|
DUODERM CGF DRESSING EXTRA THIN 4X4
|
Facility
|
IP
|
$7.30
|
|
|
Service Code
|
NDC 68455010691
|
| Hospital Charge Code |
150728
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$6.57 |
| Rate for Payer: Aetna American Axle |
$4.75
|
| Rate for Payer: Aetna Commercial |
$6.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.75
|
| Rate for Payer: Cash Price |
$5.84
|
| Rate for Payer: Cofinity Advantage |
$5.11
|
| Rate for Payer: Cofinity Commercial |
$6.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.84
|
| Rate for Payer: Healthscope Commercial |
$6.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.47
|
| Rate for Payer: PHP Commercial |
$6.21
|
| Rate for Payer: Priority Health SBD |
$4.60
|
| Rate for Payer: UMR Bronson Commercial |
$3.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.47
|
|
|
DUPILUMAB 200 MG/1.14 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$5,314.66
|
|
|
Service Code
|
NDC 00024591801
|
| Hospital Charge Code |
188703
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2,338.45 |
| Max. Negotiated Rate |
$4,783.19 |
| Rate for Payer: Aetna American Axle |
$3,454.53
|
| Rate for Payer: Aetna Commercial |
$4,517.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,454.53
|
| Rate for Payer: Cash Price |
$4,251.73
|
| Rate for Payer: Cofinity Advantage |
$3,720.26
|
| Rate for Payer: Cofinity Commercial |
$4,570.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,251.73
|
| Rate for Payer: Healthscope Commercial |
$4,783.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,720.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,985.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,517.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,985.99
|
| Rate for Payer: PHP Commercial |
$4,517.46
|
| Rate for Payer: Priority Health SBD |
$3,348.24
|
| Rate for Payer: UMR Bronson Commercial |
$2,338.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,985.99
|
|
|
DUPILUMAB 200 MG/1.14 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$5,314.66
|
|
|
Service Code
|
NDC 00024591800
|
| Hospital Charge Code |
188703
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,966.42 |
| Max. Negotiated Rate |
$4,783.19 |
| Rate for Payer: Aetna American Axle |
$3,454.53
|
| Rate for Payer: Aetna Commercial |
$4,517.46
|
| Rate for Payer: Aetna Medicare |
$2,657.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,454.53
|
| Rate for Payer: BCBS Complete |
$2,125.86
|
| Rate for Payer: Cash Price |
$4,251.73
|
| Rate for Payer: Cofinity Advantage |
$3,720.26
|
| Rate for Payer: Cofinity Commercial |
$4,570.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,251.73
|
| Rate for Payer: Healthscope Commercial |
$4,783.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,720.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,985.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,251.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,517.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,985.99
|
| Rate for Payer: PHP Commercial |
$4,517.46
|
| Rate for Payer: Priority Health SBD |
$3,348.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,454.53
|
| Rate for Payer: UHC Core |
$2,768.94
|
| Rate for Payer: UHC Exchange |
$2,088.66
|
| Rate for Payer: UMR Bronson Commercial |
$1,966.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,985.99
|
|
|
DUPILUMAB 200 MG/1.14 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$5,314.66
|
|
|
Service Code
|
NDC 00024591801
|
| Hospital Charge Code |
188703
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,966.42 |
| Max. Negotiated Rate |
$4,783.19 |
| Rate for Payer: Aetna American Axle |
$3,454.53
|
| Rate for Payer: Aetna Commercial |
$4,517.46
|
| Rate for Payer: Aetna Medicare |
$2,657.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,454.53
|
| Rate for Payer: BCBS Complete |
$2,125.86
|
| Rate for Payer: Cash Price |
$4,251.73
|
| Rate for Payer: Cofinity Advantage |
$3,720.26
|
| Rate for Payer: Cofinity Commercial |
$4,570.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,251.73
|
| Rate for Payer: Healthscope Commercial |
$4,783.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,720.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,985.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,251.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,517.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,985.99
|
| Rate for Payer: PHP Commercial |
$4,517.46
|
| Rate for Payer: Priority Health SBD |
$3,348.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,454.53
|
| Rate for Payer: UHC Core |
$2,768.94
|
| Rate for Payer: UHC Exchange |
$2,088.66
|
| Rate for Payer: UMR Bronson Commercial |
$1,966.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,985.99
|
|
|
DUPILUMAB 200 MG/1.14 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$5,314.66
|
|
|
Service Code
|
NDC 24591800
|
| Hospital Charge Code |
188703
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,966.42 |
| Max. Negotiated Rate |
$4,783.19 |
| Rate for Payer: Aetna American Axle |
$3,454.53
|
| Rate for Payer: Aetna Commercial |
$4,517.46
|
| Rate for Payer: Aetna Medicare |
$2,657.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,454.53
|
| Rate for Payer: BCBS Complete |
$2,125.86
|
| Rate for Payer: Cash Price |
$4,251.73
|
| Rate for Payer: Cofinity Advantage |
$3,720.26
|
| Rate for Payer: Cofinity Commercial |
$4,570.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,251.73
|
| Rate for Payer: Healthscope Commercial |
$4,783.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,720.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,985.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,251.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,517.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,985.99
|
| Rate for Payer: PHP Commercial |
$4,517.46
|
| Rate for Payer: Priority Health SBD |
$3,348.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,454.53
|
| Rate for Payer: UHC Core |
$2,768.94
|
| Rate for Payer: UHC Exchange |
$2,088.66
|
| Rate for Payer: UMR Bronson Commercial |
$1,966.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,985.99
|
|
|
DUPILUMAB 200 MG/1.14 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$5,314.66
|
|
|
Service Code
|
NDC 24591801
|
| Hospital Charge Code |
188703
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,966.42 |
| Max. Negotiated Rate |
$4,783.19 |
| Rate for Payer: Aetna American Axle |
$3,454.53
|
| Rate for Payer: Aetna Commercial |
$4,517.46
|
| Rate for Payer: Aetna Medicare |
$2,657.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,454.53
|
| Rate for Payer: BCBS Complete |
$2,125.86
|
| Rate for Payer: Cash Price |
$4,251.73
|
| Rate for Payer: Cofinity Advantage |
$3,720.26
|
| Rate for Payer: Cofinity Commercial |
$4,570.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,251.73
|
| Rate for Payer: Healthscope Commercial |
$4,783.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,720.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,985.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,251.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,517.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,985.99
|
| Rate for Payer: PHP Commercial |
$4,517.46
|
| Rate for Payer: Priority Health SBD |
$3,348.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,454.53
|
| Rate for Payer: UHC Core |
$2,768.94
|
| Rate for Payer: UHC Exchange |
$2,088.66
|
| Rate for Payer: UMR Bronson Commercial |
$1,966.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,985.99
|
|
|
DUPILUMAB 200 MG/1.14 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$5,314.66
|
|
|
Service Code
|
NDC 00024591800
|
| Hospital Charge Code |
188703
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2,338.45 |
| Max. Negotiated Rate |
$4,783.19 |
| Rate for Payer: Aetna American Axle |
$3,454.53
|
| Rate for Payer: Aetna Commercial |
$4,517.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,454.53
|
| Rate for Payer: Cash Price |
$4,251.73
|
| Rate for Payer: Cofinity Advantage |
$3,720.26
|
| Rate for Payer: Cofinity Commercial |
$4,570.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,251.73
|
| Rate for Payer: Healthscope Commercial |
$4,783.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,720.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,985.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,517.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,985.99
|
| Rate for Payer: PHP Commercial |
$4,517.46
|
| Rate for Payer: Priority Health SBD |
$3,348.24
|
| Rate for Payer: UMR Bronson Commercial |
$2,338.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,985.99
|
|
|
DUPILUMAB 300 MG/2 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$5,314.66
|
|
|
Service Code
|
NDC 24591400
|
| Hospital Charge Code |
182455
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,966.42 |
| Max. Negotiated Rate |
$4,783.19 |
| Rate for Payer: Aetna American Axle |
$3,454.53
|
| Rate for Payer: Aetna Commercial |
$4,517.46
|
| Rate for Payer: Aetna Medicare |
$2,657.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,454.53
|
| Rate for Payer: BCBS Complete |
$2,125.86
|
| Rate for Payer: Cash Price |
$4,251.73
|
| Rate for Payer: Cofinity Advantage |
$3,720.26
|
| Rate for Payer: Cofinity Commercial |
$4,570.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,251.73
|
| Rate for Payer: Healthscope Commercial |
$4,783.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,720.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,985.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,251.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,517.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,985.99
|
| Rate for Payer: PHP Commercial |
$4,517.46
|
| Rate for Payer: Priority Health SBD |
$3,348.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,454.53
|
| Rate for Payer: UHC Core |
$2,768.94
|
| Rate for Payer: UHC Exchange |
$2,088.66
|
| Rate for Payer: UMR Bronson Commercial |
$1,966.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,985.99
|
|
|
DUPILUMAB 300 MG/2 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$5,314.66
|
|
|
Service Code
|
NDC 24591401
|
| Hospital Charge Code |
182455
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,966.42 |
| Max. Negotiated Rate |
$4,783.19 |
| Rate for Payer: Aetna American Axle |
$3,454.53
|
| Rate for Payer: Aetna Commercial |
$4,517.46
|
| Rate for Payer: Aetna Medicare |
$2,657.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,454.53
|
| Rate for Payer: BCBS Complete |
$2,125.86
|
| Rate for Payer: Cash Price |
$4,251.73
|
| Rate for Payer: Cofinity Advantage |
$3,720.26
|
| Rate for Payer: Cofinity Commercial |
$4,570.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,251.73
|
| Rate for Payer: Healthscope Commercial |
$4,783.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,720.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,985.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,251.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,517.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,985.99
|
| Rate for Payer: PHP Commercial |
$4,517.46
|
| Rate for Payer: Priority Health SBD |
$3,348.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,454.53
|
| Rate for Payer: UHC Core |
$2,768.94
|
| Rate for Payer: UHC Exchange |
$2,088.66
|
| Rate for Payer: UMR Bronson Commercial |
$1,966.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,985.99
|
|
|
DUPILUMAB 300 MG/2 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$5,314.66
|
|
|
Service Code
|
NDC 00024591401
|
| Hospital Charge Code |
182455
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,966.42 |
| Max. Negotiated Rate |
$4,783.19 |
| Rate for Payer: Aetna American Axle |
$3,454.53
|
| Rate for Payer: Aetna Commercial |
$4,517.46
|
| Rate for Payer: Aetna Medicare |
$2,657.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,454.53
|
| Rate for Payer: BCBS Complete |
$2,125.86
|
| Rate for Payer: Cash Price |
$4,251.73
|
| Rate for Payer: Cofinity Advantage |
$3,720.26
|
| Rate for Payer: Cofinity Commercial |
$4,570.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,251.73
|
| Rate for Payer: Healthscope Commercial |
$4,783.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,720.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,985.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,251.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,517.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,985.99
|
| Rate for Payer: PHP Commercial |
$4,517.46
|
| Rate for Payer: Priority Health SBD |
$3,348.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,454.53
|
| Rate for Payer: UHC Core |
$2,768.94
|
| Rate for Payer: UHC Exchange |
$2,088.66
|
| Rate for Payer: UMR Bronson Commercial |
$1,966.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,985.99
|
|
|
DUPILUMAB 300 MG/2 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$5,314.66
|
|
|
Service Code
|
NDC 00024591400
|
| Hospital Charge Code |
182455
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2,338.45 |
| Max. Negotiated Rate |
$4,783.19 |
| Rate for Payer: Aetna American Axle |
$3,454.53
|
| Rate for Payer: Aetna Commercial |
$4,517.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,454.53
|
| Rate for Payer: Cash Price |
$4,251.73
|
| Rate for Payer: Cofinity Advantage |
$3,720.26
|
| Rate for Payer: Cofinity Commercial |
$4,570.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,251.73
|
| Rate for Payer: Healthscope Commercial |
$4,783.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,720.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,985.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,517.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,985.99
|
| Rate for Payer: PHP Commercial |
$4,517.46
|
| Rate for Payer: Priority Health SBD |
$3,348.24
|
| Rate for Payer: UMR Bronson Commercial |
$2,338.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,985.99
|
|
|
DUPILUMAB 300 MG/2 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$5,314.66
|
|
|
Service Code
|
NDC 00024591400
|
| Hospital Charge Code |
182455
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,966.42 |
| Max. Negotiated Rate |
$4,783.19 |
| Rate for Payer: Aetna American Axle |
$3,454.53
|
| Rate for Payer: Aetna Commercial |
$4,517.46
|
| Rate for Payer: Aetna Medicare |
$2,657.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,454.53
|
| Rate for Payer: BCBS Complete |
$2,125.86
|
| Rate for Payer: Cash Price |
$4,251.73
|
| Rate for Payer: Cofinity Advantage |
$3,720.26
|
| Rate for Payer: Cofinity Commercial |
$4,570.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,251.73
|
| Rate for Payer: Healthscope Commercial |
$4,783.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,720.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,985.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,251.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,517.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,985.99
|
| Rate for Payer: PHP Commercial |
$4,517.46
|
| Rate for Payer: Priority Health SBD |
$3,348.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,454.53
|
| Rate for Payer: UHC Core |
$2,768.94
|
| Rate for Payer: UHC Exchange |
$2,088.66
|
| Rate for Payer: UMR Bronson Commercial |
$1,966.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,985.99
|
|
|
DUPILUMAB 300 MG/2 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$5,314.66
|
|
|
Service Code
|
NDC 00024591401
|
| Hospital Charge Code |
182455
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2,338.45 |
| Max. Negotiated Rate |
$4,783.19 |
| Rate for Payer: Aetna American Axle |
$3,454.53
|
| Rate for Payer: Aetna Commercial |
$4,517.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,454.53
|
| Rate for Payer: Cash Price |
$4,251.73
|
| Rate for Payer: Cofinity Advantage |
$3,720.26
|
| Rate for Payer: Cofinity Commercial |
$4,570.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,251.73
|
| Rate for Payer: Healthscope Commercial |
$4,783.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,720.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,985.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,517.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,985.99
|
| Rate for Payer: PHP Commercial |
$4,517.46
|
| Rate for Payer: Priority Health SBD |
$3,348.24
|
| Rate for Payer: UMR Bronson Commercial |
$2,338.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,985.99
|
|
|
DURVALUMAB 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$4,743.64
|
|
|
Service Code
|
HCPCS J9173
|
| Hospital Charge Code |
183305
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.06 |
| Max. Negotiated Rate |
$4,269.28 |
| Rate for Payer: Aetna American Axle |
$3,083.37
|
| Rate for Payer: Aetna American Axle |
$12,847.33
|
| Rate for Payer: Aetna Commercial |
$16,800.35
|
| Rate for Payer: Aetna Commercial |
$4,032.09
|
| Rate for Payer: Aetna Medicare |
$89.60
|
| Rate for Payer: Aetna Medicare |
$89.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,847.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,083.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.69
|
| Rate for Payer: BCBS Complete |
$47.31
|
| Rate for Payer: BCBS Complete |
$47.31
|
| Rate for Payer: BCBS MAPPO |
$86.15
|
| Rate for Payer: BCBS MAPPO |
$86.15
|
| Rate for Payer: BCBS Trust/PPO |
$279.72
|
| Rate for Payer: BCBS Trust/PPO |
$279.72
|
| Rate for Payer: BCN Commercial |
$279.72
|
| Rate for Payer: BCN Commercial |
$279.72
|
| Rate for Payer: BCN Medicare Advantage |
$86.15
|
| Rate for Payer: BCN Medicare Advantage |
$86.15
|
| Rate for Payer: Cash Price |
$15,812.10
|
| Rate for Payer: Cash Price |
$3,794.91
|
| Rate for Payer: Cash Price |
$3,794.91
|
| Rate for Payer: Cash Price |
$15,812.10
|
| Rate for Payer: Cofinity Advantage |
$3,320.55
|
| Rate for Payer: Cofinity Advantage |
$13,835.58
|
| Rate for Payer: Cofinity Commercial |
$16,998.00
|
| Rate for Payer: Cofinity Commercial |
$4,079.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,812.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,794.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.15
|
| Rate for Payer: Healthscope Commercial |
$17,788.61
|
| Rate for Payer: Healthscope Commercial |
$4,269.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,320.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13,835.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,823.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,557.73
|
| Rate for Payer: Mclaren Medicaid |
$86.15
|
| Rate for Payer: Mclaren Medicaid |
$86.15
|
| Rate for Payer: Mclaren Medicare |
$86.15
|
| Rate for Payer: Mclaren Medicare |
$86.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.46
|
| Rate for Payer: Meridian Medicaid |
$90.46
|
| Rate for Payer: Meridian Medicaid |
$90.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$94.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$94.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,800.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,032.09
|
| Rate for Payer: Nomi Health Commercial |
$258.45
|
| Rate for Payer: Nomi Health Commercial |
$258.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,557.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,823.84
|
| Rate for Payer: PACE Medicare |
$81.84
|
| Rate for Payer: PACE Medicare |
$81.84
|
| Rate for Payer: PACE SWMI |
$86.15
|
| Rate for Payer: PACE SWMI |
$86.15
|
| Rate for Payer: PHP Commercial |
$16,800.35
|
| Rate for Payer: PHP Commercial |
$4,032.09
|
| Rate for Payer: PHP Medicare Advantage |
$86.15
|
| Rate for Payer: PHP Medicare Advantage |
$86.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$268.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$268.45
|
| Rate for Payer: Priority Health Medicare |
$86.15
|
| Rate for Payer: Priority Health Medicare |
$86.15
|
| Rate for Payer: Priority Health SBD |
$12,452.03
|
| Rate for Payer: Priority Health SBD |
$2,988.49
|
| Rate for Payer: Priority Health Tiered Network |
$214.76
|
| Rate for Payer: Priority Health Tiered Network |
$214.76
|
| Rate for Payer: Railroad Medicare Medicare |
$86.15
|
| Rate for Payer: Railroad Medicare Medicare |
$86.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.35
|
| Rate for Payer: UHC Core |
$142.35
|
| Rate for Payer: UHC Core |
$142.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.15
|
| Rate for Payer: UHC Exchange |
$142.35
|
| Rate for Payer: UHC Exchange |
$142.35
|
| Rate for Payer: UHC Medicaid |
$45.06
|
| Rate for Payer: UHC Medicaid |
$45.06
|
| Rate for Payer: UHCCP Medicaid |
$45.06
|
| Rate for Payer: UHCCP Medicaid |
$45.06
|
| Rate for Payer: UMR Bronson Commercial |
$7,313.09
|
| Rate for Payer: UMR Bronson Commercial |
$1,755.15
|
| Rate for Payer: VA VA |
$86.15
|
| Rate for Payer: VA VA |
$86.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,557.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,823.84
|
|
|
DURVALUMAB 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19,765.12
|
|
|
Service Code
|
HCPCS J9173
|
| Hospital Charge Code |
183305
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8,696.65 |
| Max. Negotiated Rate |
$17,788.61 |
| Rate for Payer: Aetna American Axle |
$12,847.33
|
| Rate for Payer: Aetna American Axle |
$3,083.37
|
| Rate for Payer: Aetna Commercial |
$16,800.35
|
| Rate for Payer: Aetna Commercial |
$4,032.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,847.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,083.37
|
| Rate for Payer: Cash Price |
$15,812.10
|
| Rate for Payer: Cash Price |
$3,794.91
|
| Rate for Payer: Cofinity Advantage |
$3,320.55
|
| Rate for Payer: Cofinity Advantage |
$13,835.58
|
| Rate for Payer: Cofinity Commercial |
$4,079.53
|
| Rate for Payer: Cofinity Commercial |
$16,998.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,812.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,794.91
|
| Rate for Payer: Healthscope Commercial |
$17,788.61
|
| Rate for Payer: Healthscope Commercial |
$4,269.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,320.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13,835.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,823.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,557.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,800.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,032.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,823.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,557.73
|
| Rate for Payer: PHP Commercial |
$16,800.35
|
| Rate for Payer: PHP Commercial |
$4,032.09
|
| Rate for Payer: Priority Health SBD |
$2,988.49
|
| Rate for Payer: Priority Health SBD |
$12,452.03
|
| Rate for Payer: UMR Bronson Commercial |
$8,696.65
|
| Rate for Payer: UMR Bronson Commercial |
$2,087.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,823.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,557.73
|
|
|
DYSEQUILIBRIUM
|
Facility
|
IP
|
$17,758.05
|
|
|
Service Code
|
MSDRG 149
|
| Min. Negotiated Rate |
$6,534.45 |
| Max. Negotiated Rate |
$17,758.05 |
| Rate for Payer: Aetna Medicare |
$7,153.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,597.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,597.96
|
| Rate for Payer: BCBS MAPPO |
$6,878.37
|
| Rate for Payer: BCBS Trust/PPO |
$17,758.05
|
| Rate for Payer: BCN Commercial |
$17,758.05
|
| Rate for Payer: BCN Medicare Advantage |
$6,878.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,878.37
|
| Rate for Payer: Mclaren Medicare |
$6,878.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,222.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,910.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,566.21
|
| Rate for Payer: Nomi Health Commercial |
$9,695.64
|
| Rate for Payer: PACE Medicare |
$6,534.45
|
| Rate for Payer: PACE SWMI |
$6,878.37
|
| Rate for Payer: PHP Medicare Advantage |
$6,878.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,117.40
|
| Rate for Payer: Priority Health Medicare |
$6,878.37
|
| Rate for Payer: Priority Health Tiered Network |
$9,693.92
|
| Rate for Payer: Railroad Medicare Medicare |
$6,878.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,251.08
|
| Rate for Payer: UHC Core |
$10,249.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,878.37
|
| Rate for Payer: UHC Exchange |
$8,370.57
|
| Rate for Payer: VA VA |
$6,878.37
|
|
|
EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC
|
Facility
|
IP
|
$26,923.94
|
|
|
Service Code
|
MSDRG 147
|
| Min. Negotiated Rate |
$10,664.82 |
| Max. Negotiated Rate |
$26,923.94 |
| Rate for Payer: Aetna Medicare |
$11,675.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,032.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,032.66
|
| Rate for Payer: BCBS MAPPO |
$11,226.13
|
| Rate for Payer: BCBS Trust/PPO |
$26,923.94
|
| Rate for Payer: BCN Commercial |
$26,923.94
|
| Rate for Payer: BCN Medicare Advantage |
$11,226.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,226.13
|
| Rate for Payer: Mclaren Medicare |
$11,226.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,787.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,910.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,348.74
|
| Rate for Payer: Nomi Health Commercial |
$16,402.35
|
| Rate for Payer: PACE Medicare |
$10,664.82
|
| Rate for Payer: PACE SWMI |
$11,226.13
|
| Rate for Payer: PHP Medicare Advantage |
$11,226.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$20,499.30
|
| Rate for Payer: Priority Health Medicare |
$11,226.13
|
| Rate for Payer: Priority Health Tiered Network |
$16,399.44
|
| Rate for Payer: Railroad Medicare Medicare |
$11,226.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20,725.45
|
| Rate for Payer: UHC Core |
$17,339.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,226.13
|
| Rate for Payer: UHC Exchange |
$14,160.70
|
| Rate for Payer: VA VA |
$11,226.13
|
|
|
EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC
|
Facility
|
IP
|
$35,958.06
|
|
|
Service Code
|
MSDRG 146
|
| Min. Negotiated Rate |
$17,385.13 |
| Max. Negotiated Rate |
$35,958.06 |
| Rate for Payer: Aetna Medicare |
$19,032.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,875.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,875.17
|
| Rate for Payer: BCBS MAPPO |
$18,300.14
|
| Rate for Payer: BCBS Trust/PPO |
$35,958.06
|
| Rate for Payer: BCN Commercial |
$35,958.06
|
| Rate for Payer: BCN Medicare Advantage |
$18,300.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,300.14
|
| Rate for Payer: Mclaren Medicare |
$18,300.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19,215.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,045.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$20,130.15
|
| Rate for Payer: Nomi Health Commercial |
$27,314.46
|
| Rate for Payer: PACE Medicare |
$17,385.13
|
| Rate for Payer: PACE SWMI |
$18,300.14
|
| Rate for Payer: PHP Medicare Advantage |
$18,300.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$34,137.02
|
| Rate for Payer: Priority Health Medicare |
$18,300.14
|
| Rate for Payer: Priority Health Tiered Network |
$27,309.61
|
| Rate for Payer: Railroad Medicare Medicare |
$18,300.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34,513.62
|
| Rate for Payer: UHC Core |
$28,874.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18,300.14
|
| Rate for Payer: UHC Exchange |
$23,581.48
|
| Rate for Payer: VA VA |
$18,300.14
|
|
|
EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$22,378.06
|
|
|
Service Code
|
MSDRG 148
|
| Min. Negotiated Rate |
$6,895.93 |
| Max. Negotiated Rate |
$22,378.06 |
| Rate for Payer: Aetna Medicare |
$7,549.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,073.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,073.59
|
| Rate for Payer: BCBS MAPPO |
$7,258.87
|
| Rate for Payer: BCBS Trust/PPO |
$22,378.06
|
| Rate for Payer: BCN Commercial |
$22,378.06
|
| Rate for Payer: BCN Medicare Advantage |
$7,258.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,258.87
|
| Rate for Payer: Mclaren Medicare |
$7,258.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,621.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,347.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,984.76
|
| Rate for Payer: Nomi Health Commercial |
$10,282.59
|
| Rate for Payer: PACE Medicare |
$6,895.93
|
| Rate for Payer: PACE SWMI |
$7,258.87
|
| Rate for Payer: PHP Medicare Advantage |
$7,258.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,850.96
|
| Rate for Payer: Priority Health Medicare |
$7,258.87
|
| Rate for Payer: Priority Health Tiered Network |
$10,280.76
|
| Rate for Payer: Railroad Medicare Medicare |
$7,258.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,992.73
|
| Rate for Payer: UHC Core |
$10,870.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,258.87
|
| Rate for Payer: UHC Exchange |
$8,877.30
|
| Rate for Payer: VA VA |
$7,258.87
|
|
|
EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL MALIGNANCIES
|
Facility
|
IP
|
$14,713.03
|
|
|
Service Code
|
APR-DRG 1104
|
| Min. Negotiated Rate |
$14,012.41 |
| Max. Negotiated Rate |
$14,713.03 |
| Rate for Payer: BCBS Complete |
$14,713.03
|
| Rate for Payer: Mclaren Medicaid |
$14,012.41
|
| Rate for Payer: Meridian Medicaid |
$14,713.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,012.41
|
| Rate for Payer: UHC Medicaid |
$14,012.41
|
| Rate for Payer: UHCCP Medicaid |
$14,012.41
|
|
|
EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL MALIGNANCIES
|
Facility
|
IP
|
$10,752.99
|
|
|
Service Code
|
APR-DRG 1103
|
| Min. Negotiated Rate |
$10,240.95 |
| Max. Negotiated Rate |
$10,752.99 |
| Rate for Payer: BCBS Complete |
$10,752.99
|
| Rate for Payer: Mclaren Medicaid |
$10,240.95
|
| Rate for Payer: Meridian Medicaid |
$10,752.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,240.95
|
| Rate for Payer: UHC Medicaid |
$10,240.95
|
| Rate for Payer: UHCCP Medicaid |
$10,240.95
|
|
|
EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL MALIGNANCIES
|
Facility
|
IP
|
$5,714.87
|
|
|
Service Code
|
APR-DRG 1102
|
| Min. Negotiated Rate |
$5,442.74 |
| Max. Negotiated Rate |
$5,714.87 |
| Rate for Payer: BCBS Complete |
$5,714.87
|
| Rate for Payer: Mclaren Medicaid |
$5,442.74
|
| Rate for Payer: Meridian Medicaid |
$5,714.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,442.74
|
| Rate for Payer: UHC Medicaid |
$5,442.74
|
| Rate for Payer: UHCCP Medicaid |
$5,442.74
|
|
|
EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL MALIGNANCIES
|
Facility
|
IP
|
$5,166.45
|
|
|
Service Code
|
APR-DRG 1101
|
| Min. Negotiated Rate |
$4,920.43 |
| Max. Negotiated Rate |
$5,166.45 |
| Rate for Payer: BCBS Complete |
$5,166.45
|
| Rate for Payer: Mclaren Medicaid |
$4,920.43
|
| Rate for Payer: Meridian Medicaid |
$5,166.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,920.43
|
| Rate for Payer: UHC Medicaid |
$4,920.43
|
| Rate for Payer: UHCCP Medicaid |
$4,920.43
|
|
|
EATING DISORDERS
|
Facility
|
IP
|
$7,548.40
|
|
|
Service Code
|
APR-DRG 7592
|
| Min. Negotiated Rate |
$7,188.95 |
| Max. Negotiated Rate |
$7,548.40 |
| Rate for Payer: BCBS Complete |
$7,548.40
|
| Rate for Payer: Mclaren Medicaid |
$7,188.95
|
| Rate for Payer: Meridian Medicaid |
$7,548.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,188.95
|
| Rate for Payer: UHC Medicaid |
$7,188.95
|
| Rate for Payer: UHCCP Medicaid |
$7,188.95
|
|
|
EATING DISORDERS
|
Facility
|
IP
|
$11,736.04
|
|
|
Service Code
|
APR-DRG 7593
|
| Min. Negotiated Rate |
$11,177.18 |
| Max. Negotiated Rate |
$11,736.04 |
| Rate for Payer: BCBS Complete |
$11,736.04
|
| Rate for Payer: Mclaren Medicaid |
$11,177.18
|
| Rate for Payer: Meridian Medicaid |
$11,736.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,177.18
|
| Rate for Payer: UHC Medicaid |
$11,177.18
|
| Rate for Payer: UHCCP Medicaid |
$11,177.18
|
|
