|
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
|
IP
|
$215.65
|
|
|
Service Code
|
NDC 62756016088
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.89 |
| Max. Negotiated Rate |
$194.09 |
| Rate for Payer: Aetna American Axle |
$140.17
|
| Rate for Payer: Aetna Commercial |
$183.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.17
|
| Rate for Payer: Cash Price |
$172.52
|
| Rate for Payer: Cofinity Commercial |
$150.96
|
| Rate for Payer: Cofinity Commercial |
$185.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$150.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.52
|
| Rate for Payer: Healthscope Commercial |
$194.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$150.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.30
|
| Rate for Payer: PHP Commercial |
$183.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.17
|
| Rate for Payer: Priority Health SBD |
$135.86
|
| Rate for Payer: UMR Bronson Commercial |
$94.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.74
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
OP
|
$288.80
|
|
|
Service Code
|
NDC 51079029420
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.86 |
| Max. Negotiated Rate |
$259.92 |
| Rate for Payer: Aetna American Axle |
$187.72
|
| Rate for Payer: Aetna Commercial |
$245.48
|
| Rate for Payer: Aetna Medicare |
$144.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.72
|
| Rate for Payer: BCBS Complete |
$115.52
|
| Rate for Payer: Cash Price |
$231.04
|
| Rate for Payer: Cofinity Commercial |
$202.16
|
| Rate for Payer: Cofinity Commercial |
$248.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$202.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.04
|
| Rate for Payer: Healthscope Commercial |
$259.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$202.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.48
|
| Rate for Payer: PHP Commercial |
$245.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.72
|
| Rate for Payer: Priority Health SBD |
$181.94
|
| Rate for Payer: UMR Bronson Commercial |
$106.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.60
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$288.80
|
|
|
Service Code
|
NDC 51079029420
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.07 |
| Max. Negotiated Rate |
$259.92 |
| Rate for Payer: Aetna American Axle |
$187.72
|
| Rate for Payer: Aetna Commercial |
$245.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.72
|
| Rate for Payer: Cash Price |
$231.04
|
| Rate for Payer: Cofinity Commercial |
$202.16
|
| Rate for Payer: Cofinity Commercial |
$248.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$202.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.04
|
| Rate for Payer: Healthscope Commercial |
$259.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$202.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.48
|
| Rate for Payer: PHP Commercial |
$245.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.72
|
| Rate for Payer: Priority Health SBD |
$181.94
|
| Rate for Payer: UMR Bronson Commercial |
$127.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.60
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$2.89
|
|
|
Service Code
|
NDC 51079029401
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Aetna American Axle |
$1.88
|
| Rate for Payer: Aetna Commercial |
$2.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.88
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.31
|
| Rate for Payer: Healthscope Commercial |
$2.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.46
|
| Rate for Payer: PHP Commercial |
$2.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.88
|
| Rate for Payer: Priority Health SBD |
$1.82
|
| Rate for Payer: UMR Bronson Commercial |
$1.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.17
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
OP
|
$2.52
|
|
|
Service Code
|
NDC 50268074011
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$2.27 |
| Rate for Payer: Aetna American Axle |
$1.64
|
| Rate for Payer: Aetna Commercial |
$2.14
|
| Rate for Payer: Aetna Medicare |
$1.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.64
|
| Rate for Payer: BCBS Complete |
$1.01
|
| Rate for Payer: Cash Price |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$1.76
|
| Rate for Payer: Cofinity Commercial |
$2.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.02
|
| Rate for Payer: Healthscope Commercial |
$2.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.14
|
| Rate for Payer: PHP Commercial |
$2.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.64
|
| Rate for Payer: Priority Health SBD |
$1.59
|
| Rate for Payer: UMR Bronson Commercial |
$0.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.89
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
OP
|
$215.65
|
|
|
Service Code
|
NDC 62756016088
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.79 |
| Max. Negotiated Rate |
$194.09 |
| Rate for Payer: Aetna American Axle |
$140.17
|
| Rate for Payer: Aetna Commercial |
$183.30
|
| Rate for Payer: Aetna Medicare |
$107.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.17
|
| Rate for Payer: BCBS Complete |
$86.26
|
| Rate for Payer: Cash Price |
$172.52
|
| Rate for Payer: Cofinity Commercial |
$150.96
|
| Rate for Payer: Cofinity Commercial |
$185.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$150.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.52
|
| Rate for Payer: Healthscope Commercial |
$194.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$150.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.30
|
| Rate for Payer: PHP Commercial |
$183.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.17
|
| Rate for Payer: Priority Health SBD |
$135.86
|
| Rate for Payer: UMR Bronson Commercial |
$79.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.74
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$166.85
|
|
|
Service Code
|
NDC 65862059801
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.41 |
| Max. Negotiated Rate |
$150.16 |
| Rate for Payer: Aetna American Axle |
$108.45
|
| Rate for Payer: Aetna Commercial |
$141.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.45
|
| Rate for Payer: Cash Price |
$133.48
|
| Rate for Payer: Cofinity Commercial |
$116.80
|
| Rate for Payer: Cofinity Commercial |
$143.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$116.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.48
|
| Rate for Payer: Healthscope Commercial |
$150.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.82
|
| Rate for Payer: PHP Commercial |
$141.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.45
|
| Rate for Payer: Priority Health SBD |
$105.12
|
| Rate for Payer: UMR Bronson Commercial |
$73.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.14
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$125.88
|
|
|
Service Code
|
NDC 50268074015
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.39 |
| Max. Negotiated Rate |
$113.29 |
| Rate for Payer: Aetna American Axle |
$81.82
|
| Rate for Payer: Aetna Commercial |
$107.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.82
|
| Rate for Payer: Cash Price |
$100.70
|
| Rate for Payer: Cofinity Commercial |
$108.26
|
| Rate for Payer: Cofinity Commercial |
$88.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$88.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.70
|
| Rate for Payer: Healthscope Commercial |
$113.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.00
|
| Rate for Payer: PHP Commercial |
$107.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.82
|
| Rate for Payer: Priority Health SBD |
$79.30
|
| Rate for Payer: UMR Bronson Commercial |
$55.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.41
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
OP
|
$125.88
|
|
|
Service Code
|
NDC 50268074015
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.58 |
| Max. Negotiated Rate |
$113.29 |
| Rate for Payer: Aetna American Axle |
$81.82
|
| Rate for Payer: Aetna Commercial |
$107.00
|
| Rate for Payer: Aetna Medicare |
$62.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.82
|
| Rate for Payer: BCBS Complete |
$50.35
|
| Rate for Payer: Cash Price |
$100.70
|
| Rate for Payer: Cofinity Commercial |
$108.26
|
| Rate for Payer: Cofinity Commercial |
$88.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$88.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.70
|
| Rate for Payer: Healthscope Commercial |
$113.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.00
|
| Rate for Payer: PHP Commercial |
$107.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.82
|
| Rate for Payer: Priority Health SBD |
$79.30
|
| Rate for Payer: UMR Bronson Commercial |
$46.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.41
|
|
|
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
|
OP
|
$166.85
|
|
|
Service Code
|
NDC 65862059801
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.73 |
| Max. Negotiated Rate |
$150.16 |
| Rate for Payer: Aetna American Axle |
$108.45
|
| Rate for Payer: Aetna Commercial |
$141.82
|
| Rate for Payer: Aetna Medicare |
$83.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.45
|
| Rate for Payer: BCBS Complete |
$66.74
|
| Rate for Payer: Cash Price |
$133.48
|
| Rate for Payer: Cofinity Commercial |
$116.80
|
| Rate for Payer: Cofinity Commercial |
$143.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$116.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.48
|
| Rate for Payer: Healthscope Commercial |
$150.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.82
|
| Rate for Payer: PHP Commercial |
$141.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.45
|
| Rate for Payer: Priority Health SBD |
$105.12
|
| Rate for Payer: UMR Bronson Commercial |
$61.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.14
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$243.20
|
|
|
Service Code
|
NDC 68382013201
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.01 |
| Max. Negotiated Rate |
$218.88 |
| Rate for Payer: Aetna American Axle |
$158.08
|
| Rate for Payer: Aetna Commercial |
$206.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.08
|
| Rate for Payer: Cash Price |
$194.56
|
| Rate for Payer: Cofinity Commercial |
$170.24
|
| Rate for Payer: Cofinity Commercial |
$209.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$170.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.56
|
| Rate for Payer: Healthscope Commercial |
$218.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$170.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.72
|
| Rate for Payer: PHP Commercial |
$206.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.08
|
| Rate for Payer: Priority Health SBD |
$153.22
|
| Rate for Payer: UMR Bronson Commercial |
$107.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.40
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$192.85
|
|
|
Service Code
|
NDC 00904640161
|
| 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
|
$2.89
|
|
|
Service Code
|
NDC 51079029401
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Aetna American Axle |
$1.88
|
| Rate for Payer: Aetna Commercial |
$2.46
|
| Rate for Payer: Aetna Medicare |
$1.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.88
|
| Rate for Payer: BCBS Complete |
$1.16
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.31
|
| Rate for Payer: Healthscope Commercial |
$2.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.46
|
| Rate for Payer: PHP Commercial |
$2.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.88
|
| Rate for Payer: Priority Health SBD |
$1.82
|
| Rate for Payer: UMR Bronson Commercial |
$1.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.17
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
OP
|
$192.85
|
|
|
Service Code
|
NDC 00904738361
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.35 |
| Max. Negotiated Rate |
$173.56 |
| Rate for Payer: Aetna American Axle |
$125.35
|
| Rate for Payer: Aetna Commercial |
$163.92
|
| Rate for Payer: Aetna Medicare |
$96.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.35
|
| Rate for Payer: BCBS Complete |
$77.14
|
| 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 |
$71.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.64
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
OP
|
$243.20
|
|
|
Service Code
|
NDC 68382013201
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.98 |
| Max. Negotiated Rate |
$218.88 |
| Rate for Payer: Aetna American Axle |
$158.08
|
| Rate for Payer: Aetna Commercial |
$206.72
|
| Rate for Payer: Aetna Medicare |
$121.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.08
|
| Rate for Payer: BCBS Complete |
$97.28
|
| Rate for Payer: Cash Price |
$194.56
|
| Rate for Payer: Cofinity Commercial |
$170.24
|
| Rate for Payer: Cofinity Commercial |
$209.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$170.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.56
|
| Rate for Payer: Healthscope Commercial |
$218.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$170.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.72
|
| Rate for Payer: PHP Commercial |
$206.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.08
|
| Rate for Payer: Priority Health SBD |
$153.22
|
| Rate for Payer: UMR Bronson Commercial |
$89.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.40
|
|
|
TANGENTIAL BIOPSY OF SKIN (EG, SHAVE, SCOOP, SAUCERIZE, CURETTE); SINGLE LESION
|
Facility
|
OP
|
$545.50
|
|
|
Service Code
|
CPT 11102
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$545.50 |
| Rate for Payer: Aetna Medicare |
$201.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Exchange |
$370.35
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$103.87
|
| Rate for Payer: VA VA |
$193.79
|
|
|
TAPENTADOL 50 MG TABLET
|
Facility
|
IP
|
$1,922.70
|
|
|
Service Code
|
NDC 50458082002
|
| Hospital Charge Code |
98253
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$845.99 |
| Max. Negotiated Rate |
$1,730.43 |
| Rate for Payer: Aetna American Axle |
$1,249.76
|
| Rate for Payer: Aetna Commercial |
$1,634.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,249.76
|
| Rate for Payer: Cash Price |
$1,538.16
|
| Rate for Payer: Cofinity Commercial |
$1,345.89
|
| Rate for Payer: Cofinity Commercial |
$1,653.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,345.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,538.16
|
| Rate for Payer: Healthscope Commercial |
$1,730.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,345.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,442.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,634.30
|
| Rate for Payer: PHP Commercial |
$1,634.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,249.76
|
| Rate for Payer: Priority Health SBD |
$1,211.30
|
| Rate for Payer: UMR Bronson Commercial |
$845.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,442.03
|
|
|
TAPENTADOL 50 MG TABLET
|
Facility
|
OP
|
$1,922.70
|
|
|
Service Code
|
NDC 50458082002
|
| Hospital Charge Code |
98253
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$711.40 |
| Max. Negotiated Rate |
$1,730.43 |
| Rate for Payer: Aetna American Axle |
$1,249.76
|
| Rate for Payer: Aetna Commercial |
$1,634.30
|
| Rate for Payer: Aetna Medicare |
$961.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,249.76
|
| Rate for Payer: BCBS Complete |
$769.08
|
| Rate for Payer: Cash Price |
$1,538.16
|
| Rate for Payer: Cofinity Commercial |
$1,345.89
|
| Rate for Payer: Cofinity Commercial |
$1,653.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,345.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,538.16
|
| Rate for Payer: Healthscope Commercial |
$1,730.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,345.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,442.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,634.30
|
| Rate for Payer: PHP Commercial |
$1,634.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,249.76
|
| Rate for Payer: Priority Health SBD |
$1,211.30
|
| Rate for Payer: UMR Bronson Commercial |
$711.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,442.03
|
|
|
TARLATAMAB-DLLE 10 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$67,350.00
|
|
|
Service Code
|
HCPCS J9026
|
| Hospital Charge Code |
207439
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$838.65 |
| Max. Negotiated Rate |
$60,615.00 |
| Rate for Payer: Aetna American Axle |
$43,777.50
|
| Rate for Payer: Aetna Commercial |
$57,247.50
|
| Rate for Payer: Aetna Medicare |
$1,627.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43,777.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,955.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,955.80
|
| Rate for Payer: BCBS Complete |
$880.58
|
| Rate for Payer: BCBS MAPPO |
$1,564.64
|
| Rate for Payer: BCN Medicare Advantage |
$1,564.64
|
| Rate for Payer: Cash Price |
$53,880.00
|
| Rate for Payer: Cash Price |
$53,880.00
|
| Rate for Payer: Cofinity Commercial |
$57,921.00
|
| Rate for Payer: Cofinity Commercial |
$47,145.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$47,145.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53,880.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,564.64
|
| Rate for Payer: Healthscope Commercial |
$60,615.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47,145.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50,512.50
|
| Rate for Payer: Mclaren Medicaid |
$838.65
|
| Rate for Payer: Mclaren Medicare |
$1,564.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,642.87
|
| Rate for Payer: Meridian Medicaid |
$880.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,799.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57,247.50
|
| Rate for Payer: PACE Medicare |
$1,486.41
|
| Rate for Payer: PACE SWMI |
$1,564.64
|
| Rate for Payer: PHP Commercial |
$57,247.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,564.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$838.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43,777.50
|
| Rate for Payer: Priority Health Medicare |
$1,564.64
|
| Rate for Payer: Priority Health SBD |
$42,430.50
|
| Rate for Payer: Railroad Medicare Medicare |
$1,564.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,404.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,564.64
|
| Rate for Payer: UHC Exchange |
$2,990.18
|
| Rate for Payer: UHC Medicare Advantage |
$1,564.64
|
| Rate for Payer: UHCCP Medicaid |
$838.65
|
| Rate for Payer: UMR Bronson Commercial |
$24,919.50
|
| Rate for Payer: VA VA |
$1,564.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50,512.50
|
|
|
TARLATAMAB-DLLE 10 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$67,350.00
|
|
|
Service Code
|
HCPCS J9026
|
| Hospital Charge Code |
207439
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29,634.00 |
| Max. Negotiated Rate |
$60,615.00 |
| Rate for Payer: Aetna American Axle |
$43,777.50
|
| Rate for Payer: Aetna Commercial |
$57,247.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43,777.50
|
| Rate for Payer: Cash Price |
$53,880.00
|
| Rate for Payer: Cofinity Commercial |
$47,145.00
|
| Rate for Payer: Cofinity Commercial |
$57,921.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$47,145.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53,880.00
|
| Rate for Payer: Healthscope Commercial |
$60,615.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47,145.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50,512.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57,247.50
|
| Rate for Payer: PHP Commercial |
$57,247.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43,777.50
|
| Rate for Payer: Priority Health SBD |
$42,430.50
|
| Rate for Payer: UMR Bronson Commercial |
$29,634.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50,512.50
|
|
|
TBO-FILGRASTIM 300 MCG/0.5 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$572.34
|
|
|
Service Code
|
HCPCS J1447
|
| Hospital Charge Code |
168855
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$251.83 |
| Max. Negotiated Rate |
$515.11 |
| Rate for Payer: Aetna American Axle |
$372.02
|
| Rate for Payer: Aetna Commercial |
$486.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.02
|
| Rate for Payer: Cash Price |
$457.87
|
| Rate for Payer: Cofinity Commercial |
$400.64
|
| Rate for Payer: Cofinity Commercial |
$492.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$400.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$457.87
|
| Rate for Payer: Healthscope Commercial |
$515.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$400.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$429.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$486.49
|
| Rate for Payer: PHP Commercial |
$486.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$372.02
|
| Rate for Payer: Priority Health SBD |
$360.57
|
| Rate for Payer: UMR Bronson Commercial |
$251.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$429.25
|
|
|
TBO-FILGRASTIM 300 MCG/0.5 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$572.34
|
|
|
Service Code
|
HCPCS J1447
|
| Hospital Charge Code |
168855
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$515.11 |
| Rate for Payer: Aetna American Axle |
$372.02
|
| Rate for Payer: Aetna Commercial |
$486.49
|
| Rate for Payer: Aetna Medicare |
$0.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.35
|
| Rate for Payer: BCBS Complete |
$0.16
|
| Rate for Payer: BCBS MAPPO |
$0.28
|
| Rate for Payer: BCN Medicare Advantage |
$0.28
|
| Rate for Payer: Cash Price |
$457.87
|
| Rate for Payer: Cash Price |
$457.87
|
| Rate for Payer: Cofinity Commercial |
$492.21
|
| Rate for Payer: Cofinity Commercial |
$400.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$400.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$457.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.28
|
| Rate for Payer: Healthscope Commercial |
$515.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$400.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$429.25
|
| Rate for Payer: Mclaren Medicaid |
$0.15
|
| Rate for Payer: Mclaren Medicare |
$0.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.29
|
| Rate for Payer: Meridian Medicaid |
$0.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$486.49
|
| Rate for Payer: PACE Medicare |
$0.27
|
| Rate for Payer: PACE SWMI |
$0.28
|
| Rate for Payer: PHP Commercial |
$486.49
|
| Rate for Payer: PHP Medicare Advantage |
$0.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$372.02
|
| Rate for Payer: Priority Health Medicare |
$0.28
|
| Rate for Payer: Priority Health SBD |
$360.57
|
| Rate for Payer: Railroad Medicare Medicare |
$0.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.28
|
| Rate for Payer: UHC Exchange |
$0.54
|
| Rate for Payer: UHC Medicare Advantage |
$0.28
|
| Rate for Payer: UHCCP Medicaid |
$0.15
|
| Rate for Payer: UMR Bronson Commercial |
$211.77
|
| Rate for Payer: VA VA |
$0.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$429.25
|
|
|
TBO-FILGRASTIM 480 MCG/0.8 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$911.49
|
|
|
Service Code
|
HCPCS J1447
|
| Hospital Charge Code |
168856
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$401.06 |
| Max. Negotiated Rate |
$820.34 |
| Rate for Payer: Aetna American Axle |
$592.47
|
| Rate for Payer: Aetna American Axle |
$592.48
|
| Rate for Payer: Aetna Commercial |
$774.77
|
| Rate for Payer: Aetna Commercial |
$774.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$592.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$592.48
|
| Rate for Payer: Cash Price |
$729.19
|
| Rate for Payer: Cash Price |
$729.20
|
| Rate for Payer: Cofinity Commercial |
$783.89
|
| Rate for Payer: Cofinity Commercial |
$638.05
|
| Rate for Payer: Cofinity Commercial |
$638.04
|
| Rate for Payer: Cofinity Commercial |
$783.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$638.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$638.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$729.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$729.20
|
| Rate for Payer: Healthscope Commercial |
$820.34
|
| Rate for Payer: Healthscope Commercial |
$820.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$638.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$638.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$683.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$683.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$774.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$774.77
|
| Rate for Payer: PHP Commercial |
$774.77
|
| Rate for Payer: PHP Commercial |
$774.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$592.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$592.48
|
| Rate for Payer: Priority Health SBD |
$574.24
|
| Rate for Payer: Priority Health SBD |
$574.25
|
| Rate for Payer: UMR Bronson Commercial |
$401.06
|
| Rate for Payer: UMR Bronson Commercial |
$401.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$683.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$683.62
|
|
