|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC
|
Facility
|
IP
|
$80,261.23
|
|
|
Service Code
|
MSDRG 094
|
| Min. Negotiated Rate |
$28,523.40 |
| Max. Negotiated Rate |
$80,261.23 |
| Rate for Payer: Aetna Medicare |
$31,225.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37,530.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37,530.79
|
| Rate for Payer: BCBS MAPPO |
$30,024.63
|
| Rate for Payer: BCBS Trust/PPO |
$80,261.23
|
| Rate for Payer: BCN Commercial |
$80,261.23
|
| Rate for Payer: BCN Medicare Advantage |
$30,024.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30,024.63
|
| Rate for Payer: Mclaren Medicare |
$30,024.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31,525.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34,528.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$33,027.09
|
| Rate for Payer: Nomi Health Commercial |
$45,400.26
|
| Rate for Payer: PACE Medicare |
$28,523.40
|
| Rate for Payer: PACE SWMI |
$30,024.63
|
| Rate for Payer: PHP Medicare Advantage |
$30,024.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$56,740.26
|
| Rate for Payer: Priority Health Medicare |
$30,024.63
|
| Rate for Payer: Priority Health Tiered Network |
$45,392.20
|
| Rate for Payer: Railroad Medicare Medicare |
$30,024.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57,366.22
|
| Rate for Payer: UHC Core |
$47,994.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$30,024.63
|
| Rate for Payer: UHC Exchange |
$39,195.56
|
| Rate for Payer: VA VA |
$30,024.63
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC
|
Facility
|
IP
|
$47,759.25
|
|
|
Service Code
|
MSDRG 096
|
| Min. Negotiated Rate |
$21,053.92 |
| Max. Negotiated Rate |
$47,759.25 |
| Rate for Payer: Aetna Medicare |
$23,048.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27,702.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27,702.53
|
| Rate for Payer: BCBS MAPPO |
$22,162.02
|
| Rate for Payer: BCBS Trust/PPO |
$47,759.25
|
| Rate for Payer: BCN Commercial |
$47,759.25
|
| Rate for Payer: BCN Medicare Advantage |
$22,162.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22,162.02
|
| Rate for Payer: Mclaren Medicare |
$22,162.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23,270.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25,486.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$24,378.22
|
| Rate for Payer: Nomi Health Commercial |
$33,271.68
|
| Rate for Payer: PACE Medicare |
$21,053.92
|
| Rate for Payer: PACE SWMI |
$22,162.02
|
| Rate for Payer: PHP Medicare Advantage |
$22,162.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$41,582.22
|
| Rate for Payer: Priority Health Medicare |
$22,162.02
|
| Rate for Payer: Priority Health Tiered Network |
$33,265.77
|
| Rate for Payer: Railroad Medicare Medicare |
$22,162.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42,040.96
|
| Rate for Payer: UHC Core |
$35,172.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22,162.02
|
| Rate for Payer: UHC Exchange |
$28,724.55
|
| Rate for Payer: VA VA |
$22,162.02
|
|
|
BALANCED SALT SOLUTION COMBINATION NO.1 INTRAOCULAR IRRIGATION
|
Facility
|
IP
|
$201.25
|
|
|
Service Code
|
NDC 00065080050
|
| Hospital Charge Code |
14123
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$88.55 |
| Max. Negotiated Rate |
$181.12 |
| Rate for Payer: Aetna American Axle |
$130.81
|
| Rate for Payer: Aetna Commercial |
$171.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.81
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: Cofinity Advantage |
$140.88
|
| Rate for Payer: Cofinity Commercial |
$173.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.00
|
| Rate for Payer: Healthscope Commercial |
$181.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.94
|
| Rate for Payer: PHP Commercial |
$171.06
|
| Rate for Payer: Priority Health SBD |
$126.79
|
| Rate for Payer: UMR Bronson Commercial |
$88.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.94
|
|
|
BALANCED SALT SOLUTION COMBINATION NO.1 INTRAOCULAR IRRIGATION
|
Facility
|
OP
|
$201.25
|
|
|
Service Code
|
NDC 00065080050
|
| Hospital Charge Code |
14123
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$74.46 |
| Max. Negotiated Rate |
$181.12 |
| Rate for Payer: Aetna American Axle |
$130.81
|
| Rate for Payer: Aetna Commercial |
$171.06
|
| Rate for Payer: Aetna Medicare |
$100.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.81
|
| Rate for Payer: BCBS Complete |
$80.50
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: Cofinity Advantage |
$140.88
|
| Rate for Payer: Cofinity Commercial |
$173.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.00
|
| Rate for Payer: Healthscope Commercial |
$181.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$161.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.94
|
| Rate for Payer: PHP Commercial |
$171.06
|
| Rate for Payer: Priority Health SBD |
$126.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.81
|
| Rate for Payer: UHC Core |
$104.85
|
| Rate for Payer: UHC Exchange |
$79.09
|
| Rate for Payer: UMR Bronson Commercial |
$74.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.94
|
|
|
BALANCED SALT SOLUTION COMBINATION NO.2 INTRAOCULAR IRRIGATION
|
Facility
|
OP
|
$10.53
|
|
|
Service Code
|
NDC 00065079515
|
| Hospital Charge Code |
10781
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$9.48 |
| Rate for Payer: Aetna American Axle |
$6.84
|
| Rate for Payer: Aetna Commercial |
$8.95
|
| Rate for Payer: Aetna Medicare |
$5.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.84
|
| Rate for Payer: BCBS Complete |
$4.21
|
| Rate for Payer: Cash Price |
$8.42
|
| Rate for Payer: Cofinity Advantage |
$7.37
|
| Rate for Payer: Cofinity Commercial |
$9.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.42
|
| Rate for Payer: Healthscope Commercial |
$9.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.90
|
| Rate for Payer: PHP Commercial |
$8.95
|
| Rate for Payer: Priority Health SBD |
$6.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.84
|
| Rate for Payer: UHC Core |
$5.49
|
| Rate for Payer: UHC Exchange |
$4.14
|
| Rate for Payer: UMR Bronson Commercial |
$3.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.90
|
|
|
BALANCED SALT SOLUTION COMBINATION NO.2 INTRAOCULAR IRRIGATION
|
Facility
|
OP
|
$24.75
|
|
|
Service Code
|
NDC 00065079550
|
| Hospital Charge Code |
10781
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.16 |
| Max. Negotiated Rate |
$22.27 |
| Rate for Payer: Aetna American Axle |
$16.09
|
| Rate for Payer: Aetna Commercial |
$21.04
|
| Rate for Payer: Aetna Medicare |
$12.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.09
|
| Rate for Payer: BCBS Complete |
$9.90
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cofinity Advantage |
$17.32
|
| Rate for Payer: Cofinity Commercial |
$21.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.80
|
| Rate for Payer: Healthscope Commercial |
$22.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.56
|
| Rate for Payer: PHP Commercial |
$21.04
|
| Rate for Payer: Priority Health SBD |
$15.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.09
|
| Rate for Payer: UHC Core |
$12.89
|
| Rate for Payer: UHC Exchange |
$9.73
|
| Rate for Payer: UMR Bronson Commercial |
$9.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.56
|
|
|
BALANCED SALT SOLUTION COMBINATION NO.2 INTRAOCULAR IRRIGATION
|
Facility
|
IP
|
$24.75
|
|
|
Service Code
|
NDC 00065079550
|
| Hospital Charge Code |
10781
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.89 |
| Max. Negotiated Rate |
$22.27 |
| Rate for Payer: Aetna American Axle |
$16.09
|
| Rate for Payer: Aetna Commercial |
$21.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.09
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cofinity Advantage |
$17.32
|
| Rate for Payer: Cofinity Commercial |
$21.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.80
|
| Rate for Payer: Healthscope Commercial |
$22.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.56
|
| Rate for Payer: PHP Commercial |
$21.04
|
| Rate for Payer: Priority Health SBD |
$15.59
|
| Rate for Payer: UMR Bronson Commercial |
$10.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.56
|
|
|
BALANCED SALT SOLUTION COMBINATION NO.2 INTRAOCULAR IRRIGATION
|
Facility
|
IP
|
$10.53
|
|
|
Service Code
|
NDC 00065079515
|
| Hospital Charge Code |
10781
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.63 |
| Max. Negotiated Rate |
$9.48 |
| Rate for Payer: Aetna American Axle |
$6.84
|
| Rate for Payer: Aetna Commercial |
$8.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.84
|
| Rate for Payer: Cash Price |
$8.42
|
| Rate for Payer: Cofinity Advantage |
$7.37
|
| Rate for Payer: Cofinity Commercial |
$9.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.42
|
| Rate for Payer: Healthscope Commercial |
$9.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.90
|
| Rate for Payer: PHP Commercial |
$8.95
|
| Rate for Payer: Priority Health SBD |
$6.63
|
| Rate for Payer: UMR Bronson Commercial |
$4.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.90
|
|
|
BALSALAZIDE 750 MG CAPSULE
|
Facility
|
IP
|
$731.14
|
|
|
Service Code
|
NDC 00378675082
|
| Hospital Charge Code |
29299
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$321.70 |
| Max. Negotiated Rate |
$658.03 |
| Rate for Payer: Aetna American Axle |
$475.24
|
| Rate for Payer: Aetna Commercial |
$621.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$475.24
|
| Rate for Payer: Cash Price |
$584.91
|
| Rate for Payer: Cofinity Advantage |
$511.80
|
| Rate for Payer: Cofinity Commercial |
$628.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$584.91
|
| Rate for Payer: Healthscope Commercial |
$658.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$511.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$548.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$621.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$548.36
|
| Rate for Payer: PHP Commercial |
$621.47
|
| Rate for Payer: Priority Health SBD |
$460.62
|
| Rate for Payer: UMR Bronson Commercial |
$321.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$548.36
|
|
|
BALSALAZIDE 750 MG CAPSULE
|
Facility
|
OP
|
$204.63
|
|
|
Service Code
|
NDC 50268010213
|
| Hospital Charge Code |
29299
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.71 |
| Max. Negotiated Rate |
$184.17 |
| Rate for Payer: Aetna American Axle |
$133.01
|
| Rate for Payer: Aetna Commercial |
$173.94
|
| Rate for Payer: Aetna Medicare |
$102.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.01
|
| Rate for Payer: BCBS Complete |
$81.85
|
| Rate for Payer: Cash Price |
$163.70
|
| Rate for Payer: Cofinity Advantage |
$143.24
|
| Rate for Payer: Cofinity Commercial |
$175.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.70
|
| Rate for Payer: Healthscope Commercial |
$184.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$143.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$163.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.47
|
| Rate for Payer: PHP Commercial |
$173.94
|
| Rate for Payer: Priority Health SBD |
$128.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.01
|
| Rate for Payer: UHC Core |
$106.61
|
| Rate for Payer: UHC Exchange |
$80.42
|
| Rate for Payer: UMR Bronson Commercial |
$75.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.47
|
|
|
BALSALAZIDE 750 MG CAPSULE
|
Facility
|
OP
|
$6.83
|
|
|
Service Code
|
NDC 50268010211
|
| Hospital Charge Code |
29299
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$6.15 |
| Rate for Payer: Aetna American Axle |
$4.44
|
| Rate for Payer: Aetna Commercial |
$5.81
|
| Rate for Payer: Aetna Medicare |
$3.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.44
|
| Rate for Payer: BCBS Complete |
$2.73
|
| Rate for Payer: Cash Price |
$5.46
|
| Rate for Payer: Cofinity Advantage |
$4.78
|
| Rate for Payer: Cofinity Commercial |
$5.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.46
|
| Rate for Payer: Healthscope Commercial |
$6.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.12
|
| Rate for Payer: PHP Commercial |
$5.81
|
| Rate for Payer: Priority Health SBD |
$4.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.44
|
| Rate for Payer: UHC Core |
$3.56
|
| Rate for Payer: UHC Exchange |
$2.68
|
| Rate for Payer: UMR Bronson Commercial |
$2.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.12
|
|
|
BALSALAZIDE 750 MG CAPSULE
|
Facility
|
OP
|
$731.14
|
|
|
Service Code
|
NDC 00378675082
|
| Hospital Charge Code |
29299
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$270.52 |
| Max. Negotiated Rate |
$658.03 |
| Rate for Payer: Aetna American Axle |
$475.24
|
| Rate for Payer: Aetna Commercial |
$621.47
|
| Rate for Payer: Aetna Medicare |
$365.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$475.24
|
| Rate for Payer: BCBS Complete |
$292.46
|
| Rate for Payer: Cash Price |
$584.91
|
| Rate for Payer: Cofinity Advantage |
$511.80
|
| Rate for Payer: Cofinity Commercial |
$628.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$584.91
|
| Rate for Payer: Healthscope Commercial |
$658.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$511.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$548.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$584.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$621.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$548.36
|
| Rate for Payer: PHP Commercial |
$621.47
|
| Rate for Payer: Priority Health SBD |
$460.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$475.24
|
| Rate for Payer: UHC Core |
$380.92
|
| Rate for Payer: UHC Exchange |
$287.34
|
| Rate for Payer: UMR Bronson Commercial |
$270.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$548.36
|
|
|
BALSALAZIDE 750 MG CAPSULE
|
Facility
|
IP
|
$204.63
|
|
|
Service Code
|
NDC 50268010213
|
| Hospital Charge Code |
29299
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.04 |
| Max. Negotiated Rate |
$184.17 |
| Rate for Payer: Aetna American Axle |
$133.01
|
| Rate for Payer: Aetna Commercial |
$173.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.01
|
| Rate for Payer: Cash Price |
$163.70
|
| Rate for Payer: Cofinity Advantage |
$143.24
|
| Rate for Payer: Cofinity Commercial |
$175.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.70
|
| Rate for Payer: Healthscope Commercial |
$184.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$143.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.47
|
| Rate for Payer: PHP Commercial |
$173.94
|
| Rate for Payer: Priority Health SBD |
$128.92
|
| Rate for Payer: UMR Bronson Commercial |
$90.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.47
|
|
|
BALSALAZIDE 750 MG CAPSULE
|
Facility
|
OP
|
$942.15
|
|
|
Service Code
|
NDC 00054007928
|
| Hospital Charge Code |
29299
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$348.60 |
| Max. Negotiated Rate |
$847.93 |
| Rate for Payer: Aetna American Axle |
$612.40
|
| Rate for Payer: Aetna Commercial |
$800.83
|
| Rate for Payer: Aetna Medicare |
$471.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$612.40
|
| Rate for Payer: BCBS Complete |
$376.86
|
| Rate for Payer: Cash Price |
$753.72
|
| Rate for Payer: Cofinity Advantage |
$659.50
|
| Rate for Payer: Cofinity Commercial |
$810.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$753.72
|
| Rate for Payer: Healthscope Commercial |
$847.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$659.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$706.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$753.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$800.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$706.61
|
| Rate for Payer: PHP Commercial |
$800.83
|
| Rate for Payer: Priority Health SBD |
$593.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$612.40
|
| Rate for Payer: UHC Core |
$490.86
|
| Rate for Payer: UHC Exchange |
$370.26
|
| Rate for Payer: UMR Bronson Commercial |
$348.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$706.61
|
|
|
BALSALAZIDE 750 MG CAPSULE
|
Facility
|
OP
|
$892.42
|
|
|
Service Code
|
NDC 60505257507
|
| Hospital Charge Code |
29299
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$330.20 |
| Max. Negotiated Rate |
$803.18 |
| Rate for Payer: Aetna American Axle |
$580.07
|
| Rate for Payer: Aetna Commercial |
$758.56
|
| Rate for Payer: Aetna Medicare |
$446.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$580.07
|
| Rate for Payer: BCBS Complete |
$356.97
|
| Rate for Payer: Cash Price |
$713.94
|
| Rate for Payer: Cofinity Advantage |
$624.69
|
| Rate for Payer: Cofinity Commercial |
$767.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$713.94
|
| Rate for Payer: Healthscope Commercial |
$803.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$624.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$669.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$713.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$758.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$669.32
|
| Rate for Payer: PHP Commercial |
$758.56
|
| Rate for Payer: Priority Health SBD |
$562.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$580.07
|
| Rate for Payer: UHC Core |
$464.95
|
| Rate for Payer: UHC Exchange |
$350.72
|
| Rate for Payer: UMR Bronson Commercial |
$330.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$669.32
|
|
|
BALSALAZIDE 750 MG CAPSULE
|
Facility
|
IP
|
$892.42
|
|
|
Service Code
|
NDC 60505257507
|
| Hospital Charge Code |
29299
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$392.66 |
| Max. Negotiated Rate |
$803.18 |
| Rate for Payer: Aetna American Axle |
$580.07
|
| Rate for Payer: Aetna Commercial |
$758.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$580.07
|
| Rate for Payer: Cash Price |
$713.94
|
| Rate for Payer: Cofinity Advantage |
$624.69
|
| Rate for Payer: Cofinity Commercial |
$767.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$713.94
|
| Rate for Payer: Healthscope Commercial |
$803.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$624.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$669.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$758.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$669.32
|
| Rate for Payer: PHP Commercial |
$758.56
|
| Rate for Payer: Priority Health SBD |
$562.22
|
| Rate for Payer: UMR Bronson Commercial |
$392.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$669.32
|
|
|
BALSALAZIDE 750 MG CAPSULE
|
Facility
|
IP
|
$6.83
|
|
|
Service Code
|
NDC 50268010211
|
| Hospital Charge Code |
29299
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$6.15 |
| Rate for Payer: Aetna American Axle |
$4.44
|
| Rate for Payer: Aetna Commercial |
$5.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.44
|
| Rate for Payer: Cash Price |
$5.46
|
| Rate for Payer: Cofinity Advantage |
$4.78
|
| Rate for Payer: Cofinity Commercial |
$5.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.46
|
| Rate for Payer: Healthscope Commercial |
$6.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.12
|
| Rate for Payer: PHP Commercial |
$5.81
|
| Rate for Payer: Priority Health SBD |
$4.30
|
| Rate for Payer: UMR Bronson Commercial |
$3.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.12
|
|
|
BALSALAZIDE 750 MG CAPSULE
|
Facility
|
IP
|
$942.15
|
|
|
Service Code
|
NDC 00054007928
|
| Hospital Charge Code |
29299
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$414.55 |
| Max. Negotiated Rate |
$847.93 |
| Rate for Payer: Aetna American Axle |
$612.40
|
| Rate for Payer: Aetna Commercial |
$800.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$612.40
|
| Rate for Payer: Cash Price |
$753.72
|
| Rate for Payer: Cofinity Advantage |
$659.50
|
| Rate for Payer: Cofinity Commercial |
$810.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$753.72
|
| Rate for Payer: Healthscope Commercial |
$847.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$659.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$706.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$800.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$706.61
|
| Rate for Payer: PHP Commercial |
$800.83
|
| Rate for Payer: Priority Health SBD |
$593.55
|
| Rate for Payer: UMR Bronson Commercial |
$414.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$706.61
|
|
|
BARICITINIB 2 MG TABLET
|
Facility
|
OP
|
$9,736.26
|
|
|
Service Code
|
NDC 00002418230
|
| Hospital Charge Code |
186973
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,602.42 |
| Max. Negotiated Rate |
$8,762.63 |
| Rate for Payer: Aetna American Axle |
$6,328.57
|
| Rate for Payer: Aetna Commercial |
$8,275.82
|
| Rate for Payer: Aetna Medicare |
$4,868.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,328.57
|
| Rate for Payer: BCBS Complete |
$3,894.50
|
| Rate for Payer: Cash Price |
$7,789.01
|
| Rate for Payer: Cofinity Advantage |
$6,815.38
|
| Rate for Payer: Cofinity Commercial |
$8,373.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,789.01
|
| Rate for Payer: Healthscope Commercial |
$8,762.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,815.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,302.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,789.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,275.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,302.19
|
| Rate for Payer: PHP Commercial |
$8,275.82
|
| Rate for Payer: Priority Health SBD |
$6,133.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,328.57
|
| Rate for Payer: UHC Core |
$5,072.59
|
| Rate for Payer: UHC Exchange |
$3,826.35
|
| Rate for Payer: UMR Bronson Commercial |
$3,602.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,302.19
|
|
|
BARICITINIB 2 MG TABLET
|
Facility
|
IP
|
$9,736.26
|
|
|
Service Code
|
NDC 00002418230
|
| Hospital Charge Code |
186973
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,283.95 |
| Max. Negotiated Rate |
$8,762.63 |
| Rate for Payer: Aetna American Axle |
$6,328.57
|
| Rate for Payer: Aetna Commercial |
$8,275.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,328.57
|
| Rate for Payer: Cash Price |
$7,789.01
|
| Rate for Payer: Cofinity Advantage |
$6,815.38
|
| Rate for Payer: Cofinity Commercial |
$8,373.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,789.01
|
| Rate for Payer: Healthscope Commercial |
$8,762.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,815.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,302.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,275.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,302.19
|
| Rate for Payer: PHP Commercial |
$8,275.82
|
| Rate for Payer: Priority Health SBD |
$6,133.84
|
| Rate for Payer: UMR Bronson Commercial |
$4,283.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,302.19
|
|
|
BASILIXIMAB 20 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16,321.89
|
|
|
Service Code
|
HCPCS J0480
|
| Hospital Charge Code |
23082
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,181.63 |
| Max. Negotiated Rate |
$14,689.70 |
| Rate for Payer: Aetna American Axle |
$10,609.23
|
| Rate for Payer: Aetna Commercial |
$13,873.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,609.23
|
| Rate for Payer: Cash Price |
$13,057.51
|
| Rate for Payer: Cofinity Advantage |
$11,425.32
|
| Rate for Payer: Cofinity Commercial |
$14,036.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,057.51
|
| Rate for Payer: Healthscope Commercial |
$14,689.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,425.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,241.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,873.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,241.42
|
| Rate for Payer: PHP Commercial |
$13,873.61
|
| Rate for Payer: Priority Health SBD |
$10,282.79
|
| Rate for Payer: UMR Bronson Commercial |
$7,181.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,241.42
|
|
|
BASILIXIMAB 20 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$16,321.89
|
|
|
Service Code
|
HCPCS J0480
|
| Hospital Charge Code |
23082
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,516.84 |
| Max. Negotiated Rate |
$15,503.34 |
| Rate for Payer: Aetna American Axle |
$10,609.23
|
| Rate for Payer: Aetna Commercial |
$13,873.61
|
| Rate for Payer: Aetna Medicare |
$5,004.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,609.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,015.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,015.39
|
| Rate for Payer: BCBS Complete |
$2,642.92
|
| Rate for Payer: BCBS MAPPO |
$4,812.31
|
| Rate for Payer: BCBS Trust/PPO |
$15,503.34
|
| Rate for Payer: BCN Commercial |
$15,503.34
|
| Rate for Payer: BCN Medicare Advantage |
$4,812.31
|
| Rate for Payer: Cash Price |
$13,057.51
|
| Rate for Payer: Cash Price |
$13,057.51
|
| Rate for Payer: Cofinity Advantage |
$11,425.32
|
| Rate for Payer: Cofinity Commercial |
$14,036.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,057.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,812.31
|
| Rate for Payer: Healthscope Commercial |
$14,689.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,425.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,241.42
|
| Rate for Payer: Mclaren Medicaid |
$4,812.31
|
| Rate for Payer: Mclaren Medicare |
$4,812.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,052.93
|
| Rate for Payer: Meridian Medicaid |
$5,052.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,534.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,293.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,873.61
|
| Rate for Payer: Nomi Health Commercial |
$14,436.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,241.42
|
| Rate for Payer: PACE Medicare |
$4,571.69
|
| Rate for Payer: PACE SWMI |
$4,812.31
|
| Rate for Payer: PHP Commercial |
$13,873.61
|
| Rate for Payer: PHP Medicare Advantage |
$4,812.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,516.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14,782.20
|
| Rate for Payer: Priority Health Medicare |
$4,812.31
|
| Rate for Payer: Priority Health SBD |
$10,282.79
|
| Rate for Payer: Priority Health Tiered Network |
$11,825.76
|
| Rate for Payer: Railroad Medicare Medicare |
$4,812.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,888.77
|
| Rate for Payer: UHC Core |
$7,888.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4,812.31
|
| Rate for Payer: UHC Exchange |
$7,888.77
|
| Rate for Payer: UHC Medicaid |
$2,516.84
|
| Rate for Payer: UHCCP Medicaid |
$2,516.84
|
| Rate for Payer: UMR Bronson Commercial |
$6,039.10
|
| Rate for Payer: VA VA |
$4,812.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,241.42
|
|
|
BCG LIVE 50 MG INTRAVESICAL SUSPENSION
|
Facility
|
OP
|
$522.78
|
|
|
Service Code
|
HCPCS J9030
|
| Hospital Charge Code |
116210
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$470.50 |
| Rate for Payer: Aetna American Axle |
$339.81
|
| Rate for Payer: Aetna Commercial |
$444.36
|
| Rate for Payer: Aetna Medicare |
$3.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$339.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.24
|
| Rate for Payer: BCBS Complete |
$1.86
|
| Rate for Payer: BCBS MAPPO |
$3.39
|
| Rate for Payer: BCBS Trust/PPO |
$10.63
|
| Rate for Payer: BCN Commercial |
$10.63
|
| Rate for Payer: BCN Medicare Advantage |
$3.39
|
| Rate for Payer: Cash Price |
$418.22
|
| Rate for Payer: Cash Price |
$418.22
|
| Rate for Payer: Cofinity Advantage |
$365.95
|
| Rate for Payer: Cofinity Commercial |
$449.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$418.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.39
|
| Rate for Payer: Healthscope Commercial |
$470.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$365.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$392.08
|
| Rate for Payer: Mclaren Medicaid |
$3.39
|
| Rate for Payer: Mclaren Medicare |
$3.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.56
|
| Rate for Payer: Meridian Medicaid |
$3.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$444.36
|
| Rate for Payer: Nomi Health Commercial |
$10.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$392.08
|
| Rate for Payer: PACE Medicare |
$3.22
|
| Rate for Payer: PACE SWMI |
$3.39
|
| Rate for Payer: PHP Commercial |
$444.36
|
| Rate for Payer: PHP Medicare Advantage |
$3.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10.29
|
| Rate for Payer: Priority Health Medicare |
$3.39
|
| Rate for Payer: Priority Health SBD |
$329.35
|
| Rate for Payer: Priority Health Tiered Network |
$8.23
|
| Rate for Payer: Railroad Medicare Medicare |
$3.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.41
|
| Rate for Payer: UHC Core |
$5.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.39
|
| Rate for Payer: UHC Exchange |
$5.41
|
| Rate for Payer: UHC Medicaid |
$1.77
|
| Rate for Payer: UHCCP Medicaid |
$1.77
|
| Rate for Payer: UMR Bronson Commercial |
$193.43
|
| Rate for Payer: VA VA |
$3.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$392.08
|
|
|
BCG LIVE 50 MG INTRAVESICAL SUSPENSION
|
Facility
|
IP
|
$522.78
|
|
|
Service Code
|
HCPCS J9030
|
| Hospital Charge Code |
116210
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$230.02 |
| Max. Negotiated Rate |
$470.50 |
| Rate for Payer: Aetna American Axle |
$339.81
|
| Rate for Payer: Aetna Commercial |
$444.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$339.81
|
| Rate for Payer: Cash Price |
$418.22
|
| Rate for Payer: Cofinity Advantage |
$365.95
|
| Rate for Payer: Cofinity Commercial |
$449.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$418.22
|
| Rate for Payer: Healthscope Commercial |
$470.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$365.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$392.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$444.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$392.08
|
| Rate for Payer: PHP Commercial |
$444.36
|
| Rate for Payer: Priority Health SBD |
$329.35
|
| Rate for Payer: UMR Bronson Commercial |
$230.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$392.08
|
|
|
B-COMPLEX WITH VITAMIN C TABLET
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
NDC 40985022668
|
| Hospital Charge Code |
807
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.32 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Aetna American Axle |
$148.20
|
| Rate for Payer: Aetna Commercial |
$193.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.20
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cofinity Advantage |
$159.60
|
| Rate for Payer: Cofinity Commercial |
$196.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.40
|
| Rate for Payer: Healthscope Commercial |
$205.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$159.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.00
|
| Rate for Payer: PHP Commercial |
$193.80
|
| Rate for Payer: Priority Health SBD |
$143.64
|
| Rate for Payer: UMR Bronson Commercial |
$100.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.00
|
|
