
$1,722.51
|
| Rate for Payer: Aetna Commercial |
$2,252.51
|
| Rate for Payer: Aetna Medicare |
$75.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,722.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$90.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$90.78
|
| Rate for Payer: BCBS Complete |
$40.87
|
| Rate for Payer: BCBS MAPPO |
$72.62
|
| Rate for Payer: BCN Medicare Advantage |
$72.62
|
| Rate for Payer: Cash Price |
$2,120.01
|
| Rate for Payer: Cash Price |
$2,120.01
|
| Rate for Payer: Cofinity Commercial |
$2,279.01
|
| Rate for Payer: Cofinity Commercial |
$1,855.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,855.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,120.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.62
|
| Rate for Payer: Healthscope Commercial |
$2,385.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,855.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,987.51
|
| Rate for Payer: Mclaren Medicaid |
$38.92
|
| Rate for Payer: Mclaren Medicare |
$72.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.25
|
| Rate for Payer: Meridian Medicaid |
$40.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,252.51
|
| Rate for Payer: PACE Medicare |
$68.99
|
| Rate for Payer: PACE SWMI |
$72.62
|
| Rate for Payer: PHP Commercial |
$2,252.51
|
| Rate for Payer: PHP Medicare Advantage |
$72.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,722.51
|
| Rate for Payer: Priority Health Medicare |
$72.62
|
| Rate for Payer: Priority Health SBD |
$1,669.51
|
| Rate for Payer: Railroad Medicare Medicare |
$72.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.62
|
| Rate for Payer: UHC Exchange |
$138.78
|
| Rate for Payer: UHC Medicare Advantage |
$72.62
|
| Rate for Payer: UHCCP Medicaid |
$38.92
|
| Rate for Payer: UMR Bronson Commercial |
$980.50
|
| Rate for Payer: VA VA |
$72.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,987.51
|
|
|
TALQUETAMAB-TGVS 40 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$35,263.61
|
|
|
Service Code
|
HCPCS J3055
|
| Hospital Charge Code |
204983
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.92 |
| Max. Negotiated Rate |
$31,737.25 |
| Rate for Payer: Aetna American Axle |
$22,921.35
|
| Rate for Payer: Aetna Commercial |
$29,974.07
|
| Rate for Payer: Aetna Medicare |
$75.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22,921.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$90.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$90.78
|
| Rate for Payer: BCBS Complete |
$40.87
|
| Rate for Payer: BCBS MAPPO |
$72.62
|
| Rate for Payer: BCN Medicare Advantage |
$72.62
|
| Rate for Payer: Cash Price |
$28,210.89
|
| Rate for Payer: Cash Price |
$28,210.89
|
| Rate for Payer: Cofinity Commercial |
$30,326.70
|
| Rate for Payer: Cofinity Commercial |
$24,684.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$24,684.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28,210.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.62
|
| Rate for Payer: Healthscope Commercial |
$31,737.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24,684.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26,447.71
|
| Rate for Payer: Mclaren Medicaid |
$38.92
|
| Rate for Payer: Mclaren Medicare |
$72.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.25
|
| Rate for Payer: Meridian Medicaid |
$40.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29,974.07
|
| Rate for Payer: PACE Medicare |
$68.99
|
| Rate for Payer: PACE SWMI |
$72.62
|
| Rate for Payer: PHP Commercial |
$29,974.07
|
| Rate for Payer: PHP Medicare Advantage |
$72.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22,921.35
|
| Rate for Payer: Priority Health Medicare |
$72.62
|
| Rate for Payer: Priority Health SBD |
$22,216.07
|
| Rate for Payer: Railroad Medicare Medicare |
$72.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.62
|
| Rate for Payer: UHC Exchange |
$138.78
|
| Rate for Payer: UHC Medicare Advantage |
$72.62
|
| Rate for Payer: UHCCP Medicaid |
$38.92
|
| Rate for Payer: UMR Bronson Commercial |
$13,047.54
|
| Rate for Payer: VA VA |
$72.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26,447.71
|
|
|
TALQUETAMAB-TGVS 40 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$35,263.61
|
|
|
Service Code
|
HCPCS J3055
|
| Hospital Charge Code |
204983
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15,515.99 |
| Max. Negotiated Rate |
$31,737.25 |
| Rate for Payer: Aetna American Axle |
$22,921.35
|
| Rate for Payer: Aetna Commercial |
$29,974.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22,921.35
|
| Rate for Payer: Cash Price |
$28,210.89
|
| Rate for Payer: Cofinity Commercial |
$24,684.53
|
| Rate for Payer: Cofinity Commercial |
$30,326.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$24,684.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28,210.89
|
| Rate for Payer: Healthscope Commercial |
$31,737.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24,684.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26,447.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29,974.07
|
| Rate for Payer: PHP Commercial |
$29,974.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22,921.35
|
| Rate for Payer: Priority Health SBD |
$22,216.07
|
| Rate for Payer: UMR Bronson Commercial |
$15,515.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26,447.71
|
|
|
TAMOXIFEN 10 MG TABLET
|
Facility
|
IP
|
$249.57
|
|
|
Service Code
|
NDC 59651029960
|
| Hospital Charge Code |
7711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.81 |
| Max. Negotiated Rate |
$224.61 |
| Rate for Payer: Aetna American Axle |
$162.22
|
| Rate for Payer: Aetna Commercial |
$212.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.22
|
| Rate for Payer: Cash Price |
$199.66
|
| Rate for Payer: Cofinity Commercial |
$174.70
|
| Rate for Payer: Cofinity Commercial |
$214.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.66
|
| Rate for Payer: Healthscope Commercial |
$224.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.13
|
| Rate for Payer: PHP Commercial |
$212.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.22
|
| Rate for Payer: Priority Health SBD |
$157.23
|
| Rate for Payer: UMR Bronson Commercial |
$109.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.18
|
|
|
TAMOXIFEN 10 MG TABLET
|
Facility
|
IP
|
$387.60
|
|
|
Service Code
|
NDC 63739014310
|
| Hospital Charge Code |
7711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.54 |
| Max. Negotiated Rate |
$348.84 |
| Rate for Payer: Aetna American Axle |
$251.94
|
| Rate for Payer: Aetna Commercial |
$329.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.94
|
| Rate for Payer: Cash Price |
$310.08
|
| Rate for Payer: Cofinity Commercial |
$271.32
|
| Rate for Payer: Cofinity Commercial |
$333.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$271.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.08
|
| Rate for Payer: Healthscope Commercial |
$348.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$271.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.46
|
| Rate for Payer: PHP Commercial |
$329.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.94
|
| Rate for Payer: Priority Health SBD |
$244.19
|
| Rate for Payer: UMR Bronson Commercial |
$170.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.70
|
|
|
TAMOXIFEN 10 MG TABLET
|
Facility
|
OP
|
$249.57
|
|
|
Service Code
|
NDC 59651029960
|
| Hospital Charge Code |
7711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.34 |
| Max. Negotiated Rate |
$224.61 |
| Rate for Payer: Aetna American Axle |
$162.22
|
| Rate for Payer: Aetna Commercial |
$212.13
|
| Rate for Payer: Aetna Medicare |
$124.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.22
|
| Rate for Payer: BCBS Complete |
$99.83
|
| Rate for Payer: Cash Price |
$199.66
|
| Rate for Payer: Cofinity Commercial |
$174.70
|
| Rate for Payer: Cofinity Commercial |
$214.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.66
|
| Rate for Payer: Healthscope Commercial |
$224.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.13
|
| Rate for Payer: PHP Commercial |
$212.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.22
|
| Rate for Payer: Priority Health SBD |
$157.23
|
| Rate for Payer: UMR Bronson Commercial |
$92.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.18
|
|
|
TAMOXIFEN 10 MG TABLET
|
Facility
|
OP
|
$279.18
|
|
|
Service Code
|
NDC 00378014491
|
| Hospital Charge Code |
7711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.30 |
| Max. Negotiated Rate |
$251.26 |
| Rate for Payer: Aetna American Axle |
$181.47
|
| Rate for Payer: Aetna Commercial |
$237.30
|
| Rate for Payer: Aetna Medicare |
$139.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.47
|
| Rate for Payer: BCBS Complete |
$111.67
|
| Rate for Payer: Cash Price |
$223.34
|
| Rate for Payer: Cofinity Commercial |
$195.43
|
| Rate for Payer: Cofinity Commercial |
$240.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$195.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.34
|
| Rate for Payer: Healthscope Commercial |
$251.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$195.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.30
|
| Rate for Payer: PHP Commercial |
$237.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.47
|
| Rate for Payer: Priority Health SBD |
$175.88
|
| Rate for Payer: UMR Bronson Commercial |
$103.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.38
|
|
|
TAMOXIFEN 10 MG TABLET
|
Facility
|
OP
|
$387.60
|
|
|
Service Code
|
NDC 63739014310
|
| Hospital Charge Code |
7711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.41 |
| Max. Negotiated Rate |
$348.84 |
| Rate for Payer: Aetna American Axle |
$251.94
|
| Rate for Payer: Aetna Commercial |
$329.46
|
| Rate for Payer: Aetna Medicare |
$193.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.94
|
| Rate for Payer: BCBS Complete |
$155.04
|
| Rate for Payer: Cash Price |
$310.08
|
| Rate for Payer: Cofinity Commercial |
$271.32
|
| Rate for Payer: Cofinity Commercial |
$333.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$271.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.08
|
| Rate for Payer: Healthscope Commercial |
$348.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$271.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.46
|
| Rate for Payer: PHP Commercial |
$329.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.94
|
| Rate for Payer: Priority Health SBD |
$244.19
|
| Rate for Payer: UMR Bronson Commercial |
$143.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.70
|
|
|
TAMOXIFEN 10 MG TABLET
|
Facility
|
IP
|
$279.18
|
|
|
Service Code
|
NDC 00378014491
|
| Hospital Charge Code |
7711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.84 |
| Max. Negotiated Rate |
$251.26 |
| Rate for Payer: Aetna American Axle |
$181.47
|
| Rate for Payer: Aetna Commercial |
$237.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.47
|
| Rate for Payer: Cash Price |
$223.34
|
| Rate for Payer: Cofinity Commercial |
$195.43
|
| Rate for Payer: Cofinity Commercial |
$240.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$195.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.34
|
| Rate for Payer: Healthscope Commercial |
$251.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$195.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.30
|
| Rate for Payer: PHP Commercial |
$237.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.47
|
| Rate for Payer: Priority Health SBD |
$175.88
|
| Rate for Payer: UMR Bronson Commercial |
$122.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.38
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$441.75
|
|
|
Service Code
|
NDC 00781207601
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.37 |
| Max. Negotiated Rate |
$397.57 |
| Rate for Payer: Aetna American Axle |
$287.14
|
| Rate for Payer: Aetna Commercial |
$375.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.14
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Cofinity Commercial |
$309.23
|
| Rate for Payer: Cofinity Commercial |
$379.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$309.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.40
|
| Rate for Payer: Healthscope Commercial |
$397.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$309.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$331.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$375.49
|
| Rate for Payer: PHP Commercial |
$375.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.14
|
| Rate for Payer: Priority Health SBD |
$278.30
|
| Rate for Payer: UMR Bronson Commercial |
$194.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$331.31
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$192.85
|
|
|
Service Code
|
NDC 00904738361
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.85 |
| Max. Negotiated Rate |
$173.56 |
| Rate for Payer: Aetna American Axle |
$125.35
|
| Rate for Payer: Aetna Commercial |
$163.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.35
|
| Rate for Payer: Cash Price |
$154.28
|
| Rate for Payer: Cofinity Commercial |
$135.00
|
| Rate for Payer: Cofinity Commercial |
$165.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$135.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.28
|
| Rate for Payer: Healthscope Commercial |
$173.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.92
|
| Rate for Payer: PHP Commercial |
$163.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.35
|
| Rate for Payer: Priority Health SBD |
$121.50
|
| Rate for Payer: UMR Bronson Commercial |
$84.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.64
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
OP
|
$441.75
|
|
|
Service Code
|
NDC 00781207601
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.45 |
| Max. Negotiated Rate |
$397.57 |
| Rate for Payer: Aetna American Axle |
$287.14
|
| Rate for Payer: Aetna Commercial |
$375.49
|
| Rate for Payer: Aetna Medicare |
$220.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.14
|
| Rate for Payer: BCBS Complete |
$176.70
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Cofinity Commercial |
$309.23
|
| Rate for Payer: Cofinity Commercial |
$379.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$309.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.40
|
| Rate for Payer: Healthscope Commercial |
$397.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$309.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$331.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$375.49
|
| Rate for Payer: PHP Commercial |
$375.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.14
|
| Rate for Payer: Priority Health SBD |
$278.30
|
| Rate for Payer: UMR Bronson Commercial |
$163.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$331.31
|
|
