|
BENZTROPINE 1 MG TABLET
|
Facility
|
OP
|
$350.15
|
|
|
Service Code
|
NDC 00603243421
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.56 |
| Max. Negotiated Rate |
$315.13 |
| Rate for Payer: Aetna American Axle |
$227.60
|
| Rate for Payer: Aetna Commercial |
$297.63
|
| Rate for Payer: Aetna Medicare |
$175.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.60
|
| Rate for Payer: BCBS Complete |
$140.06
|
| Rate for Payer: Cash Price |
$280.12
|
| Rate for Payer: Cofinity Advantage |
$245.10
|
| Rate for Payer: Cofinity Commercial |
$301.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.12
|
| Rate for Payer: Healthscope Commercial |
$315.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$245.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$280.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$297.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$262.61
|
| Rate for Payer: PHP Commercial |
$297.63
|
| Rate for Payer: Priority Health SBD |
$220.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.60
|
| Rate for Payer: UHC Core |
$182.43
|
| Rate for Payer: UHC Exchange |
$137.61
|
| Rate for Payer: UMR Bronson Commercial |
$129.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.61
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
|
IP
|
$331.35
|
|
|
Service Code
|
NDC 69097082707
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.79 |
| Max. Negotiated Rate |
$298.21 |
| Rate for Payer: Aetna American Axle |
$215.38
|
| Rate for Payer: Aetna Commercial |
$281.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.38
|
| Rate for Payer: Cash Price |
$265.08
|
| Rate for Payer: Cofinity Advantage |
$231.94
|
| Rate for Payer: Cofinity Commercial |
$284.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.08
|
| Rate for Payer: Healthscope Commercial |
$298.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$231.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$281.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$248.51
|
| Rate for Payer: PHP Commercial |
$281.65
|
| Rate for Payer: Priority Health SBD |
$208.75
|
| Rate for Payer: UMR Bronson Commercial |
$145.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.51
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
|
IP
|
$350.15
|
|
|
Service Code
|
NDC 00603243421
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.07 |
| Max. Negotiated Rate |
$315.13 |
| Rate for Payer: Aetna American Axle |
$227.60
|
| Rate for Payer: Aetna Commercial |
$297.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.60
|
| Rate for Payer: Cash Price |
$280.12
|
| Rate for Payer: Cofinity Advantage |
$245.10
|
| Rate for Payer: Cofinity Commercial |
$301.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.12
|
| Rate for Payer: Healthscope Commercial |
$315.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$245.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$297.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$262.61
|
| Rate for Payer: PHP Commercial |
$297.63
|
| Rate for Payer: Priority Health SBD |
$220.59
|
| Rate for Payer: UMR Bronson Commercial |
$154.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.61
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
|
IP
|
$199.75
|
|
|
Service Code
|
NDC 69315013701
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.89 |
| Max. Negotiated Rate |
$179.78 |
| Rate for Payer: Aetna American Axle |
$129.84
|
| Rate for Payer: Aetna Commercial |
$169.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.84
|
| Rate for Payer: Cash Price |
$159.80
|
| Rate for Payer: Cofinity Advantage |
$139.82
|
| Rate for Payer: Cofinity Commercial |
$171.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.80
|
| Rate for Payer: Healthscope Commercial |
$179.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.81
|
| Rate for Payer: PHP Commercial |
$169.79
|
| Rate for Payer: Priority Health SBD |
$125.84
|
| Rate for Payer: UMR Bronson Commercial |
$87.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.81
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
|
OP
|
$331.35
|
|
|
Service Code
|
NDC 69097082707
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.60 |
| Max. Negotiated Rate |
$298.21 |
| Rate for Payer: Aetna American Axle |
$215.38
|
| Rate for Payer: Aetna Commercial |
$281.65
|
| Rate for Payer: Aetna Medicare |
$165.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.38
|
| Rate for Payer: BCBS Complete |
$132.54
|
| Rate for Payer: Cash Price |
$265.08
|
| Rate for Payer: Cofinity Advantage |
$231.94
|
| Rate for Payer: Cofinity Commercial |
$284.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.08
|
| Rate for Payer: Healthscope Commercial |
$298.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$231.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$265.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$281.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$248.51
|
| Rate for Payer: PHP Commercial |
$281.65
|
| Rate for Payer: Priority Health SBD |
$208.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.38
|
| Rate for Payer: UHC Core |
$172.63
|
| Rate for Payer: UHC Exchange |
$130.22
|
| Rate for Payer: UMR Bronson Commercial |
$122.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.51
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
|
OP
|
$199.75
|
|
|
Service Code
|
NDC 69315013701
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.91 |
| Max. Negotiated Rate |
$179.78 |
| Rate for Payer: Aetna American Axle |
$129.84
|
| Rate for Payer: Aetna Commercial |
$169.79
|
| Rate for Payer: Aetna Medicare |
$99.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.84
|
| Rate for Payer: BCBS Complete |
$79.90
|
| Rate for Payer: Cash Price |
$159.80
|
| Rate for Payer: Cofinity Advantage |
$139.82
|
| Rate for Payer: Cofinity Commercial |
$171.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.80
|
| Rate for Payer: Healthscope Commercial |
$179.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.81
|
| Rate for Payer: PHP Commercial |
$169.79
|
| Rate for Payer: Priority Health SBD |
$125.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.84
|
| Rate for Payer: UHC Core |
$104.07
|
| Rate for Payer: UHC Exchange |
$78.50
|
| Rate for Payer: UMR Bronson Commercial |
$73.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.81
|
|
|
BESIFLOXACIN 0.6 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$748.76
|
|
|
Service Code
|
NDC 24208044605
|
| Hospital Charge Code |
97934
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$329.45 |
| Max. Negotiated Rate |
$673.88 |
| Rate for Payer: Aetna American Axle |
$486.69
|
| Rate for Payer: Aetna Commercial |
$636.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$486.69
|
| Rate for Payer: Cash Price |
$599.01
|
| Rate for Payer: Cofinity Advantage |
$524.13
|
| Rate for Payer: Cofinity Commercial |
$643.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$599.01
|
| Rate for Payer: Healthscope Commercial |
$673.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$524.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$561.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$636.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$561.57
|
| Rate for Payer: PHP Commercial |
$636.45
|
| Rate for Payer: Priority Health SBD |
$471.72
|
| Rate for Payer: UMR Bronson Commercial |
$329.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$561.57
|
|
|
BESIFLOXACIN 0.6 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$748.76
|
|
|
Service Code
|
NDC 24208044605
|
| Hospital Charge Code |
97934
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$277.04 |
| Max. Negotiated Rate |
$673.88 |
| Rate for Payer: Aetna American Axle |
$486.69
|
| Rate for Payer: Aetna Commercial |
$636.45
|
| Rate for Payer: Aetna Medicare |
$374.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$486.69
|
| Rate for Payer: BCBS Complete |
$299.50
|
| Rate for Payer: Cash Price |
$599.01
|
| Rate for Payer: Cofinity Advantage |
$524.13
|
| Rate for Payer: Cofinity Commercial |
$643.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$599.01
|
| Rate for Payer: Healthscope Commercial |
$673.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$524.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$561.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$599.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$636.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$561.57
|
| Rate for Payer: PHP Commercial |
$636.45
|
| Rate for Payer: Priority Health SBD |
$471.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$486.69
|
| Rate for Payer: UHC Core |
$390.10
|
| Rate for Payer: UHC Exchange |
$294.26
|
| Rate for Payer: UMR Bronson Commercial |
$277.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$561.57
|
|
|
BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
OP
|
$158.16
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
9266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$142.34 |
| Rate for Payer: Aetna American Axle |
$102.80
|
| Rate for Payer: Aetna American Axle |
$101.09
|
| Rate for Payer: Aetna American Axle |
$129.16
|
| Rate for Payer: Aetna Commercial |
$134.44
|
| Rate for Payer: Aetna Commercial |
$168.90
|
| Rate for Payer: Aetna Commercial |
$132.20
|
| Rate for Payer: Aetna Medicare |
$79.08
|
| Rate for Payer: Aetna Medicare |
$77.77
|
| Rate for Payer: Aetna Medicare |
$99.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.16
|
| Rate for Payer: BCBS Complete |
$62.21
|
| Rate for Payer: BCBS Complete |
$63.26
|
| Rate for Payer: BCBS Complete |
$79.48
|
| Rate for Payer: BCBS Trust/PPO |
$22.37
|
| Rate for Payer: BCBS Trust/PPO |
$22.37
|
| Rate for Payer: BCBS Trust/PPO |
$22.37
|
| Rate for Payer: BCN Commercial |
$22.37
|
| Rate for Payer: BCN Commercial |
$22.37
|
| Rate for Payer: BCN Commercial |
$22.37
|
| Rate for Payer: Cash Price |
$124.42
|
| Rate for Payer: Cash Price |
$124.42
|
| Rate for Payer: Cash Price |
$158.96
|
| Rate for Payer: Cash Price |
$158.96
|
| Rate for Payer: Cash Price |
$126.53
|
| Rate for Payer: Cash Price |
$126.53
|
| Rate for Payer: Cofinity Advantage |
$139.09
|
| Rate for Payer: Cofinity Advantage |
$110.71
|
| Rate for Payer: Cofinity Advantage |
$108.87
|
| Rate for Payer: Cofinity Commercial |
$133.76
|
| Rate for Payer: Cofinity Commercial |
$136.02
|
| Rate for Payer: Cofinity Commercial |
$170.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.53
|
| Rate for Payer: Healthscope Commercial |
$139.98
|
| Rate for Payer: Healthscope Commercial |
$142.34
|
| Rate for Payer: Healthscope Commercial |
$178.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$110.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$126.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$124.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$158.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$116.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.03
|
| Rate for Payer: PHP Commercial |
$134.44
|
| Rate for Payer: PHP Commercial |
$132.20
|
| Rate for Payer: PHP Commercial |
$168.90
|
| Rate for Payer: Priority Health SBD |
$97.98
|
| Rate for Payer: Priority Health SBD |
$125.18
|
| Rate for Payer: Priority Health SBD |
$99.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.40
|
| Rate for Payer: UHC Core |
$11.40
|
| Rate for Payer: UHC Core |
$11.40
|
| Rate for Payer: UHC Core |
$11.40
|
| Rate for Payer: UHC Exchange |
$11.40
|
| Rate for Payer: UHC Exchange |
$11.40
|
| Rate for Payer: UHC Exchange |
$11.40
|
| Rate for Payer: UMR Bronson Commercial |
$73.52
|
| Rate for Payer: UMR Bronson Commercial |
$57.55
|
| Rate for Payer: UMR Bronson Commercial |
$58.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.03
|
|
|
BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
IP
|
$155.53
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
9266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.43 |
| Max. Negotiated Rate |
$139.98 |
| Rate for Payer: Aetna American Axle |
$101.09
|
| Rate for Payer: Aetna American Axle |
$129.16
|
| Rate for Payer: Aetna American Axle |
$102.80
|
| Rate for Payer: Aetna Commercial |
$134.44
|
| Rate for Payer: Aetna Commercial |
$132.20
|
| Rate for Payer: Aetna Commercial |
$168.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.80
|
| Rate for Payer: Cash Price |
$126.53
|
| Rate for Payer: Cash Price |
$124.42
|
| Rate for Payer: Cash Price |
$158.96
|
| Rate for Payer: Cofinity Advantage |
$139.09
|
| Rate for Payer: Cofinity Advantage |
$108.87
|
| Rate for Payer: Cofinity Advantage |
$110.71
|
| Rate for Payer: Cofinity Commercial |
$170.88
|
| Rate for Payer: Cofinity Commercial |
$133.76
|
| Rate for Payer: Cofinity Commercial |
$136.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.96
|
| Rate for Payer: Healthscope Commercial |
$142.34
|
| Rate for Payer: Healthscope Commercial |
$178.83
|
| Rate for Payer: Healthscope Commercial |
$139.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$110.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$116.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.03
|
| Rate for Payer: PHP Commercial |
$134.44
|
| Rate for Payer: PHP Commercial |
$132.20
|
| Rate for Payer: PHP Commercial |
$168.90
|
| Rate for Payer: Priority Health SBD |
$97.98
|
| Rate for Payer: Priority Health SBD |
$99.64
|
| Rate for Payer: Priority Health SBD |
$125.18
|
| Rate for Payer: UMR Bronson Commercial |
$68.43
|
| Rate for Payer: UMR Bronson Commercial |
$87.43
|
| Rate for Payer: UMR Bronson Commercial |
$69.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.03
|
|
|
BETAXOLOL 0.25 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$1,451.03
|
|
|
Service Code
|
NDC 00078072910
|
| Hospital Charge Code |
19703
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$536.88 |
| Max. Negotiated Rate |
$1,305.93 |
| Rate for Payer: Aetna American Axle |
$943.17
|
| Rate for Payer: Aetna Commercial |
$1,233.38
|
| Rate for Payer: Aetna Medicare |
$725.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$943.17
|
| Rate for Payer: BCBS Complete |
$580.41
|
| Rate for Payer: Cash Price |
$1,160.82
|
| Rate for Payer: Cofinity Advantage |
$1,015.72
|
| Rate for Payer: Cofinity Commercial |
$1,247.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,160.82
|
| Rate for Payer: Healthscope Commercial |
$1,305.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,015.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,088.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,160.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,233.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,088.27
|
| Rate for Payer: PHP Commercial |
$1,233.38
|
| Rate for Payer: Priority Health SBD |
$914.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$943.17
|
| Rate for Payer: UHC Core |
$755.99
|
| Rate for Payer: UHC Exchange |
$570.25
|
| Rate for Payer: UMR Bronson Commercial |
$536.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,088.27
|
|
|
BETAXOLOL 0.25 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$1,451.03
|
|
|
Service Code
|
NDC 00078072910
|
| Hospital Charge Code |
19703
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$638.45 |
| Max. Negotiated Rate |
$1,305.93 |
| Rate for Payer: Aetna American Axle |
$943.17
|
| Rate for Payer: Aetna Commercial |
$1,233.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$943.17
|
| Rate for Payer: Cash Price |
$1,160.82
|
| Rate for Payer: Cofinity Advantage |
$1,015.72
|
| Rate for Payer: Cofinity Commercial |
$1,247.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,160.82
|
| Rate for Payer: Healthscope Commercial |
$1,305.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,015.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,088.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,233.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,088.27
|
| Rate for Payer: PHP Commercial |
$1,233.38
|
| Rate for Payer: Priority Health SBD |
$914.15
|
| Rate for Payer: UMR Bronson Commercial |
$638.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,088.27
|
|
|
BETAXOLOL 0.5 % EYE DROPS
|
Facility
|
IP
|
$173.67
|
|
|
Service Code
|
NDC 61314024501
|
| Hospital Charge Code |
9268
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.41 |
| Max. Negotiated Rate |
$156.30 |
| Rate for Payer: Aetna American Axle |
$112.89
|
| Rate for Payer: Aetna Commercial |
$147.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.89
|
| Rate for Payer: Cash Price |
$138.94
|
| Rate for Payer: Cofinity Advantage |
$121.57
|
| Rate for Payer: Cofinity Commercial |
$149.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.94
|
| Rate for Payer: Healthscope Commercial |
$156.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.25
|
| Rate for Payer: PHP Commercial |
$147.62
|
| Rate for Payer: Priority Health SBD |
$109.41
|
| Rate for Payer: UMR Bronson Commercial |
$76.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.25
|
|
|
BETAXOLOL 0.5 % EYE DROPS
|
Facility
|
OP
|
$173.67
|
|
|
Service Code
|
NDC 61314024501
|
| Hospital Charge Code |
9268
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.26 |
| Max. Negotiated Rate |
$156.30 |
| Rate for Payer: Aetna American Axle |
$112.89
|
| Rate for Payer: Aetna Commercial |
$147.62
|
| Rate for Payer: Aetna Medicare |
$86.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.89
|
| Rate for Payer: BCBS Complete |
$69.47
|
| Rate for Payer: Cash Price |
$138.94
|
| Rate for Payer: Cofinity Advantage |
$121.57
|
| Rate for Payer: Cofinity Commercial |
$149.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.94
|
| Rate for Payer: Healthscope Commercial |
$156.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.25
|
| Rate for Payer: PHP Commercial |
$147.62
|
| Rate for Payer: Priority Health SBD |
$109.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.89
|
| Rate for Payer: UHC Core |
$90.48
|
| Rate for Payer: UHC Exchange |
$68.25
|
| Rate for Payer: UMR Bronson Commercial |
$64.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.25
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET
|
Facility
|
IP
|
$3.45
|
|
|
Service Code
|
NDC 00832051189
|
| Hospital Charge Code |
1043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$3.10 |
| Rate for Payer: Aetna American Axle |
$2.24
|
| Rate for Payer: Aetna Commercial |
$2.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.24
|
| Rate for Payer: Cash Price |
$2.76
|
| Rate for Payer: Cofinity Advantage |
$2.42
|
| Rate for Payer: Cofinity Commercial |
$2.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.76
|
| Rate for Payer: Healthscope Commercial |
$3.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.59
|
| Rate for Payer: PHP Commercial |
$2.93
|
| Rate for Payer: Priority Health SBD |
$2.17
|
| Rate for Payer: UMR Bronson Commercial |
$1.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.59
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET
|
Facility
|
OP
|
$344.85
|
|
|
Service Code
|
NDC 00832051101
|
| Hospital Charge Code |
1043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.59 |
| Max. Negotiated Rate |
$310.37 |
| Rate for Payer: Aetna American Axle |
$224.15
|
| Rate for Payer: Aetna Commercial |
$293.12
|
| Rate for Payer: Aetna Medicare |
$172.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.15
|
| Rate for Payer: BCBS Complete |
$137.94
|
| Rate for Payer: Cash Price |
$275.88
|
| Rate for Payer: Cofinity Advantage |
$241.40
|
| Rate for Payer: Cofinity Commercial |
$296.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.88
|
| Rate for Payer: Healthscope Commercial |
$310.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$241.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$258.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$275.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$258.64
|
| Rate for Payer: PHP Commercial |
$293.12
|
| Rate for Payer: Priority Health SBD |
$217.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.15
|
| Rate for Payer: UHC Core |
$179.67
|
| Rate for Payer: UHC Exchange |
$135.53
|
| Rate for Payer: UMR Bronson Commercial |
$127.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.64
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET
|
Facility
|
OP
|
$3.45
|
|
|
Service Code
|
NDC 00832051189
|
| Hospital Charge Code |
1043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$3.10 |
| Rate for Payer: Aetna American Axle |
$2.24
|
| Rate for Payer: Aetna Commercial |
$2.93
|
| Rate for Payer: Aetna Medicare |
$1.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.24
|
| Rate for Payer: BCBS Complete |
$1.38
|
| Rate for Payer: Cash Price |
$2.76
|
| Rate for Payer: Cofinity Advantage |
$2.42
|
| Rate for Payer: Cofinity Commercial |
$2.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.76
|
| Rate for Payer: Healthscope Commercial |
$3.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.59
|
| Rate for Payer: PHP Commercial |
$2.93
|
| Rate for Payer: Priority Health SBD |
$2.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.24
|
| Rate for Payer: UHC Core |
$1.80
|
| Rate for Payer: UHC Exchange |
$1.36
|
| Rate for Payer: UMR Bronson Commercial |
$1.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.59
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET
|
Facility
|
OP
|
$279.30
|
|
|
Service Code
|
NDC 65162057210
|
| Hospital Charge Code |
1043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.34 |
| Max. Negotiated Rate |
$251.37 |
| Rate for Payer: Aetna American Axle |
$181.54
|
| Rate for Payer: Aetna Commercial |
$237.41
|
| Rate for Payer: Aetna Medicare |
$139.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.54
|
| Rate for Payer: BCBS Complete |
$111.72
|
| Rate for Payer: Cash Price |
$223.44
|
| Rate for Payer: Cofinity Advantage |
$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 |
$209.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$209.47
|
| Rate for Payer: PHP Commercial |
$237.41
|
| Rate for Payer: Priority Health SBD |
$175.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.54
|
| Rate for Payer: UHC Core |
$145.52
|
| Rate for Payer: UHC Exchange |
$109.76
|
| Rate for Payer: UMR Bronson Commercial |
$103.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.47
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET
|
Facility
|
IP
|
$344.85
|
|
|
Service Code
|
NDC 00832051101
|
| Hospital Charge Code |
1043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.73 |
| Max. Negotiated Rate |
$310.37 |
| Rate for Payer: Aetna American Axle |
$224.15
|
| Rate for Payer: Aetna Commercial |
$293.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.15
|
| Rate for Payer: Cash Price |
$275.88
|
| Rate for Payer: Cofinity Advantage |
$241.40
|
| Rate for Payer: Cofinity Commercial |
$296.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.88
|
| Rate for Payer: Healthscope Commercial |
$310.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$241.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$258.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$258.64
|
| Rate for Payer: PHP Commercial |
$293.12
|
| Rate for Payer: Priority Health SBD |
$217.26
|
| Rate for Payer: UMR Bronson Commercial |
$151.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.64
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET
|
Facility
|
OP
|
$280.25
|
|
|
Service Code
|
NDC 00832051100
|
| Hospital Charge Code |
1043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.69 |
| Max. Negotiated Rate |
$252.22 |
| Rate for Payer: Aetna American Axle |
$182.16
|
| Rate for Payer: Aetna Commercial |
$238.21
|
| Rate for Payer: Aetna Medicare |
$140.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.16
|
| Rate for Payer: BCBS Complete |
$112.10
|
| Rate for Payer: Cash Price |
$224.20
|
| Rate for Payer: Cofinity Advantage |
$196.18
|
| Rate for Payer: Cofinity Commercial |
$241.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.20
|
| Rate for Payer: Healthscope Commercial |
$252.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$224.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.19
|
| Rate for Payer: PHP Commercial |
$238.21
|
| Rate for Payer: Priority Health SBD |
$176.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.16
|
| Rate for Payer: UHC Core |
$146.01
|
| Rate for Payer: UHC Exchange |
$110.14
|
| Rate for Payer: UMR Bronson Commercial |
$103.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.19
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET
|
Facility
|
IP
|
$280.25
|
|
|
Service Code
|
NDC 00832051100
|
| Hospital Charge Code |
1043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.31 |
| Max. Negotiated Rate |
$252.22 |
| Rate for Payer: Aetna American Axle |
$182.16
|
| Rate for Payer: Aetna Commercial |
$238.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.16
|
| Rate for Payer: Cash Price |
$224.20
|
| Rate for Payer: Cofinity Advantage |
$196.18
|
| Rate for Payer: Cofinity Commercial |
$241.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.20
|
| Rate for Payer: Healthscope Commercial |
$252.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.19
|
| Rate for Payer: PHP Commercial |
$238.21
|
| Rate for Payer: Priority Health SBD |
$176.56
|
| Rate for Payer: UMR Bronson Commercial |
$123.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.19
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET
|
Facility
|
IP
|
$279.30
|
|
|
Service Code
|
NDC 65162057210
|
| 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 |
$237.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.54
|
| Rate for Payer: Cash Price |
$223.44
|
| Rate for Payer: Cofinity Advantage |
$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 |
$209.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$209.47
|
| Rate for Payer: PHP Commercial |
$237.41
|
| 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 |
$209.47
|
|
|
BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$14,313.05
|
|
|
Service Code
|
HCPCS J9035
|
| Hospital Charge Code |
38022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,297.74 |
| Max. Negotiated Rate |
$12,881.75 |
| Rate for Payer: Aetna American Axle |
$9,303.48
|
| Rate for Payer: Aetna American Axle |
$2,325.88
|
| Rate for Payer: Aetna Commercial |
$12,166.09
|
| Rate for Payer: Aetna Commercial |
$3,041.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,303.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,325.88
|
| Rate for Payer: Cash Price |
$11,450.44
|
| Rate for Payer: Cash Price |
$2,862.62
|
| Rate for Payer: Cofinity Advantage |
$2,504.79
|
| Rate for Payer: Cofinity Advantage |
$10,019.14
|
| Rate for Payer: Cofinity Commercial |
$3,077.31
|
| Rate for Payer: Cofinity Commercial |
$12,309.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,450.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,862.62
|
| Rate for Payer: Healthscope Commercial |
$12,881.75
|
| Rate for Payer: Healthscope Commercial |
$3,220.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,504.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,019.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,734.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,683.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,166.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,041.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,734.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,683.70
|
| Rate for Payer: PHP Commercial |
$12,166.09
|
| Rate for Payer: PHP Commercial |
$3,041.53
|
| Rate for Payer: Priority Health SBD |
$2,254.31
|
| Rate for Payer: Priority Health SBD |
$9,017.22
|
| Rate for Payer: UMR Bronson Commercial |
$6,297.74
|
| Rate for Payer: UMR Bronson Commercial |
$1,574.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,734.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,683.70
|
|
|
BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,578.27
|
|
|
Service Code
|
HCPCS J9035
|
| Hospital Charge Code |
38022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.89 |
| Max. Negotiated Rate |
$3,220.44 |
| Rate for Payer: Aetna American Axle |
$2,325.88
|
| Rate for Payer: Aetna American Axle |
$9,303.48
|
| Rate for Payer: Aetna Commercial |
$12,166.09
|
| Rate for Payer: Aetna Commercial |
$3,041.53
|
| Rate for Payer: Aetna Medicare |
$77.33
|
| Rate for Payer: Aetna Medicare |
$77.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,303.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,325.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.95
|
| Rate for Payer: BCBS Complete |
$40.84
|
| Rate for Payer: BCBS Complete |
$40.84
|
| Rate for Payer: BCBS MAPPO |
$74.36
|
| Rate for Payer: BCBS MAPPO |
$74.36
|
| Rate for Payer: BCBS Trust/PPO |
$238.76
|
| Rate for Payer: BCBS Trust/PPO |
$238.76
|
| Rate for Payer: BCN Commercial |
$238.76
|
| Rate for Payer: BCN Commercial |
$238.76
|
| Rate for Payer: BCN Medicare Advantage |
$74.36
|
| Rate for Payer: BCN Medicare Advantage |
$74.36
|
| Rate for Payer: Cash Price |
$11,450.44
|
| Rate for Payer: Cash Price |
$2,862.62
|
| Rate for Payer: Cash Price |
$2,862.62
|
| Rate for Payer: Cash Price |
$11,450.44
|
| Rate for Payer: Cofinity Advantage |
$2,504.79
|
| Rate for Payer: Cofinity Advantage |
$10,019.14
|
| Rate for Payer: Cofinity Commercial |
$12,309.22
|
| Rate for Payer: Cofinity Commercial |
$3,077.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,450.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,862.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.36
|
| Rate for Payer: Healthscope Commercial |
$12,881.75
|
| Rate for Payer: Healthscope Commercial |
$3,220.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,504.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,019.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,734.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,683.70
|
| Rate for Payer: Mclaren Medicaid |
$74.36
|
| Rate for Payer: Mclaren Medicaid |
$74.36
|
| Rate for Payer: Mclaren Medicare |
$74.36
|
| Rate for Payer: Mclaren Medicare |
$74.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.08
|
| Rate for Payer: Meridian Medicaid |
$78.08
|
| Rate for Payer: Meridian Medicaid |
$78.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$81.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$81.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,166.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,041.53
|
| Rate for Payer: Nomi Health Commercial |
$223.08
|
| Rate for Payer: Nomi Health Commercial |
$223.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,683.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,734.79
|
| Rate for Payer: PACE Medicare |
$70.64
|
| Rate for Payer: PACE Medicare |
$70.64
|
| Rate for Payer: PACE SWMI |
$74.36
|
| Rate for Payer: PACE SWMI |
$74.36
|
| Rate for Payer: PHP Commercial |
$12,166.09
|
| Rate for Payer: PHP Commercial |
$3,041.53
|
| Rate for Payer: PHP Medicare Advantage |
$74.36
|
| Rate for Payer: PHP Medicare Advantage |
$74.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$230.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$230.89
|
| Rate for Payer: Priority Health Medicare |
$74.36
|
| Rate for Payer: Priority Health Medicare |
$74.36
|
| Rate for Payer: Priority Health SBD |
$9,017.22
|
| Rate for Payer: Priority Health SBD |
$2,254.31
|
| Rate for Payer: Priority Health Tiered Network |
$184.71
|
| Rate for Payer: Priority Health Tiered Network |
$184.71
|
| Rate for Payer: Railroad Medicare Medicare |
$74.36
|
| Rate for Payer: Railroad Medicare Medicare |
$74.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.49
|
| Rate for Payer: UHC Core |
$121.49
|
| Rate for Payer: UHC Core |
$121.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$74.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$74.36
|
| Rate for Payer: UHC Exchange |
$121.49
|
| Rate for Payer: UHC Exchange |
$121.49
|
| Rate for Payer: UHC Medicaid |
$38.89
|
| Rate for Payer: UHC Medicaid |
$38.89
|
| Rate for Payer: UHCCP Medicaid |
$38.89
|
| Rate for Payer: UHCCP Medicaid |
$38.89
|
| Rate for Payer: UMR Bronson Commercial |
$5,295.83
|
| Rate for Payer: UMR Bronson Commercial |
$1,323.96
|
| Rate for Payer: VA VA |
$74.36
|
| Rate for Payer: VA VA |
$74.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,683.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,734.79
|
|
|
BEVACIZUMAB-AWWB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$12,217.83
|
|
|
Service Code
|
HCPCS Q5107
|
| Hospital Charge Code |
190598
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,375.85 |
| Max. Negotiated Rate |
$10,996.05 |
| Rate for Payer: Aetna American Axle |
$7,941.59
|
| Rate for Payer: Aetna American Axle |
$1,985.44
|
| Rate for Payer: Aetna Commercial |
$10,385.16
|
| Rate for Payer: Aetna Commercial |
$2,596.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,941.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,985.44
|
| Rate for Payer: Cash Price |
$9,774.26
|
| Rate for Payer: Cash Price |
$2,443.62
|
| Rate for Payer: Cofinity Advantage |
$2,138.16
|
| Rate for Payer: Cofinity Advantage |
$8,552.48
|
| Rate for Payer: Cofinity Commercial |
$2,626.89
|
| Rate for Payer: Cofinity Commercial |
$10,507.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,774.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,443.62
|
| Rate for Payer: Healthscope Commercial |
$10,996.05
|
| Rate for Payer: Healthscope Commercial |
$2,749.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,138.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,552.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,163.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,290.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,385.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,596.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,163.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,290.89
|
| Rate for Payer: PHP Commercial |
$10,385.16
|
| Rate for Payer: PHP Commercial |
$2,596.34
|
| Rate for Payer: Priority Health SBD |
$1,924.35
|
| Rate for Payer: Priority Health SBD |
$7,697.23
|
| Rate for Payer: UMR Bronson Commercial |
$5,375.85
|
| Rate for Payer: UMR Bronson Commercial |
$1,343.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,163.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,290.89
|
|
