|
ALDESLEUKIN 22 MILLION UNIT INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$24,926.11
|
|
|
Service Code
|
HCPCS J9015
|
| Hospital Charge Code |
8993
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,746.23 |
| Max. Negotiated Rate |
$22,433.50 |
| Rate for Payer: Aetna American Axle |
$16,201.97
|
| Rate for Payer: Aetna Commercial |
$21,187.19
|
| Rate for Payer: Aetna Medicare |
$3,472.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,201.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,173.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,173.59
|
| Rate for Payer: BCBS Complete |
$1,833.71
|
| Rate for Payer: BCBS MAPPO |
$3,338.87
|
| Rate for Payer: BCBS Trust/PPO |
$19,086.72
|
| Rate for Payer: BCN Commercial |
$19,086.72
|
| Rate for Payer: BCN Medicare Advantage |
$3,338.87
|
| Rate for Payer: Cash Price |
$19,940.89
|
| Rate for Payer: Cash Price |
$19,940.89
|
| Rate for Payer: Cofinity Advantage |
$17,448.28
|
| Rate for Payer: Cofinity Commercial |
$21,436.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,940.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,338.87
|
| Rate for Payer: Healthscope Commercial |
$22,433.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17,448.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18,694.58
|
| Rate for Payer: Mclaren Medicaid |
$3,338.87
|
| Rate for Payer: Mclaren Medicare |
$3,338.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,505.81
|
| Rate for Payer: Meridian Medicaid |
$3,505.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,839.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,672.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21,187.19
|
| Rate for Payer: Nomi Health Commercial |
$10,016.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18,694.58
|
| Rate for Payer: PACE Medicare |
$3,171.93
|
| Rate for Payer: PACE SWMI |
$3,338.87
|
| Rate for Payer: PHP Commercial |
$21,187.19
|
| Rate for Payer: PHP Medicare Advantage |
$3,338.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,746.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,530.69
|
| Rate for Payer: Priority Health Medicare |
$3,338.87
|
| Rate for Payer: Priority Health SBD |
$15,703.45
|
| Rate for Payer: Priority Health Tiered Network |
$8,424.55
|
| Rate for Payer: Railroad Medicare Medicare |
$3,338.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,201.97
|
| Rate for Payer: UHC Core |
$12,986.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,338.87
|
| Rate for Payer: UHC Exchange |
$9,795.96
|
| Rate for Payer: UHC Medicaid |
$1,746.23
|
| Rate for Payer: UHCCP Medicaid |
$1,746.23
|
| Rate for Payer: UMR Bronson Commercial |
$9,222.66
|
| Rate for Payer: VA VA |
$3,338.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18,694.58
|
|
|
ALEMTUZUMAB 12 MG/1.2 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$109,073.33
|
|
|
Service Code
|
HCPCS J0202
|
| Hospital Charge Code |
173140
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47,992.27 |
| Max. Negotiated Rate |
$98,166.00 |
| Rate for Payer: Aetna American Axle |
$70,897.66
|
| Rate for Payer: Aetna Commercial |
$92,712.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70,897.66
|
| Rate for Payer: Cash Price |
$87,258.66
|
| Rate for Payer: Cofinity Advantage |
$76,351.33
|
| Rate for Payer: Cofinity Commercial |
$93,803.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87,258.66
|
| Rate for Payer: Healthscope Commercial |
$98,166.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76,351.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81,805.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92,712.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81,805.00
|
| Rate for Payer: PHP Commercial |
$92,712.33
|
| Rate for Payer: Priority Health SBD |
$68,716.20
|
| Rate for Payer: UMR Bronson Commercial |
$47,992.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81,805.00
|
|
|
ALEMTUZUMAB 12 MG/1.2 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$109,073.33
|
|
|
Service Code
|
HCPCS J0202
|
| Hospital Charge Code |
173140
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,276.34 |
| Max. Negotiated Rate |
$98,166.00 |
| Rate for Payer: Aetna American Axle |
$70,897.66
|
| Rate for Payer: Aetna Commercial |
$92,712.33
|
| Rate for Payer: Aetna Medicare |
$2,538.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70,897.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,050.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,050.53
|
| Rate for Payer: BCBS Complete |
$1,340.28
|
| Rate for Payer: BCBS MAPPO |
$2,440.42
|
| Rate for Payer: BCBS Trust/PPO |
$7,935.08
|
| Rate for Payer: BCN Commercial |
$7,935.08
|
| Rate for Payer: BCN Medicare Advantage |
$2,440.42
|
| Rate for Payer: Cash Price |
$87,258.66
|
| Rate for Payer: Cash Price |
$87,258.66
|
| Rate for Payer: Cofinity Advantage |
$76,351.33
|
| Rate for Payer: Cofinity Commercial |
$93,803.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87,258.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,440.42
|
| Rate for Payer: Healthscope Commercial |
$98,166.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76,351.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81,805.00
|
| Rate for Payer: Mclaren Medicaid |
$2,440.42
|
| Rate for Payer: Mclaren Medicare |
$2,440.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,562.44
|
| Rate for Payer: Meridian Medicaid |
$2,562.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,806.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,684.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92,712.33
|
| Rate for Payer: Nomi Health Commercial |
$7,321.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81,805.00
|
| Rate for Payer: PACE Medicare |
$2,318.40
|
| Rate for Payer: PACE SWMI |
$2,440.42
|
| Rate for Payer: PHP Commercial |
$92,712.33
|
| Rate for Payer: PHP Medicare Advantage |
$2,440.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,276.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$7,663.81
|
| Rate for Payer: Priority Health Medicare |
$2,440.42
|
| Rate for Payer: Priority Health SBD |
$68,716.20
|
| Rate for Payer: Priority Health Tiered Network |
$6,131.05
|
| Rate for Payer: Railroad Medicare Medicare |
$2,440.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,037.72
|
| Rate for Payer: UHC Core |
$4,037.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,440.42
|
| Rate for Payer: UHC Exchange |
$4,037.72
|
| Rate for Payer: UHC Medicaid |
$1,276.34
|
| Rate for Payer: UHCCP Medicaid |
$1,276.34
|
| Rate for Payer: UMR Bronson Commercial |
$40,357.13
|
| Rate for Payer: VA VA |
$2,440.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81,805.00
|
|
|
ALENDRONATE 10 MG TABLET
|
Facility
|
OP
|
$279.65
|
|
|
Service Code
|
NDC 64980034001
|
| Hospital Charge Code |
15661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.47 |
| Max. Negotiated Rate |
$251.69 |
| Rate for Payer: Aetna American Axle |
$181.77
|
| Rate for Payer: Aetna Commercial |
$237.70
|
| Rate for Payer: Aetna Medicare |
$139.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.77
|
| Rate for Payer: BCBS Complete |
$111.86
|
| Rate for Payer: Cash Price |
$223.72
|
| Rate for Payer: Cofinity Advantage |
$195.75
|
| Rate for Payer: Cofinity Commercial |
$240.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.72
|
| Rate for Payer: Healthscope Commercial |
$251.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$195.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$209.74
|
| Rate for Payer: PHP Commercial |
$237.70
|
| Rate for Payer: Priority Health SBD |
$176.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.77
|
| Rate for Payer: UHC Core |
$145.70
|
| Rate for Payer: UHC Exchange |
$109.90
|
| Rate for Payer: UMR Bronson Commercial |
$103.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.74
|
|
|
ALENDRONATE 10 MG TABLET
|
Facility
|
IP
|
$279.65
|
|
|
Service Code
|
NDC 64980034001
|
| Hospital Charge Code |
15661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.05 |
| Max. Negotiated Rate |
$251.69 |
| Rate for Payer: Aetna American Axle |
$181.77
|
| Rate for Payer: Aetna Commercial |
$237.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.77
|
| Rate for Payer: Cash Price |
$223.72
|
| Rate for Payer: Cofinity Advantage |
$195.75
|
| Rate for Payer: Cofinity Commercial |
$240.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.72
|
| Rate for Payer: Healthscope Commercial |
$251.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$195.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$209.74
|
| Rate for Payer: PHP Commercial |
$237.70
|
| Rate for Payer: Priority Health SBD |
$176.18
|
| Rate for Payer: UMR Bronson Commercial |
$123.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.74
|
|
|
ALENDRONATE 35 MG TABLET
|
Facility
|
OP
|
$33.51
|
|
|
Service Code
|
NDC 65862032804
|
| Hospital Charge Code |
29072
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$30.16 |
| Rate for Payer: Aetna American Axle |
$21.78
|
| Rate for Payer: Aetna Commercial |
$28.48
|
| Rate for Payer: Aetna Medicare |
$16.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.78
|
| Rate for Payer: BCBS Complete |
$13.40
|
| Rate for Payer: Cash Price |
$26.81
|
| Rate for Payer: Cofinity Advantage |
$23.46
|
| Rate for Payer: Cofinity Commercial |
$28.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.81
|
| Rate for Payer: Healthscope Commercial |
$30.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.13
|
| Rate for Payer: PHP Commercial |
$28.48
|
| Rate for Payer: Priority Health SBD |
$21.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.78
|
| Rate for Payer: UHC Core |
$17.46
|
| Rate for Payer: UHC Exchange |
$13.17
|
| Rate for Payer: UMR Bronson Commercial |
$12.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.13
|
|
|
ALENDRONATE 35 MG TABLET
|
Facility
|
IP
|
$33.51
|
|
|
Service Code
|
NDC 65862032804
|
| Hospital Charge Code |
29072
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.74 |
| Max. Negotiated Rate |
$30.16 |
| Rate for Payer: Aetna American Axle |
$21.78
|
| Rate for Payer: Aetna Commercial |
$28.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.78
|
| Rate for Payer: Cash Price |
$26.81
|
| Rate for Payer: Cofinity Advantage |
$23.46
|
| Rate for Payer: Cofinity Commercial |
$28.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.81
|
| Rate for Payer: Healthscope Commercial |
$30.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.13
|
| Rate for Payer: PHP Commercial |
$28.48
|
| Rate for Payer: Priority Health SBD |
$21.11
|
| Rate for Payer: UMR Bronson Commercial |
$14.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.13
|
|
|
ALENDRONATE 35 MG TABLET
|
Facility
|
OP
|
$13.49
|
|
|
Service Code
|
NDC 69097022316
|
| Hospital Charge Code |
29072
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.99 |
| Max. Negotiated Rate |
$12.14 |
| Rate for Payer: Aetna American Axle |
$8.77
|
| Rate for Payer: Aetna Commercial |
$11.47
|
| Rate for Payer: Aetna Medicare |
$6.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.77
|
| Rate for Payer: BCBS Complete |
$5.40
|
| Rate for Payer: Cash Price |
$10.79
|
| Rate for Payer: Cofinity Advantage |
$9.44
|
| Rate for Payer: Cofinity Commercial |
$11.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.79
|
| Rate for Payer: Healthscope Commercial |
$12.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.12
|
| Rate for Payer: PHP Commercial |
$11.47
|
| Rate for Payer: Priority Health SBD |
$8.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.77
|
| Rate for Payer: UHC Core |
$7.03
|
| Rate for Payer: UHC Exchange |
$5.30
|
| Rate for Payer: UMR Bronson Commercial |
$4.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.12
|
|
|
ALENDRONATE 35 MG TABLET
|
Facility
|
IP
|
$13.49
|
|
|
Service Code
|
NDC 69097022316
|
| Hospital Charge Code |
29072
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$12.14 |
| Rate for Payer: Aetna American Axle |
$8.77
|
| Rate for Payer: Aetna Commercial |
$11.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.77
|
| Rate for Payer: Cash Price |
$10.79
|
| Rate for Payer: Cofinity Advantage |
$9.44
|
| Rate for Payer: Cofinity Commercial |
$11.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.79
|
| Rate for Payer: Healthscope Commercial |
$12.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.12
|
| Rate for Payer: PHP Commercial |
$11.47
|
| Rate for Payer: Priority Health SBD |
$8.50
|
| Rate for Payer: UMR Bronson Commercial |
$5.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.12
|
|
|
ALENDRONATE 70 MG/75 ML ORAL SOLUTION
|
Facility
|
IP
|
$240.87
|
|
|
Service Code
|
NDC 00054028259
|
| Hospital Charge Code |
37640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.98 |
| Max. Negotiated Rate |
$216.78 |
| Rate for Payer: Aetna American Axle |
$156.57
|
| Rate for Payer: Aetna Commercial |
$204.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.57
|
| Rate for Payer: Cash Price |
$192.70
|
| Rate for Payer: Cofinity Advantage |
$168.61
|
| Rate for Payer: Cofinity Commercial |
$207.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.70
|
| Rate for Payer: Healthscope Commercial |
$216.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$168.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.65
|
| Rate for Payer: PHP Commercial |
$204.74
|
| Rate for Payer: Priority Health SBD |
$151.75
|
| Rate for Payer: UMR Bronson Commercial |
$105.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.65
|
|
|
ALENDRONATE 70 MG/75 ML ORAL SOLUTION
|
Facility
|
OP
|
$240.87
|
|
|
Service Code
|
NDC 00054028259
|
| Hospital Charge Code |
37640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.12 |
| Max. Negotiated Rate |
$216.78 |
| Rate for Payer: Aetna American Axle |
$156.57
|
| Rate for Payer: Aetna Commercial |
$204.74
|
| Rate for Payer: Aetna Medicare |
$120.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.57
|
| Rate for Payer: BCBS Complete |
$96.35
|
| Rate for Payer: Cash Price |
$192.70
|
| Rate for Payer: Cofinity Advantage |
$168.61
|
| Rate for Payer: Cofinity Commercial |
$207.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.70
|
| Rate for Payer: Healthscope Commercial |
$216.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$168.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$192.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.65
|
| Rate for Payer: PHP Commercial |
$204.74
|
| Rate for Payer: Priority Health SBD |
$151.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.57
|
| Rate for Payer: UHC Core |
$125.49
|
| Rate for Payer: UHC Exchange |
$94.66
|
| Rate for Payer: UMR Bronson Commercial |
$89.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.65
|
|
|
ALENDRONATE 70 MG TABLET
|
Facility
|
OP
|
$13.83
|
|
|
Service Code
|
NDC 41616063860
|
| Hospital Charge Code |
29048
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.12 |
| Max. Negotiated Rate |
$12.45 |
| Rate for Payer: Aetna American Axle |
$8.99
|
| Rate for Payer: Aetna Commercial |
$11.76
|
| Rate for Payer: Aetna Medicare |
$6.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.99
|
| Rate for Payer: BCBS Complete |
$5.53
|
| Rate for Payer: Cash Price |
$11.06
|
| Rate for Payer: Cofinity Advantage |
$9.68
|
| Rate for Payer: Cofinity Commercial |
$11.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.06
|
| Rate for Payer: Healthscope Commercial |
$12.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.37
|
| Rate for Payer: PHP Commercial |
$11.76
|
| Rate for Payer: Priority Health SBD |
$8.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.99
|
| Rate for Payer: UHC Core |
$7.21
|
| Rate for Payer: UHC Exchange |
$5.44
|
| Rate for Payer: UMR Bronson Commercial |
$5.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.37
|
|
|
ALENDRONATE 70 MG TABLET
|
Facility
|
IP
|
$13.83
|
|
|
Service Code
|
NDC 41616063860
|
| Hospital Charge Code |
29048
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.09 |
| Max. Negotiated Rate |
$12.45 |
| Rate for Payer: Aetna American Axle |
$8.99
|
| Rate for Payer: Aetna Commercial |
$11.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.99
|
| Rate for Payer: Cash Price |
$11.06
|
| Rate for Payer: Cofinity Advantage |
$9.68
|
| Rate for Payer: Cofinity Commercial |
$11.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.06
|
| Rate for Payer: Healthscope Commercial |
$12.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.37
|
| Rate for Payer: PHP Commercial |
$11.76
|
| Rate for Payer: Priority Health SBD |
$8.71
|
| Rate for Payer: UMR Bronson Commercial |
$6.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.37
|
|
|
ALGLUCOSIDASE ALFA 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3,086.18
|
|
|
Service Code
|
HCPCS J0221
|
| Hospital Charge Code |
76353
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,357.92 |
| Max. Negotiated Rate |
$2,777.56 |
| Rate for Payer: Aetna American Axle |
$2,006.02
|
| Rate for Payer: Aetna Commercial |
$2,623.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,006.02
|
| Rate for Payer: Cash Price |
$2,468.94
|
| Rate for Payer: Cofinity Advantage |
$2,160.33
|
| Rate for Payer: Cofinity Commercial |
$2,654.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,468.94
|
| Rate for Payer: Healthscope Commercial |
$2,777.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,160.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,314.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,623.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,314.64
|
| Rate for Payer: PHP Commercial |
$2,623.25
|
| Rate for Payer: Priority Health SBD |
$1,944.29
|
| Rate for Payer: UMR Bronson Commercial |
$1,357.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,314.64
|
|
|
ALGLUCOSIDASE ALFA 50 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,086.18
|
|
|
Service Code
|
HCPCS J0221
|
| Hospital Charge Code |
76353
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.53 |
| Max. Negotiated Rate |
$2,777.56 |
| Rate for Payer: Aetna American Axle |
$2,006.02
|
| Rate for Payer: Aetna Commercial |
$2,623.25
|
| Rate for Payer: Aetna Medicare |
$215.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,006.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$259.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$259.39
|
| Rate for Payer: BCBS Complete |
$113.96
|
| Rate for Payer: BCBS MAPPO |
$207.51
|
| Rate for Payer: BCBS Trust/PPO |
$672.45
|
| Rate for Payer: BCN Commercial |
$672.45
|
| Rate for Payer: BCN Medicare Advantage |
$207.51
|
| Rate for Payer: Cash Price |
$2,468.94
|
| Rate for Payer: Cash Price |
$2,468.94
|
| Rate for Payer: Cofinity Advantage |
$2,160.33
|
| Rate for Payer: Cofinity Commercial |
$2,654.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,468.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$207.51
|
| Rate for Payer: Healthscope Commercial |
$2,777.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,160.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,314.64
|
| Rate for Payer: Mclaren Medicaid |
$207.51
|
| Rate for Payer: Mclaren Medicare |
$207.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$217.89
|
| Rate for Payer: Meridian Medicaid |
$217.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$238.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$228.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,623.25
|
| Rate for Payer: Nomi Health Commercial |
$622.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,314.64
|
| Rate for Payer: PACE Medicare |
$197.13
|
| Rate for Payer: PACE SWMI |
$207.51
|
| Rate for Payer: PHP Commercial |
$2,623.25
|
| Rate for Payer: PHP Medicare Advantage |
$207.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$108.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$651.57
|
| Rate for Payer: Priority Health Medicare |
$207.51
|
| Rate for Payer: Priority Health SBD |
$1,944.29
|
| Rate for Payer: Priority Health Tiered Network |
$521.26
|
| Rate for Payer: Railroad Medicare Medicare |
$207.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$342.19
|
| Rate for Payer: UHC Core |
$342.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$207.51
|
| Rate for Payer: UHC Exchange |
$342.19
|
| Rate for Payer: UHC Medicaid |
$108.53
|
| Rate for Payer: UHCCP Medicaid |
$108.53
|
| Rate for Payer: UMR Bronson Commercial |
$1,141.89
|
| Rate for Payer: VA VA |
$207.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,314.64
|
|
|
ALISKIREN 150 MG TABLET
|
Facility
|
OP
|
$1,295.15
|
|
|
Service Code
|
NDC 70839015030
|
| Hospital Charge Code |
78653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$479.21 |
| Max. Negotiated Rate |
$1,165.63 |
| Rate for Payer: Aetna American Axle |
$841.85
|
| Rate for Payer: Aetna Commercial |
$1,100.88
|
| Rate for Payer: Aetna Medicare |
$647.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$841.85
|
| Rate for Payer: BCBS Complete |
$518.06
|
| Rate for Payer: Cash Price |
$1,036.12
|
| Rate for Payer: Cofinity Advantage |
$906.61
|
| Rate for Payer: Cofinity Commercial |
$1,113.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,036.12
|
| Rate for Payer: Healthscope Commercial |
$1,165.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$906.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$971.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,036.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,100.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$971.36
|
| Rate for Payer: PHP Commercial |
$1,100.88
|
| Rate for Payer: Priority Health SBD |
$815.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$841.85
|
| Rate for Payer: UHC Core |
$674.77
|
| Rate for Payer: UHC Exchange |
$508.99
|
| Rate for Payer: UMR Bronson Commercial |
$479.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$971.36
|
|
|
ALISKIREN 150 MG TABLET
|
Facility
|
OP
|
$642.81
|
|
|
Service Code
|
NDC 66993014130
|
| Hospital Charge Code |
78653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$237.84 |
| Max. Negotiated Rate |
$578.53 |
| Rate for Payer: Aetna American Axle |
$417.83
|
| Rate for Payer: Aetna Commercial |
$546.39
|
| Rate for Payer: Aetna Medicare |
$321.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$417.83
|
| Rate for Payer: BCBS Complete |
$257.12
|
| Rate for Payer: Cash Price |
$514.25
|
| Rate for Payer: Cofinity Advantage |
$449.97
|
| Rate for Payer: Cofinity Commercial |
$552.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.25
|
| Rate for Payer: Healthscope Commercial |
$578.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$449.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$482.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$514.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$546.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$482.11
|
| Rate for Payer: PHP Commercial |
$546.39
|
| Rate for Payer: Priority Health SBD |
$404.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$417.83
|
| Rate for Payer: UHC Core |
$334.90
|
| Rate for Payer: UHC Exchange |
$252.62
|
| Rate for Payer: UMR Bronson Commercial |
$237.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$482.11
|
|
|
ALISKIREN 150 MG TABLET
|
Facility
|
IP
|
$1,295.15
|
|
|
Service Code
|
NDC 70839015030
|
| Hospital Charge Code |
78653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$569.87 |
| Max. Negotiated Rate |
$1,165.63 |
| Rate for Payer: Aetna American Axle |
$841.85
|
| Rate for Payer: Aetna Commercial |
$1,100.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$841.85
|
| Rate for Payer: Cash Price |
$1,036.12
|
| Rate for Payer: Cofinity Advantage |
$906.61
|
| Rate for Payer: Cofinity Commercial |
$1,113.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,036.12
|
| Rate for Payer: Healthscope Commercial |
$1,165.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$906.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$971.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,100.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$971.36
|
| Rate for Payer: PHP Commercial |
$1,100.88
|
| Rate for Payer: Priority Health SBD |
$815.94
|
| Rate for Payer: UMR Bronson Commercial |
$569.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$971.36
|
|
|
ALISKIREN 150 MG TABLET
|
Facility
|
IP
|
$642.81
|
|
|
Service Code
|
NDC 66993014130
|
| Hospital Charge Code |
78653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$282.84 |
| Max. Negotiated Rate |
$578.53 |
| Rate for Payer: Aetna American Axle |
$417.83
|
| Rate for Payer: Aetna Commercial |
$546.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$417.83
|
| Rate for Payer: Cash Price |
$514.25
|
| Rate for Payer: Cofinity Advantage |
$449.97
|
| Rate for Payer: Cofinity Commercial |
$552.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.25
|
| Rate for Payer: Healthscope Commercial |
$578.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$449.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$482.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$546.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$482.11
|
| Rate for Payer: PHP Commercial |
$546.39
|
| Rate for Payer: Priority Health SBD |
$404.97
|
| Rate for Payer: UMR Bronson Commercial |
$282.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$482.11
|
|
|
ALLERGIC REACTIONS
|
Facility
|
IP
|
$5,397.08
|
|
|
Service Code
|
APR-DRG 8113
|
| Min. Negotiated Rate |
$5,140.07 |
| Max. Negotiated Rate |
$5,397.08 |
| Rate for Payer: BCBS Complete |
$5,397.08
|
| Rate for Payer: Mclaren Medicaid |
$5,140.07
|
| Rate for Payer: Meridian Medicaid |
$5,397.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,140.07
|
| Rate for Payer: UHC Medicaid |
$5,140.07
|
| Rate for Payer: UHCCP Medicaid |
$5,140.07
|
|
|
ALLERGIC REACTIONS
|
Facility
|
IP
|
$1,684.62
|
|
|
Service Code
|
APR-DRG 8111
|
| Min. Negotiated Rate |
$1,604.40 |
| Max. Negotiated Rate |
$1,684.62 |
| Rate for Payer: BCBS Complete |
$1,684.62
|
| Rate for Payer: Mclaren Medicaid |
$1,604.40
|
| Rate for Payer: Meridian Medicaid |
$1,684.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,604.40
|
| Rate for Payer: UHC Medicaid |
$1,604.40
|
| Rate for Payer: UHCCP Medicaid |
$1,604.40
|
|
|
ALLERGIC REACTIONS
|
Facility
|
IP
|
$2,431.59
|
|
|
Service Code
|
APR-DRG 8112
|
| Min. Negotiated Rate |
$2,315.80 |
| Max. Negotiated Rate |
$2,431.59 |
| Rate for Payer: BCBS Complete |
$2,431.59
|
| Rate for Payer: Mclaren Medicaid |
$2,315.80
|
| Rate for Payer: Meridian Medicaid |
$2,431.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,315.80
|
| Rate for Payer: UHC Medicaid |
$2,315.80
|
| Rate for Payer: UHCCP Medicaid |
$2,315.80
|
|
|
ALLERGIC REACTIONS
|
Facility
|
IP
|
$10,856.50
|
|
|
Service Code
|
APR-DRG 8114
|
| Min. Negotiated Rate |
$10,339.53 |
| Max. Negotiated Rate |
$10,856.50 |
| Rate for Payer: BCBS Complete |
$10,856.50
|
| Rate for Payer: Mclaren Medicaid |
$10,339.53
|
| Rate for Payer: Meridian Medicaid |
$10,856.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,339.53
|
| Rate for Payer: UHC Medicaid |
$10,339.53
|
| Rate for Payer: UHCCP Medicaid |
$10,339.53
|
|
|
ALLERGIC REACTIONS WITH MCC
|
Facility
|
IP
|
$35,499.63
|
|
|
Service Code
|
MSDRG 915
|
| Min. Negotiated Rate |
$13,922.88 |
| Max. Negotiated Rate |
$35,499.63 |
| Rate for Payer: Aetna Medicare |
$15,241.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,319.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,319.58
|
| Rate for Payer: BCBS MAPPO |
$14,655.66
|
| Rate for Payer: BCBS Trust/PPO |
$35,499.63
|
| Rate for Payer: BCN Commercial |
$35,499.63
|
| Rate for Payer: BCN Medicare Advantage |
$14,655.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,655.66
|
| Rate for Payer: Mclaren Medicare |
$14,655.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,388.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,854.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$16,121.23
|
| Rate for Payer: Nomi Health Commercial |
$21,692.64
|
| Rate for Payer: PACE Medicare |
$13,922.88
|
| Rate for Payer: PACE SWMI |
$14,655.66
|
| Rate for Payer: PHP Medicare Advantage |
$14,655.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$27,110.99
|
| Rate for Payer: Priority Health Medicare |
$14,655.66
|
| Rate for Payer: Priority Health Tiered Network |
$21,688.79
|
| Rate for Payer: Railroad Medicare Medicare |
$14,655.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,410.08
|
| Rate for Payer: UHC Core |
$22,931.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,655.66
|
| Rate for Payer: UHC Exchange |
$18,727.98
|
| Rate for Payer: VA VA |
$14,655.66
|
|
|
ALLERGIC REACTIONS WITHOUT MCC
|
Facility
|
IP
|
$12,641.19
|
|
|
Service Code
|
MSDRG 916
|
| Min. Negotiated Rate |
$5,856.78 |
| Max. Negotiated Rate |
$12,641.19 |
| Rate for Payer: Aetna Medicare |
$6,411.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,706.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,706.29
|
| Rate for Payer: BCBS MAPPO |
$6,165.03
|
| Rate for Payer: BCBS Trust/PPO |
$12,641.19
|
| Rate for Payer: BCN Commercial |
$12,641.19
|
| Rate for Payer: BCN Medicare Advantage |
$6,165.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,165.03
|
| Rate for Payer: Mclaren Medicare |
$6,165.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,473.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,089.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,781.53
|
| Rate for Payer: Nomi Health Commercial |
$8,595.27
|
| Rate for Payer: PACE Medicare |
$5,856.78
|
| Rate for Payer: PACE SWMI |
$6,165.03
|
| Rate for Payer: PHP Medicare Advantage |
$6,165.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,742.18
|
| Rate for Payer: Priority Health Medicare |
$6,165.03
|
| Rate for Payer: Priority Health Tiered Network |
$8,593.74
|
| Rate for Payer: Railroad Medicare Medicare |
$6,165.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,860.69
|
| Rate for Payer: UHC Core |
$9,086.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,165.03
|
| Rate for Payer: UHC Exchange |
$7,420.58
|
| Rate for Payer: VA VA |
$6,165.03
|
|
