|
BARICITINIB 2 MG TABLET
|
Facility
|
IP
|
$9,317.01
|
|
|
Service Code
|
NDC 0002-4182-30
|
| Hospital Charge Code |
186973
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,099.48 |
| Max. Negotiated Rate |
$8,385.31 |
| Rate for Payer: Aetna American Axle |
$6,056.06
|
| Rate for Payer: Aetna Commercial |
$7,919.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,056.06
|
| Rate for Payer: Cash Price |
$7,453.61
|
| Rate for Payer: Cofinity Commercial |
$6,521.91
|
| Rate for Payer: Cofinity Commercial |
$8,012.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,453.61
|
| Rate for Payer: Healthscope Commercial |
$8,385.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,521.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,987.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,919.46
|
| Rate for Payer: PHP Commercial |
$7,919.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,521.91
|
| Rate for Payer: Priority Health SBD |
$5,869.72
|
| Rate for Payer: UMR Bronson Commercial |
$4,099.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,987.76
|
|
|
BASILIXIMAB 20 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$14,783.28
|
|
|
Service Code
|
HCPCS J0480
|
| Hospital Charge Code |
23082
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,504.64 |
| Max. Negotiated Rate |
$13,304.95 |
| Rate for Payer: Aetna American Axle |
$9,609.13
|
| Rate for Payer: Aetna Commercial |
$12,565.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,609.13
|
| Rate for Payer: Cash Price |
$11,826.62
|
| Rate for Payer: Cofinity Commercial |
$12,713.62
|
| Rate for Payer: Cofinity Commercial |
$10,348.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,826.62
|
| Rate for Payer: Healthscope Commercial |
$13,304.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,348.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,087.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,565.79
|
| Rate for Payer: PHP Commercial |
$12,565.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,348.30
|
| Rate for Payer: Priority Health SBD |
$9,313.47
|
| Rate for Payer: UMR Bronson Commercial |
$6,504.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,087.46
|
|
|
BASILIXIMAB 20 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$14,783.28
|
|
|
Service Code
|
HCPCS J0480
|
| Hospital Charge Code |
23082
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,448.52 |
| Max. Negotiated Rate |
$14,465.24 |
| Rate for Payer: Aetna American Axle |
$9,609.13
|
| Rate for Payer: Aetna Commercial |
$12,565.79
|
| Rate for Payer: Aetna Medicare |
$4,655.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,609.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,595.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,595.33
|
| Rate for Payer: BCBS Complete |
$2,571.17
|
| Rate for Payer: BCBS MAPPO |
$4,476.26
|
| Rate for Payer: BCBS Trust/PPO |
$14,465.24
|
| Rate for Payer: BCN Medicare Advantage |
$4,476.26
|
| Rate for Payer: Cash Price |
$11,826.62
|
| Rate for Payer: Cash Price |
$11,826.62
|
| Rate for Payer: Cofinity Commercial |
$10,348.30
|
| Rate for Payer: Cofinity Commercial |
$12,713.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,826.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,476.26
|
| Rate for Payer: Healthscope Commercial |
$13,304.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,348.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,087.46
|
| Rate for Payer: Mclaren Medicaid |
$2,448.52
|
| Rate for Payer: Mclaren Medicare |
$4,476.26
|
| Rate for Payer: Meridian Medicaid |
$2,571.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,700.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,147.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,565.79
|
| Rate for Payer: PACE Medicare |
$4,252.45
|
| Rate for Payer: PACE SWMI |
$4,476.26
|
| Rate for Payer: PHP Commercial |
$12,565.79
|
| Rate for Payer: PHP Medicare Advantage |
$4,476.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,448.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,348.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,903.28
|
| Rate for Payer: Priority Health Medicare |
$4,476.26
|
| Rate for Payer: Priority Health Narrow Network |
$10,322.62
|
| Rate for Payer: Priority Health SBD |
$9,313.47
|
| Rate for Payer: Railroad Medicare Medicare |
$4,476.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,476.26
|
| Rate for Payer: UHC Medicare Advantage |
$4,610.55
|
| Rate for Payer: UMR Bronson Commercial |
$5,469.81
|
| Rate for Payer: VA VA |
$4,476.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,087.46
|
|
|
BCG LIVE 50 MG INTRAVESICAL SUSPENSION
|
Facility
|
IP
|
$451.25
|
|
|
Service Code
|
HCPCS J9030
|
| Hospital Charge Code |
116210
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$198.55 |
| Max. Negotiated Rate |
$406.12 |
| Rate for Payer: Aetna American Axle |
$293.31
|
| Rate for Payer: Aetna Commercial |
$383.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.31
|
| Rate for Payer: Cash Price |
$361.00
|
| Rate for Payer: Cofinity Commercial |
$315.88
|
| Rate for Payer: Cofinity Commercial |
$388.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.00
|
| Rate for Payer: Healthscope Commercial |
$406.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$315.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$338.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$383.56
|
| Rate for Payer: PHP Commercial |
$383.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.88
|
| Rate for Payer: Priority Health SBD |
$284.29
|
| Rate for Payer: UMR Bronson Commercial |
$198.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$338.44
|
|
|
BCG LIVE 50 MG INTRAVESICAL SUSPENSION
|
Facility
|
OP
|
$451.25
|
|
|
Service Code
|
HCPCS J9030
|
| Hospital Charge Code |
116210
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.32 |
| Max. Negotiated Rate |
$406.12 |
| Rate for Payer: Aetna American Axle |
$293.31
|
| Rate for Payer: Aetna Commercial |
$383.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.31
|
| Rate for Payer: BCBS Complete |
$180.50
|
| Rate for Payer: BCBS Trust/PPO |
$9.32
|
| Rate for Payer: Cash Price |
$361.00
|
| Rate for Payer: Cash Price |
$361.00
|
| Rate for Payer: Cofinity Commercial |
$315.88
|
| Rate for Payer: Cofinity Commercial |
$388.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.00
|
| Rate for Payer: Healthscope Commercial |
$406.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$315.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$338.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$383.56
|
| Rate for Payer: PHP Commercial |
$383.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.88
|
| Rate for Payer: Priority Health SBD |
$284.29
|
| Rate for Payer: UMR Bronson Commercial |
$166.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$338.44
|
|
|
B-COMPLEX WITH VITAMIN C TABLET
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
NDC 4098522668
|
| Hospital Charge Code |
807
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.28 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Aetna American Axle |
$137.80
|
| Rate for Payer: Aetna Commercial |
$180.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.80
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cofinity Commercial |
$182.32
|
| Rate for Payer: Cofinity Commercial |
$148.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.60
|
| Rate for Payer: Healthscope Commercial |
$190.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$180.20
|
| Rate for Payer: PHP Commercial |
$180.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.40
|
| Rate for Payer: Priority Health SBD |
$133.56
|
| Rate for Payer: UMR Bronson Commercial |
$93.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.00
|
|
|
B-COMPLEX WITH VITAMIN C TABLET
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
NDC 9629511845
|
| Hospital Charge Code |
807
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.16 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Aetna American Axle |
$122.85
|
| Rate for Payer: Aetna Commercial |
$160.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.85
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cofinity Commercial |
$132.30
|
| Rate for Payer: Cofinity Commercial |
$162.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.20
|
| Rate for Payer: Healthscope Commercial |
$170.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$160.65
|
| Rate for Payer: PHP Commercial |
$160.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.30
|
| Rate for Payer: Priority Health SBD |
$119.07
|
| Rate for Payer: UMR Bronson Commercial |
$83.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.75
|
|
|
B-COMPLEX WITH VITAMIN C TABLET
|
Facility
|
IP
|
$188.37
|
|
|
Service Code
|
NDC 8068112600
|
| Hospital Charge Code |
807
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.88 |
| Max. Negotiated Rate |
$169.53 |
| Rate for Payer: Aetna American Axle |
$122.44
|
| Rate for Payer: Aetna Commercial |
$160.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.44
|
| Rate for Payer: Cash Price |
$150.70
|
| Rate for Payer: Cofinity Commercial |
$131.86
|
| Rate for Payer: Cofinity Commercial |
$162.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.70
|
| Rate for Payer: Healthscope Commercial |
$169.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$131.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$160.11
|
| Rate for Payer: PHP Commercial |
$160.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.86
|
| Rate for Payer: Priority Health SBD |
$118.67
|
| Rate for Payer: UMR Bronson Commercial |
$82.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.28
|
|
|
B-COMPLEX WITH VITAMIN C TABLET
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
NDC 8068115400
|
| Hospital Charge Code |
807
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.12 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna American Axle |
$96.20
|
| Rate for Payer: Aetna Commercial |
$125.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.20
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cofinity Commercial |
$103.60
|
| Rate for Payer: Cofinity Commercial |
$127.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.40
|
| Rate for Payer: Healthscope Commercial |
$133.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.80
|
| Rate for Payer: PHP Commercial |
$125.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.60
|
| Rate for Payer: Priority Health SBD |
$93.24
|
| Rate for Payer: UMR Bronson Commercial |
$65.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.00
|
|
|
BEHAVIORAL AND DEVELOPMENTAL DISORDERS
|
Facility
|
IP
|
$25,652.65
|
|
|
Service Code
|
MS-DRG 886
|
| Min. Negotiated Rate |
$12,798.01 |
| Max. Negotiated Rate |
$25,652.65 |
| Rate for Payer: Aetna Medicare |
$14,010.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,839.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,839.49
|
| Rate for Payer: BCBS MAPPO |
$13,471.59
|
| Rate for Payer: BCBS Trust/PPO |
$21,550.63
|
| Rate for Payer: BCN Medicare Advantage |
$13,471.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,471.59
|
| Rate for Payer: Mclaren Medicare |
$13,471.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,145.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,492.33
|
| Rate for Payer: PACE Medicare |
$12,798.01
|
| Rate for Payer: PACE SWMI |
$13,471.59
|
| Rate for Payer: PHP Medicare Advantage |
$13,471.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24,132.26
|
| Rate for Payer: Priority Health Medicare |
$13,471.59
|
| Rate for Payer: Priority Health Narrow Network |
$19,305.81
|
| Rate for Payer: Railroad Medicare Medicare |
$13,471.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,652.65
|
| Rate for Payer: UHC Core |
$21,034.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,471.59
|
| Rate for Payer: UHC Exchange |
$16,722.82
|
| Rate for Payer: UHC Medicare Advantage |
$13,875.74
|
| Rate for Payer: VA VA |
$13,471.59
|
|
|
BELANTAMAB MAFODOTIN-BLMF 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$37,163.73
|
|
|
Service Code
|
HCPCS J9037
|
| Hospital Charge Code |
194707
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16,352.04 |
| Max. Negotiated Rate |
$33,447.36 |
| Rate for Payer: Aetna American Axle |
$24,156.42
|
| Rate for Payer: Aetna Commercial |
$31,589.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24,156.42
|
| Rate for Payer: Cash Price |
$29,730.98
|
| Rate for Payer: Cofinity Commercial |
$26,014.61
|
| Rate for Payer: Cofinity Commercial |
$31,960.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29,730.98
|
| Rate for Payer: Healthscope Commercial |
$33,447.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26,014.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27,872.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31,589.17
|
| Rate for Payer: PHP Commercial |
$31,589.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26,014.61
|
| Rate for Payer: Priority Health SBD |
$23,413.15
|
| Rate for Payer: UMR Bronson Commercial |
$16,352.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27,872.80
|
|
|
BELANTAMAB MAFODOTIN-BLMF 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$37,163.73
|
|
|
Service Code
|
HCPCS J9037
|
| Hospital Charge Code |
194707
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.59 |
| Max. Negotiated Rate |
$33,447.36 |
| Rate for Payer: Aetna American Axle |
$24,156.42
|
| Rate for Payer: Aetna Commercial |
$31,589.17
|
| Rate for Payer: Aetna Medicare |
$48.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24,156.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.48
|
| Rate for Payer: BCBS Complete |
$26.87
|
| Rate for Payer: BCBS MAPPO |
$46.78
|
| Rate for Payer: BCBS Trust/PPO |
$145.90
|
| Rate for Payer: BCN Medicare Advantage |
$46.78
|
| Rate for Payer: Cash Price |
$29,730.98
|
| Rate for Payer: Cash Price |
$29,730.98
|
| Rate for Payer: Cofinity Commercial |
$26,014.61
|
| Rate for Payer: Cofinity Commercial |
$31,960.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29,730.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.78
|
| Rate for Payer: Healthscope Commercial |
$33,447.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26,014.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27,872.80
|
| Rate for Payer: Mclaren Medicaid |
$25.59
|
| Rate for Payer: Mclaren Medicare |
$46.78
|
| Rate for Payer: Meridian Medicaid |
$26.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$49.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31,589.17
|
| Rate for Payer: PACE Medicare |
$44.44
|
| Rate for Payer: PACE SWMI |
$46.78
|
| Rate for Payer: PHP Commercial |
$31,589.17
|
| Rate for Payer: PHP Medicare Advantage |
$46.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26,014.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$137.40
|
| Rate for Payer: Priority Health Medicare |
$46.78
|
| Rate for Payer: Priority Health Narrow Network |
$109.92
|
| Rate for Payer: Priority Health SBD |
$23,413.15
|
| Rate for Payer: Railroad Medicare Medicare |
$46.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.78
|
| Rate for Payer: UHC Medicare Advantage |
$48.18
|
| Rate for Payer: UMR Bronson Commercial |
$13,750.58
|
| Rate for Payer: VA VA |
$46.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27,872.80
|
|
|
BELATACEPT 250 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,650.15
|
|
|
Service Code
|
HCPCS J0485
|
| Hospital Charge Code |
152968
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.12 |
| Max. Negotiated Rate |
$2,385.14 |
| Rate for Payer: Aetna American Axle |
$1,722.60
|
| Rate for Payer: Aetna Commercial |
$2,252.63
|
| Rate for Payer: Aetna Medicare |
$4.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,722.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.84
|
| Rate for Payer: BCBS Complete |
$2.23
|
| Rate for Payer: BCBS MAPPO |
$3.87
|
| Rate for Payer: BCBS Trust/PPO |
$12.50
|
| Rate for Payer: BCN Medicare Advantage |
$3.87
|
| Rate for Payer: Cash Price |
$2,120.12
|
| Rate for Payer: Cash Price |
$2,120.12
|
| Rate for Payer: Cofinity Commercial |
$2,279.13
|
| Rate for Payer: Cofinity Commercial |
$1,855.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,120.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.87
|
| Rate for Payer: Healthscope Commercial |
$2,385.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,855.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,987.61
|
| Rate for Payer: Mclaren Medicaid |
$2.12
|
| Rate for Payer: Mclaren Medicare |
$3.87
|
| Rate for Payer: Meridian Medicaid |
$2.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,252.63
|
| Rate for Payer: PACE Medicare |
$3.68
|
| Rate for Payer: PACE SWMI |
$3.87
|
| Rate for Payer: PHP Commercial |
$2,252.63
|
| Rate for Payer: PHP Medicare Advantage |
$3.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,855.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.11
|
| Rate for Payer: Priority Health Medicare |
$3.87
|
| Rate for Payer: Priority Health Narrow Network |
$8.89
|
| Rate for Payer: Priority Health SBD |
$1,669.59
|
| Rate for Payer: Railroad Medicare Medicare |
$3.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.87
|
| Rate for Payer: UHC Medicare Advantage |
$3.99
|
| Rate for Payer: UMR Bronson Commercial |
$980.56
|
| Rate for Payer: VA VA |
$3.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,987.61
|
|
|
BELATACEPT 250 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,650.15
|
|
|
Service Code
|
HCPCS J0485
|
| Hospital Charge Code |
152968
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,166.07 |
| Max. Negotiated Rate |
$2,385.14 |
| Rate for Payer: Aetna American Axle |
$1,722.60
|
| Rate for Payer: Aetna Commercial |
$2,252.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,722.60
|
| Rate for Payer: Cash Price |
$2,120.12
|
| Rate for Payer: Cofinity Commercial |
$1,855.10
|
| Rate for Payer: Cofinity Commercial |
$2,279.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,120.12
|
| Rate for Payer: Healthscope Commercial |
$2,385.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,855.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,987.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,252.63
|
| Rate for Payer: PHP Commercial |
$2,252.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,855.10
|
| Rate for Payer: Priority Health SBD |
$1,669.59
|
| Rate for Payer: UMR Bronson Commercial |
$1,166.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,987.61
|
|
|
BELIMUMAB 120 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,961.92
|
|
|
Service Code
|
HCPCS J0490
|
| Hospital Charge Code |
152250
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.44 |
| Max. Negotiated Rate |
$1,765.73 |
| Rate for Payer: Aetna American Axle |
$1,275.25
|
| Rate for Payer: Aetna Commercial |
$1,667.63
|
| Rate for Payer: Aetna Medicare |
$54.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,275.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.00
|
| Rate for Payer: BCBS Complete |
$29.87
|
| Rate for Payer: BCBS MAPPO |
$52.00
|
| Rate for Payer: BCBS Trust/PPO |
$168.00
|
| Rate for Payer: BCN Medicare Advantage |
$52.00
|
| Rate for Payer: Cash Price |
$1,569.54
|
| Rate for Payer: Cash Price |
$1,569.54
|
| Rate for Payer: Cofinity Commercial |
$1,373.34
|
| Rate for Payer: Cofinity Commercial |
$1,687.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,569.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.00
|
| Rate for Payer: Healthscope Commercial |
$1,765.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,373.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,471.44
|
| Rate for Payer: Mclaren Medicaid |
$28.44
|
| Rate for Payer: Mclaren Medicare |
$52.00
|
| Rate for Payer: Meridian Medicaid |
$29.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$54.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,667.63
|
| Rate for Payer: PACE Medicare |
$49.40
|
| Rate for Payer: PACE SWMI |
$52.00
|
| Rate for Payer: PHP Commercial |
$1,667.63
|
| Rate for Payer: PHP Medicare Advantage |
$52.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,373.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$152.62
|
| Rate for Payer: Priority Health Medicare |
$52.00
|
| Rate for Payer: Priority Health Narrow Network |
$122.10
|
| Rate for Payer: Priority Health SBD |
$1,236.01
|
| Rate for Payer: Railroad Medicare Medicare |
$52.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.00
|
| Rate for Payer: UHC Medicare Advantage |
$53.56
|
| Rate for Payer: UMR Bronson Commercial |
$725.91
|
| Rate for Payer: VA VA |
$52.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,471.44
|
|
|
BELIMUMAB 400 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$5,313.29
|
|
|
Service Code
|
HCPCS J0490
|
| Hospital Charge Code |
152251
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.44 |
| Max. Negotiated Rate |
$4,781.96 |
| Rate for Payer: Aetna American Axle |
$3,453.64
|
| Rate for Payer: Aetna Commercial |
$4,516.30
|
| Rate for Payer: Aetna Medicare |
$54.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,453.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.00
|
| Rate for Payer: BCBS Complete |
$29.87
|
| Rate for Payer: BCBS MAPPO |
$52.00
|
| Rate for Payer: BCBS Trust/PPO |
$168.00
|
| Rate for Payer: BCN Medicare Advantage |
$52.00
|
| Rate for Payer: Cash Price |
$4,250.63
|
| Rate for Payer: Cash Price |
$4,250.63
|
| Rate for Payer: Cofinity Commercial |
$4,569.43
|
| Rate for Payer: Cofinity Commercial |
$3,719.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,250.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.00
|
| Rate for Payer: Healthscope Commercial |
$4,781.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,719.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,984.97
|
| Rate for Payer: Mclaren Medicaid |
$28.44
|
| Rate for Payer: Mclaren Medicare |
$52.00
|
| Rate for Payer: Meridian Medicaid |
$29.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$54.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,516.30
|
| Rate for Payer: PACE Medicare |
$49.40
|
| Rate for Payer: PACE SWMI |
$52.00
|
| Rate for Payer: PHP Commercial |
$4,516.30
|
| Rate for Payer: PHP Medicare Advantage |
$52.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,719.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$152.62
|
| Rate for Payer: Priority Health Medicare |
$52.00
|
| Rate for Payer: Priority Health Narrow Network |
$122.10
|
| Rate for Payer: Priority Health SBD |
$3,347.37
|
| Rate for Payer: Railroad Medicare Medicare |
$52.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.00
|
| Rate for Payer: UHC Medicare Advantage |
$53.56
|
| Rate for Payer: UMR Bronson Commercial |
$1,965.92
|
| Rate for Payer: VA VA |
$52.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,984.97
|
|
|
BELIMUMAB 400 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$5,313.29
|
|
|
Service Code
|
HCPCS J0490
|
| Hospital Charge Code |
152251
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,337.85 |
| Max. Negotiated Rate |
$4,781.96 |
| Rate for Payer: Aetna American Axle |
$3,453.64
|
| Rate for Payer: Aetna Commercial |
$4,516.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,453.64
|
| Rate for Payer: Cash Price |
$4,250.63
|
| Rate for Payer: Cofinity Commercial |
$3,719.30
|
| Rate for Payer: Cofinity Commercial |
$4,569.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,250.63
|
| Rate for Payer: Healthscope Commercial |
$4,781.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,719.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,984.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,516.30
|
| Rate for Payer: PHP Commercial |
$4,516.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,719.30
|
| Rate for Payer: Priority Health SBD |
$3,347.37
|
| Rate for Payer: UMR Bronson Commercial |
$2,337.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,984.97
|
|
|
BENDAMUSTINE (BELRAPZO) 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$9,665.50
|
|
|
Service Code
|
HCPCS J9036
|
| Hospital Charge Code |
300602
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.16 |
| Max. Negotiated Rate |
$8,698.95 |
| Rate for Payer: Aetna American Axle |
$6,282.58
|
| Rate for Payer: Aetna Commercial |
$8,215.68
|
| Rate for Payer: Aetna Medicare |
$13.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,282.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.36
|
| Rate for Payer: BCBS Complete |
$7.52
|
| Rate for Payer: BCBS MAPPO |
$13.09
|
| Rate for Payer: BCBS Trust/PPO |
$42.28
|
| Rate for Payer: BCN Medicare Advantage |
$13.09
|
| Rate for Payer: Cash Price |
$7,732.40
|
| Rate for Payer: Cash Price |
$7,732.40
|
| Rate for Payer: Cofinity Commercial |
$6,765.85
|
| Rate for Payer: Cofinity Commercial |
$8,312.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,732.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.09
|
| Rate for Payer: Healthscope Commercial |
$8,698.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,765.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,249.12
|
| Rate for Payer: Mclaren Medicaid |
$7.16
|
| Rate for Payer: Mclaren Medicare |
$13.09
|
| Rate for Payer: Meridian Medicaid |
$7.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,215.68
|
| Rate for Payer: PACE Medicare |
$12.43
|
| Rate for Payer: PACE SWMI |
$13.09
|
| Rate for Payer: PHP Commercial |
$8,215.68
|
| Rate for Payer: PHP Medicare Advantage |
$13.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,765.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.14
|
| Rate for Payer: Priority Health Medicare |
$13.09
|
| Rate for Payer: Priority Health Narrow Network |
$35.31
|
| Rate for Payer: Priority Health SBD |
$6,089.26
|
| Rate for Payer: Railroad Medicare Medicare |
$13.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.09
|
| Rate for Payer: UHC Medicare Advantage |
$13.48
|
| Rate for Payer: UMR Bronson Commercial |
$3,576.24
|
| Rate for Payer: VA VA |
$13.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,249.12
|
|
|
BENDAMUSTINE (BELRAPZO) 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$9,665.50
|
|
|
Service Code
|
HCPCS J9036
|
| Hospital Charge Code |
300602
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,252.82 |
| Max. Negotiated Rate |
$8,698.95 |
| Rate for Payer: Aetna American Axle |
$6,282.58
|
| Rate for Payer: Aetna Commercial |
$8,215.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,282.58
|
| Rate for Payer: Cash Price |
$7,732.40
|
| Rate for Payer: Cofinity Commercial |
$6,765.85
|
| Rate for Payer: Cofinity Commercial |
$8,312.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,732.40
|
| Rate for Payer: Healthscope Commercial |
$8,698.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,765.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,249.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,215.68
|
| Rate for Payer: PHP Commercial |
$8,215.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,765.85
|
| Rate for Payer: Priority Health SBD |
$6,089.26
|
| Rate for Payer: UMR Bronson Commercial |
$4,252.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,249.12
|
|
|
BENDAMUSTINE (BENDEKA) 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,483.75
|
|
|
Service Code
|
HCPCS J9058
|
| Hospital Charge Code |
176654
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.37 |
| Max. Negotiated Rate |
$5,835.38 |
| Rate for Payer: Aetna American Axle |
$4,214.44
|
| Rate for Payer: Aetna Commercial |
$5,511.19
|
| Rate for Payer: Aetna Medicare |
$21.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,214.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.97
|
| Rate for Payer: BCBS Complete |
$11.93
|
| Rate for Payer: BCBS MAPPO |
$20.78
|
| Rate for Payer: BCBS Trust/PPO |
$67.14
|
| Rate for Payer: BCN Medicare Advantage |
$20.78
|
| Rate for Payer: Cash Price |
$5,187.00
|
| Rate for Payer: Cash Price |
$5,187.00
|
| Rate for Payer: Cofinity Commercial |
$4,538.62
|
| Rate for Payer: Cofinity Commercial |
$5,576.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,187.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.78
|
| Rate for Payer: Healthscope Commercial |
$5,835.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,538.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,862.81
|
| Rate for Payer: Mclaren Medicaid |
$11.37
|
| Rate for Payer: Mclaren Medicare |
$20.78
|
| Rate for Payer: Meridian Medicaid |
$11.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,511.19
|
| Rate for Payer: PACE Medicare |
$19.74
|
| Rate for Payer: PACE SWMI |
$20.78
|
| Rate for Payer: PHP Commercial |
$5,511.19
|
| Rate for Payer: PHP Medicare Advantage |
$20.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,538.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.08
|
| Rate for Payer: Priority Health Medicare |
$20.78
|
| Rate for Payer: Priority Health Narrow Network |
$77.66
|
| Rate for Payer: Priority Health SBD |
$4,084.76
|
| Rate for Payer: Railroad Medicare Medicare |
$20.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.78
|
| Rate for Payer: UHC Medicare Advantage |
$21.40
|
| Rate for Payer: UMR Bronson Commercial |
$2,398.99
|
| Rate for Payer: VA VA |
$20.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,862.81
|
|
|
BENDAMUSTINE (BENDEKA) 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$6,483.75
|
|
|
Service Code
|
HCPCS J9058
|
| Hospital Charge Code |
176654
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,852.85 |
| Max. Negotiated Rate |
$5,835.38 |
| Rate for Payer: Aetna American Axle |
$4,214.44
|
| Rate for Payer: Aetna Commercial |
$5,511.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,214.44
|
| Rate for Payer: Cash Price |
$5,187.00
|
| Rate for Payer: Cofinity Commercial |
$4,538.62
|
| Rate for Payer: Cofinity Commercial |
$5,576.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,187.00
|
| Rate for Payer: Healthscope Commercial |
$5,835.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,538.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,862.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,511.19
|
| Rate for Payer: PHP Commercial |
$5,511.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,538.62
|
| Rate for Payer: Priority Health SBD |
$4,084.76
|
| Rate for Payer: UMR Bronson Commercial |
$2,852.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,862.81
|
|
|
BENDAMUSTINE (BENDEKA) 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$9,530.12
|
|
|
Service Code
|
HCPCS J9034
|
| Hospital Charge Code |
176654
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$8,577.11 |
| Rate for Payer: Aetna American Axle |
$6,194.58
|
| Rate for Payer: Aetna Commercial |
$8,100.60
|
| Rate for Payer: Aetna Medicare |
$15.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,194.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.44
|
| Rate for Payer: BCBS Complete |
$8.48
|
| Rate for Payer: BCBS MAPPO |
$14.76
|
| Rate for Payer: BCBS Trust/PPO |
$47.67
|
| Rate for Payer: BCN Medicare Advantage |
$14.76
|
| Rate for Payer: Cash Price |
$7,624.10
|
| Rate for Payer: Cash Price |
$7,624.10
|
| Rate for Payer: Cofinity Commercial |
$6,671.08
|
| Rate for Payer: Cofinity Commercial |
$8,195.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,624.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.76
|
| Rate for Payer: Healthscope Commercial |
$8,577.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,671.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,147.59
|
| Rate for Payer: Mclaren Medicaid |
$8.07
|
| Rate for Payer: Mclaren Medicare |
$14.76
|
| Rate for Payer: Meridian Medicaid |
$8.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,100.60
|
| Rate for Payer: PACE Medicare |
$14.02
|
| Rate for Payer: PACE SWMI |
$14.76
|
| Rate for Payer: PHP Commercial |
$8,100.60
|
| Rate for Payer: PHP Medicare Advantage |
$14.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,671.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.58
|
| Rate for Payer: Priority Health Medicare |
$14.76
|
| Rate for Payer: Priority Health Narrow Network |
$37.26
|
| Rate for Payer: Priority Health SBD |
$6,003.98
|
| Rate for Payer: Railroad Medicare Medicare |
$14.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.76
|
| Rate for Payer: UHC Medicare Advantage |
$15.20
|
| Rate for Payer: UMR Bronson Commercial |
$3,526.14
|
| Rate for Payer: VA VA |
$14.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,147.59
|
|
|
BENDAMUSTINE (BENDEKA) 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$9,530.12
|
|
|
Service Code
|
HCPCS J9034
|
| Hospital Charge Code |
176654
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,193.25 |
| Max. Negotiated Rate |
$8,577.11 |
| Rate for Payer: Aetna American Axle |
$6,194.58
|
| Rate for Payer: Aetna Commercial |
$8,100.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,194.58
|
| Rate for Payer: Cash Price |
$7,624.10
|
| Rate for Payer: Cofinity Commercial |
$6,671.08
|
| Rate for Payer: Cofinity Commercial |
$8,195.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,624.10
|
| Rate for Payer: Healthscope Commercial |
$8,577.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,671.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,147.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,100.60
|
| Rate for Payer: PHP Commercial |
$8,100.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,671.08
|
| Rate for Payer: Priority Health SBD |
$6,003.98
|
| Rate for Payer: UMR Bronson Commercial |
$4,193.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,147.59
|
|
|
BENDAMUSTINE (TREANDA) 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$10,472.89
|
|
|
Service Code
|
HCPCS J9033
|
| Hospital Charge Code |
91300
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.03 |
| Max. Negotiated Rate |
$9,425.60 |
| Rate for Payer: Aetna American Axle |
$6,807.38
|
| Rate for Payer: Aetna Commercial |
$8,901.96
|
| Rate for Payer: Aetna Medicare |
$9.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,807.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.49
|
| Rate for Payer: BCBS Complete |
$5.28
|
| Rate for Payer: BCBS MAPPO |
$9.19
|
| Rate for Payer: BCBS Trust/PPO |
$29.69
|
| Rate for Payer: BCN Medicare Advantage |
$9.19
|
| Rate for Payer: Cash Price |
$8,378.31
|
| Rate for Payer: Cash Price |
$8,378.31
|
| Rate for Payer: Cofinity Commercial |
$9,006.69
|
| Rate for Payer: Cofinity Commercial |
$7,331.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,378.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.19
|
| Rate for Payer: Healthscope Commercial |
$9,425.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,331.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,854.67
|
| Rate for Payer: Mclaren Medicaid |
$5.03
|
| Rate for Payer: Mclaren Medicare |
$9.19
|
| Rate for Payer: Meridian Medicaid |
$5.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,901.96
|
| Rate for Payer: PACE Medicare |
$8.73
|
| Rate for Payer: PACE SWMI |
$9.19
|
| Rate for Payer: PHP Commercial |
$8,901.96
|
| Rate for Payer: PHP Medicare Advantage |
$9.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,331.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.52
|
| Rate for Payer: Priority Health Medicare |
$9.19
|
| Rate for Payer: Priority Health Narrow Network |
$26.82
|
| Rate for Payer: Priority Health SBD |
$6,597.92
|
| Rate for Payer: Railroad Medicare Medicare |
$9.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.19
|
| Rate for Payer: UHC Medicare Advantage |
$9.47
|
| Rate for Payer: UMR Bronson Commercial |
$3,874.97
|
| Rate for Payer: VA VA |
$9.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,854.67
|
|
|
BENIGN PROSTATIC HYPERTROPHY WITH MCC
|
Facility
|
IP
|
$22,852.31
|
|
|
Service Code
|
MS-DRG 725
|
| Min. Negotiated Rate |
$9,571.03 |
| Max. Negotiated Rate |
$22,852.31 |
| Rate for Payer: Aetna Medicare |
$10,477.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,593.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,593.46
|
| Rate for Payer: BCBS MAPPO |
$10,074.77
|
| Rate for Payer: BCBS Trust/PPO |
$22,852.31
|
| Rate for Payer: BCN Medicare Advantage |
$10,074.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,074.77
|
| Rate for Payer: Mclaren Medicare |
$10,074.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,578.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,585.99
|
| Rate for Payer: PACE Medicare |
$9,571.03
|
| Rate for Payer: PACE SWMI |
$10,074.77
|
| Rate for Payer: PHP Medicare Advantage |
$10,074.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,806.82
|
| Rate for Payer: Priority Health Medicare |
$10,074.77
|
| Rate for Payer: Priority Health Narrow Network |
$14,245.46
|
| Rate for Payer: Railroad Medicare Medicare |
$10,074.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,928.69
|
| Rate for Payer: UHC Core |
$15,521.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,074.77
|
| Rate for Payer: UHC Exchange |
$12,339.51
|
| Rate for Payer: UHC Medicare Advantage |
$10,377.01
|
| Rate for Payer: VA VA |
$10,074.77
|
|
