|
BEVACIZUMAB-AWWB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,054.52
|
|
|
Service Code
|
HCPCS Q5107
|
| Hospital Charge Code |
190598
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.42 |
| Max. Negotiated Rate |
$2,749.07 |
| Rate for Payer: Aetna American Axle |
$1,985.44
|
| Rate for Payer: Aetna American Axle |
$7,941.59
|
| Rate for Payer: Aetna Commercial |
$10,385.16
|
| Rate for Payer: Aetna Commercial |
$2,596.34
|
| Rate for Payer: Aetna Medicare |
$24.69
|
| Rate for Payer: Aetna Medicare |
$24.69
|
| 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: Allen County Amish Medical Aid Commercial |
$29.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.68
|
| Rate for Payer: BCBS Complete |
$13.04
|
| Rate for Payer: BCBS Complete |
$13.04
|
| Rate for Payer: BCBS MAPPO |
$23.74
|
| Rate for Payer: BCBS MAPPO |
$23.74
|
| Rate for Payer: BCBS Trust/PPO |
$93.25
|
| Rate for Payer: BCBS Trust/PPO |
$93.25
|
| Rate for Payer: BCN Commercial |
$93.25
|
| Rate for Payer: BCN Commercial |
$93.25
|
| Rate for Payer: BCN Medicare Advantage |
$23.74
|
| Rate for Payer: BCN Medicare Advantage |
$23.74
|
| Rate for Payer: Cash Price |
$9,774.26
|
| Rate for Payer: Cash Price |
$2,443.62
|
| Rate for Payer: Cash Price |
$2,443.62
|
| Rate for Payer: Cash Price |
$9,774.26
|
| Rate for Payer: Cofinity Advantage |
$2,138.16
|
| Rate for Payer: Cofinity Advantage |
$8,552.48
|
| Rate for Payer: Cofinity Commercial |
$10,507.33
|
| Rate for Payer: Cofinity Commercial |
$2,626.89
|
| 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: Health Alliance Plan Medicare Advantage |
$23.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.74
|
| 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: Mclaren Medicaid |
$23.74
|
| Rate for Payer: Mclaren Medicaid |
$23.74
|
| Rate for Payer: Mclaren Medicare |
$23.74
|
| Rate for Payer: Mclaren Medicare |
$23.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.93
|
| Rate for Payer: Meridian Medicaid |
$24.93
|
| Rate for Payer: Meridian Medicaid |
$24.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.11
|
| 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: Nomi Health Commercial |
$71.22
|
| Rate for Payer: Nomi Health Commercial |
$71.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,290.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,163.37
|
| Rate for Payer: PACE Medicare |
$22.55
|
| Rate for Payer: PACE Medicare |
$22.55
|
| Rate for Payer: PACE SWMI |
$23.74
|
| Rate for Payer: PACE SWMI |
$23.74
|
| Rate for Payer: PHP Commercial |
$10,385.16
|
| Rate for Payer: PHP Commercial |
$2,596.34
|
| Rate for Payer: PHP Medicare Advantage |
$23.74
|
| Rate for Payer: PHP Medicare Advantage |
$23.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$87.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$87.88
|
| Rate for Payer: Priority Health Medicare |
$23.74
|
| Rate for Payer: Priority Health Medicare |
$23.74
|
| Rate for Payer: Priority Health SBD |
$7,697.23
|
| Rate for Payer: Priority Health SBD |
$1,924.35
|
| Rate for Payer: Priority Health Tiered Network |
$70.30
|
| Rate for Payer: Priority Health Tiered Network |
$70.30
|
| Rate for Payer: Railroad Medicare Medicare |
$23.74
|
| Rate for Payer: Railroad Medicare Medicare |
$23.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.34
|
| Rate for Payer: UHC Core |
$39.34
|
| Rate for Payer: UHC Core |
$39.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$23.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$23.74
|
| Rate for Payer: UHC Exchange |
$39.34
|
| Rate for Payer: UHC Exchange |
$39.34
|
| Rate for Payer: UHC Medicaid |
$12.42
|
| Rate for Payer: UHC Medicaid |
$12.42
|
| Rate for Payer: UHCCP Medicaid |
$12.42
|
| Rate for Payer: UHCCP Medicaid |
$12.42
|
| Rate for Payer: UMR Bronson Commercial |
$4,520.60
|
| Rate for Payer: UMR Bronson Commercial |
$1,130.17
|
| Rate for Payer: VA VA |
$23.74
|
| Rate for Payer: VA VA |
$23.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,290.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,163.37
|
|
|
BEVACIZUMAB-BVZR 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,427.53
|
|
|
Service Code
|
HCPCS Q5118
|
| Hospital Charge Code |
192559
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,068.11 |
| Max. Negotiated Rate |
$2,184.78 |
| Rate for Payer: Aetna American Axle |
$1,577.89
|
| Rate for Payer: Aetna American Axle |
$6,311.57
|
| Rate for Payer: Aetna Commercial |
$2,063.40
|
| Rate for Payer: Aetna Commercial |
$8,253.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,577.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,311.57
|
| Rate for Payer: Cash Price |
$1,942.02
|
| Rate for Payer: Cash Price |
$7,768.09
|
| Rate for Payer: Cofinity Advantage |
$6,797.08
|
| Rate for Payer: Cofinity Advantage |
$1,699.27
|
| Rate for Payer: Cofinity Commercial |
$8,350.69
|
| Rate for Payer: Cofinity Commercial |
$2,087.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,942.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,768.09
|
| Rate for Payer: Healthscope Commercial |
$2,184.78
|
| Rate for Payer: Healthscope Commercial |
$8,739.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,797.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,699.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,820.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,282.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,063.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,253.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,820.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,282.58
|
| Rate for Payer: PHP Commercial |
$2,063.40
|
| Rate for Payer: PHP Commercial |
$8,253.59
|
| Rate for Payer: Priority Health SBD |
$6,117.37
|
| Rate for Payer: Priority Health SBD |
$1,529.34
|
| Rate for Payer: UMR Bronson Commercial |
$1,068.11
|
| Rate for Payer: UMR Bronson Commercial |
$4,272.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,820.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,282.58
|
|
|
BEVACIZUMAB-BVZR 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$9,710.11
|
|
|
Service Code
|
HCPCS Q5118
|
| Hospital Charge Code |
192559
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.52 |
| Max. Negotiated Rate |
$8,739.10 |
| Rate for Payer: Aetna American Axle |
$6,311.57
|
| Rate for Payer: Aetna American Axle |
$1,577.89
|
| Rate for Payer: Aetna Commercial |
$2,063.40
|
| Rate for Payer: Aetna Commercial |
$8,253.59
|
| Rate for Payer: Aetna Medicare |
$26.88
|
| Rate for Payer: Aetna Medicare |
$26.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,577.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,311.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.31
|
| Rate for Payer: BCBS Complete |
$14.20
|
| Rate for Payer: BCBS Complete |
$14.20
|
| Rate for Payer: BCBS MAPPO |
$25.85
|
| Rate for Payer: BCBS MAPPO |
$25.85
|
| Rate for Payer: BCBS Trust/PPO |
$69.57
|
| Rate for Payer: BCBS Trust/PPO |
$69.57
|
| Rate for Payer: BCN Commercial |
$69.57
|
| Rate for Payer: BCN Commercial |
$69.57
|
| Rate for Payer: BCN Medicare Advantage |
$25.85
|
| Rate for Payer: BCN Medicare Advantage |
$25.85
|
| Rate for Payer: Cash Price |
$1,942.02
|
| Rate for Payer: Cash Price |
$7,768.09
|
| Rate for Payer: Cash Price |
$7,768.09
|
| Rate for Payer: Cash Price |
$1,942.02
|
| Rate for Payer: Cofinity Advantage |
$6,797.08
|
| Rate for Payer: Cofinity Advantage |
$1,699.27
|
| Rate for Payer: Cofinity Commercial |
$2,087.68
|
| Rate for Payer: Cofinity Commercial |
$8,350.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,942.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,768.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.85
|
| Rate for Payer: Healthscope Commercial |
$2,184.78
|
| Rate for Payer: Healthscope Commercial |
$8,739.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,797.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,699.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,820.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,282.58
|
| Rate for Payer: Mclaren Medicaid |
$25.85
|
| Rate for Payer: Mclaren Medicaid |
$25.85
|
| Rate for Payer: Mclaren Medicare |
$25.85
|
| Rate for Payer: Mclaren Medicare |
$25.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.14
|
| Rate for Payer: Meridian Medicaid |
$27.14
|
| Rate for Payer: Meridian Medicaid |
$27.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,063.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,253.59
|
| Rate for Payer: Nomi Health Commercial |
$77.55
|
| Rate for Payer: Nomi Health Commercial |
$77.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,282.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,820.65
|
| Rate for Payer: PACE Medicare |
$24.56
|
| Rate for Payer: PACE Medicare |
$24.56
|
| Rate for Payer: PACE SWMI |
$25.85
|
| Rate for Payer: PACE SWMI |
$25.85
|
| Rate for Payer: PHP Commercial |
$2,063.40
|
| Rate for Payer: PHP Commercial |
$8,253.59
|
| Rate for Payer: PHP Medicare Advantage |
$25.85
|
| Rate for Payer: PHP Medicare Advantage |
$25.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$81.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$81.28
|
| Rate for Payer: Priority Health Medicare |
$25.85
|
| Rate for Payer: Priority Health Medicare |
$25.85
|
| Rate for Payer: Priority Health SBD |
$1,529.34
|
| Rate for Payer: Priority Health SBD |
$6,117.37
|
| Rate for Payer: Priority Health Tiered Network |
$65.02
|
| Rate for Payer: Priority Health Tiered Network |
$65.02
|
| Rate for Payer: Railroad Medicare Medicare |
$25.85
|
| Rate for Payer: Railroad Medicare Medicare |
$25.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.57
|
| Rate for Payer: UHC Core |
$42.57
|
| Rate for Payer: UHC Core |
$42.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$25.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$25.85
|
| Rate for Payer: UHC Exchange |
$42.57
|
| Rate for Payer: UHC Exchange |
$42.57
|
| Rate for Payer: UHC Medicaid |
$13.52
|
| Rate for Payer: UHC Medicaid |
$13.52
|
| Rate for Payer: UHCCP Medicaid |
$13.52
|
| Rate for Payer: UHCCP Medicaid |
$13.52
|
| Rate for Payer: UMR Bronson Commercial |
$898.19
|
| Rate for Payer: UMR Bronson Commercial |
$3,592.74
|
| Rate for Payer: VA VA |
$25.85
|
| Rate for Payer: VA VA |
$25.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,282.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,820.65
|
|
|
BEXAROTENE 75 MG CAPSULE
|
Facility
|
OP
|
$735.03
|
|
|
Service Code
|
NDC 42292000701
|
| Hospital Charge Code |
27027
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$271.96 |
| Max. Negotiated Rate |
$661.53 |
| Rate for Payer: Aetna American Axle |
$477.77
|
| Rate for Payer: Aetna Commercial |
$624.78
|
| Rate for Payer: Aetna Medicare |
$367.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$477.77
|
| Rate for Payer: BCBS Complete |
$294.01
|
| Rate for Payer: Cash Price |
$588.02
|
| Rate for Payer: Cofinity Advantage |
$514.52
|
| Rate for Payer: Cofinity Commercial |
$632.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$588.02
|
| Rate for Payer: Healthscope Commercial |
$661.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$514.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$551.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$588.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$624.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$551.27
|
| Rate for Payer: PHP Commercial |
$624.78
|
| Rate for Payer: Priority Health SBD |
$463.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$477.77
|
| Rate for Payer: UHC Core |
$382.95
|
| Rate for Payer: UHC Exchange |
$288.87
|
| Rate for Payer: UMR Bronson Commercial |
$271.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$551.27
|
|
|
BEXAROTENE 75 MG CAPSULE
|
Facility
|
IP
|
$735.03
|
|
|
Service Code
|
NDC 42292000701
|
| Hospital Charge Code |
27027
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$323.41 |
| Max. Negotiated Rate |
$661.53 |
| Rate for Payer: Aetna American Axle |
$477.77
|
| Rate for Payer: Aetna Commercial |
$624.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$477.77
|
| Rate for Payer: Cash Price |
$588.02
|
| Rate for Payer: Cofinity Advantage |
$514.52
|
| Rate for Payer: Cofinity Commercial |
$632.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$588.02
|
| Rate for Payer: Healthscope Commercial |
$661.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$514.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$551.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$624.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$551.27
|
| Rate for Payer: PHP Commercial |
$624.78
|
| Rate for Payer: Priority Health SBD |
$463.07
|
| Rate for Payer: UMR Bronson Commercial |
$323.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$551.27
|
|
|
BEXAROTENE 75 MG CAPSULE
|
Facility
|
OP
|
$7,350.24
|
|
|
Service Code
|
NDC 42292000710
|
| Hospital Charge Code |
27027
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,719.59 |
| Max. Negotiated Rate |
$6,615.22 |
| Rate for Payer: Aetna American Axle |
$4,777.66
|
| Rate for Payer: Aetna Commercial |
$6,247.70
|
| Rate for Payer: Aetna Medicare |
$3,675.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,777.66
|
| Rate for Payer: BCBS Complete |
$2,940.10
|
| Rate for Payer: Cash Price |
$5,880.19
|
| Rate for Payer: Cofinity Advantage |
$5,145.17
|
| Rate for Payer: Cofinity Commercial |
$6,321.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,880.19
|
| Rate for Payer: Healthscope Commercial |
$6,615.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,145.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,512.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,880.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,247.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,512.68
|
| Rate for Payer: PHP Commercial |
$6,247.70
|
| Rate for Payer: Priority Health SBD |
$4,630.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,777.66
|
| Rate for Payer: UHC Core |
$3,829.48
|
| Rate for Payer: UHC Exchange |
$2,888.64
|
| Rate for Payer: UMR Bronson Commercial |
$2,719.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,512.68
|
|
|
BEXAROTENE 75 MG CAPSULE
|
Facility
|
IP
|
$7,350.24
|
|
|
Service Code
|
NDC 42292000710
|
| Hospital Charge Code |
27027
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,234.11 |
| Max. Negotiated Rate |
$6,615.22 |
| Rate for Payer: Aetna American Axle |
$4,777.66
|
| Rate for Payer: Aetna Commercial |
$6,247.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,777.66
|
| Rate for Payer: Cash Price |
$5,880.19
|
| Rate for Payer: Cofinity Advantage |
$5,145.17
|
| Rate for Payer: Cofinity Commercial |
$6,321.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,880.19
|
| Rate for Payer: Healthscope Commercial |
$6,615.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,145.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,512.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,247.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,512.68
|
| Rate for Payer: PHP Commercial |
$6,247.70
|
| Rate for Payer: Priority Health SBD |
$4,630.65
|
| Rate for Payer: UMR Bronson Commercial |
$3,234.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,512.68
|
|
|
BEZLOTOXUMAB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$9,879.90
|
|
|
Service Code
|
HCPCS J0565
|
| Hospital Charge Code |
181631
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.83 |
| Max. Negotiated Rate |
$8,891.91 |
| Rate for Payer: Aetna American Axle |
$6,421.94
|
| Rate for Payer: Aetna Commercial |
$8,397.92
|
| Rate for Payer: Aetna Medicare |
$41.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,421.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.79
|
| Rate for Payer: BCBS Complete |
$21.87
|
| Rate for Payer: BCBS MAPPO |
$39.83
|
| Rate for Payer: BCBS Trust/PPO |
$129.12
|
| Rate for Payer: BCN Commercial |
$129.12
|
| Rate for Payer: BCN Medicare Advantage |
$39.83
|
| Rate for Payer: Cash Price |
$7,903.92
|
| Rate for Payer: Cash Price |
$7,903.92
|
| Rate for Payer: Cofinity Advantage |
$6,915.93
|
| Rate for Payer: Cofinity Commercial |
$8,496.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,903.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.83
|
| Rate for Payer: Healthscope Commercial |
$8,891.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,915.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,409.93
|
| Rate for Payer: Mclaren Medicaid |
$39.83
|
| Rate for Payer: Mclaren Medicare |
$39.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.82
|
| Rate for Payer: Meridian Medicaid |
$41.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$43.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,397.92
|
| Rate for Payer: Nomi Health Commercial |
$119.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,409.93
|
| Rate for Payer: PACE Medicare |
$37.84
|
| Rate for Payer: PACE SWMI |
$39.83
|
| Rate for Payer: PHP Commercial |
$8,397.92
|
| Rate for Payer: PHP Medicare Advantage |
$39.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$125.62
|
| Rate for Payer: Priority Health Medicare |
$39.83
|
| Rate for Payer: Priority Health SBD |
$6,224.34
|
| Rate for Payer: Priority Health Tiered Network |
$100.50
|
| Rate for Payer: Railroad Medicare Medicare |
$39.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.72
|
| Rate for Payer: UHC Core |
$65.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$39.83
|
| Rate for Payer: UHC Exchange |
$65.72
|
| Rate for Payer: UHC Medicaid |
$20.83
|
| Rate for Payer: UHCCP Medicaid |
$20.83
|
| Rate for Payer: UMR Bronson Commercial |
$3,655.56
|
| Rate for Payer: VA VA |
$39.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,409.93
|
|
|
BEZLOTOXUMAB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$9,879.90
|
|
|
Service Code
|
HCPCS J0565
|
| Hospital Charge Code |
181631
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,347.16 |
| Max. Negotiated Rate |
$8,891.91 |
| Rate for Payer: Aetna American Axle |
$6,421.94
|
| Rate for Payer: Aetna Commercial |
$8,397.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,421.94
|
| Rate for Payer: Cash Price |
$7,903.92
|
| Rate for Payer: Cofinity Advantage |
$6,915.93
|
| Rate for Payer: Cofinity Commercial |
$8,496.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,903.92
|
| Rate for Payer: Healthscope Commercial |
$8,891.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,915.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,409.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,397.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,409.93
|
| Rate for Payer: PHP Commercial |
$8,397.92
|
| Rate for Payer: Priority Health SBD |
$6,224.34
|
| Rate for Payer: UMR Bronson Commercial |
$4,347.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,409.93
|
|
|
BICALUTAMIDE 50 MG TABLET
|
Facility
|
IP
|
$129.11
|
|
|
Service Code
|
NDC 47335048583
|
| Hospital Charge Code |
15746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.81 |
| Max. Negotiated Rate |
$116.20 |
| Rate for Payer: Aetna American Axle |
$83.92
|
| Rate for Payer: Aetna Commercial |
$109.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.92
|
| Rate for Payer: Cash Price |
$103.29
|
| Rate for Payer: Cofinity Advantage |
$90.38
|
| Rate for Payer: Cofinity Commercial |
$111.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.29
|
| Rate for Payer: Healthscope Commercial |
$116.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.83
|
| Rate for Payer: PHP Commercial |
$109.74
|
| Rate for Payer: Priority Health SBD |
$81.34
|
| Rate for Payer: UMR Bronson Commercial |
$56.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.83
|
|
|
BICALUTAMIDE 50 MG TABLET
|
Facility
|
OP
|
$101.52
|
|
|
Service Code
|
NDC 16729002310
|
| Hospital Charge Code |
15746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.56 |
| Max. Negotiated Rate |
$91.37 |
| Rate for Payer: Aetna American Axle |
$65.99
|
| Rate for Payer: Aetna Commercial |
$86.29
|
| Rate for Payer: Aetna Medicare |
$50.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.99
|
| Rate for Payer: BCBS Complete |
$40.61
|
| Rate for Payer: Cash Price |
$81.22
|
| Rate for Payer: Cofinity Advantage |
$71.06
|
| Rate for Payer: Cofinity Commercial |
$87.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.22
|
| Rate for Payer: Healthscope Commercial |
$91.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.14
|
| Rate for Payer: PHP Commercial |
$86.29
|
| Rate for Payer: Priority Health SBD |
$63.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.99
|
| Rate for Payer: UHC Core |
$52.89
|
| Rate for Payer: UHC Exchange |
$39.90
|
| Rate for Payer: UMR Bronson Commercial |
$37.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.14
|
|
|
BICALUTAMIDE 50 MG TABLET
|
Facility
|
OP
|
$76.38
|
|
|
Service Code
|
NDC 00904601946
|
| Hospital Charge Code |
15746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.26 |
| Max. Negotiated Rate |
$68.74 |
| Rate for Payer: Aetna American Axle |
$49.65
|
| Rate for Payer: Aetna Commercial |
$64.92
|
| Rate for Payer: Aetna Medicare |
$38.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.65
|
| Rate for Payer: BCBS Complete |
$30.55
|
| Rate for Payer: Cash Price |
$61.10
|
| Rate for Payer: Cofinity Advantage |
$53.47
|
| Rate for Payer: Cofinity Commercial |
$65.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.10
|
| Rate for Payer: Healthscope Commercial |
$68.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.28
|
| Rate for Payer: PHP Commercial |
$64.92
|
| Rate for Payer: Priority Health SBD |
$48.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.65
|
| Rate for Payer: UHC Core |
$39.79
|
| Rate for Payer: UHC Exchange |
$30.02
|
| Rate for Payer: UMR Bronson Commercial |
$28.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.28
|
|
|
BICALUTAMIDE 50 MG TABLET
|
Facility
|
OP
|
$129.11
|
|
|
Service Code
|
NDC 47335048583
|
| Hospital Charge Code |
15746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.77 |
| Max. Negotiated Rate |
$116.20 |
| Rate for Payer: Aetna American Axle |
$83.92
|
| Rate for Payer: Aetna Commercial |
$109.74
|
| Rate for Payer: Aetna Medicare |
$64.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.92
|
| Rate for Payer: BCBS Complete |
$51.64
|
| Rate for Payer: Cash Price |
$103.29
|
| Rate for Payer: Cofinity Advantage |
$90.38
|
| Rate for Payer: Cofinity Commercial |
$111.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.29
|
| Rate for Payer: Healthscope Commercial |
$116.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.83
|
| Rate for Payer: PHP Commercial |
$109.74
|
| Rate for Payer: Priority Health SBD |
$81.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.92
|
| Rate for Payer: UHC Core |
$67.27
|
| Rate for Payer: UHC Exchange |
$50.74
|
| Rate for Payer: UMR Bronson Commercial |
$47.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.83
|
|
|
BICALUTAMIDE 50 MG TABLET
|
Facility
|
IP
|
$76.38
|
|
|
Service Code
|
NDC 00904601946
|
| Hospital Charge Code |
15746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.61 |
| Max. Negotiated Rate |
$68.74 |
| Rate for Payer: Aetna American Axle |
$49.65
|
| Rate for Payer: Aetna Commercial |
$64.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.65
|
| Rate for Payer: Cash Price |
$61.10
|
| Rate for Payer: Cofinity Advantage |
$53.47
|
| Rate for Payer: Cofinity Commercial |
$65.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.10
|
| Rate for Payer: Healthscope Commercial |
$68.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.28
|
| Rate for Payer: PHP Commercial |
$64.92
|
| Rate for Payer: Priority Health SBD |
$48.12
|
| Rate for Payer: UMR Bronson Commercial |
$33.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.28
|
|
|
BICALUTAMIDE 50 MG TABLET
|
Facility
|
IP
|
$101.52
|
|
|
Service Code
|
NDC 16729002310
|
| Hospital Charge Code |
15746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.67 |
| Max. Negotiated Rate |
$91.37 |
| Rate for Payer: Aetna American Axle |
$65.99
|
| Rate for Payer: Aetna Commercial |
$86.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.99
|
| Rate for Payer: Cash Price |
$81.22
|
| Rate for Payer: Cofinity Advantage |
$71.06
|
| Rate for Payer: Cofinity Commercial |
$87.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.22
|
| Rate for Payer: Healthscope Commercial |
$91.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.14
|
| Rate for Payer: PHP Commercial |
$86.29
|
| Rate for Payer: Priority Health SBD |
$63.96
|
| Rate for Payer: UMR Bronson Commercial |
$44.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.14
|
|
|
BICARBONATE DIALYSIS SOLN WITHOUT CALCIUM NO15 POT 4 MEQ-MAG 1.2 MEQ/L
|
Facility
|
OP
|
$394.40
|
|
|
Service Code
|
NDC 24571011406
|
| Hospital Charge Code |
119755
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$145.93 |
| Max. Negotiated Rate |
$354.96 |
| Rate for Payer: Aetna American Axle |
$256.36
|
| Rate for Payer: Aetna Commercial |
$335.24
|
| Rate for Payer: Aetna Medicare |
$197.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.36
|
| Rate for Payer: BCBS Complete |
$157.76
|
| Rate for Payer: Cash Price |
$315.52
|
| Rate for Payer: Cofinity Advantage |
$276.08
|
| Rate for Payer: Cofinity Commercial |
$339.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.52
|
| Rate for Payer: Healthscope Commercial |
$354.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$276.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$315.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.80
|
| Rate for Payer: PHP Commercial |
$335.24
|
| Rate for Payer: Priority Health SBD |
$248.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$256.36
|
| Rate for Payer: UHC Core |
$205.48
|
| Rate for Payer: UHC Exchange |
$155.00
|
| Rate for Payer: UMR Bronson Commercial |
$145.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.80
|
|
|
BICARBONATE DIALYSIS SOLN WITHOUT CALCIUM NO15 POT 4 MEQ-MAG 1.2 MEQ/L
|
Facility
|
IP
|
$394.40
|
|
|
Service Code
|
NDC 24571011406
|
| Hospital Charge Code |
119755
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$173.54 |
| Max. Negotiated Rate |
$354.96 |
| Rate for Payer: Aetna American Axle |
$256.36
|
| Rate for Payer: Aetna Commercial |
$335.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.36
|
| Rate for Payer: Cash Price |
$315.52
|
| Rate for Payer: Cofinity Advantage |
$276.08
|
| Rate for Payer: Cofinity Commercial |
$339.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.52
|
| Rate for Payer: Healthscope Commercial |
$354.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$276.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.80
|
| Rate for Payer: PHP Commercial |
$335.24
|
| Rate for Payer: Priority Health SBD |
$248.47
|
| Rate for Payer: UMR Bronson Commercial |
$173.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.80
|
|
|
BICARBONATE HEMODIALYSIS SOLN WITHOUT CALCIUM 8 POT 2 MEQ-MAG 1 MEQ/L
|
Facility
|
IP
|
$394.40
|
|
|
Service Code
|
NDC 24571010206
|
| Hospital Charge Code |
118523
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$173.54 |
| Max. Negotiated Rate |
$354.96 |
| Rate for Payer: Aetna American Axle |
$256.36
|
| Rate for Payer: Aetna Commercial |
$335.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.36
|
| Rate for Payer: Cash Price |
$315.52
|
| Rate for Payer: Cofinity Advantage |
$276.08
|
| Rate for Payer: Cofinity Commercial |
$339.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.52
|
| Rate for Payer: Healthscope Commercial |
$354.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$276.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.80
|
| Rate for Payer: PHP Commercial |
$335.24
|
| Rate for Payer: Priority Health SBD |
$248.47
|
| Rate for Payer: UMR Bronson Commercial |
$173.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.80
|
|
|
BICARBONATE HEMODIALYSIS SOLN WITHOUT CALCIUM 8 POT 2 MEQ-MAG 1 MEQ/L
|
Facility
|
OP
|
$394.40
|
|
|
Service Code
|
NDC 24571010206
|
| Hospital Charge Code |
118523
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$145.93 |
| Max. Negotiated Rate |
$354.96 |
| Rate for Payer: Aetna American Axle |
$256.36
|
| Rate for Payer: Aetna Commercial |
$335.24
|
| Rate for Payer: Aetna Medicare |
$197.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.36
|
| Rate for Payer: BCBS Complete |
$157.76
|
| Rate for Payer: Cash Price |
$315.52
|
| Rate for Payer: Cofinity Advantage |
$276.08
|
| Rate for Payer: Cofinity Commercial |
$339.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.52
|
| Rate for Payer: Healthscope Commercial |
$354.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$276.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$315.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.80
|
| Rate for Payer: PHP Commercial |
$335.24
|
| Rate for Payer: Priority Health SBD |
$248.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$256.36
|
| Rate for Payer: UHC Core |
$205.48
|
| Rate for Payer: UHC Exchange |
$155.00
|
| Rate for Payer: UMR Bronson Commercial |
$145.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.80
|
|
|
BICARBONATE HEMODIALYSIS SOLUTION NO.9 K 4 MEQ-CA 2.5 MEQ-MG 1.5 MEQ/L
|
Facility
|
OP
|
$394.40
|
|
|
Service Code
|
NDC 24571010506
|
| Hospital Charge Code |
100176
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$145.93 |
| Max. Negotiated Rate |
$354.96 |
| Rate for Payer: Aetna American Axle |
$256.36
|
| Rate for Payer: Aetna Commercial |
$335.24
|
| Rate for Payer: Aetna Medicare |
$197.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.36
|
| Rate for Payer: BCBS Complete |
$157.76
|
| Rate for Payer: Cash Price |
$315.52
|
| Rate for Payer: Cofinity Advantage |
$276.08
|
| Rate for Payer: Cofinity Commercial |
$339.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.52
|
| Rate for Payer: Healthscope Commercial |
$354.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$276.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$315.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.80
|
| Rate for Payer: PHP Commercial |
$335.24
|
| Rate for Payer: Priority Health SBD |
$248.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$256.36
|
| Rate for Payer: UHC Core |
$205.48
|
| Rate for Payer: UHC Exchange |
$155.00
|
| Rate for Payer: UMR Bronson Commercial |
$145.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.80
|
|
|
BICARBONATE HEMODIALYSIS SOLUTION NO.9 K 4 MEQ-CA 2.5 MEQ-MG 1.5 MEQ/L
|
Facility
|
IP
|
$394.40
|
|
|
Service Code
|
NDC 24571010506
|
| Hospital Charge Code |
100176
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$173.54 |
| Max. Negotiated Rate |
$354.96 |
| Rate for Payer: Aetna American Axle |
$256.36
|
| Rate for Payer: Aetna Commercial |
$335.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.36
|
| Rate for Payer: Cash Price |
$315.52
|
| Rate for Payer: Cofinity Advantage |
$276.08
|
| Rate for Payer: Cofinity Commercial |
$339.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.52
|
| Rate for Payer: Healthscope Commercial |
$354.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$276.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.80
|
| Rate for Payer: PHP Commercial |
$335.24
|
| Rate for Payer: Priority Health SBD |
$248.47
|
| Rate for Payer: UMR Bronson Commercial |
$173.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.80
|
|
|
BICTEGRAVIR 50 MG-EMTRICITABINE 200 MG-TENOFOVIR ALAFENAM 25 MG TABLET
|
Facility
|
IP
|
$15,209.56
|
|
|
Service Code
|
NDC 61958250101
|
| Hospital Charge Code |
185933
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6,692.21 |
| Max. Negotiated Rate |
$13,688.60 |
| Rate for Payer: Aetna American Axle |
$9,886.21
|
| Rate for Payer: Aetna Commercial |
$12,928.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,886.21
|
| Rate for Payer: Cash Price |
$12,167.65
|
| Rate for Payer: Cofinity Advantage |
$10,646.69
|
| Rate for Payer: Cofinity Commercial |
$13,080.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,167.65
|
| Rate for Payer: Healthscope Commercial |
$13,688.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,646.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,407.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,928.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11,407.17
|
| Rate for Payer: PHP Commercial |
$12,928.13
|
| Rate for Payer: Priority Health SBD |
$9,582.02
|
| Rate for Payer: UMR Bronson Commercial |
$6,692.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,407.17
|
|
|
BICTEGRAVIR 50 MG-EMTRICITABINE 200 MG-TENOFOVIR ALAFENAM 25 MG TABLET
|
Facility
|
OP
|
$15,209.56
|
|
|
Service Code
|
NDC 61958250101
|
| Hospital Charge Code |
185933
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5,627.54 |
| Max. Negotiated Rate |
$13,688.60 |
| Rate for Payer: Aetna American Axle |
$9,886.21
|
| Rate for Payer: Aetna Commercial |
$12,928.13
|
| Rate for Payer: Aetna Medicare |
$7,604.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,886.21
|
| Rate for Payer: BCBS Complete |
$6,083.82
|
| Rate for Payer: Cash Price |
$12,167.65
|
| Rate for Payer: Cofinity Advantage |
$10,646.69
|
| Rate for Payer: Cofinity Commercial |
$13,080.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,167.65
|
| Rate for Payer: Healthscope Commercial |
$13,688.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,646.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,407.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,167.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,928.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11,407.17
|
| Rate for Payer: PHP Commercial |
$12,928.13
|
| Rate for Payer: Priority Health SBD |
$9,582.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,886.21
|
| Rate for Payer: UHC Core |
$7,924.18
|
| Rate for Payer: UHC Exchange |
$5,977.36
|
| Rate for Payer: UMR Bronson Commercial |
$5,627.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,407.17
|
|
|
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC
|
Facility
|
IP
|
$121,736.95
|
|
|
Service Code
|
MSDRG 461
|
| Min. Negotiated Rate |
$44,441.11 |
| Max. Negotiated Rate |
$121,736.95 |
| Rate for Payer: Aetna Medicare |
$48,651.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58,475.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58,475.15
|
| Rate for Payer: BCBS MAPPO |
$46,780.12
|
| Rate for Payer: BCBS Trust/PPO |
$121,736.95
|
| Rate for Payer: BCN Commercial |
$121,736.95
|
| Rate for Payer: BCN Medicare Advantage |
$46,780.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46,780.12
|
| Rate for Payer: Mclaren Medicare |
$46,780.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49,119.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53,797.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$51,458.13
|
| Rate for Payer: Nomi Health Commercial |
$69,151.74
|
| Rate for Payer: PACE Medicare |
$44,441.11
|
| Rate for Payer: PACE SWMI |
$46,780.12
|
| Rate for Payer: PHP Medicare Advantage |
$46,780.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$89,042.58
|
| Rate for Payer: Priority Health Medicare |
$46,780.12
|
| Rate for Payer: Priority Health Tiered Network |
$71,234.05
|
| Rate for Payer: Railroad Medicare Medicare |
$46,780.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87,377.78
|
| Rate for Payer: UHC Core |
$73,102.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$46,780.12
|
| Rate for Payer: UHC Exchange |
$59,701.00
|
| Rate for Payer: VA VA |
$46,780.12
|
|
|
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC
|
Facility
|
IP
|
$65,577.69
|
|
|
Service Code
|
MSDRG 462
|
| Min. Negotiated Rate |
$21,695.84 |
| Max. Negotiated Rate |
$65,577.69 |
| Rate for Payer: Aetna Medicare |
$23,751.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28,547.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28,547.16
|
| Rate for Payer: BCBS MAPPO |
$22,837.73
|
| Rate for Payer: BCBS Trust/PPO |
$65,577.69
|
| Rate for Payer: BCN Commercial |
$65,577.69
|
| Rate for Payer: BCN Medicare Advantage |
$22,837.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22,837.73
|
| Rate for Payer: Mclaren Medicare |
$22,837.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23,979.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26,263.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$25,121.50
|
| Rate for Payer: Nomi Health Commercial |
$34,314.00
|
| Rate for Payer: PACE Medicare |
$21,695.84
|
| Rate for Payer: PACE SWMI |
$22,837.73
|
| Rate for Payer: PHP Medicare Advantage |
$22,837.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$42,884.89
|
| Rate for Payer: Priority Health Medicare |
$22,837.73
|
| Rate for Payer: Priority Health Tiered Network |
$34,307.91
|
| Rate for Payer: Railroad Medicare Medicare |
$22,837.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43,358.00
|
| Rate for Payer: UHC Core |
$36,274.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22,837.73
|
| Rate for Payer: UHC Exchange |
$29,624.42
|
| Rate for Payer: VA VA |
$22,837.73
|
|
