|
DEFERASIROX 250 MG DISPERSIBLE TABLET
|
Facility
|
OP
|
$1,307.81
|
|
|
Service Code
|
NDC 43598085630
|
| Hospital Charge Code |
43416
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$483.89 |
| Max. Negotiated Rate |
$1,177.03 |
| Rate for Payer: Aetna American Axle |
$850.08
|
| Rate for Payer: Aetna Commercial |
$1,111.64
|
| Rate for Payer: Aetna Medicare |
$653.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$850.08
|
| Rate for Payer: BCBS Complete |
$523.12
|
| Rate for Payer: Cash Price |
$1,046.25
|
| Rate for Payer: Cofinity Commercial |
$1,124.72
|
| Rate for Payer: Cofinity Commercial |
$915.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$915.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,046.25
|
| Rate for Payer: Healthscope Commercial |
$1,177.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$915.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$980.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,111.64
|
| Rate for Payer: PHP Commercial |
$1,111.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$850.08
|
| Rate for Payer: Priority Health SBD |
$823.92
|
| Rate for Payer: UMR Bronson Commercial |
$483.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$980.86
|
|
|
DEFERASIROX 250 MG DISPERSIBLE TABLET
|
Facility
|
IP
|
$1,307.81
|
|
|
Service Code
|
NDC 43598085630
|
| Hospital Charge Code |
43416
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$575.44 |
| Max. Negotiated Rate |
$1,177.03 |
| Rate for Payer: Aetna American Axle |
$850.08
|
| Rate for Payer: Aetna Commercial |
$1,111.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$850.08
|
| Rate for Payer: Cash Price |
$1,046.25
|
| Rate for Payer: Cofinity Commercial |
$1,124.72
|
| Rate for Payer: Cofinity Commercial |
$915.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$915.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,046.25
|
| Rate for Payer: Healthscope Commercial |
$1,177.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$915.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$980.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,111.64
|
| Rate for Payer: PHP Commercial |
$1,111.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$850.08
|
| Rate for Payer: Priority Health SBD |
$823.92
|
| Rate for Payer: UMR Bronson Commercial |
$575.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$980.86
|
|
|
DEFERASIROX 360 MG TABLET
|
Facility
|
OP
|
$236.74
|
|
|
Service Code
|
NDC 43598085130
|
| Hospital Charge Code |
163509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.59 |
| Max. Negotiated Rate |
$213.07 |
| Rate for Payer: Aetna American Axle |
$153.88
|
| Rate for Payer: Aetna Commercial |
$201.23
|
| Rate for Payer: Aetna Medicare |
$118.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.88
|
| Rate for Payer: BCBS Complete |
$94.70
|
| Rate for Payer: Cash Price |
$189.39
|
| Rate for Payer: Cofinity Commercial |
$165.72
|
| Rate for Payer: Cofinity Commercial |
$203.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$165.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.39
|
| Rate for Payer: Healthscope Commercial |
$213.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.23
|
| Rate for Payer: PHP Commercial |
$201.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.88
|
| Rate for Payer: Priority Health SBD |
$149.15
|
| Rate for Payer: UMR Bronson Commercial |
$87.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.56
|
|
|
DEFERASIROX 360 MG TABLET
|
Facility
|
IP
|
$236.74
|
|
|
Service Code
|
NDC 43598085130
|
| Hospital Charge Code |
163509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.17 |
| Max. Negotiated Rate |
$213.07 |
| Rate for Payer: Aetna American Axle |
$153.88
|
| Rate for Payer: Aetna Commercial |
$201.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.88
|
| Rate for Payer: Cash Price |
$189.39
|
| Rate for Payer: Cofinity Commercial |
$165.72
|
| Rate for Payer: Cofinity Commercial |
$203.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$165.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.39
|
| Rate for Payer: Healthscope Commercial |
$213.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.23
|
| Rate for Payer: PHP Commercial |
$201.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.88
|
| Rate for Payer: Priority Health SBD |
$149.15
|
| Rate for Payer: UMR Bronson Commercial |
$104.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.56
|
|
|
DEFERASIROX 90 MG TABLET
|
Facility
|
OP
|
$85.54
|
|
|
Service Code
|
NDC 43598085330
|
| Hospital Charge Code |
163507
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.65 |
| Max. Negotiated Rate |
$76.99 |
| Rate for Payer: Aetna American Axle |
$55.60
|
| Rate for Payer: Aetna Commercial |
$72.71
|
| Rate for Payer: Aetna Medicare |
$42.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.60
|
| Rate for Payer: BCBS Complete |
$34.22
|
| Rate for Payer: Cash Price |
$68.43
|
| Rate for Payer: Cofinity Commercial |
$59.88
|
| Rate for Payer: Cofinity Commercial |
$73.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.43
|
| Rate for Payer: Healthscope Commercial |
$76.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.71
|
| Rate for Payer: PHP Commercial |
$72.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.60
|
| Rate for Payer: Priority Health SBD |
$53.89
|
| Rate for Payer: UMR Bronson Commercial |
$31.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.16
|
|
|
DEFERASIROX 90 MG TABLET
|
Facility
|
OP
|
$5,432.01
|
|
|
Service Code
|
NDC 00078065415
|
| Hospital Charge Code |
163507
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,009.84 |
| Max. Negotiated Rate |
$4,888.81 |
| Rate for Payer: Aetna American Axle |
$3,530.81
|
| Rate for Payer: Aetna Commercial |
$4,617.21
|
| Rate for Payer: Aetna Medicare |
$2,716.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,530.81
|
| Rate for Payer: BCBS Complete |
$2,172.80
|
| Rate for Payer: Cash Price |
$4,345.61
|
| Rate for Payer: Cofinity Commercial |
$3,802.41
|
| Rate for Payer: Cofinity Commercial |
$4,671.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,802.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,345.61
|
| Rate for Payer: Healthscope Commercial |
$4,888.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,802.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,074.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,617.21
|
| Rate for Payer: PHP Commercial |
$4,617.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,530.81
|
| Rate for Payer: Priority Health SBD |
$3,422.17
|
| Rate for Payer: UMR Bronson Commercial |
$2,009.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,074.01
|
|
|
DEFERASIROX 90 MG TABLET
|
Facility
|
IP
|
$85.54
|
|
|
Service Code
|
NDC 43598085330
|
| Hospital Charge Code |
163507
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.64 |
| Max. Negotiated Rate |
$76.99 |
| Rate for Payer: Aetna American Axle |
$55.60
|
| Rate for Payer: Aetna Commercial |
$72.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.60
|
| Rate for Payer: Cash Price |
$68.43
|
| Rate for Payer: Cofinity Commercial |
$59.88
|
| Rate for Payer: Cofinity Commercial |
$73.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.43
|
| Rate for Payer: Healthscope Commercial |
$76.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.71
|
| Rate for Payer: PHP Commercial |
$72.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.60
|
| Rate for Payer: Priority Health SBD |
$53.89
|
| Rate for Payer: UMR Bronson Commercial |
$37.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.16
|
|
|
DEFERASIROX 90 MG TABLET
|
Facility
|
IP
|
$5,432.01
|
|
|
Service Code
|
NDC 00078065415
|
| Hospital Charge Code |
163507
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,390.08 |
| Max. Negotiated Rate |
$4,888.81 |
| Rate for Payer: Aetna American Axle |
$3,530.81
|
| Rate for Payer: Aetna Commercial |
$4,617.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,530.81
|
| Rate for Payer: Cash Price |
$4,345.61
|
| Rate for Payer: Cofinity Commercial |
$3,802.41
|
| Rate for Payer: Cofinity Commercial |
$4,671.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,802.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,345.61
|
| Rate for Payer: Healthscope Commercial |
$4,888.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,802.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,074.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,617.21
|
| Rate for Payer: PHP Commercial |
$4,617.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,530.81
|
| Rate for Payer: Priority Health SBD |
$3,422.17
|
| Rate for Payer: UMR Bronson Commercial |
$2,390.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,074.01
|
|
|
DEFEROXAMINE 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$156.90
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
9722
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.26 |
| Max. Negotiated Rate |
$141.21 |
| Rate for Payer: Aetna American Axle |
$101.98
|
| Rate for Payer: Aetna American Axle |
$83.40
|
| Rate for Payer: Aetna American Axle |
$66.10
|
| Rate for Payer: Aetna Commercial |
$133.36
|
| Rate for Payer: Aetna Commercial |
$86.44
|
| Rate for Payer: Aetna Commercial |
$109.06
|
| Rate for Payer: Aetna Medicare |
$64.15
|
| Rate for Payer: Aetna Medicare |
$50.84
|
| Rate for Payer: Aetna Medicare |
$78.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.40
|
| Rate for Payer: BCBS Complete |
$51.32
|
| Rate for Payer: BCBS Complete |
$62.76
|
| Rate for Payer: BCBS Complete |
$40.68
|
| Rate for Payer: BCBS Trust/PPO |
$18.26
|
| Rate for Payer: BCBS Trust/PPO |
$18.26
|
| Rate for Payer: BCBS Trust/PPO |
$18.26
|
| Rate for Payer: BCN Commercial |
$18.26
|
| Rate for Payer: BCN Commercial |
$18.26
|
| Rate for Payer: BCN Commercial |
$18.26
|
| Rate for Payer: Cash Price |
$102.64
|
| Rate for Payer: Cash Price |
$125.52
|
| Rate for Payer: Cash Price |
$81.35
|
| Rate for Payer: Cash Price |
$102.64
|
| Rate for Payer: Cash Price |
$81.35
|
| Rate for Payer: Cash Price |
$125.52
|
| Rate for Payer: Cofinity Commercial |
$89.81
|
| Rate for Payer: Cofinity Commercial |
$71.18
|
| Rate for Payer: Cofinity Commercial |
$87.45
|
| Rate for Payer: Cofinity Commercial |
$110.34
|
| Rate for Payer: Cofinity Commercial |
$109.83
|
| Rate for Payer: Cofinity Commercial |
$134.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$89.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.52
|
| Rate for Payer: Healthscope Commercial |
$141.21
|
| Rate for Payer: Healthscope Commercial |
$115.47
|
| Rate for Payer: Healthscope Commercial |
$91.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$89.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.36
|
| Rate for Payer: PHP Commercial |
$133.36
|
| Rate for Payer: PHP Commercial |
$86.44
|
| Rate for Payer: PHP Commercial |
$109.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.98
|
| Rate for Payer: Priority Health SBD |
$80.83
|
| Rate for Payer: Priority Health SBD |
$98.85
|
| Rate for Payer: Priority Health SBD |
$64.06
|
| Rate for Payer: UMR Bronson Commercial |
$58.05
|
| Rate for Payer: UMR Bronson Commercial |
$37.63
|
| Rate for Payer: UMR Bronson Commercial |
$47.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.68
|
|
|
DEFEROXAMINE 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$101.69
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
9722
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.74 |
| Max. Negotiated Rate |
$91.52 |
| Rate for Payer: Aetna American Axle |
$66.10
|
| Rate for Payer: Aetna American Axle |
$83.40
|
| Rate for Payer: Aetna American Axle |
$101.98
|
| Rate for Payer: Aetna Commercial |
$109.06
|
| Rate for Payer: Aetna Commercial |
$86.44
|
| Rate for Payer: Aetna Commercial |
$133.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.40
|
| Rate for Payer: Cash Price |
$125.52
|
| Rate for Payer: Cash Price |
$102.64
|
| Rate for Payer: Cash Price |
$81.35
|
| Rate for Payer: Cofinity Commercial |
$87.45
|
| Rate for Payer: Cofinity Commercial |
$89.81
|
| Rate for Payer: Cofinity Commercial |
$110.34
|
| Rate for Payer: Cofinity Commercial |
$134.93
|
| Rate for Payer: Cofinity Commercial |
$109.83
|
| Rate for Payer: Cofinity Commercial |
$71.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$89.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.64
|
| Rate for Payer: Healthscope Commercial |
$115.47
|
| Rate for Payer: Healthscope Commercial |
$91.52
|
| Rate for Payer: Healthscope Commercial |
$141.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$89.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.06
|
| Rate for Payer: PHP Commercial |
$133.36
|
| Rate for Payer: PHP Commercial |
$109.06
|
| Rate for Payer: PHP Commercial |
$86.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.10
|
| Rate for Payer: Priority Health SBD |
$98.85
|
| Rate for Payer: Priority Health SBD |
$80.83
|
| Rate for Payer: Priority Health SBD |
$64.06
|
| Rate for Payer: UMR Bronson Commercial |
$44.74
|
| Rate for Payer: UMR Bronson Commercial |
$69.04
|
| Rate for Payer: UMR Bronson Commercial |
$56.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.22
|
|
|
DEFEROXAMINE 500 MG IM INJECTION
|
Facility
|
OP
|
$150.65
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
200070
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.26 |
| Max. Negotiated Rate |
$135.58 |
| Rate for Payer: Aetna American Axle |
$97.92
|
| Rate for Payer: Aetna Commercial |
$128.05
|
| Rate for Payer: Aetna Medicare |
$75.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.92
|
| Rate for Payer: BCBS Complete |
$60.26
|
| Rate for Payer: BCBS Trust/PPO |
$18.26
|
| Rate for Payer: BCN Commercial |
$18.26
|
| Rate for Payer: Cash Price |
$120.52
|
| Rate for Payer: Cash Price |
$120.52
|
| Rate for Payer: Cofinity Commercial |
$105.46
|
| Rate for Payer: Cofinity Commercial |
$129.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$105.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.52
|
| Rate for Payer: Healthscope Commercial |
$135.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.05
|
| Rate for Payer: PHP Commercial |
$128.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.92
|
| Rate for Payer: Priority Health SBD |
$94.91
|
| Rate for Payer: UMR Bronson Commercial |
$55.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.99
|
|
|
DEFEROXAMINE 500 MG IM INJECTION
|
Facility
|
IP
|
$150.65
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
200070
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.29 |
| Max. Negotiated Rate |
$135.58 |
| Rate for Payer: Aetna American Axle |
$97.92
|
| Rate for Payer: Aetna Commercial |
$128.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.92
|
| Rate for Payer: Cash Price |
$120.52
|
| Rate for Payer: Cofinity Commercial |
$105.46
|
| Rate for Payer: Cofinity Commercial |
$129.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$105.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.52
|
| Rate for Payer: Healthscope Commercial |
$135.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.05
|
| Rate for Payer: PHP Commercial |
$128.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.92
|
| Rate for Payer: Priority Health SBD |
$94.91
|
| Rate for Payer: UMR Bronson Commercial |
$66.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.99
|
|
|
DEFEROXAMINE 500 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$150.65
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
9723
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.29 |
| Max. Negotiated Rate |
$135.58 |
| Rate for Payer: Aetna American Axle |
$97.92
|
| Rate for Payer: Aetna American Axle |
$34.80
|
| Rate for Payer: Aetna Commercial |
$128.05
|
| Rate for Payer: Aetna Commercial |
$45.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.80
|
| Rate for Payer: Cash Price |
$120.52
|
| Rate for Payer: Cash Price |
$42.83
|
| Rate for Payer: Cofinity Commercial |
$46.04
|
| Rate for Payer: Cofinity Commercial |
$37.48
|
| Rate for Payer: Cofinity Commercial |
$105.46
|
| Rate for Payer: Cofinity Commercial |
$129.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$105.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.83
|
| Rate for Payer: Healthscope Commercial |
$135.58
|
| Rate for Payer: Healthscope Commercial |
$48.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.05
|
| Rate for Payer: PHP Commercial |
$45.51
|
| Rate for Payer: PHP Commercial |
$128.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.80
|
| Rate for Payer: Priority Health SBD |
$94.91
|
| Rate for Payer: Priority Health SBD |
$33.73
|
| Rate for Payer: UMR Bronson Commercial |
$66.29
|
| Rate for Payer: UMR Bronson Commercial |
$23.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.16
|
|
|
DEFEROXAMINE 500 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$53.54
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
9723
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.26 |
| Max. Negotiated Rate |
$48.19 |
| Rate for Payer: Aetna American Axle |
$34.80
|
| Rate for Payer: Aetna American Axle |
$24.04
|
| Rate for Payer: Aetna American Axle |
$97.92
|
| Rate for Payer: Aetna Commercial |
$45.51
|
| Rate for Payer: Aetna Commercial |
$128.05
|
| Rate for Payer: Aetna Commercial |
$31.43
|
| Rate for Payer: Aetna Medicare |
$18.49
|
| Rate for Payer: Aetna Medicare |
$75.32
|
| Rate for Payer: Aetna Medicare |
$26.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.04
|
| Rate for Payer: BCBS Complete |
$14.79
|
| Rate for Payer: BCBS Complete |
$21.42
|
| Rate for Payer: BCBS Complete |
$60.26
|
| Rate for Payer: BCBS Trust/PPO |
$18.26
|
| Rate for Payer: BCBS Trust/PPO |
$18.26
|
| Rate for Payer: BCBS Trust/PPO |
$18.26
|
| Rate for Payer: BCN Commercial |
$18.26
|
| Rate for Payer: BCN Commercial |
$18.26
|
| Rate for Payer: BCN Commercial |
$18.26
|
| Rate for Payer: Cash Price |
$29.58
|
| Rate for Payer: Cash Price |
$42.83
|
| Rate for Payer: Cash Price |
$120.52
|
| Rate for Payer: Cash Price |
$29.58
|
| Rate for Payer: Cash Price |
$120.52
|
| Rate for Payer: Cash Price |
$42.83
|
| Rate for Payer: Cofinity Commercial |
$31.80
|
| Rate for Payer: Cofinity Commercial |
$105.46
|
| Rate for Payer: Cofinity Commercial |
$129.56
|
| Rate for Payer: Cofinity Commercial |
$25.89
|
| Rate for Payer: Cofinity Commercial |
$37.48
|
| Rate for Payer: Cofinity Commercial |
$46.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$105.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.83
|
| Rate for Payer: Healthscope Commercial |
$48.19
|
| Rate for Payer: Healthscope Commercial |
$33.28
|
| Rate for Payer: Healthscope Commercial |
$135.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.51
|
| Rate for Payer: PHP Commercial |
$45.51
|
| Rate for Payer: PHP Commercial |
$128.05
|
| Rate for Payer: PHP Commercial |
$31.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.80
|
| Rate for Payer: Priority Health SBD |
$23.30
|
| Rate for Payer: Priority Health SBD |
$33.73
|
| Rate for Payer: Priority Health SBD |
$94.91
|
| Rate for Payer: UMR Bronson Commercial |
$19.81
|
| Rate for Payer: UMR Bronson Commercial |
$55.74
|
| Rate for Payer: UMR Bronson Commercial |
$13.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.16
|
|
|
DEGARELIX 120 MG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$2,377.73
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
96987
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$2,139.96 |
| Rate for Payer: Aetna American Axle |
$1,545.52
|
| Rate for Payer: Aetna American Axle |
$3,091.05
|
| Rate for Payer: Aetna Commercial |
$4,042.14
|
| Rate for Payer: Aetna Commercial |
$2,021.07
|
| Rate for Payer: Aetna Medicare |
$4.45
|
| Rate for Payer: Aetna Medicare |
$4.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,545.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,091.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.35
|
| Rate for Payer: BCBS Complete |
$2.41
|
| Rate for Payer: BCBS Complete |
$2.41
|
| Rate for Payer: BCBS MAPPO |
$4.28
|
| Rate for Payer: BCBS MAPPO |
$4.28
|
| Rate for Payer: BCBS Trust/PPO |
$11.30
|
| Rate for Payer: BCBS Trust/PPO |
$11.30
|
| Rate for Payer: BCN Commercial |
$11.30
|
| Rate for Payer: BCN Commercial |
$11.30
|
| Rate for Payer: BCN Medicare Advantage |
$4.28
|
| Rate for Payer: BCN Medicare Advantage |
$4.28
|
| Rate for Payer: Cash Price |
$3,804.37
|
| Rate for Payer: Cash Price |
$1,902.18
|
| Rate for Payer: Cash Price |
$3,804.37
|
| Rate for Payer: Cash Price |
$1,902.18
|
| Rate for Payer: Cofinity Commercial |
$3,328.82
|
| Rate for Payer: Cofinity Commercial |
$1,664.41
|
| Rate for Payer: Cofinity Commercial |
$2,044.85
|
| Rate for Payer: Cofinity Commercial |
$4,089.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,664.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,328.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,902.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,804.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.28
|
| Rate for Payer: Healthscope Commercial |
$2,139.96
|
| Rate for Payer: Healthscope Commercial |
$4,279.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,328.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,664.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,783.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,566.60
|
| Rate for Payer: Mclaren Medicaid |
$2.29
|
| Rate for Payer: Mclaren Medicaid |
$2.29
|
| Rate for Payer: Mclaren Medicare |
$4.28
|
| Rate for Payer: Mclaren Medicare |
$4.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.49
|
| Rate for Payer: Meridian Medicaid |
$2.41
|
| Rate for Payer: Meridian Medicaid |
$2.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,021.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,042.14
|
| Rate for Payer: Nomi Health Commercial |
$12.84
|
| Rate for Payer: Nomi Health Commercial |
$12.84
|
| Rate for Payer: PACE Medicare |
$4.07
|
| Rate for Payer: PACE Medicare |
$4.07
|
| Rate for Payer: PACE SWMI |
$4.28
|
| Rate for Payer: PACE SWMI |
$4.28
|
| Rate for Payer: PHP Commercial |
$2,021.07
|
| Rate for Payer: PHP Commercial |
$4,042.14
|
| Rate for Payer: PHP Medicare Advantage |
$4.28
|
| Rate for Payer: PHP Medicare Advantage |
$4.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,545.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,091.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.01
|
| Rate for Payer: Priority Health Medicare |
$4.28
|
| Rate for Payer: Priority Health Medicare |
$4.28
|
| Rate for Payer: Priority Health Narrow Network |
$9.61
|
| Rate for Payer: Priority Health Narrow Network |
$9.61
|
| Rate for Payer: Priority Health SBD |
$1,497.97
|
| Rate for Payer: Priority Health SBD |
$2,995.94
|
| Rate for Payer: Railroad Medicare Medicare |
$4.28
|
| Rate for Payer: Railroad Medicare Medicare |
$4.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.28
|
| Rate for Payer: UHC Exchange |
$8.18
|
| Rate for Payer: UHC Exchange |
$8.18
|
| Rate for Payer: UHC Medicare Advantage |
$4.28
|
| Rate for Payer: UHC Medicare Advantage |
$4.28
|
| Rate for Payer: UHCCP Medicaid |
$2.29
|
| Rate for Payer: UHCCP Medicaid |
$2.29
|
| Rate for Payer: UMR Bronson Commercial |
$879.76
|
| Rate for Payer: UMR Bronson Commercial |
$1,759.52
|
| Rate for Payer: VA VA |
$4.28
|
| Rate for Payer: VA VA |
$4.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,783.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,566.60
|
|
|
DEGARELIX 80 MG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$1,523.97
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
96986
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$1,371.57 |
| Rate for Payer: Aetna American Axle |
$990.58
|
| Rate for Payer: Aetna Commercial |
$1,295.37
|
| Rate for Payer: Aetna Medicare |
$4.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$990.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.35
|
| Rate for Payer: BCBS Complete |
$2.41
|
| Rate for Payer: BCBS MAPPO |
$4.28
|
| Rate for Payer: BCBS Trust/PPO |
$11.30
|
| Rate for Payer: BCN Commercial |
$11.30
|
| Rate for Payer: BCN Medicare Advantage |
$4.28
|
| Rate for Payer: Cash Price |
$1,219.18
|
| Rate for Payer: Cash Price |
$1,219.18
|
| Rate for Payer: Cofinity Commercial |
$1,310.61
|
| Rate for Payer: Cofinity Commercial |
$1,066.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,066.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,219.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.28
|
| Rate for Payer: Healthscope Commercial |
$1,371.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,066.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,142.98
|
| Rate for Payer: Mclaren Medicaid |
$2.29
|
| Rate for Payer: Mclaren Medicare |
$4.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.49
|
| Rate for Payer: Meridian Medicaid |
$2.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,295.37
|
| Rate for Payer: Nomi Health Commercial |
$12.84
|
| Rate for Payer: PACE Medicare |
$4.07
|
| Rate for Payer: PACE SWMI |
$4.28
|
| Rate for Payer: PHP Commercial |
$1,295.37
|
| Rate for Payer: PHP Medicare Advantage |
$4.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$990.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.01
|
| Rate for Payer: Priority Health Medicare |
$4.28
|
| Rate for Payer: Priority Health Narrow Network |
$9.61
|
| Rate for Payer: Priority Health SBD |
$960.10
|
| Rate for Payer: Railroad Medicare Medicare |
$4.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.28
|
| Rate for Payer: UHC Exchange |
$8.18
|
| Rate for Payer: UHC Medicare Advantage |
$4.28
|
| Rate for Payer: UHCCP Medicaid |
$2.29
|
| Rate for Payer: UMR Bronson Commercial |
$563.87
|
| Rate for Payer: VA VA |
$4.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,142.98
|
|
|
DEIONIZED WATER
|
Facility
|
IP
|
$889.48
|
|
|
Service Code
|
NDC 09900000039
|
| Hospital Charge Code |
150892
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$391.37 |
| Max. Negotiated Rate |
$800.53 |
| Rate for Payer: Aetna American Axle |
$578.16
|
| Rate for Payer: Aetna Commercial |
$756.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$578.16
|
| Rate for Payer: Cash Price |
$711.58
|
| Rate for Payer: Cofinity Commercial |
$622.64
|
| Rate for Payer: Cofinity Commercial |
$764.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$622.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$711.58
|
| Rate for Payer: Healthscope Commercial |
$800.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$622.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$667.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$756.06
|
| Rate for Payer: PHP Commercial |
$756.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$578.16
|
| Rate for Payer: Priority Health SBD |
$560.37
|
| Rate for Payer: UMR Bronson Commercial |
$391.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$667.11
|
|
|
DEIONIZED WATER
|
Facility
|
OP
|
$889.48
|
|
|
Service Code
|
NDC 09900000039
|
| Hospital Charge Code |
150892
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$329.11 |
| Max. Negotiated Rate |
$800.53 |
| Rate for Payer: Aetna American Axle |
$578.16
|
| Rate for Payer: Aetna Commercial |
$756.06
|
| Rate for Payer: Aetna Medicare |
$444.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$578.16
|
| Rate for Payer: BCBS Complete |
$355.79
|
| Rate for Payer: Cash Price |
$711.58
|
| Rate for Payer: Cofinity Commercial |
$622.64
|
| Rate for Payer: Cofinity Commercial |
$764.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$622.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$711.58
|
| Rate for Payer: Healthscope Commercial |
$800.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$622.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$667.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$756.06
|
| Rate for Payer: PHP Commercial |
$756.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$578.16
|
| Rate for Payer: Priority Health SBD |
$560.37
|
| Rate for Payer: UMR Bronson Commercial |
$329.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$667.11
|
|
|
DELAY OF FLAP OR SECTIONING OF FLAP (DIVISION AND INSET); AT EYELIDS, NOSE, EARS, OR LIPS
|
Facility
|
OP
|
$5,632.99
|
|
|
Service Code
|
CPT 15630
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$326.33 |
| Max. Negotiated Rate |
$5,632.99 |
| Rate for Payer: Aetna Medicare |
$1,863.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,401.99
|
| Rate for Payer: BCN Commercial |
$1,401.99
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Nomi Health Commercial |
$3,763.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,632.99
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,506.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$358.96
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$326.33
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$960.64
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
DELAY OF FLAP OR SECTIONING OF FLAP (DIVISION AND INSET); AT FOREHEAD, CHEEKS, CHIN, NECK, AXILLAE, GENITALIA, HANDS, OR FEET
|
Facility
|
OP
|
$5,632.99
|
|
|
Service Code
|
CPT 15620
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$310.41 |
| Max. Negotiated Rate |
$5,632.99 |
| Rate for Payer: Aetna Medicare |
$1,863.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,550.49
|
| Rate for Payer: BCN Commercial |
$1,550.49
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Nomi Health Commercial |
$3,763.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,632.99
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,506.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$341.45
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$310.41
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$960.64
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
DELIVERY OF PLACENTA (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$9,791.14
|
|
|
Service Code
|
CPT 59414
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$90.03 |
| Max. Negotiated Rate |
$9,791.14 |
| Rate for Payer: Aetna Medicare |
$3,239.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,894.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,894.05
|
| Rate for Payer: BCBS Complete |
$1,753.26
|
| Rate for Payer: BCBS MAPPO |
$3,115.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,660.74
|
| Rate for Payer: BCN Commercial |
$1,660.74
|
| Rate for Payer: BCN Medicare Advantage |
$3,115.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,115.24
|
| Rate for Payer: Mclaren Medicaid |
$1,669.77
|
| Rate for Payer: Mclaren Medicare |
$3,115.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,271.00
|
| Rate for Payer: Meridian Medicaid |
$1,753.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,582.53
|
| Rate for Payer: Nomi Health Commercial |
$6,542.00
|
| Rate for Payer: PACE Medicare |
$2,959.48
|
| Rate for Payer: PACE SWMI |
$3,115.24
|
| Rate for Payer: PHP Medicare Advantage |
$3,115.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,669.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,791.14
|
| Rate for Payer: Priority Health Medicare |
$3,115.24
|
| Rate for Payer: Priority Health Narrow Network |
$7,832.91
|
| Rate for Payer: Railroad Medicare Medicare |
$3,115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.03
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Exchange |
$90.03
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.24
|
| Rate for Payer: UHCCP Medicaid |
$1,669.77
|
| Rate for Payer: VA VA |
$3,115.24
|
|
|
DEMECLOCYCLINE 150 MG TABLET
|
Facility
|
OP
|
$1,221.37
|
|
|
Service Code
|
NDC 42806014301
|
| Hospital Charge Code |
9726
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$451.91 |
| Max. Negotiated Rate |
$1,099.23 |
| Rate for Payer: Aetna American Axle |
$793.89
|
| Rate for Payer: Aetna Commercial |
$1,038.16
|
| Rate for Payer: Aetna Medicare |
$610.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$793.89
|
| Rate for Payer: BCBS Complete |
$488.55
|
| Rate for Payer: Cash Price |
$977.10
|
| Rate for Payer: Cofinity Commercial |
$1,050.38
|
| Rate for Payer: Cofinity Commercial |
$854.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$854.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$977.10
|
| Rate for Payer: Healthscope Commercial |
$1,099.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$854.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$916.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,038.16
|
| Rate for Payer: PHP Commercial |
$1,038.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$793.89
|
| Rate for Payer: Priority Health SBD |
$769.46
|
| Rate for Payer: UMR Bronson Commercial |
$451.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$916.03
|
|
|
DEMECLOCYCLINE 150 MG TABLET
|
Facility
|
IP
|
$1,221.37
|
|
|
Service Code
|
NDC 42806014301
|
| Hospital Charge Code |
9726
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$537.40 |
| Max. Negotiated Rate |
$1,099.23 |
| Rate for Payer: Aetna American Axle |
$793.89
|
| Rate for Payer: Aetna Commercial |
$1,038.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$793.89
|
| Rate for Payer: Cash Price |
$977.10
|
| Rate for Payer: Cofinity Commercial |
$1,050.38
|
| Rate for Payer: Cofinity Commercial |
$854.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$854.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$977.10
|
| Rate for Payer: Healthscope Commercial |
$1,099.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$854.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$916.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,038.16
|
| Rate for Payer: PHP Commercial |
$1,038.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$793.89
|
| Rate for Payer: Priority Health SBD |
$769.46
|
| Rate for Payer: UMR Bronson Commercial |
$537.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$916.03
|
|
|
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$7,924.39
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
106804
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,486.73 |
| Max. Negotiated Rate |
$7,131.95 |
| Rate for Payer: Aetna American Axle |
$5,150.85
|
| Rate for Payer: Aetna Commercial |
$6,735.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,150.85
|
| Rate for Payer: Cash Price |
$6,339.51
|
| Rate for Payer: Cofinity Commercial |
$5,547.07
|
| Rate for Payer: Cofinity Commercial |
$6,814.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,547.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,339.51
|
| Rate for Payer: Healthscope Commercial |
$7,131.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,547.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,943.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,735.73
|
| Rate for Payer: PHP Commercial |
$6,735.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,150.85
|
| Rate for Payer: Priority Health SBD |
$4,992.37
|
| Rate for Payer: UMR Bronson Commercial |
$3,486.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,943.29
|
|
|
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$7,924.39
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
106804
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.83 |
| Max. Negotiated Rate |
$7,131.95 |
| Rate for Payer: Aetna American Axle |
$5,150.85
|
| Rate for Payer: Aetna Commercial |
$6,735.73
|
| Rate for Payer: Aetna Medicare |
$28.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,150.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.58
|
| Rate for Payer: BCBS Complete |
$15.57
|
| Rate for Payer: BCBS MAPPO |
$27.66
|
| Rate for Payer: BCBS Trust/PPO |
$72.67
|
| Rate for Payer: BCN Commercial |
$72.67
|
| Rate for Payer: BCN Medicare Advantage |
$27.66
|
| Rate for Payer: Cash Price |
$6,339.51
|
| Rate for Payer: Cash Price |
$6,339.51
|
| Rate for Payer: Cofinity Commercial |
$6,814.98
|
| Rate for Payer: Cofinity Commercial |
$5,547.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,547.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,339.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.66
|
| Rate for Payer: Healthscope Commercial |
$7,131.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,547.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,943.29
|
| Rate for Payer: Mclaren Medicaid |
$14.83
|
| Rate for Payer: Mclaren Medicare |
$27.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.04
|
| Rate for Payer: Meridian Medicaid |
$15.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,735.73
|
| Rate for Payer: Nomi Health Commercial |
$82.98
|
| Rate for Payer: PACE Medicare |
$26.28
|
| Rate for Payer: PACE SWMI |
$27.66
|
| Rate for Payer: PHP Commercial |
$6,735.73
|
| Rate for Payer: PHP Medicare Advantage |
$27.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,150.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77.58
|
| Rate for Payer: Priority Health Medicare |
$27.66
|
| Rate for Payer: Priority Health Narrow Network |
$62.06
|
| Rate for Payer: Priority Health SBD |
$4,992.37
|
| Rate for Payer: Railroad Medicare Medicare |
$27.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.66
|
| Rate for Payer: UHC Exchange |
$52.86
|
| Rate for Payer: UHC Medicare Advantage |
$27.66
|
| Rate for Payer: UHCCP Medicaid |
$14.83
|
| Rate for Payer: UMR Bronson Commercial |
$2,932.02
|
| Rate for Payer: VA VA |
$27.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,943.29
|
|
