|
B-COMPLEX WITH VITAMIN C TABLET
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
NDC 80681015400
|
| 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 Advantage |
$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 Commercial |
$125.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.00
|
| Rate for Payer: PHP Commercial |
$125.80
|
| 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
|
|
|
B-COMPLEX WITH VITAMIN C TABLET
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
NDC 40985022668
|
| Hospital Charge Code |
807
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.36 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Aetna American Axle |
$148.20
|
| Rate for Payer: Aetna Commercial |
$193.80
|
| Rate for Payer: Aetna Medicare |
$114.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.20
|
| Rate for Payer: BCBS Complete |
$91.20
|
| 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: MI Amish Medical Board Commercial |
$182.40
|
| 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: UHC All Payor (Choice/PPO) |
$148.20
|
| Rate for Payer: UHC Core |
$118.79
|
| Rate for Payer: UHC Exchange |
$89.60
|
| Rate for Payer: UMR Bronson Commercial |
$84.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.00
|
|
|
B-COMPLEX WITH VITAMIN C TABLET
|
Facility
|
IP
|
$196.56
|
|
|
Service Code
|
NDC 80681012600
|
| Hospital Charge Code |
807
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.49 |
| Max. Negotiated Rate |
$176.90 |
| Rate for Payer: Aetna American Axle |
$127.76
|
| Rate for Payer: Aetna Commercial |
$167.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.76
|
| Rate for Payer: Cash Price |
$157.25
|
| Rate for Payer: Cofinity Advantage |
$137.59
|
| Rate for Payer: Cofinity Commercial |
$169.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.25
|
| Rate for Payer: Healthscope Commercial |
$176.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.42
|
| Rate for Payer: PHP Commercial |
$167.08
|
| Rate for Payer: Priority Health SBD |
$123.83
|
| Rate for Payer: UMR Bronson Commercial |
$86.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.42
|
|
|
B-COMPLEX WITH VITAMIN C TABLET
|
Facility
|
OP
|
$196.56
|
|
|
Service Code
|
NDC 80681012600
|
| Hospital Charge Code |
807
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.73 |
| Max. Negotiated Rate |
$176.90 |
| Rate for Payer: Aetna American Axle |
$127.76
|
| Rate for Payer: Aetna Commercial |
$167.08
|
| Rate for Payer: Aetna Medicare |
$98.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.76
|
| Rate for Payer: BCBS Complete |
$78.62
|
| Rate for Payer: Cash Price |
$157.25
|
| Rate for Payer: Cofinity Advantage |
$137.59
|
| Rate for Payer: Cofinity Commercial |
$169.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.25
|
| Rate for Payer: Healthscope Commercial |
$176.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$157.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.42
|
| Rate for Payer: PHP Commercial |
$167.08
|
| Rate for Payer: Priority Health SBD |
$123.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.76
|
| Rate for Payer: UHC Core |
$102.41
|
| Rate for Payer: UHC Exchange |
$77.25
|
| Rate for Payer: UMR Bronson Commercial |
$72.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.42
|
|
|
B-COMPLEX WITH VITAMIN C TABLET
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
NDC 80681015400
|
| Hospital Charge Code |
807
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.76 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna American Axle |
$96.20
|
| Rate for Payer: Aetna Commercial |
$125.80
|
| Rate for Payer: Aetna Medicare |
$74.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.20
|
| Rate for Payer: BCBS Complete |
$59.20
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$118.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.00
|
| Rate for Payer: PHP Commercial |
$125.80
|
| Rate for Payer: Priority Health SBD |
$93.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.20
|
| Rate for Payer: UHC Core |
$77.11
|
| Rate for Payer: UHC Exchange |
$58.16
|
| Rate for Payer: UMR Bronson Commercial |
$54.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.00
|
|
|
BEHAVIORAL AND DEVELOPMENTAL DISORDERS
|
Facility
|
IP
|
$33,827.39
|
|
|
Service Code
|
MSDRG 886
|
| Min. Negotiated Rate |
$1,069.00 |
| Max. Negotiated Rate |
$33,827.39 |
| Rate for Payer: Aetna Medicare |
$18,665.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,435.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,435.09
|
| Rate for Payer: BCBS MAPPO |
$17,948.07
|
| Rate for Payer: BCBS Trust/PPO |
$23,541.98
|
| Rate for Payer: BCN Commercial |
$23,541.98
|
| Rate for Payer: BCN Medicare Advantage |
$17,948.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,948.07
|
| Rate for Payer: Mclaren Medicare |
$17,948.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,845.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,640.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$19,742.88
|
| Rate for Payer: Nomi Health Commercial |
$1,069.00
|
| Rate for Payer: PACE Medicare |
$17,050.67
|
| Rate for Payer: PACE SWMI |
$17,948.07
|
| Rate for Payer: PHP Medicare Advantage |
$17,948.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$33,458.28
|
| Rate for Payer: Priority Health Medicare |
$17,948.07
|
| Rate for Payer: Priority Health Tiered Network |
$26,766.62
|
| Rate for Payer: Railroad Medicare Medicare |
$17,948.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33,827.39
|
| Rate for Payer: UHC Core |
$28,300.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17,948.07
|
| Rate for Payer: UHC Exchange |
$23,112.62
|
| Rate for Payer: VA VA |
$17,948.07
|
|
|
BELANTAMAB MAFODOTIN-BLMF 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$39,630.86
|
|
|
Service Code
|
HCPCS J9037
|
| Hospital Charge Code |
194707
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14,663.42 |
| Max. Negotiated Rate |
$35,667.77 |
| Rate for Payer: Aetna American Axle |
$25,760.06
|
| Rate for Payer: Aetna Commercial |
$33,686.23
|
| Rate for Payer: Aetna Medicare |
$19,815.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25,760.06
|
| Rate for Payer: BCBS Complete |
$15,852.34
|
| Rate for Payer: Cash Price |
$31,704.69
|
| Rate for Payer: Cofinity Advantage |
$27,741.60
|
| Rate for Payer: Cofinity Commercial |
$34,082.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31,704.69
|
| Rate for Payer: Healthscope Commercial |
$35,667.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27,741.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29,723.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31,704.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33,686.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29,723.15
|
| Rate for Payer: PHP Commercial |
$33,686.23
|
| Rate for Payer: Priority Health SBD |
$24,967.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,815.43
|
| Rate for Payer: UHC Core |
$19,815.43
|
| Rate for Payer: UHC Exchange |
$19,815.43
|
| Rate for Payer: UMR Bronson Commercial |
$14,663.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29,723.15
|
|
|
BELANTAMAB MAFODOTIN-BLMF 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$39,630.86
|
|
|
Service Code
|
HCPCS J9037
|
| Hospital Charge Code |
194707
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17,437.58 |
| Max. Negotiated Rate |
$35,667.77 |
| Rate for Payer: Aetna American Axle |
$25,760.06
|
| Rate for Payer: Aetna Commercial |
$33,686.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25,760.06
|
| Rate for Payer: Cash Price |
$31,704.69
|
| Rate for Payer: Cofinity Advantage |
$27,741.60
|
| Rate for Payer: Cofinity Commercial |
$34,082.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31,704.69
|
| Rate for Payer: Healthscope Commercial |
$35,667.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27,741.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29,723.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33,686.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29,723.15
|
| Rate for Payer: PHP Commercial |
$33,686.23
|
| Rate for Payer: Priority Health SBD |
$24,967.44
|
| Rate for Payer: UMR Bronson Commercial |
$17,437.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29,723.15
|
|
|
BELATACEPT 250 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,948.45
|
|
|
Service Code
|
HCPCS J0485
|
| Hospital Charge Code |
152968
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,297.32 |
| Max. Negotiated Rate |
$2,653.61 |
| Rate for Payer: Aetna American Axle |
$1,916.49
|
| Rate for Payer: Aetna Commercial |
$2,506.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,916.49
|
| Rate for Payer: Cash Price |
$2,358.76
|
| Rate for Payer: Cofinity Advantage |
$2,063.91
|
| Rate for Payer: Cofinity Commercial |
$2,535.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,358.76
|
| Rate for Payer: Healthscope Commercial |
$2,653.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,063.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,211.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,506.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,211.34
|
| Rate for Payer: PHP Commercial |
$2,506.18
|
| Rate for Payer: Priority Health SBD |
$1,857.52
|
| Rate for Payer: UMR Bronson Commercial |
$1,297.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,211.34
|
|
|
BELATACEPT 250 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,948.45
|
|
|
Service Code
|
HCPCS J0485
|
| Hospital Charge Code |
152968
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$2,653.61 |
| Rate for Payer: Aetna American Axle |
$1,916.49
|
| Rate for Payer: Aetna Commercial |
$2,506.18
|
| Rate for Payer: Aetna Medicare |
$4.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,916.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.86
|
| Rate for Payer: BCBS Complete |
$2.14
|
| Rate for Payer: BCBS MAPPO |
$3.89
|
| Rate for Payer: BCBS Trust/PPO |
$12.60
|
| Rate for Payer: BCN Commercial |
$12.60
|
| Rate for Payer: BCN Medicare Advantage |
$3.89
|
| Rate for Payer: Cash Price |
$2,358.76
|
| Rate for Payer: Cash Price |
$2,358.76
|
| Rate for Payer: Cofinity Advantage |
$2,063.91
|
| Rate for Payer: Cofinity Commercial |
$2,535.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,358.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.89
|
| Rate for Payer: Healthscope Commercial |
$2,653.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,063.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,211.34
|
| Rate for Payer: Mclaren Medicaid |
$3.89
|
| Rate for Payer: Mclaren Medicare |
$3.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.08
|
| Rate for Payer: Meridian Medicaid |
$4.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,506.18
|
| Rate for Payer: Nomi Health Commercial |
$11.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,211.34
|
| Rate for Payer: PACE Medicare |
$3.70
|
| Rate for Payer: PACE SWMI |
$3.89
|
| Rate for Payer: PHP Commercial |
$2,506.18
|
| Rate for Payer: PHP Medicare Advantage |
$3.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.25
|
| Rate for Payer: Priority Health Medicare |
$3.89
|
| Rate for Payer: Priority Health SBD |
$1,857.52
|
| Rate for Payer: Priority Health Tiered Network |
$9.80
|
| Rate for Payer: Railroad Medicare Medicare |
$3.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.42
|
| Rate for Payer: UHC Core |
$6.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.89
|
| Rate for Payer: UHC Exchange |
$6.42
|
| Rate for Payer: UHC Medicaid |
$2.03
|
| Rate for Payer: UHCCP Medicaid |
$2.03
|
| Rate for Payer: UMR Bronson Commercial |
$1,090.93
|
| Rate for Payer: VA VA |
$3.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,211.34
|
|
|
BELIMUMAB 120 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,113.28
|
|
|
Service Code
|
HCPCS J0490
|
| Hospital Charge Code |
152250
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.91 |
| Max. Negotiated Rate |
$1,901.95 |
| Rate for Payer: Aetna American Axle |
$1,373.63
|
| Rate for Payer: Aetna Commercial |
$1,796.29
|
| Rate for Payer: Aetna Medicare |
$59.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,373.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71.49
|
| Rate for Payer: BCBS Complete |
$31.41
|
| Rate for Payer: BCBS MAPPO |
$57.19
|
| Rate for Payer: BCBS Trust/PPO |
$185.32
|
| Rate for Payer: BCN Commercial |
$185.32
|
| Rate for Payer: BCN Medicare Advantage |
$57.19
|
| Rate for Payer: Cash Price |
$1,690.62
|
| Rate for Payer: Cash Price |
$1,690.62
|
| Rate for Payer: Cofinity Advantage |
$1,479.30
|
| Rate for Payer: Cofinity Commercial |
$1,817.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,690.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.19
|
| Rate for Payer: Healthscope Commercial |
$1,901.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,479.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,584.96
|
| Rate for Payer: Mclaren Medicaid |
$57.19
|
| Rate for Payer: Mclaren Medicare |
$57.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.05
|
| Rate for Payer: Meridian Medicaid |
$60.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$62.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,796.29
|
| Rate for Payer: Nomi Health Commercial |
$171.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,584.96
|
| Rate for Payer: PACE Medicare |
$54.33
|
| Rate for Payer: PACE SWMI |
$57.19
|
| Rate for Payer: PHP Commercial |
$1,796.29
|
| Rate for Payer: PHP Medicare Advantage |
$57.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$176.83
|
| Rate for Payer: Priority Health Medicare |
$57.19
|
| Rate for Payer: Priority Health SBD |
$1,331.37
|
| Rate for Payer: Priority Health Tiered Network |
$141.46
|
| Rate for Payer: Railroad Medicare Medicare |
$57.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.31
|
| Rate for Payer: UHC Core |
$94.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$57.19
|
| Rate for Payer: UHC Exchange |
$94.31
|
| Rate for Payer: UHC Medicaid |
$29.91
|
| Rate for Payer: UHCCP Medicaid |
$29.91
|
| Rate for Payer: UMR Bronson Commercial |
$781.91
|
| Rate for Payer: VA VA |
$57.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,584.96
|
|
|
BELIMUMAB 400 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$5,723.05
|
|
|
Service Code
|
HCPCS J0490
|
| Hospital Charge Code |
152251
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,518.14 |
| Max. Negotiated Rate |
$5,150.74 |
| Rate for Payer: Aetna American Axle |
$3,719.98
|
| Rate for Payer: Aetna Commercial |
$4,864.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,719.98
|
| Rate for Payer: Cash Price |
$4,578.44
|
| Rate for Payer: Cofinity Advantage |
$4,006.14
|
| Rate for Payer: Cofinity Commercial |
$4,921.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,578.44
|
| Rate for Payer: Healthscope Commercial |
$5,150.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,006.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,292.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,864.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,292.29
|
| Rate for Payer: PHP Commercial |
$4,864.59
|
| Rate for Payer: Priority Health SBD |
$3,605.52
|
| Rate for Payer: UMR Bronson Commercial |
$2,518.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,292.29
|
|
|
BELIMUMAB 400 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$5,723.05
|
|
|
Service Code
|
HCPCS J0490
|
| Hospital Charge Code |
152251
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.91 |
| Max. Negotiated Rate |
$5,150.74 |
| Rate for Payer: Aetna American Axle |
$3,719.98
|
| Rate for Payer: Aetna Commercial |
$4,864.59
|
| Rate for Payer: Aetna Medicare |
$59.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,719.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71.49
|
| Rate for Payer: BCBS Complete |
$31.41
|
| Rate for Payer: BCBS MAPPO |
$57.19
|
| Rate for Payer: BCBS Trust/PPO |
$185.32
|
| Rate for Payer: BCN Commercial |
$185.32
|
| Rate for Payer: BCN Medicare Advantage |
$57.19
|
| Rate for Payer: Cash Price |
$4,578.44
|
| Rate for Payer: Cash Price |
$4,578.44
|
| Rate for Payer: Cofinity Advantage |
$4,006.14
|
| Rate for Payer: Cofinity Commercial |
$4,921.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,578.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.19
|
| Rate for Payer: Healthscope Commercial |
$5,150.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,006.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,292.29
|
| Rate for Payer: Mclaren Medicaid |
$57.19
|
| Rate for Payer: Mclaren Medicare |
$57.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.05
|
| Rate for Payer: Meridian Medicaid |
$60.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$62.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,864.59
|
| Rate for Payer: Nomi Health Commercial |
$171.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,292.29
|
| Rate for Payer: PACE Medicare |
$54.33
|
| Rate for Payer: PACE SWMI |
$57.19
|
| Rate for Payer: PHP Commercial |
$4,864.59
|
| Rate for Payer: PHP Medicare Advantage |
$57.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$176.83
|
| Rate for Payer: Priority Health Medicare |
$57.19
|
| Rate for Payer: Priority Health SBD |
$3,605.52
|
| Rate for Payer: Priority Health Tiered Network |
$141.46
|
| Rate for Payer: Railroad Medicare Medicare |
$57.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.31
|
| Rate for Payer: UHC Core |
$94.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$57.19
|
| Rate for Payer: UHC Exchange |
$94.31
|
| Rate for Payer: UHC Medicaid |
$29.91
|
| Rate for Payer: UHCCP Medicaid |
$29.91
|
| Rate for Payer: UMR Bronson Commercial |
$2,117.53
|
| Rate for Payer: VA VA |
$57.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,292.29
|
|
|
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 |
$6,282.57
|
| Rate for Payer: Aetna Commercial |
$8,215.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,282.57
|
| Rate for Payer: Cash Price |
$7,732.40
|
| Rate for Payer: Cofinity Advantage |
$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 Commercial |
$8,215.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,249.12
|
| Rate for Payer: PHP Commercial |
$8,215.67
|
| Rate for Payer: Priority Health SBD |
$6,089.27
|
| Rate for Payer: UMR Bronson Commercial |
$4,252.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,249.12
|
|
|
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 |
$7.29 |
| Max. Negotiated Rate |
$8,698.95 |
| Rate for Payer: Aetna American Axle |
$6,282.57
|
| Rate for Payer: Aetna Commercial |
$8,215.67
|
| Rate for Payer: Aetna Medicare |
$14.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,282.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.43
|
| Rate for Payer: BCBS Complete |
$7.66
|
| Rate for Payer: BCBS MAPPO |
$13.94
|
| Rate for Payer: BCBS Trust/PPO |
$44.24
|
| Rate for Payer: BCN Commercial |
$44.24
|
| Rate for Payer: BCN Medicare Advantage |
$13.94
|
| Rate for Payer: Cash Price |
$7,732.40
|
| Rate for Payer: Cash Price |
$7,732.40
|
| Rate for Payer: Cofinity Advantage |
$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 |
$13.94
|
| 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 |
$13.94
|
| Rate for Payer: Mclaren Medicare |
$13.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.64
|
| Rate for Payer: Meridian Medicaid |
$14.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,215.67
|
| Rate for Payer: Nomi Health Commercial |
$41.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,249.12
|
| Rate for Payer: PACE Medicare |
$13.24
|
| Rate for Payer: PACE SWMI |
$13.94
|
| Rate for Payer: PHP Commercial |
$8,215.67
|
| Rate for Payer: PHP Medicare Advantage |
$13.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$38.75
|
| Rate for Payer: Priority Health Medicare |
$13.94
|
| Rate for Payer: Priority Health SBD |
$6,089.27
|
| Rate for Payer: Priority Health Tiered Network |
$31.00
|
| Rate for Payer: Railroad Medicare Medicare |
$13.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.52
|
| Rate for Payer: UHC Core |
$22.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.94
|
| Rate for Payer: UHC Exchange |
$22.52
|
| Rate for Payer: UHC Medicaid |
$7.29
|
| Rate for Payer: UHCCP Medicaid |
$7.29
|
| Rate for Payer: UMR Bronson Commercial |
$3,576.24
|
| Rate for Payer: VA VA |
$13.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,249.12
|
|
|
BENDAMUSTINE (BENDEKA) 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3,105.40
|
|
|
Service Code
|
HCPCS J9036
|
| Hospital Charge Code |
176654
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,366.38 |
| Max. Negotiated Rate |
$2,794.86 |
| Rate for Payer: Aetna American Axle |
$2,018.51
|
| Rate for Payer: Aetna Commercial |
$2,639.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,018.51
|
| Rate for Payer: Cash Price |
$2,484.32
|
| Rate for Payer: Cofinity Advantage |
$2,173.78
|
| Rate for Payer: Cofinity Commercial |
$2,670.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,484.32
|
| Rate for Payer: Healthscope Commercial |
$2,794.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,173.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,329.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,639.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,329.05
|
| Rate for Payer: PHP Commercial |
$2,639.59
|
| Rate for Payer: Priority Health SBD |
$1,956.40
|
| Rate for Payer: UMR Bronson Commercial |
$1,366.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,329.05
|
|
|
BENDAMUSTINE (BENDEKA) 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,105.40
|
|
|
Service Code
|
HCPCS J9036
|
| Hospital Charge Code |
176654
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.29 |
| Max. Negotiated Rate |
$2,794.86 |
| Rate for Payer: Aetna American Axle |
$2,018.51
|
| Rate for Payer: Aetna Commercial |
$2,639.59
|
| Rate for Payer: Aetna Medicare |
$14.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,018.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.43
|
| Rate for Payer: BCBS Complete |
$7.66
|
| Rate for Payer: BCBS MAPPO |
$13.94
|
| Rate for Payer: BCBS Trust/PPO |
$44.24
|
| Rate for Payer: BCN Commercial |
$44.24
|
| Rate for Payer: BCN Medicare Advantage |
$13.94
|
| Rate for Payer: Cash Price |
$2,484.32
|
| Rate for Payer: Cash Price |
$2,484.32
|
| Rate for Payer: Cofinity Advantage |
$2,173.78
|
| Rate for Payer: Cofinity Commercial |
$2,670.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,484.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.94
|
| Rate for Payer: Healthscope Commercial |
$2,794.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,173.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,329.05
|
| Rate for Payer: Mclaren Medicaid |
$13.94
|
| Rate for Payer: Mclaren Medicare |
$13.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.64
|
| Rate for Payer: Meridian Medicaid |
$14.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,639.59
|
| Rate for Payer: Nomi Health Commercial |
$41.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,329.05
|
| Rate for Payer: PACE Medicare |
$13.24
|
| Rate for Payer: PACE SWMI |
$13.94
|
| Rate for Payer: PHP Commercial |
$2,639.59
|
| Rate for Payer: PHP Medicare Advantage |
$13.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$38.75
|
| Rate for Payer: Priority Health Medicare |
$13.94
|
| Rate for Payer: Priority Health SBD |
$1,956.40
|
| Rate for Payer: Priority Health Tiered Network |
$31.00
|
| Rate for Payer: Railroad Medicare Medicare |
$13.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.52
|
| Rate for Payer: UHC Core |
$22.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.94
|
| Rate for Payer: UHC Exchange |
$22.52
|
| Rate for Payer: UHC Medicaid |
$7.29
|
| Rate for Payer: UHCCP Medicaid |
$7.29
|
| Rate for Payer: UMR Bronson Commercial |
$1,149.00
|
| Rate for Payer: VA VA |
$13.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,329.05
|
|
|
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 |
$6.75 |
| 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 |
$13.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,194.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.12
|
| Rate for Payer: BCBS Complete |
$7.08
|
| Rate for Payer: BCBS MAPPO |
$12.90
|
| Rate for Payer: BCBS Trust/PPO |
$41.60
|
| Rate for Payer: BCN Commercial |
$41.60
|
| Rate for Payer: BCN Medicare Advantage |
$12.90
|
| Rate for Payer: Cash Price |
$7,624.10
|
| Rate for Payer: Cash Price |
$7,624.10
|
| Rate for Payer: Cofinity Advantage |
$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 |
$12.90
|
| 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 |
$12.90
|
| Rate for Payer: Mclaren Medicare |
$12.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.54
|
| Rate for Payer: Meridian Medicaid |
$13.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,100.60
|
| Rate for Payer: Nomi Health Commercial |
$38.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,147.59
|
| Rate for Payer: PACE Medicare |
$12.26
|
| Rate for Payer: PACE SWMI |
$12.90
|
| Rate for Payer: PHP Commercial |
$8,100.60
|
| Rate for Payer: PHP Medicare Advantage |
$12.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$42.53
|
| Rate for Payer: Priority Health Medicare |
$12.90
|
| Rate for Payer: Priority Health SBD |
$6,003.98
|
| Rate for Payer: Priority Health Tiered Network |
$34.02
|
| Rate for Payer: Railroad Medicare Medicare |
$12.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.17
|
| Rate for Payer: UHC Core |
$21.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.90
|
| Rate for Payer: UHC Exchange |
$21.17
|
| Rate for Payer: UHC Medicaid |
$6.75
|
| Rate for Payer: UHCCP Medicaid |
$6.75
|
| Rate for Payer: UMR Bronson Commercial |
$3,526.14
|
| Rate for Payer: VA VA |
$12.90
|
| 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 Advantage |
$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 Commercial |
$8,100.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,147.59
|
| Rate for Payer: PHP Commercial |
$8,100.60
|
| 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 |
$1.13 |
| 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 |
$2.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,807.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.70
|
| Rate for Payer: BCBS Complete |
$1.19
|
| Rate for Payer: BCBS MAPPO |
$2.16
|
| Rate for Payer: BCBS Trust/PPO |
$6.49
|
| Rate for Payer: BCN Commercial |
$6.49
|
| Rate for Payer: BCN Medicare Advantage |
$2.16
|
| Rate for Payer: Cash Price |
$8,378.31
|
| Rate for Payer: Cash Price |
$8,378.31
|
| Rate for Payer: Cofinity Advantage |
$7,331.02
|
| Rate for Payer: Cofinity Commercial |
$9,006.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,378.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.16
|
| 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 |
$2.16
|
| Rate for Payer: Mclaren Medicare |
$2.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.27
|
| Rate for Payer: Meridian Medicaid |
$2.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,901.96
|
| Rate for Payer: Nomi Health Commercial |
$6.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,854.67
|
| Rate for Payer: PACE Medicare |
$2.05
|
| Rate for Payer: PACE SWMI |
$2.16
|
| Rate for Payer: PHP Commercial |
$8,901.96
|
| Rate for Payer: PHP Medicare Advantage |
$2.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.94
|
| Rate for Payer: Priority Health Medicare |
$2.16
|
| Rate for Payer: Priority Health SBD |
$6,597.92
|
| Rate for Payer: Priority Health Tiered Network |
$4.75
|
| Rate for Payer: Railroad Medicare Medicare |
$2.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.38
|
| Rate for Payer: UHC Core |
$3.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2.16
|
| Rate for Payer: UHC Exchange |
$3.38
|
| Rate for Payer: UHC Medicaid |
$1.13
|
| Rate for Payer: UHCCP Medicaid |
$1.13
|
| Rate for Payer: UMR Bronson Commercial |
$3,874.97
|
| Rate for Payer: VA VA |
$2.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,854.67
|
|
|
BENIGN PROSTATIC HYPERTROPHY WITH MCC
|
Facility
|
IP
|
$24,963.94
|
|
|
Service Code
|
MSDRG 725
|
| Min. Negotiated Rate |
$9,860.05 |
| Max. Negotiated Rate |
$24,963.94 |
| Rate for Payer: Aetna Medicare |
$10,794.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,973.75
|
| Rate for Payer: BCBS MAPPO |
$10,379.00
|
| Rate for Payer: BCBS Trust/PPO |
$24,963.94
|
| Rate for Payer: BCN Commercial |
$24,963.94
|
| Rate for Payer: BCN Medicare Advantage |
$10,379.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,379.00
|
| Rate for Payer: Mclaren Medicare |
$10,379.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,897.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,935.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,416.90
|
| Rate for Payer: Nomi Health Commercial |
$15,095.58
|
| Rate for Payer: PACE Medicare |
$9,860.05
|
| Rate for Payer: PACE SWMI |
$10,379.00
|
| Rate for Payer: PHP Medicare Advantage |
$10,379.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18,866.13
|
| Rate for Payer: Priority Health Medicare |
$10,379.00
|
| Rate for Payer: Priority Health Tiered Network |
$15,092.90
|
| Rate for Payer: Railroad Medicare Medicare |
$10,379.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,074.26
|
| Rate for Payer: UHC Core |
$15,958.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,379.00
|
| Rate for Payer: UHC Exchange |
$13,032.52
|
| Rate for Payer: VA VA |
$10,379.00
|
|
|
BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC
|
Facility
|
IP
|
$14,702.76
|
|
|
Service Code
|
MSDRG 726
|
| Min. Negotiated Rate |
$6,299.30 |
| Max. Negotiated Rate |
$14,702.76 |
| Rate for Payer: Aetna Medicare |
$6,896.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,288.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,288.55
|
| Rate for Payer: BCBS MAPPO |
$6,630.84
|
| Rate for Payer: BCBS Trust/PPO |
$14,702.76
|
| Rate for Payer: BCN Commercial |
$14,702.76
|
| Rate for Payer: BCN Medicare Advantage |
$6,630.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,630.84
|
| Rate for Payer: Mclaren Medicare |
$6,630.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,962.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,625.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,293.92
|
| Rate for Payer: Nomi Health Commercial |
$9,313.80
|
| Rate for Payer: PACE Medicare |
$6,299.30
|
| Rate for Payer: PACE SWMI |
$6,630.84
|
| Rate for Payer: PHP Medicare Advantage |
$6,630.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,640.19
|
| Rate for Payer: Priority Health Medicare |
$6,630.84
|
| Rate for Payer: Priority Health Tiered Network |
$9,312.15
|
| Rate for Payer: Railroad Medicare Medicare |
$6,630.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,768.60
|
| Rate for Payer: UHC Core |
$9,845.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,630.84
|
| Rate for Payer: UHC Exchange |
$8,040.91
|
| Rate for Payer: VA VA |
$6,630.84
|
|
|
BENRALIZUMAB 30 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$19,720.60
|
|
|
Service Code
|
HCPCS J0517
|
| Hospital Charge Code |
185161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$85.44 |
| Max. Negotiated Rate |
$17,748.54 |
| Rate for Payer: Aetna American Axle |
$12,818.39
|
| Rate for Payer: Aetna Commercial |
$16,762.51
|
| Rate for Payer: Aetna Medicare |
$169.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,818.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.20
|
| Rate for Payer: BCBS Complete |
$89.72
|
| Rate for Payer: BCBS MAPPO |
$163.36
|
| Rate for Payer: BCBS Trust/PPO |
$531.65
|
| Rate for Payer: BCN Commercial |
$531.65
|
| Rate for Payer: BCN Medicare Advantage |
$163.36
|
| Rate for Payer: Cash Price |
$15,776.48
|
| Rate for Payer: Cash Price |
$15,776.48
|
| Rate for Payer: Cofinity Advantage |
$13,804.42
|
| Rate for Payer: Cofinity Commercial |
$16,959.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,776.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.36
|
| Rate for Payer: Healthscope Commercial |
$17,748.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13,804.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,790.45
|
| Rate for Payer: Mclaren Medicaid |
$163.36
|
| Rate for Payer: Mclaren Medicare |
$163.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$171.53
|
| Rate for Payer: Meridian Medicaid |
$171.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$179.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,762.51
|
| Rate for Payer: Nomi Health Commercial |
$490.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,790.45
|
| Rate for Payer: PACE Medicare |
$155.19
|
| Rate for Payer: PACE SWMI |
$163.36
|
| Rate for Payer: PHP Commercial |
$16,762.51
|
| Rate for Payer: PHP Medicare Advantage |
$163.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$85.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$519.09
|
| Rate for Payer: Priority Health Medicare |
$163.36
|
| Rate for Payer: Priority Health SBD |
$12,423.98
|
| Rate for Payer: Priority Health Tiered Network |
$415.27
|
| Rate for Payer: Railroad Medicare Medicare |
$163.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$270.55
|
| Rate for Payer: UHC Core |
$270.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$163.36
|
| Rate for Payer: UHC Exchange |
$270.55
|
| Rate for Payer: UHC Medicaid |
$85.44
|
| Rate for Payer: UHCCP Medicaid |
$85.44
|
| Rate for Payer: UMR Bronson Commercial |
$7,296.62
|
| Rate for Payer: VA VA |
$163.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,790.45
|
|
|
BENRALIZUMAB 30 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$19,720.60
|
|
|
Service Code
|
HCPCS J0517
|
| Hospital Charge Code |
185161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8,677.06 |
| Max. Negotiated Rate |
$17,748.54 |
| Rate for Payer: Aetna American Axle |
$12,818.39
|
| Rate for Payer: Aetna Commercial |
$16,762.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,818.39
|
| Rate for Payer: Cash Price |
$15,776.48
|
| Rate for Payer: Cofinity Advantage |
$13,804.42
|
| Rate for Payer: Cofinity Commercial |
$16,959.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,776.48
|
| Rate for Payer: Healthscope Commercial |
$17,748.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13,804.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,790.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,762.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,790.45
|
| Rate for Payer: PHP Commercial |
$16,762.51
|
| Rate for Payer: Priority Health SBD |
$12,423.98
|
| Rate for Payer: UMR Bronson Commercial |
$8,677.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,790.45
|
|
|
BENZOCAINE 20 % MUCOSAL AEROSOL SPRAY
|
Facility
|
IP
|
$104.06
|
|
|
Service Code
|
NDC 00283067902
|
| Hospital Charge Code |
19696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.79 |
| Max. Negotiated Rate |
$93.65 |
| Rate for Payer: Aetna American Axle |
$67.64
|
| Rate for Payer: Aetna Commercial |
$88.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.64
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cofinity Advantage |
$72.84
|
| Rate for Payer: Cofinity Commercial |
$89.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.25
|
| Rate for Payer: Healthscope Commercial |
$93.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.05
|
| Rate for Payer: PHP Commercial |
$88.45
|
| Rate for Payer: Priority Health SBD |
$65.56
|
| Rate for Payer: UMR Bronson Commercial |
$45.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.05
|
|
