|
DORSAL AND LUMBAR FUSION PROCEDURE EXCEPT FOR CURVATURE OF BACK
|
Facility
|
IP
|
$18,367.98
|
|
|
Service Code
|
APR-DRG 3042
|
| Min. Negotiated Rate |
$17,493.32 |
| Max. Negotiated Rate |
$18,367.98 |
| Rate for Payer: BCBS Complete |
$18,367.98
|
| Rate for Payer: Mclaren Medicaid |
$17,493.32
|
| Rate for Payer: Meridian Medicaid |
$18,367.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$17,493.32
|
| Rate for Payer: UHC Medicaid |
$17,493.32
|
| Rate for Payer: UHCCP Medicaid |
$17,493.32
|
|
|
DORSAL AND LUMBAR FUSION PROCEDURE EXCEPT FOR CURVATURE OF BACK
|
Facility
|
IP
|
$34,666.36
|
|
|
Service Code
|
APR-DRG 3044
|
| Min. Negotiated Rate |
$33,015.58 |
| Max. Negotiated Rate |
$34,666.36 |
| Rate for Payer: BCBS Complete |
$34,666.36
|
| Rate for Payer: Mclaren Medicaid |
$33,015.58
|
| Rate for Payer: Meridian Medicaid |
$34,666.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$33,015.58
|
| Rate for Payer: UHC Medicaid |
$33,015.58
|
| Rate for Payer: UHCCP Medicaid |
$33,015.58
|
|
|
DORSAL AND LUMBAR FUSION PROCEDURE EXCEPT FOR CURVATURE OF BACK
|
Facility
|
IP
|
$14,416.42
|
|
|
Service Code
|
APR-DRG 3041
|
| Min. Negotiated Rate |
$13,729.92 |
| Max. Negotiated Rate |
$14,416.42 |
| Rate for Payer: BCBS Complete |
$14,416.42
|
| Rate for Payer: Mclaren Medicaid |
$13,729.92
|
| Rate for Payer: Meridian Medicaid |
$14,416.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,729.92
|
| Rate for Payer: UHC Medicaid |
$13,729.92
|
| Rate for Payer: UHCCP Medicaid |
$13,729.92
|
|
|
DORSAL AND LUMBAR FUSION PROCEDURE FOR CURVATURE OF BACK
|
Facility
|
IP
|
$27,808.03
|
|
|
Service Code
|
APR-DRG 3032
|
| Min. Negotiated Rate |
$26,483.83 |
| Max. Negotiated Rate |
$27,808.03 |
| Rate for Payer: BCBS Complete |
$27,808.03
|
| Rate for Payer: Mclaren Medicaid |
$26,483.83
|
| Rate for Payer: Meridian Medicaid |
$27,808.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$26,483.83
|
| Rate for Payer: UHC Medicaid |
$26,483.83
|
| Rate for Payer: UHCCP Medicaid |
$26,483.83
|
|
|
DORSAL AND LUMBAR FUSION PROCEDURE FOR CURVATURE OF BACK
|
Facility
|
IP
|
$62,976.20
|
|
|
Service Code
|
APR-DRG 3034
|
| Min. Negotiated Rate |
$59,977.33 |
| Max. Negotiated Rate |
$62,976.20 |
| Rate for Payer: BCBS Complete |
$62,976.20
|
| Rate for Payer: Mclaren Medicaid |
$59,977.33
|
| Rate for Payer: Meridian Medicaid |
$62,976.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$59,977.33
|
| Rate for Payer: UHC Medicaid |
$59,977.33
|
| Rate for Payer: UHCCP Medicaid |
$59,977.33
|
|
|
DORSAL AND LUMBAR FUSION PROCEDURE FOR CURVATURE OF BACK
|
Facility
|
IP
|
$40,134.26
|
|
|
Service Code
|
APR-DRG 3033
|
| Min. Negotiated Rate |
$38,223.10 |
| Max. Negotiated Rate |
$40,134.26 |
| Rate for Payer: BCBS Complete |
$40,134.26
|
| Rate for Payer: Mclaren Medicaid |
$38,223.10
|
| Rate for Payer: Meridian Medicaid |
$40,134.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$38,223.10
|
| Rate for Payer: UHC Medicaid |
$38,223.10
|
| Rate for Payer: UHCCP Medicaid |
$38,223.10
|
|
|
DORSAL AND LUMBAR FUSION PROCEDURE FOR CURVATURE OF BACK
|
Facility
|
IP
|
$24,987.21
|
|
|
Service Code
|
APR-DRG 3031
|
| Min. Negotiated Rate |
$23,797.34 |
| Max. Negotiated Rate |
$24,987.21 |
| Rate for Payer: BCBS Complete |
$24,987.21
|
| Rate for Payer: Mclaren Medicaid |
$23,797.34
|
| Rate for Payer: Meridian Medicaid |
$24,987.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$23,797.34
|
| Rate for Payer: UHC Medicaid |
$23,797.34
|
| Rate for Payer: UHCCP Medicaid |
$23,797.34
|
|
|
DORZOLAMIDE 22.3 MG-TIMOLOL 6.8 MG/ML EYE DROPS
|
Facility
|
OP
|
$30.49
|
|
|
Service Code
|
NDC 24208048610
|
| Hospital Charge Code |
22982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.28 |
| Max. Negotiated Rate |
$27.44 |
| Rate for Payer: Aetna American Axle |
$19.82
|
| Rate for Payer: Aetna Commercial |
$25.92
|
| Rate for Payer: Aetna Medicare |
$15.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.82
|
| Rate for Payer: BCBS Complete |
$12.20
|
| Rate for Payer: Cash Price |
$24.39
|
| Rate for Payer: Cofinity Advantage |
$21.34
|
| Rate for Payer: Cofinity Commercial |
$26.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.39
|
| Rate for Payer: Healthscope Commercial |
$27.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.87
|
| Rate for Payer: PHP Commercial |
$25.92
|
| Rate for Payer: Priority Health SBD |
$19.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.82
|
| Rate for Payer: UHC Core |
$15.89
|
| Rate for Payer: UHC Exchange |
$11.98
|
| Rate for Payer: UMR Bronson Commercial |
$11.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.87
|
|
|
DORZOLAMIDE 22.3 MG-TIMOLOL 6.8 MG/ML EYE DROPS
|
Facility
|
IP
|
$30.49
|
|
|
Service Code
|
NDC 24208048610
|
| Hospital Charge Code |
22982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$27.44 |
| Rate for Payer: Aetna American Axle |
$19.82
|
| Rate for Payer: Aetna Commercial |
$25.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.82
|
| Rate for Payer: Cash Price |
$24.39
|
| Rate for Payer: Cofinity Advantage |
$21.34
|
| Rate for Payer: Cofinity Commercial |
$26.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.39
|
| Rate for Payer: Healthscope Commercial |
$27.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.87
|
| Rate for Payer: PHP Commercial |
$25.92
|
| Rate for Payer: Priority Health SBD |
$19.21
|
| Rate for Payer: UMR Bronson Commercial |
$13.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.87
|
|
|
DORZOLAMIDE 2 % EYE DROPS
|
Facility
|
IP
|
$86.03
|
|
|
Service Code
|
NDC 61314001910
|
| Hospital Charge Code |
14471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.85 |
| Max. Negotiated Rate |
$77.43 |
| Rate for Payer: Aetna American Axle |
$55.92
|
| Rate for Payer: Aetna Commercial |
$73.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.92
|
| Rate for Payer: Cash Price |
$68.82
|
| Rate for Payer: Cofinity Advantage |
$60.22
|
| Rate for Payer: Cofinity Commercial |
$73.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.82
|
| Rate for Payer: Healthscope Commercial |
$77.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.52
|
| Rate for Payer: PHP Commercial |
$73.13
|
| Rate for Payer: Priority Health SBD |
$54.20
|
| Rate for Payer: UMR Bronson Commercial |
$37.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.52
|
|
|
DORZOLAMIDE 2 % EYE DROPS
|
Facility
|
IP
|
$116.96
|
|
|
Service Code
|
NDC 69315030410
|
| Hospital Charge Code |
14471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.46 |
| Max. Negotiated Rate |
$105.26 |
| Rate for Payer: Aetna American Axle |
$76.02
|
| Rate for Payer: Aetna Commercial |
$99.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.02
|
| Rate for Payer: Cash Price |
$93.57
|
| Rate for Payer: Cofinity Advantage |
$81.87
|
| Rate for Payer: Cofinity Commercial |
$100.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.57
|
| Rate for Payer: Healthscope Commercial |
$105.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.72
|
| Rate for Payer: PHP Commercial |
$99.42
|
| Rate for Payer: Priority Health SBD |
$73.68
|
| Rate for Payer: UMR Bronson Commercial |
$51.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.72
|
|
|
DORZOLAMIDE 2 % EYE DROPS
|
Facility
|
OP
|
$262.33
|
|
|
Service Code
|
NDC 00006351936
|
| Hospital Charge Code |
14471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.06 |
| Max. Negotiated Rate |
$236.10 |
| Rate for Payer: Aetna American Axle |
$170.51
|
| Rate for Payer: Aetna Commercial |
$222.98
|
| Rate for Payer: Aetna Medicare |
$131.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.51
|
| Rate for Payer: BCBS Complete |
$104.93
|
| Rate for Payer: Cash Price |
$209.86
|
| Rate for Payer: Cofinity Advantage |
$183.63
|
| Rate for Payer: Cofinity Commercial |
$225.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.86
|
| Rate for Payer: Healthscope Commercial |
$236.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$209.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.75
|
| Rate for Payer: PHP Commercial |
$222.98
|
| Rate for Payer: Priority Health SBD |
$165.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.51
|
| Rate for Payer: UHC Core |
$136.67
|
| Rate for Payer: UHC Exchange |
$103.10
|
| Rate for Payer: UMR Bronson Commercial |
$97.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.75
|
|
|
DORZOLAMIDE 2 % EYE DROPS
|
Facility
|
OP
|
$36.63
|
|
|
Service Code
|
NDC 50383023210
|
| Hospital Charge Code |
14471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.55 |
| Max. Negotiated Rate |
$32.97 |
| Rate for Payer: Aetna American Axle |
$23.81
|
| Rate for Payer: Aetna Commercial |
$31.14
|
| Rate for Payer: Aetna Medicare |
$18.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.81
|
| Rate for Payer: BCBS Complete |
$14.65
|
| Rate for Payer: Cash Price |
$29.30
|
| Rate for Payer: Cofinity Advantage |
$25.64
|
| Rate for Payer: Cofinity Commercial |
$31.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.30
|
| Rate for Payer: Healthscope Commercial |
$32.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.47
|
| Rate for Payer: PHP Commercial |
$31.14
|
| Rate for Payer: Priority Health SBD |
$23.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.81
|
| Rate for Payer: UHC Core |
$19.08
|
| Rate for Payer: UHC Exchange |
$14.40
|
| Rate for Payer: UMR Bronson Commercial |
$13.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.47
|
|
|
DORZOLAMIDE 2 % EYE DROPS
|
Facility
|
IP
|
$116.96
|
|
|
Service Code
|
NDC 24208048510
|
| Hospital Charge Code |
14471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.46 |
| Max. Negotiated Rate |
$105.26 |
| Rate for Payer: Aetna American Axle |
$76.02
|
| Rate for Payer: Aetna Commercial |
$99.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.02
|
| Rate for Payer: Cash Price |
$93.57
|
| Rate for Payer: Cofinity Advantage |
$81.87
|
| Rate for Payer: Cofinity Commercial |
$100.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.57
|
| Rate for Payer: Healthscope Commercial |
$105.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.72
|
| Rate for Payer: PHP Commercial |
$99.42
|
| Rate for Payer: Priority Health SBD |
$73.68
|
| Rate for Payer: UMR Bronson Commercial |
$51.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.72
|
|
|
DORZOLAMIDE 2 % EYE DROPS
|
Facility
|
OP
|
$86.03
|
|
|
Service Code
|
NDC 61314001910
|
| Hospital Charge Code |
14471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.83 |
| Max. Negotiated Rate |
$77.43 |
| Rate for Payer: Aetna American Axle |
$55.92
|
| Rate for Payer: Aetna Commercial |
$73.13
|
| Rate for Payer: Aetna Medicare |
$43.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.92
|
| Rate for Payer: BCBS Complete |
$34.41
|
| Rate for Payer: Cash Price |
$68.82
|
| Rate for Payer: Cofinity Advantage |
$60.22
|
| Rate for Payer: Cofinity Commercial |
$73.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.82
|
| Rate for Payer: Healthscope Commercial |
$77.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.52
|
| Rate for Payer: PHP Commercial |
$73.13
|
| Rate for Payer: Priority Health SBD |
$54.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.92
|
| Rate for Payer: UHC Core |
$44.82
|
| Rate for Payer: UHC Exchange |
$33.81
|
| Rate for Payer: UMR Bronson Commercial |
$31.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.52
|
|
|
DORZOLAMIDE 2 % EYE DROPS
|
Facility
|
IP
|
$36.63
|
|
|
Service Code
|
NDC 50383023210
|
| Hospital Charge Code |
14471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.12 |
| Max. Negotiated Rate |
$32.97 |
| Rate for Payer: Aetna American Axle |
$23.81
|
| Rate for Payer: Aetna Commercial |
$31.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.81
|
| Rate for Payer: Cash Price |
$29.30
|
| Rate for Payer: Cofinity Advantage |
$25.64
|
| Rate for Payer: Cofinity Commercial |
$31.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.30
|
| Rate for Payer: Healthscope Commercial |
$32.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.47
|
| Rate for Payer: PHP Commercial |
$31.14
|
| Rate for Payer: Priority Health SBD |
$23.08
|
| Rate for Payer: UMR Bronson Commercial |
$16.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.47
|
|
|
DORZOLAMIDE 2 % EYE DROPS
|
Facility
|
IP
|
$262.33
|
|
|
Service Code
|
NDC 00006351936
|
| Hospital Charge Code |
14471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.43 |
| Max. Negotiated Rate |
$236.10 |
| Rate for Payer: Aetna American Axle |
$170.51
|
| Rate for Payer: Aetna Commercial |
$222.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.51
|
| Rate for Payer: Cash Price |
$209.86
|
| Rate for Payer: Cofinity Advantage |
$183.63
|
| Rate for Payer: Cofinity Commercial |
$225.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.86
|
| Rate for Payer: Healthscope Commercial |
$236.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.75
|
| Rate for Payer: PHP Commercial |
$222.98
|
| Rate for Payer: Priority Health SBD |
$165.27
|
| Rate for Payer: UMR Bronson Commercial |
$115.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.75
|
|
|
DORZOLAMIDE 2 % EYE DROPS
|
Facility
|
OP
|
$116.96
|
|
|
Service Code
|
NDC 69315030410
|
| Hospital Charge Code |
14471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.28 |
| Max. Negotiated Rate |
$105.26 |
| Rate for Payer: Aetna American Axle |
$76.02
|
| Rate for Payer: Aetna Commercial |
$99.42
|
| Rate for Payer: Aetna Medicare |
$58.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.02
|
| Rate for Payer: BCBS Complete |
$46.78
|
| Rate for Payer: Cash Price |
$93.57
|
| Rate for Payer: Cofinity Advantage |
$81.87
|
| Rate for Payer: Cofinity Commercial |
$100.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.57
|
| Rate for Payer: Healthscope Commercial |
$105.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.72
|
| Rate for Payer: PHP Commercial |
$99.42
|
| Rate for Payer: Priority Health SBD |
$73.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.02
|
| Rate for Payer: UHC Core |
$60.94
|
| Rate for Payer: UHC Exchange |
$45.97
|
| Rate for Payer: UMR Bronson Commercial |
$43.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.72
|
|
|
DORZOLAMIDE 2 % EYE DROPS
|
Facility
|
OP
|
$116.96
|
|
|
Service Code
|
NDC 24208048510
|
| Hospital Charge Code |
14471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.28 |
| Max. Negotiated Rate |
$105.26 |
| Rate for Payer: Aetna American Axle |
$76.02
|
| Rate for Payer: Aetna Commercial |
$99.42
|
| Rate for Payer: Aetna Medicare |
$58.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.02
|
| Rate for Payer: BCBS Complete |
$46.78
|
| Rate for Payer: Cash Price |
$93.57
|
| Rate for Payer: Cofinity Advantage |
$81.87
|
| Rate for Payer: Cofinity Commercial |
$100.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.57
|
| Rate for Payer: Healthscope Commercial |
$105.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.72
|
| Rate for Payer: PHP Commercial |
$99.42
|
| Rate for Payer: Priority Health SBD |
$73.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.02
|
| Rate for Payer: UHC Core |
$60.94
|
| Rate for Payer: UHC Exchange |
$45.97
|
| Rate for Payer: UMR Bronson Commercial |
$43.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.72
|
|
|
DOSTARLIMAB-GXLY 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$55,096.26
|
|
|
Service Code
|
HCPCS J9272
|
| Hospital Charge Code |
197057
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$129.22 |
| Max. Negotiated Rate |
$49,586.63 |
| Rate for Payer: Aetna American Axle |
$35,812.57
|
| Rate for Payer: Aetna Commercial |
$46,831.82
|
| Rate for Payer: Aetna Medicare |
$256.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35,812.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$308.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$308.85
|
| Rate for Payer: BCBS Complete |
$135.70
|
| Rate for Payer: BCBS MAPPO |
$247.08
|
| Rate for Payer: BCBS Trust/PPO |
$802.33
|
| Rate for Payer: BCN Commercial |
$802.33
|
| Rate for Payer: BCN Medicare Advantage |
$247.08
|
| Rate for Payer: Cash Price |
$44,077.01
|
| Rate for Payer: Cash Price |
$44,077.01
|
| Rate for Payer: Cofinity Advantage |
$38,567.38
|
| Rate for Payer: Cofinity Commercial |
$47,382.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44,077.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$247.08
|
| Rate for Payer: Healthscope Commercial |
$49,586.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38,567.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41,322.19
|
| Rate for Payer: Mclaren Medicaid |
$247.08
|
| Rate for Payer: Mclaren Medicare |
$247.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$259.43
|
| Rate for Payer: Meridian Medicaid |
$259.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$284.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$271.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46,831.82
|
| Rate for Payer: Nomi Health Commercial |
$741.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41,322.19
|
| Rate for Payer: PACE Medicare |
$234.73
|
| Rate for Payer: PACE SWMI |
$247.08
|
| Rate for Payer: PHP Commercial |
$46,831.82
|
| Rate for Payer: PHP Medicare Advantage |
$247.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$129.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$768.66
|
| Rate for Payer: Priority Health Medicare |
$247.08
|
| Rate for Payer: Priority Health SBD |
$34,710.64
|
| Rate for Payer: Priority Health Tiered Network |
$614.93
|
| Rate for Payer: Railroad Medicare Medicare |
$247.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$408.28
|
| Rate for Payer: UHC Core |
$408.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$247.08
|
| Rate for Payer: UHC Exchange |
$408.28
|
| Rate for Payer: UHC Medicaid |
$129.22
|
| Rate for Payer: UHCCP Medicaid |
$129.22
|
| Rate for Payer: UMR Bronson Commercial |
$20,385.62
|
| Rate for Payer: VA VA |
$247.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41,322.19
|
|
|
DOXEPIN 10 MG CAPSULE
|
Facility
|
OP
|
$2.66
|
|
|
Service Code
|
NDC 51079043601
|
| Hospital Charge Code |
2608
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$2.39 |
| Rate for Payer: Aetna American Axle |
$1.73
|
| Rate for Payer: Aetna Commercial |
$2.26
|
| Rate for Payer: Aetna Medicare |
$1.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.73
|
| Rate for Payer: BCBS Complete |
$1.06
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cofinity Advantage |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$2.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.13
|
| Rate for Payer: Healthscope Commercial |
$2.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.00
|
| Rate for Payer: PHP Commercial |
$2.26
|
| Rate for Payer: Priority Health SBD |
$1.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.73
|
| Rate for Payer: UHC Core |
$1.39
|
| Rate for Payer: UHC Exchange |
$1.05
|
| Rate for Payer: UMR Bronson Commercial |
$0.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.00
|
|
|
DOXEPIN 10 MG CAPSULE
|
Facility
|
IP
|
$414.20
|
|
|
Service Code
|
NDC 00378104901
|
| Hospital Charge Code |
2608
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$182.25 |
| Max. Negotiated Rate |
$372.78 |
| Rate for Payer: Aetna American Axle |
$269.23
|
| Rate for Payer: Aetna Commercial |
$352.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.23
|
| Rate for Payer: Cash Price |
$331.36
|
| Rate for Payer: Cofinity Advantage |
$289.94
|
| Rate for Payer: Cofinity Commercial |
$356.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.36
|
| Rate for Payer: Healthscope Commercial |
$372.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$289.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$310.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$310.65
|
| Rate for Payer: PHP Commercial |
$352.07
|
| Rate for Payer: Priority Health SBD |
$260.95
|
| Rate for Payer: UMR Bronson Commercial |
$182.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$310.65
|
|
|
DOXEPIN 10 MG CAPSULE
|
Facility
|
OP
|
$265.44
|
|
|
Service Code
|
NDC 51079043620
|
| Hospital Charge Code |
2608
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.21 |
| Max. Negotiated Rate |
$238.90 |
| Rate for Payer: Aetna American Axle |
$172.54
|
| Rate for Payer: Aetna Commercial |
$225.62
|
| Rate for Payer: Aetna Medicare |
$132.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.54
|
| Rate for Payer: BCBS Complete |
$106.18
|
| Rate for Payer: Cash Price |
$212.35
|
| Rate for Payer: Cofinity Advantage |
$185.81
|
| Rate for Payer: Cofinity Commercial |
$228.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.35
|
| Rate for Payer: Healthscope Commercial |
$238.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$212.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.08
|
| Rate for Payer: PHP Commercial |
$225.62
|
| Rate for Payer: Priority Health SBD |
$167.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.54
|
| Rate for Payer: UHC Core |
$138.29
|
| Rate for Payer: UHC Exchange |
$104.32
|
| Rate for Payer: UMR Bronson Commercial |
$98.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.08
|
|
|
DOXEPIN 10 MG CAPSULE
|
Facility
|
IP
|
$2.66
|
|
|
Service Code
|
NDC 51079043601
|
| Hospital Charge Code |
2608
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$2.39 |
| Rate for Payer: Aetna American Axle |
$1.73
|
| Rate for Payer: Aetna Commercial |
$2.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.73
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cofinity Advantage |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$2.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.13
|
| Rate for Payer: Healthscope Commercial |
$2.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.00
|
| Rate for Payer: PHP Commercial |
$2.26
|
| Rate for Payer: Priority Health SBD |
$1.68
|
| Rate for Payer: UMR Bronson Commercial |
$1.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.00
|
|
|
DOXEPIN 10 MG CAPSULE
|
Facility
|
OP
|
$241.44
|
|
|
Service Code
|
NDC 00904705261
|
| Hospital Charge Code |
2608
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.33 |
| Max. Negotiated Rate |
$217.30 |
| Rate for Payer: Aetna American Axle |
$156.94
|
| Rate for Payer: Aetna Commercial |
$205.22
|
| Rate for Payer: Aetna Medicare |
$120.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.94
|
| Rate for Payer: BCBS Complete |
$96.58
|
| Rate for Payer: Cash Price |
$193.15
|
| Rate for Payer: Cofinity Advantage |
$169.01
|
| Rate for Payer: Cofinity Commercial |
$207.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.15
|
| Rate for Payer: Healthscope Commercial |
$217.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$169.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$181.08
|
| Rate for Payer: PHP Commercial |
$205.22
|
| Rate for Payer: Priority Health SBD |
$152.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.94
|
| Rate for Payer: UHC Core |
$125.79
|
| Rate for Payer: UHC Exchange |
$94.89
|
| Rate for Payer: UMR Bronson Commercial |
$89.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.08
|
|
