|
BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM
|
Facility
|
IP
|
$137.55
|
|
|
Service Code
|
NDC 0168-0055-15
|
| Hospital Charge Code |
1027
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.52 |
| Max. Negotiated Rate |
$123.80 |
| Rate for Payer: Aetna American Axle |
$89.41
|
| Rate for Payer: Aetna Commercial |
$116.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.41
|
| Rate for Payer: Cash Price |
$110.04
|
| Rate for Payer: Cofinity Commercial |
$118.29
|
| Rate for Payer: Cofinity Commercial |
$96.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.04
|
| Rate for Payer: Healthscope Commercial |
$123.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$116.92
|
| Rate for Payer: PHP Commercial |
$116.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.28
|
| Rate for Payer: Priority Health SBD |
$86.66
|
| Rate for Payer: UMR Bronson Commercial |
$60.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.16
|
|
|
BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM
|
Facility
|
IP
|
$49.41
|
|
|
Service Code
|
NDC 70710-1233-1
|
| Hospital Charge Code |
1027
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.74 |
| Max. Negotiated Rate |
$44.47 |
| Rate for Payer: Aetna American Axle |
$32.12
|
| Rate for Payer: Aetna Commercial |
$42.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.12
|
| Rate for Payer: Cash Price |
$39.53
|
| Rate for Payer: Cofinity Commercial |
$34.59
|
| Rate for Payer: Cofinity Commercial |
$42.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.53
|
| Rate for Payer: Healthscope Commercial |
$44.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.00
|
| Rate for Payer: PHP Commercial |
$42.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.59
|
| Rate for Payer: Priority Health SBD |
$31.13
|
| Rate for Payer: UMR Bronson Commercial |
$21.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.06
|
|
|
BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL OINTMENT
|
Facility
|
IP
|
$128.73
|
|
|
Service Code
|
NDC 0472-0381-15
|
| Hospital Charge Code |
1029
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.64 |
| Max. Negotiated Rate |
$115.86 |
| Rate for Payer: Aetna American Axle |
$83.67
|
| Rate for Payer: Aetna Commercial |
$109.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.67
|
| Rate for Payer: Cash Price |
$102.98
|
| Rate for Payer: Cofinity Commercial |
$110.71
|
| Rate for Payer: Cofinity Commercial |
$90.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.98
|
| Rate for Payer: Healthscope Commercial |
$115.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.42
|
| Rate for Payer: PHP Commercial |
$109.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.11
|
| Rate for Payer: Priority Health SBD |
$81.10
|
| Rate for Payer: UMR Bronson Commercial |
$56.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.55
|
|
|
BETAMETHASONE VALERATE 0.1 % LOTION
|
Facility
|
IP
|
$195.30
|
|
|
Service Code
|
NDC 0168-0041-60
|
| Hospital Charge Code |
1032
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.93 |
| Max. Negotiated Rate |
$175.77 |
| Rate for Payer: Aetna American Axle |
$126.94
|
| Rate for Payer: Aetna Commercial |
$166.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.94
|
| Rate for Payer: Cash Price |
$156.24
|
| Rate for Payer: Cofinity Commercial |
$136.71
|
| Rate for Payer: Cofinity Commercial |
$167.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.24
|
| Rate for Payer: Healthscope Commercial |
$175.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$166.00
|
| Rate for Payer: PHP Commercial |
$166.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.71
|
| Rate for Payer: Priority Health SBD |
$123.04
|
| Rate for Payer: UMR Bronson Commercial |
$85.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.48
|
|
|
BETAMETHASONE VALERATE 0.1 % LOTION
|
Facility
|
IP
|
$195.72
|
|
|
Service Code
|
NDC 54879-004-60
|
| Hospital Charge Code |
1032
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.12 |
| Max. Negotiated Rate |
$176.15 |
| Rate for Payer: Aetna American Axle |
$127.22
|
| Rate for Payer: Aetna Commercial |
$166.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.22
|
| Rate for Payer: Cash Price |
$156.58
|
| Rate for Payer: Cofinity Commercial |
$137.00
|
| Rate for Payer: Cofinity Commercial |
$168.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.58
|
| Rate for Payer: Healthscope Commercial |
$176.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$166.36
|
| Rate for Payer: PHP Commercial |
$166.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.00
|
| Rate for Payer: Priority Health SBD |
$123.30
|
| Rate for Payer: UMR Bronson Commercial |
$86.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.79
|
|
|
BETAXOLOL 0.25 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$1,166.41
|
|
|
Service Code
|
NDC 0078-0729-10
|
| Hospital Charge Code |
19703
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$513.22 |
| Max. Negotiated Rate |
$1,049.77 |
| Rate for Payer: Aetna American Axle |
$758.17
|
| Rate for Payer: Aetna Commercial |
$991.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$758.17
|
| Rate for Payer: Cash Price |
$933.13
|
| Rate for Payer: Cofinity Commercial |
$1,003.11
|
| Rate for Payer: Cofinity Commercial |
$816.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$933.13
|
| Rate for Payer: Healthscope Commercial |
$1,049.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$816.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$874.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$991.45
|
| Rate for Payer: PHP Commercial |
$991.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$816.49
|
| Rate for Payer: Priority Health SBD |
$734.84
|
| Rate for Payer: UMR Bronson Commercial |
$513.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$874.81
|
|
|
BETAXOLOL 0.25 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$1,067.36
|
|
|
Service Code
|
NDC 0065-0246-10
|
| Hospital Charge Code |
19703
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$469.64 |
| Max. Negotiated Rate |
$960.62 |
| Rate for Payer: Aetna American Axle |
$693.78
|
| Rate for Payer: Aetna Commercial |
$907.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$693.78
|
| Rate for Payer: Cash Price |
$853.89
|
| Rate for Payer: Cofinity Commercial |
$747.15
|
| Rate for Payer: Cofinity Commercial |
$917.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$853.89
|
| Rate for Payer: Healthscope Commercial |
$960.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$747.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$800.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$907.26
|
| Rate for Payer: PHP Commercial |
$907.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$747.15
|
| Rate for Payer: Priority Health SBD |
$672.44
|
| Rate for Payer: UMR Bronson Commercial |
$469.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$800.52
|
|
|
BETAXOLOL 0.5 % EYE DROPS
|
Facility
|
IP
|
$165.87
|
|
|
Service Code
|
NDC 61314-245-01
|
| Hospital Charge Code |
9268
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.98 |
| Max. Negotiated Rate |
$149.28 |
| Rate for Payer: Aetna American Axle |
$107.82
|
| Rate for Payer: Aetna Commercial |
$140.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.82
|
| Rate for Payer: Cash Price |
$132.70
|
| Rate for Payer: Cofinity Commercial |
$142.65
|
| Rate for Payer: Cofinity Commercial |
$116.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.70
|
| Rate for Payer: Healthscope Commercial |
$149.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$140.99
|
| Rate for Payer: PHP Commercial |
$140.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.11
|
| Rate for Payer: Priority Health SBD |
$104.50
|
| Rate for Payer: UMR Bronson Commercial |
$72.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.40
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET
|
Facility
|
IP
|
$315.40
|
|
|
Service Code
|
NDC 0832-0511-01
|
| Hospital Charge Code |
1043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.78 |
| Max. Negotiated Rate |
$283.86 |
| Rate for Payer: Aetna American Axle |
$205.01
|
| Rate for Payer: Aetna Commercial |
$268.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.01
|
| Rate for Payer: Cash Price |
$252.32
|
| Rate for Payer: Cofinity Commercial |
$220.78
|
| Rate for Payer: Cofinity Commercial |
$271.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.32
|
| Rate for Payer: Healthscope Commercial |
$283.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$220.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$268.09
|
| Rate for Payer: PHP Commercial |
$268.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.78
|
| Rate for Payer: Priority Health SBD |
$198.70
|
| Rate for Payer: UMR Bronson Commercial |
$138.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.55
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET
|
Facility
|
IP
|
$279.30
|
|
|
Service Code
|
NDC 65162-572-10
|
| Hospital Charge Code |
1043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.89 |
| Max. Negotiated Rate |
$251.37 |
| Rate for Payer: Aetna American Axle |
$181.54
|
| Rate for Payer: Aetna Commercial |
$237.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.54
|
| Rate for Payer: Cash Price |
$223.44
|
| Rate for Payer: Cofinity Commercial |
$195.51
|
| Rate for Payer: Cofinity Commercial |
$240.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.44
|
| Rate for Payer: Healthscope Commercial |
$251.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$195.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$237.40
|
| Rate for Payer: PHP Commercial |
$237.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.51
|
| Rate for Payer: Priority Health SBD |
$175.96
|
| Rate for Payer: UMR Bronson Commercial |
$122.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.48
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET
|
Facility
|
IP
|
$448.85
|
|
|
Service Code
|
NDC 0832-0511-00
|
| Hospital Charge Code |
1043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$197.49 |
| Max. Negotiated Rate |
$403.96 |
| Rate for Payer: Aetna American Axle |
$291.75
|
| Rate for Payer: Aetna Commercial |
$381.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.75
|
| Rate for Payer: Cash Price |
$359.08
|
| Rate for Payer: Cofinity Commercial |
$314.20
|
| Rate for Payer: Cofinity Commercial |
$386.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.08
|
| Rate for Payer: Healthscope Commercial |
$403.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$314.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$336.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$381.52
|
| Rate for Payer: PHP Commercial |
$381.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$314.20
|
| Rate for Payer: Priority Health SBD |
$282.78
|
| Rate for Payer: UMR Bronson Commercial |
$197.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$336.64
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET
|
Facility
|
IP
|
$3.16
|
|
|
Service Code
|
NDC 0832-0511-89
|
| Hospital Charge Code |
1043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$2.84 |
| Rate for Payer: Aetna American Axle |
$2.05
|
| Rate for Payer: Aetna Commercial |
$2.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.05
|
| Rate for Payer: Cash Price |
$2.53
|
| Rate for Payer: Cofinity Commercial |
$2.21
|
| Rate for Payer: Cofinity Commercial |
$2.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.53
|
| Rate for Payer: Healthscope Commercial |
$2.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.69
|
| Rate for Payer: PHP Commercial |
$2.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.21
|
| Rate for Payer: Priority Health SBD |
$1.99
|
| Rate for Payer: UMR Bronson Commercial |
$1.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.37
|
|
|
BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,041.53
|
|
|
Service Code
|
HCPCS J9035
|
| Hospital Charge Code |
38022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.52 |
| Max. Negotiated Rate |
$2,737.38 |
| Rate for Payer: Aetna American Axle |
$1,976.99
|
| Rate for Payer: Aetna American Axle |
$7,907.97
|
| Rate for Payer: Aetna Commercial |
$10,341.19
|
| Rate for Payer: Aetna Commercial |
$2,585.30
|
| Rate for Payer: Aetna Medicare |
$77.04
|
| Rate for Payer: Aetna Medicare |
$77.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,976.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,907.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.59
|
| Rate for Payer: BCBS Complete |
$42.55
|
| Rate for Payer: BCBS Complete |
$42.55
|
| Rate for Payer: BCBS MAPPO |
$74.07
|
| Rate for Payer: BCBS MAPPO |
$74.07
|
| Rate for Payer: BCBS Trust/PPO |
$239.37
|
| Rate for Payer: BCBS Trust/PPO |
$239.37
|
| Rate for Payer: BCN Medicare Advantage |
$74.07
|
| Rate for Payer: BCN Medicare Advantage |
$74.07
|
| Rate for Payer: Cash Price |
$9,732.89
|
| Rate for Payer: Cash Price |
$2,433.22
|
| Rate for Payer: Cash Price |
$9,732.89
|
| Rate for Payer: Cash Price |
$2,433.22
|
| Rate for Payer: Cofinity Commercial |
$2,129.07
|
| Rate for Payer: Cofinity Commercial |
$10,462.85
|
| Rate for Payer: Cofinity Commercial |
$8,516.28
|
| Rate for Payer: Cofinity Commercial |
$2,615.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,433.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,732.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.07
|
| Rate for Payer: Healthscope Commercial |
$10,949.50
|
| Rate for Payer: Healthscope Commercial |
$2,737.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,516.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,129.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,281.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,124.58
|
| Rate for Payer: Mclaren Medicaid |
$40.52
|
| Rate for Payer: Mclaren Medicaid |
$40.52
|
| Rate for Payer: Mclaren Medicare |
$74.07
|
| Rate for Payer: Mclaren Medicare |
$74.07
|
| Rate for Payer: Meridian Medicaid |
$42.55
|
| Rate for Payer: Meridian Medicaid |
$42.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$77.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$77.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,585.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,341.19
|
| Rate for Payer: PACE Medicare |
$70.37
|
| Rate for Payer: PACE Medicare |
$70.37
|
| Rate for Payer: PACE SWMI |
$74.07
|
| Rate for Payer: PACE SWMI |
$74.07
|
| Rate for Payer: PHP Commercial |
$10,341.19
|
| Rate for Payer: PHP Commercial |
$2,585.30
|
| Rate for Payer: PHP Medicare Advantage |
$74.07
|
| Rate for Payer: PHP Medicare Advantage |
$74.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,129.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,516.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$216.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$216.78
|
| Rate for Payer: Priority Health Medicare |
$74.07
|
| Rate for Payer: Priority Health Medicare |
$74.07
|
| Rate for Payer: Priority Health Narrow Network |
$173.42
|
| Rate for Payer: Priority Health Narrow Network |
$173.42
|
| Rate for Payer: Priority Health SBD |
$7,664.65
|
| Rate for Payer: Priority Health SBD |
$1,916.16
|
| Rate for Payer: Railroad Medicare Medicare |
$74.07
|
| Rate for Payer: Railroad Medicare Medicare |
$74.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.07
|
| Rate for Payer: UHC Medicare Advantage |
$76.30
|
| Rate for Payer: UHC Medicare Advantage |
$76.30
|
| Rate for Payer: UMR Bronson Commercial |
$1,125.37
|
| Rate for Payer: UMR Bronson Commercial |
$4,501.46
|
| Rate for Payer: VA VA |
$74.07
|
| Rate for Payer: VA VA |
$74.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,124.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,281.15
|
|
|
BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$12,166.11
|
|
|
Service Code
|
HCPCS J9035
|
| Hospital Charge Code |
38022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,353.09 |
| Max. Negotiated Rate |
$10,949.50 |
| Rate for Payer: Aetna American Axle |
$7,907.97
|
| Rate for Payer: Aetna American Axle |
$1,976.99
|
| Rate for Payer: Aetna Commercial |
$2,585.30
|
| Rate for Payer: Aetna Commercial |
$10,341.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,907.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,976.99
|
| Rate for Payer: Cash Price |
$9,732.89
|
| Rate for Payer: Cash Price |
$2,433.22
|
| Rate for Payer: Cofinity Commercial |
$10,462.85
|
| Rate for Payer: Cofinity Commercial |
$8,516.28
|
| Rate for Payer: Cofinity Commercial |
$2,129.07
|
| Rate for Payer: Cofinity Commercial |
$2,615.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,732.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,433.22
|
| Rate for Payer: Healthscope Commercial |
$2,737.38
|
| Rate for Payer: Healthscope Commercial |
$10,949.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,129.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,516.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,124.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,281.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,585.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,341.19
|
| Rate for Payer: PHP Commercial |
$10,341.19
|
| Rate for Payer: PHP Commercial |
$2,585.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,516.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,129.07
|
| Rate for Payer: Priority Health SBD |
$7,664.65
|
| Rate for Payer: Priority Health SBD |
$1,916.16
|
| Rate for Payer: UMR Bronson Commercial |
$5,353.09
|
| Rate for Payer: UMR Bronson Commercial |
$1,338.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,124.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,281.15
|
|
|
BEVACIZUMAB-AWWB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,993.45
|
|
|
Service Code
|
HCPCS Q5107
|
| Hospital Charge Code |
190598
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.01 |
| Max. Negotiated Rate |
$2,694.10 |
| Rate for Payer: Aetna American Axle |
$1,945.74
|
| Rate for Payer: Aetna American Axle |
$7,782.73
|
| Rate for Payer: Aetna Commercial |
$2,544.43
|
| Rate for Payer: Aetna Commercial |
$10,177.42
|
| Rate for Payer: Aetna Medicare |
$26.64
|
| Rate for Payer: Aetna Medicare |
$26.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,945.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,782.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.02
|
| Rate for Payer: BCBS Complete |
$14.72
|
| Rate for Payer: BCBS Complete |
$14.72
|
| Rate for Payer: BCBS MAPPO |
$25.62
|
| Rate for Payer: BCBS MAPPO |
$25.62
|
| Rate for Payer: BCBS Trust/PPO |
$82.31
|
| Rate for Payer: BCBS Trust/PPO |
$82.31
|
| Rate for Payer: BCN Medicare Advantage |
$25.62
|
| Rate for Payer: BCN Medicare Advantage |
$25.62
|
| Rate for Payer: Cash Price |
$9,578.74
|
| Rate for Payer: Cash Price |
$2,394.76
|
| Rate for Payer: Cash Price |
$2,394.76
|
| Rate for Payer: Cash Price |
$9,578.74
|
| Rate for Payer: Cofinity Commercial |
$2,095.42
|
| Rate for Payer: Cofinity Commercial |
$2,574.37
|
| Rate for Payer: Cofinity Commercial |
$10,297.15
|
| Rate for Payer: Cofinity Commercial |
$8,381.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,394.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,578.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.62
|
| Rate for Payer: Healthscope Commercial |
$2,694.10
|
| Rate for Payer: Healthscope Commercial |
$10,776.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,095.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,381.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,980.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,245.09
|
| Rate for Payer: Mclaren Medicaid |
$14.01
|
| Rate for Payer: Mclaren Medicaid |
$14.01
|
| Rate for Payer: Mclaren Medicare |
$25.62
|
| Rate for Payer: Mclaren Medicare |
$25.62
|
| Rate for Payer: Meridian Medicaid |
$14.72
|
| Rate for Payer: Meridian Medicaid |
$14.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,544.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,177.42
|
| Rate for Payer: PACE Medicare |
$24.34
|
| Rate for Payer: PACE Medicare |
$24.34
|
| Rate for Payer: PACE SWMI |
$25.62
|
| Rate for Payer: PACE SWMI |
$25.62
|
| Rate for Payer: PHP Commercial |
$10,177.42
|
| Rate for Payer: PHP Commercial |
$2,544.43
|
| Rate for Payer: PHP Medicare Advantage |
$25.62
|
| Rate for Payer: PHP Medicare Advantage |
$25.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,381.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,095.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.79
|
| Rate for Payer: Priority Health Medicare |
$25.62
|
| Rate for Payer: Priority Health Medicare |
$25.62
|
| Rate for Payer: Priority Health Narrow Network |
$65.43
|
| Rate for Payer: Priority Health Narrow Network |
$65.43
|
| Rate for Payer: Priority Health SBD |
$1,885.87
|
| Rate for Payer: Priority Health SBD |
$7,543.26
|
| Rate for Payer: Railroad Medicare Medicare |
$25.62
|
| Rate for Payer: Railroad Medicare Medicare |
$25.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.62
|
| Rate for Payer: UHC Medicare Advantage |
$26.39
|
| Rate for Payer: UHC Medicare Advantage |
$26.39
|
| Rate for Payer: UMR Bronson Commercial |
$1,107.58
|
| Rate for Payer: UMR Bronson Commercial |
$4,430.17
|
| Rate for Payer: VA VA |
$25.62
|
| Rate for Payer: VA VA |
$25.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,980.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,245.09
|
|
|
BEVACIZUMAB-BVZR 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$9,710.11
|
|
|
Service Code
|
HCPCS Q5118
|
| Hospital Charge Code |
192559
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,272.45 |
| Max. Negotiated Rate |
$8,739.10 |
| Rate for Payer: Aetna American Axle |
$6,311.57
|
| Rate for Payer: Aetna American Axle |
$1,577.89
|
| Rate for Payer: Aetna Commercial |
$8,253.59
|
| Rate for Payer: Aetna Commercial |
$2,063.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,577.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,311.57
|
| Rate for Payer: Cash Price |
$7,768.09
|
| Rate for Payer: Cash Price |
$1,942.02
|
| Rate for Payer: Cofinity Commercial |
$8,350.69
|
| Rate for Payer: Cofinity Commercial |
$6,797.08
|
| Rate for Payer: Cofinity Commercial |
$1,699.27
|
| Rate for Payer: Cofinity Commercial |
$2,087.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,768.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,942.02
|
| Rate for Payer: Healthscope Commercial |
$8,739.10
|
| Rate for Payer: Healthscope Commercial |
$2,184.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,797.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,699.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,820.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,282.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,063.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,253.59
|
| Rate for Payer: PHP Commercial |
$8,253.59
|
| Rate for Payer: PHP Commercial |
$2,063.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,699.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,797.08
|
| Rate for Payer: Priority Health SBD |
$1,529.34
|
| Rate for Payer: Priority Health SBD |
$6,117.37
|
| Rate for Payer: UMR Bronson Commercial |
$4,272.45
|
| Rate for Payer: UMR Bronson Commercial |
$1,068.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,282.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,820.65
|
|
|
BEVACIZUMAB-BVZR 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,427.53
|
|
|
Service Code
|
HCPCS Q5118
|
| Hospital Charge Code |
192559
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$2,184.78 |
| Rate for Payer: Aetna American Axle |
$1,577.89
|
| Rate for Payer: Aetna American Axle |
$6,311.57
|
| Rate for Payer: Aetna Commercial |
$2,063.40
|
| Rate for Payer: Aetna Commercial |
$8,253.59
|
| Rate for Payer: Aetna Medicare |
$22.37
|
| Rate for Payer: Aetna Medicare |
$22.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,577.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,311.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.89
|
| Rate for Payer: BCBS Complete |
$12.36
|
| Rate for Payer: BCBS Complete |
$12.36
|
| Rate for Payer: BCBS MAPPO |
$21.51
|
| Rate for Payer: BCBS MAPPO |
$21.51
|
| Rate for Payer: BCBS Trust/PPO |
$54.52
|
| Rate for Payer: BCBS Trust/PPO |
$54.52
|
| Rate for Payer: BCN Medicare Advantage |
$21.51
|
| Rate for Payer: BCN Medicare Advantage |
$21.51
|
| Rate for Payer: Cash Price |
$7,768.09
|
| Rate for Payer: Cash Price |
$7,768.09
|
| Rate for Payer: Cash Price |
$1,942.02
|
| Rate for Payer: Cash Price |
$1,942.02
|
| Rate for Payer: Cofinity Commercial |
$1,699.27
|
| Rate for Payer: Cofinity Commercial |
$2,087.68
|
| Rate for Payer: Cofinity Commercial |
$6,797.08
|
| Rate for Payer: Cofinity Commercial |
$8,350.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,768.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,942.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.51
|
| Rate for Payer: Healthscope Commercial |
$8,739.10
|
| Rate for Payer: Healthscope Commercial |
$2,184.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,797.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,699.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,282.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,820.65
|
| Rate for Payer: Mclaren Medicaid |
$11.77
|
| Rate for Payer: Mclaren Medicaid |
$11.77
|
| Rate for Payer: Mclaren Medicare |
$21.51
|
| Rate for Payer: Mclaren Medicare |
$21.51
|
| Rate for Payer: Meridian Medicaid |
$12.36
|
| Rate for Payer: Meridian Medicaid |
$12.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,253.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,063.40
|
| Rate for Payer: PACE Medicare |
$20.44
|
| Rate for Payer: PACE Medicare |
$20.44
|
| Rate for Payer: PACE SWMI |
$21.51
|
| Rate for Payer: PACE SWMI |
$21.51
|
| Rate for Payer: PHP Commercial |
$2,063.40
|
| Rate for Payer: PHP Commercial |
$8,253.59
|
| Rate for Payer: PHP Medicare Advantage |
$21.51
|
| Rate for Payer: PHP Medicare Advantage |
$21.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,797.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,699.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.70
|
| Rate for Payer: Priority Health Medicare |
$21.51
|
| Rate for Payer: Priority Health Medicare |
$21.51
|
| Rate for Payer: Priority Health Narrow Network |
$55.76
|
| Rate for Payer: Priority Health Narrow Network |
$55.76
|
| Rate for Payer: Priority Health SBD |
$6,117.37
|
| Rate for Payer: Priority Health SBD |
$1,529.34
|
| Rate for Payer: Railroad Medicare Medicare |
$21.51
|
| Rate for Payer: Railroad Medicare Medicare |
$21.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.51
|
| Rate for Payer: UHC Medicare Advantage |
$22.16
|
| Rate for Payer: UHC Medicare Advantage |
$22.16
|
| Rate for Payer: UMR Bronson Commercial |
$3,592.74
|
| Rate for Payer: UMR Bronson Commercial |
$898.19
|
| Rate for Payer: VA VA |
$21.51
|
| Rate for Payer: VA VA |
$21.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,820.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,282.58
|
|
|
BEXAROTENE 75 MG CAPSULE
|
Facility
|
IP
|
$735.03
|
|
|
Service Code
|
NDC 42292-007-01
|
| Hospital Charge Code |
27027
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$323.41 |
| Max. Negotiated Rate |
$661.53 |
| Rate for Payer: Aetna American Axle |
$477.77
|
| Rate for Payer: Aetna Commercial |
$624.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$477.77
|
| Rate for Payer: Cash Price |
$588.02
|
| Rate for Payer: Cofinity Commercial |
$514.52
|
| Rate for Payer: Cofinity Commercial |
$632.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$588.02
|
| Rate for Payer: Healthscope Commercial |
$661.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$514.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$551.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$624.78
|
| Rate for Payer: PHP Commercial |
$624.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$514.52
|
| Rate for Payer: Priority Health SBD |
$463.07
|
| Rate for Payer: UMR Bronson Commercial |
$323.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$551.27
|
|
|
BEXAROTENE 75 MG CAPSULE
|
Facility
|
IP
|
$7,350.24
|
|
|
Service Code
|
NDC 42292-007-10
|
| Hospital Charge Code |
27027
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,234.11 |
| Max. Negotiated Rate |
$6,615.22 |
| Rate for Payer: Aetna American Axle |
$4,777.66
|
| Rate for Payer: Aetna Commercial |
$6,247.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,777.66
|
| Rate for Payer: Cash Price |
$5,880.19
|
| Rate for Payer: Cofinity Commercial |
$5,145.17
|
| Rate for Payer: Cofinity Commercial |
$6,321.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,880.19
|
| Rate for Payer: Healthscope Commercial |
$6,615.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,145.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,512.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,247.70
|
| Rate for Payer: PHP Commercial |
$6,247.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,145.17
|
| Rate for Payer: Priority Health SBD |
$4,630.65
|
| Rate for Payer: UMR Bronson Commercial |
$3,234.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,512.68
|
|
|
BEZLOTOXUMAB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$9,880.00
|
|
|
Service Code
|
HCPCS J0565
|
| Hospital Charge Code |
181631
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,347.20 |
| Max. Negotiated Rate |
$8,892.00 |
| Rate for Payer: Aetna American Axle |
$6,422.00
|
| Rate for Payer: Aetna Commercial |
$8,398.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,422.00
|
| Rate for Payer: Cash Price |
$7,904.00
|
| Rate for Payer: Cofinity Commercial |
$6,916.00
|
| Rate for Payer: Cofinity Commercial |
$8,496.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,904.00
|
| Rate for Payer: Healthscope Commercial |
$8,892.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,916.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,410.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,398.00
|
| Rate for Payer: PHP Commercial |
$8,398.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,916.00
|
| Rate for Payer: Priority Health SBD |
$6,224.40
|
| Rate for Payer: UMR Bronson Commercial |
$4,347.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,410.00
|
|
|
BEZLOTOXUMAB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$9,880.00
|
|
|
Service Code
|
HCPCS J0565
|
| Hospital Charge Code |
181631
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.80 |
| Max. Negotiated Rate |
$8,892.00 |
| Rate for Payer: Aetna American Axle |
$6,422.00
|
| Rate for Payer: Aetna Commercial |
$8,398.00
|
| Rate for Payer: Aetna Medicare |
$41.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,422.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.82
|
| Rate for Payer: BCBS Complete |
$22.89
|
| Rate for Payer: BCBS MAPPO |
$39.86
|
| Rate for Payer: BCBS Trust/PPO |
$128.80
|
| Rate for Payer: BCN Medicare Advantage |
$39.86
|
| Rate for Payer: Cash Price |
$7,904.00
|
| Rate for Payer: Cash Price |
$7,904.00
|
| Rate for Payer: Cofinity Commercial |
$6,916.00
|
| Rate for Payer: Cofinity Commercial |
$8,496.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,904.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.86
|
| Rate for Payer: Healthscope Commercial |
$8,892.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,916.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,410.00
|
| Rate for Payer: Mclaren Medicaid |
$21.80
|
| Rate for Payer: Mclaren Medicare |
$39.86
|
| Rate for Payer: Meridian Medicaid |
$22.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$41.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,398.00
|
| Rate for Payer: PACE Medicare |
$37.87
|
| Rate for Payer: PACE SWMI |
$39.86
|
| Rate for Payer: PHP Commercial |
$8,398.00
|
| Rate for Payer: PHP Medicare Advantage |
$39.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,916.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$117.02
|
| Rate for Payer: Priority Health Medicare |
$39.86
|
| Rate for Payer: Priority Health Narrow Network |
$93.62
|
| Rate for Payer: Priority Health SBD |
$6,224.40
|
| Rate for Payer: Railroad Medicare Medicare |
$39.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.86
|
| Rate for Payer: UHC Medicare Advantage |
$41.05
|
| Rate for Payer: UMR Bronson Commercial |
$3,655.60
|
| Rate for Payer: VA VA |
$39.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,410.00
|
|
|
BICALUTAMIDE 50 MG TABLET
|
Facility
|
IP
|
$101.52
|
|
|
Service Code
|
NDC 16729-023-10
|
| Hospital Charge Code |
15746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.67 |
| Max. Negotiated Rate |
$91.37 |
| Rate for Payer: Aetna American Axle |
$65.99
|
| Rate for Payer: Aetna Commercial |
$86.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.99
|
| Rate for Payer: Cash Price |
$81.22
|
| Rate for Payer: Cofinity Commercial |
$71.06
|
| Rate for Payer: Cofinity Commercial |
$87.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.22
|
| Rate for Payer: Healthscope Commercial |
$91.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.29
|
| Rate for Payer: PHP Commercial |
$86.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.06
|
| Rate for Payer: Priority Health SBD |
$63.96
|
| Rate for Payer: UMR Bronson Commercial |
$44.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.14
|
|
|
BICALUTAMIDE 50 MG TABLET
|
Facility
|
IP
|
$86.93
|
|
|
Service Code
|
NDC 47335-485-83
|
| Hospital Charge Code |
15746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.25 |
| Max. Negotiated Rate |
$78.24 |
| Rate for Payer: Aetna American Axle |
$56.50
|
| Rate for Payer: Aetna Commercial |
$73.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.50
|
| Rate for Payer: Cash Price |
$69.54
|
| Rate for Payer: Cofinity Commercial |
$60.85
|
| Rate for Payer: Cofinity Commercial |
$74.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.54
|
| Rate for Payer: Healthscope Commercial |
$78.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.89
|
| Rate for Payer: PHP Commercial |
$73.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.85
|
| Rate for Payer: Priority Health SBD |
$54.77
|
| Rate for Payer: UMR Bronson Commercial |
$38.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.20
|
|
|
BICALUTAMIDE 50 MG TABLET
|
Facility
|
IP
|
$76.38
|
|
|
Service Code
|
NDC 0904-6019-46
|
| Hospital Charge Code |
15746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.61 |
| Max. Negotiated Rate |
$68.74 |
| Rate for Payer: Aetna American Axle |
$49.65
|
| Rate for Payer: Aetna Commercial |
$64.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.65
|
| Rate for Payer: Cash Price |
$61.10
|
| Rate for Payer: Cofinity Commercial |
$53.47
|
| Rate for Payer: Cofinity Commercial |
$65.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.10
|
| Rate for Payer: Healthscope Commercial |
$68.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.92
|
| Rate for Payer: PHP Commercial |
$64.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.47
|
| Rate for Payer: Priority Health SBD |
$48.12
|
| Rate for Payer: UMR Bronson Commercial |
$33.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.28
|
|
|
BICARBONATE DIALYSIS SOLN WITHOUT CALCIUM NO15 POT 4 MEQ-MAG 1.2 MEQ/L
|
Facility
|
IP
|
$394.40
|
|
|
Service Code
|
NDC 24571-114-06
|
| Hospital Charge Code |
119755
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$173.54 |
| Max. Negotiated Rate |
$354.96 |
| Rate for Payer: Aetna American Axle |
$256.36
|
| Rate for Payer: Aetna Commercial |
$335.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.36
|
| Rate for Payer: Cash Price |
$315.52
|
| Rate for Payer: Cofinity Commercial |
$276.08
|
| Rate for Payer: Cofinity Commercial |
$339.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.52
|
| Rate for Payer: Healthscope Commercial |
$354.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$276.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$335.24
|
| Rate for Payer: PHP Commercial |
$335.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.08
|
| Rate for Payer: Priority Health SBD |
$248.47
|
| Rate for Payer: UMR Bronson Commercial |
$173.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.80
|
|
