|
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
|
$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
|
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
|
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
|
$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
|
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
|
$2.52
|
|
|
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
|
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
|
$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
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$2.52
|
|
|
Service Code
|
NDC 50268074011
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$2.27 |
| Rate for Payer: Aetna American Axle |
$1.64
|
| Rate for Payer: Aetna Commercial |
$2.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.64
|
| 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 |
$1.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.89
|
|
|
TANGENTIAL BIOPSY OF SKIN (EG, SHAVE, SCOOP, SAUCERIZE, CURETTE); SINGLE LESION
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 11102
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$35.93 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$202.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.35
|
| Rate for Payer: BCBS Complete |
$109.57
|
| Rate for Payer: BCBS MAPPO |
$194.68
|
| Rate for Payer: BCBS Trust/PPO |
$96.96
|
| Rate for Payer: BCN Commercial |
$96.96
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.68
|
| Rate for Payer: Mclaren Medicaid |
$104.35
|
| Rate for Payer: Mclaren Medicare |
$194.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.41
|
| Rate for Payer: Meridian Medicaid |
$109.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.88
|
| Rate for Payer: Nomi Health Commercial |
$408.83
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$611.90
|
| Rate for Payer: Priority Health Medicare |
$194.68
|
| Rate for Payer: Priority Health Narrow Network |
$489.52
|
| Rate for Payer: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.52
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Exchange |
$35.93
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$104.35
|
| Rate for Payer: VA VA |
$194.68
|
|
|
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 |
$1,442.02
|
| 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 |
$1,442.02
|
|
|
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 |
$1,442.02
|
| 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 |
$1,442.02
|
|
|
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 |
$844.43 |
| 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 |
$1,638.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43,777.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,969.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,969.28
|
| Rate for Payer: BCBS Complete |
$886.65
|
| Rate for Payer: BCBS MAPPO |
$1,575.42
|
| Rate for Payer: BCBS Trust/PPO |
$3,906.09
|
| Rate for Payer: BCN Commercial |
$3,906.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,575.42
|
| 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 |
$1,575.42
|
| 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 |
$844.43
|
| Rate for Payer: Mclaren Medicare |
$1,575.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,654.19
|
| Rate for Payer: Meridian Medicaid |
$886.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,811.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57,247.50
|
| Rate for Payer: Nomi Health Commercial |
$4,726.26
|
| Rate for Payer: PACE Medicare |
$1,496.65
|
| Rate for Payer: PACE SWMI |
$1,575.42
|
| Rate for Payer: PHP Commercial |
$57,247.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,575.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$844.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43,777.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,446.53
|
| Rate for Payer: Priority Health Medicare |
$1,575.42
|
| Rate for Payer: Priority Health Narrow Network |
$3,557.22
|
| Rate for Payer: Priority Health SBD |
$42,430.50
|
| Rate for Payer: Railroad Medicare Medicare |
$1,575.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,434.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,575.42
|
| Rate for Payer: UHC Exchange |
$3,010.79
|
| Rate for Payer: UHC Medicare Advantage |
$1,575.42
|
| Rate for Payer: UHCCP Medicaid |
$844.43
|
| Rate for Payer: UMR Bronson Commercial |
$24,919.50
|
| Rate for Payer: VA VA |
$1,575.42
|
| 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: 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: 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: 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
|
OP
|
$572.34
|
|
|
Service Code
|
HCPCS J1447
|
| Hospital Charge Code |
168855
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.21 |
| 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 |
$0.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.50
|
| Rate for Payer: BCBS Complete |
$0.23
|
| Rate for Payer: BCBS MAPPO |
$0.40
|
| Rate for Payer: BCBS Trust/PPO |
$1.01
|
| Rate for Payer: BCN Commercial |
$1.01
|
| Rate for Payer: BCN Medicare Advantage |
$0.40
|
| 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 |
$0.40
|
| 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 |
$429.26
|
| Rate for Payer: Mclaren Medicaid |
$0.21
|
| Rate for Payer: Mclaren Medicare |
$0.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.42
|
| Rate for Payer: Meridian Medicaid |
$0.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$486.49
|
| Rate for Payer: Nomi Health Commercial |
$1.20
|
| Rate for Payer: PACE Medicare |
$0.38
|
| Rate for Payer: PACE SWMI |
$0.40
|
| Rate for Payer: PHP Commercial |
$486.49
|
| Rate for Payer: PHP Medicare Advantage |
$0.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$372.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.13
|
| Rate for Payer: Priority Health Medicare |
$0.40
|
| Rate for Payer: Priority Health Narrow Network |
$0.90
|
| Rate for Payer: Priority Health SBD |
$360.57
|
| Rate for Payer: Railroad Medicare Medicare |
$0.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.40
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UHC Medicare Advantage |
$0.40
|
| Rate for Payer: UHCCP Medicaid |
$0.21
|
| Rate for Payer: UMR Bronson Commercial |
$211.77
|
| Rate for Payer: VA VA |
$0.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$429.26
|
|
|
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 |
$429.26
|
| 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 |
$429.26
|
|
|
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 |
$774.78
|
| 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 |
$774.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$774.77
|
| Rate for Payer: PHP Commercial |
$774.78
|
| 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 |
$574.24
|
| Rate for Payer: UMR Bronson Commercial |
$401.06
|
| Rate for Payer: UMR Bronson Commercial |
$401.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$683.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$683.62
|
|
|
TBO-FILGRASTIM 480 MCG/0.8 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$911.49
|
|
|
Service Code
|
HCPCS J1447
|
| Hospital Charge Code |
168856
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.21 |
| 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 |
$774.78
|
| Rate for Payer: Aetna Commercial |
$774.77
|
| Rate for Payer: Aetna Medicare |
$0.42
|
| Rate for Payer: Aetna Medicare |
$0.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$592.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$592.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.50
|
| Rate for Payer: BCBS Complete |
$0.23
|
| Rate for Payer: BCBS Complete |
$0.23
|
| Rate for Payer: BCBS MAPPO |
$0.40
|
| Rate for Payer: BCBS MAPPO |
$0.40
|
| Rate for Payer: BCBS Trust/PPO |
$1.01
|
| Rate for Payer: BCBS Trust/PPO |
$1.01
|
| Rate for Payer: BCN Commercial |
$1.01
|
| Rate for Payer: BCN Commercial |
$1.01
|
| Rate for Payer: BCN Medicare Advantage |
$0.40
|
| Rate for Payer: BCN Medicare Advantage |
$0.40
|
| Rate for Payer: Cash Price |
$729.20
|
| Rate for Payer: Cash Price |
$729.19
|
| Rate for Payer: Cash Price |
$729.20
|
| Rate for Payer: Cash Price |
$729.19
|
| 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 Commercial |
$783.89
|
| 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: Health Alliance Plan Medicare Advantage |
$0.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.40
|
| Rate for Payer: Healthscope Commercial |
$820.34
|
| Rate for Payer: Healthscope Commercial |
$820.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$638.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$638.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$683.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$683.62
|
| Rate for Payer: Mclaren Medicaid |
$0.21
|
| Rate for Payer: Mclaren Medicaid |
$0.21
|
| Rate for Payer: Mclaren Medicare |
$0.40
|
| Rate for Payer: Mclaren Medicare |
$0.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.42
|
| Rate for Payer: Meridian Medicaid |
$0.23
|
| Rate for Payer: Meridian Medicaid |
$0.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$774.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$774.78
|
| Rate for Payer: Nomi Health Commercial |
$1.20
|
| Rate for Payer: Nomi Health Commercial |
$1.20
|
| Rate for Payer: PACE Medicare |
$0.38
|
| Rate for Payer: PACE Medicare |
$0.38
|
| Rate for Payer: PACE SWMI |
$0.40
|
| Rate for Payer: PACE SWMI |
$0.40
|
| Rate for Payer: PHP Commercial |
$774.77
|
| Rate for Payer: PHP Commercial |
$774.78
|
| Rate for Payer: PHP Medicare Advantage |
$0.40
|
| Rate for Payer: PHP Medicare Advantage |
$0.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.21
|
| 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 HMO/PPO/Tiered Network |
$1.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.13
|
| Rate for Payer: Priority Health Medicare |
$0.40
|
| Rate for Payer: Priority Health Medicare |
$0.40
|
| Rate for Payer: Priority Health Narrow Network |
$0.90
|
| Rate for Payer: Priority Health Narrow Network |
$0.90
|
| Rate for Payer: Priority Health SBD |
$574.24
|
| Rate for Payer: Priority Health SBD |
$574.24
|
| Rate for Payer: Railroad Medicare Medicare |
$0.40
|
| Rate for Payer: Railroad Medicare Medicare |
$0.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.40
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UHC Medicare Advantage |
$0.40
|
| Rate for Payer: UHC Medicare Advantage |
$0.40
|
| Rate for Payer: UHCCP Medicaid |
$0.21
|
| Rate for Payer: UHCCP Medicaid |
$0.21
|
| Rate for Payer: UMR Bronson Commercial |
$337.25
|
| Rate for Payer: UMR Bronson Commercial |
$337.26
|
| Rate for Payer: VA VA |
$0.40
|
| Rate for Payer: VA VA |
$0.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$683.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$683.62
|
|
|
TEBENTAFUSP-TEBN 100 MCG/0.5 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$91,955.20
|
|
|
Service Code
|
HCPCS J9274
|
| Hospital Charge Code |
199147
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$115.11 |
| Max. Negotiated Rate |
$82,759.68 |
| Rate for Payer: Aetna American Axle |
$59,770.88
|
| Rate for Payer: Aetna Commercial |
$78,161.92
|
| Rate for Payer: Aetna Medicare |
$223.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59,770.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.45
|
| Rate for Payer: BCBS Complete |
$120.87
|
| Rate for Payer: BCBS MAPPO |
$214.76
|
| Rate for Payer: BCBS Trust/PPO |
$579.03
|
| Rate for Payer: BCN Commercial |
$579.03
|
| Rate for Payer: BCN Medicare Advantage |
$214.76
|
| Rate for Payer: Cash Price |
$73,564.16
|
| Rate for Payer: Cash Price |
$73,564.16
|
| Rate for Payer: Cofinity Commercial |
$79,081.47
|
| Rate for Payer: Cofinity Commercial |
$64,368.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$64,368.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73,564.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$214.76
|
| Rate for Payer: Healthscope Commercial |
$82,759.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64,368.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68,966.40
|
| Rate for Payer: Mclaren Medicaid |
$115.11
|
| Rate for Payer: Mclaren Medicare |
$214.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.50
|
| Rate for Payer: Meridian Medicaid |
$120.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$246.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78,161.92
|
| Rate for Payer: Nomi Health Commercial |
$644.28
|
| Rate for Payer: PACE Medicare |
$204.02
|
| Rate for Payer: PACE SWMI |
$214.76
|
| Rate for Payer: PHP Commercial |
$78,161.92
|
| Rate for Payer: PHP Medicare Advantage |
$214.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$115.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59,770.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$618.07
|
| Rate for Payer: Priority Health Medicare |
$214.76
|
| Rate for Payer: Priority Health Narrow Network |
$494.46
|
| Rate for Payer: Priority Health SBD |
$57,931.78
|
| Rate for Payer: Railroad Medicare Medicare |
$214.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$604.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$214.76
|
| Rate for Payer: UHC Exchange |
$410.43
|
| Rate for Payer: UHC Medicare Advantage |
$214.76
|
| Rate for Payer: UHCCP Medicaid |
$115.11
|
| Rate for Payer: UMR Bronson Commercial |
$34,023.42
|
| Rate for Payer: VA VA |
$214.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68,966.40
|
|
|
TEBENTAFUSP-TEBN 100 MCG/0.5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$91,955.20
|
|
|
Service Code
|
HCPCS J9274
|
| Hospital Charge Code |
199147
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40,460.29 |
| Max. Negotiated Rate |
$82,759.68 |
| Rate for Payer: Aetna American Axle |
$59,770.88
|
| Rate for Payer: Aetna Commercial |
$78,161.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59,770.88
|
| Rate for Payer: Cash Price |
$73,564.16
|
| Rate for Payer: Cofinity Commercial |
$64,368.64
|
| Rate for Payer: Cofinity Commercial |
$79,081.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$64,368.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73,564.16
|
| Rate for Payer: Healthscope Commercial |
$82,759.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64,368.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68,966.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78,161.92
|
| Rate for Payer: PHP Commercial |
$78,161.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59,770.88
|
| Rate for Payer: Priority Health SBD |
$57,931.78
|
| Rate for Payer: UMR Bronson Commercial |
$40,460.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68,966.40
|
|
|
TECLISTAMAB-CQYV 10 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$6,326.46
|
|
|
Service Code
|
HCPCS J9380
|
| Hospital Charge Code |
201912
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.45 |
| Max. Negotiated Rate |
$5,693.81 |
| Rate for Payer: Aetna American Axle |
$4,112.20
|
| Rate for Payer: Aetna Commercial |
$5,377.49
|
| Rate for Payer: Aetna Medicare |
$33.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,112.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.69
|
| Rate for Payer: BCBS Complete |
$18.32
|
| Rate for Payer: BCBS MAPPO |
$32.55
|
| Rate for Payer: BCBS Trust/PPO |
$87.75
|
| Rate for Payer: BCN Commercial |
$87.75
|
| Rate for Payer: BCN Medicare Advantage |
$32.55
|
| Rate for Payer: Cash Price |
$5,061.17
|
| Rate for Payer: Cash Price |
$5,061.17
|
| Rate for Payer: Cofinity Commercial |
$5,440.76
|
| Rate for Payer: Cofinity Commercial |
$4,428.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,428.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,061.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.55
|
| Rate for Payer: Healthscope Commercial |
$5,693.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,428.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,744.84
|
| Rate for Payer: Mclaren Medicaid |
$17.45
|
| Rate for Payer: Mclaren Medicare |
$32.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.18
|
| Rate for Payer: Meridian Medicaid |
$18.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,377.49
|
| Rate for Payer: Nomi Health Commercial |
$97.65
|
| Rate for Payer: PACE Medicare |
$30.92
|
| Rate for Payer: PACE SWMI |
$32.55
|
| Rate for Payer: PHP Commercial |
$5,377.49
|
| Rate for Payer: PHP Medicare Advantage |
$32.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,112.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.03
|
| Rate for Payer: Priority Health Medicare |
$32.55
|
| Rate for Payer: Priority Health Narrow Network |
$73.62
|
| Rate for Payer: Priority Health SBD |
$3,985.67
|
| Rate for Payer: Railroad Medicare Medicare |
$32.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.55
|
| Rate for Payer: UHC Exchange |
$62.21
|
| Rate for Payer: UHC Medicare Advantage |
$32.55
|
| Rate for Payer: UHCCP Medicaid |
$17.45
|
| Rate for Payer: UMR Bronson Commercial |
$2,340.79
|
| Rate for Payer: VA VA |
$32.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,744.84
|
|
|
TECLISTAMAB-CQYV 10 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$6,326.46
|
|
|
Service Code
|
HCPCS J9380
|
| Hospital Charge Code |
201912
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,783.64 |
| Max. Negotiated Rate |
$5,693.81 |
| Rate for Payer: Aetna American Axle |
$4,112.20
|
| Rate for Payer: Aetna Commercial |
$5,377.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,112.20
|
| Rate for Payer: Cash Price |
$5,061.17
|
| Rate for Payer: Cofinity Commercial |
$4,428.52
|
| Rate for Payer: Cofinity Commercial |
$5,440.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,428.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,061.17
|
| Rate for Payer: Healthscope Commercial |
$5,693.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,428.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,744.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,377.49
|
| Rate for Payer: PHP Commercial |
$5,377.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,112.20
|
| Rate for Payer: Priority Health SBD |
$3,985.67
|
| Rate for Payer: UMR Bronson Commercial |
$2,783.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,744.84
|
|
|
TECLISTAMAB-CQYV 90 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$31,957.44
|
|
|
Service Code
|
HCPCS J9380
|
| Hospital Charge Code |
201911
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14,061.27 |
| Max. Negotiated Rate |
$28,761.70 |
| Rate for Payer: Aetna American Axle |
$20,772.34
|
| Rate for Payer: Aetna Commercial |
$27,163.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20,772.34
|
| Rate for Payer: Cash Price |
$25,565.95
|
| Rate for Payer: Cofinity Commercial |
$22,370.21
|
| Rate for Payer: Cofinity Commercial |
$27,483.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$22,370.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25,565.95
|
| Rate for Payer: Healthscope Commercial |
$28,761.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22,370.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23,968.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27,163.82
|
| Rate for Payer: PHP Commercial |
$27,163.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,772.34
|
| Rate for Payer: Priority Health SBD |
$20,133.19
|
| Rate for Payer: UMR Bronson Commercial |
$14,061.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23,968.08
|
|
|
TECLISTAMAB-CQYV 90 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$31,957.44
|
|
|
Service Code
|
HCPCS J9380
|
| Hospital Charge Code |
201911
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.45 |
| Max. Negotiated Rate |
$28,761.70 |
| Rate for Payer: Aetna American Axle |
$20,772.34
|
| Rate for Payer: Aetna Commercial |
$27,163.82
|
| Rate for Payer: Aetna Medicare |
$33.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20,772.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.69
|
| Rate for Payer: BCBS Complete |
$18.32
|
| Rate for Payer: BCBS MAPPO |
$32.55
|
| Rate for Payer: BCBS Trust/PPO |
$87.75
|
| Rate for Payer: BCN Commercial |
$87.75
|
| Rate for Payer: BCN Medicare Advantage |
$32.55
|
| Rate for Payer: Cash Price |
$25,565.95
|
| Rate for Payer: Cash Price |
$25,565.95
|
| Rate for Payer: Cofinity Commercial |
$27,483.40
|
| Rate for Payer: Cofinity Commercial |
$22,370.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$22,370.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25,565.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.55
|
| Rate for Payer: Healthscope Commercial |
$28,761.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22,370.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23,968.08
|
| Rate for Payer: Mclaren Medicaid |
$17.45
|
| Rate for Payer: Mclaren Medicare |
$32.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.18
|
| Rate for Payer: Meridian Medicaid |
$18.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27,163.82
|
| Rate for Payer: Nomi Health Commercial |
$97.65
|
| Rate for Payer: PACE Medicare |
$30.92
|
| Rate for Payer: PACE SWMI |
$32.55
|
| Rate for Payer: PHP Commercial |
$27,163.82
|
| Rate for Payer: PHP Medicare Advantage |
$32.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,772.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.03
|
| Rate for Payer: Priority Health Medicare |
$32.55
|
| Rate for Payer: Priority Health Narrow Network |
$73.62
|
| Rate for Payer: Priority Health SBD |
$20,133.19
|
| Rate for Payer: Railroad Medicare Medicare |
$32.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.55
|
| Rate for Payer: UHC Exchange |
$62.21
|
| Rate for Payer: UHC Medicare Advantage |
$32.55
|
| Rate for Payer: UHCCP Medicaid |
$17.45
|
| Rate for Payer: UMR Bronson Commercial |
$11,824.25
|
| Rate for Payer: VA VA |
$32.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23,968.08
|
|
