|
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 |
$136.50 |
| Max. Negotiated Rate |
$764.01 |
| Rate for Payer: Aetna American Axle |
$531.35
|
| Rate for Payer: Aetna Commercial |
$694.84
|
| Rate for Payer: Aetna Medicare |
$264.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$531.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$318.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$318.34
|
| Rate for Payer: BCBS Complete |
$143.33
|
| Rate for Payer: BCBS MAPPO |
$254.67
|
| Rate for Payer: BCBS Trust/PPO |
$686.95
|
| Rate for Payer: BCN Commercial |
$686.95
|
| Rate for Payer: BCN Medicare Advantage |
$254.67
|
| 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 |
$254.67
|
| 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 |
$136.50
|
| Rate for Payer: Mclaren Medicare |
$254.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$267.40
|
| Rate for Payer: Meridian Medicaid |
$143.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$292.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$694.84
|
| Rate for Payer: Nomi Health Commercial |
$764.01
|
| Rate for Payer: PACE Medicare |
$241.94
|
| Rate for Payer: PACE SWMI |
$254.67
|
| Rate for Payer: PHP Commercial |
$694.84
|
| Rate for Payer: PHP Medicare Advantage |
$254.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$136.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$531.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$733.24
|
| Rate for Payer: Priority Health Medicare |
$254.67
|
| Rate for Payer: Priority Health Narrow Network |
$586.59
|
| Rate for Payer: Priority Health SBD |
$515.00
|
| Rate for Payer: Railroad Medicare Medicare |
$254.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$716.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$254.67
|
| Rate for Payer: UHC Exchange |
$486.70
|
| Rate for Payer: UHC Medicare Advantage |
$254.67
|
| Rate for Payer: UHCCP Medicaid |
$136.50
|
| Rate for Payer: UMR Bronson Commercial |
$302.46
|
| Rate for Payer: VA VA |
$254.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$613.10
|
|
|
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 |
$4.84 |
| 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: BCBS Trust/PPO |
$4.84
|
| Rate for Payer: BCN Commercial |
$4.84
|
| Rate for Payer: Cash Price |
$370.39
|
| 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 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 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 |
$1,543.46
|
| 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 |
$1,543.46
|
| 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 |
$4.84 |
| 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 |
$524.78
|
| Rate for Payer: Aetna Commercial |
$1,749.25
|
| Rate for Payer: Aetna Medicare |
$1,028.97
|
| Rate for Payer: Aetna Medicare |
$308.70
|
| 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: BCBS Trust/PPO |
$4.84
|
| Rate for Payer: BCBS Trust/PPO |
$4.84
|
| Rate for Payer: BCN Commercial |
$4.84
|
| Rate for Payer: BCN Commercial |
$4.84
|
| Rate for Payer: Cash Price |
$493.91
|
| Rate for Payer: Cash Price |
$493.91
|
| Rate for Payer: Cash Price |
$1,646.35
|
| Rate for Payer: Cash Price |
$1,646.35
|
| Rate for Payer: Cofinity Commercial |
$530.96
|
| Rate for Payer: Cofinity Commercial |
$1,440.56
|
| Rate for Payer: Cofinity Commercial |
$432.17
|
| 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 |
$493.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,646.35
|
| Rate for Payer: Healthscope Commercial |
$555.65
|
| Rate for Payer: Healthscope Commercial |
$1,852.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$432.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,440.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$463.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,543.46
|
| 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 |
$1,749.25
|
| Rate for Payer: PHP Commercial |
$524.78
|
| 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 |
$1,543.46
|
|
|
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 |
$37.50 |
| 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 |
$72.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,722.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.46
|
| Rate for Payer: BCBS Complete |
$39.38
|
| Rate for Payer: BCBS MAPPO |
$69.97
|
| Rate for Payer: BCBS Trust/PPO |
$188.64
|
| Rate for Payer: BCN Commercial |
$188.64
|
| Rate for Payer: BCN Medicare Advantage |
$69.97
|
| 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 |
$69.97
|
| 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 |
$37.50
|
| Rate for Payer: Mclaren Medicare |
$69.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.47
|
| Rate for Payer: Meridian Medicaid |
$39.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,252.51
|
| Rate for Payer: Nomi Health Commercial |
$209.91
|
| Rate for Payer: PACE Medicare |
$66.47
|
| Rate for Payer: PACE SWMI |
$69.97
|
| Rate for Payer: PHP Commercial |
$2,252.51
|
| Rate for Payer: PHP Medicare Advantage |
$69.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,722.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$194.71
|
| Rate for Payer: Priority Health Medicare |
$69.97
|
| Rate for Payer: Priority Health Narrow Network |
$155.77
|
| Rate for Payer: Priority Health SBD |
$1,669.51
|
| Rate for Payer: Railroad Medicare Medicare |
$69.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$196.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.97
|
| Rate for Payer: UHC Exchange |
$133.72
|
| Rate for Payer: UHC Medicare Advantage |
$69.97
|
| Rate for Payer: UHCCP Medicaid |
$37.50
|
| Rate for Payer: UMR Bronson Commercial |
$980.50
|
| Rate for Payer: VA VA |
$69.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,987.51
|
|
|
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 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
|
|
|
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 |
$37.50 |
| 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 |
$72.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22,921.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.46
|
| Rate for Payer: BCBS Complete |
$39.38
|
| Rate for Payer: BCBS MAPPO |
$69.97
|
| Rate for Payer: BCBS Trust/PPO |
$188.64
|
| Rate for Payer: BCN Commercial |
$188.64
|
| Rate for Payer: BCN Medicare Advantage |
$69.97
|
| 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 |
$69.97
|
| 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 |
$37.50
|
| Rate for Payer: Mclaren Medicare |
$69.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.47
|
| Rate for Payer: Meridian Medicaid |
$39.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29,974.07
|
| Rate for Payer: Nomi Health Commercial |
$209.91
|
| Rate for Payer: PACE Medicare |
$66.47
|
| Rate for Payer: PACE SWMI |
$69.97
|
| Rate for Payer: PHP Commercial |
$29,974.07
|
| Rate for Payer: PHP Medicare Advantage |
$69.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22,921.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$194.71
|
| Rate for Payer: Priority Health Medicare |
$69.97
|
| Rate for Payer: Priority Health Narrow Network |
$155.77
|
| Rate for Payer: Priority Health SBD |
$22,216.07
|
| Rate for Payer: Railroad Medicare Medicare |
$69.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$196.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.97
|
| Rate for Payer: UHC Exchange |
$133.72
|
| Rate for Payer: UHC Medicare Advantage |
$69.97
|
| Rate for Payer: UHCCP Medicaid |
$37.50
|
| Rate for Payer: UMR Bronson Commercial |
$13,047.54
|
| Rate for Payer: VA VA |
$69.97
|
| 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
|
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
|
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
|
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
|
|
|
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
|
|
|
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
|
$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
|
OP
|
$215.65
|
|
|
Service Code
|
NDC 62756016088
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.79 |
| Max. Negotiated Rate |
$194.08 |
| Rate for Payer: Aetna American Axle |
$140.17
|
| Rate for Payer: Aetna Commercial |
$183.30
|
| Rate for Payer: Aetna Medicare |
$107.82
|
| 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 |
$194.08
|
| 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
|
$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
|
$441.75
|
|
|
Service Code
|
NDC 00781207601
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.45 |
| Max. Negotiated Rate |
$397.58 |
| 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 |
$309.22
|
| Rate for Payer: Cofinity Commercial |
$379.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$309.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.40
|
| Rate for Payer: Healthscope Commercial |
$397.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$309.22
|
| 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
|
|
|
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 |
$397.58 |
| 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 |
$309.22
|
| Rate for Payer: Cofinity Commercial |
$379.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$309.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.40
|
| Rate for Payer: Healthscope Commercial |
$397.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$309.22
|
| 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
|
$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
|
$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
|
$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
|
|
