|
MORPHINE ER 30 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$1,036.70
|
|
|
Service Code
|
NDC 0406-8330-62
|
| Hospital Charge Code |
20921
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$456.15 |
| Max. Negotiated Rate |
$933.03 |
| Rate for Payer: Aetna American Axle |
$673.86
|
| Rate for Payer: Aetna Commercial |
$881.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$673.86
|
| Rate for Payer: Cash Price |
$829.36
|
| Rate for Payer: Cofinity Commercial |
$725.69
|
| Rate for Payer: Cofinity Commercial |
$891.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$829.36
|
| Rate for Payer: Healthscope Commercial |
$933.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$725.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$777.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$881.20
|
| Rate for Payer: PHP Commercial |
$881.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$725.69
|
| Rate for Payer: Priority Health SBD |
$653.12
|
| Rate for Payer: UMR Bronson Commercial |
$456.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$777.52
|
|
|
MORPHINE ER 60 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$1,072.50
|
|
|
Service Code
|
NDC 0406-8380-62
|
| Hospital Charge Code |
20922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$471.90 |
| Max. Negotiated Rate |
$965.25 |
| Rate for Payer: Aetna American Axle |
$697.12
|
| Rate for Payer: Aetna Commercial |
$911.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$697.12
|
| Rate for Payer: Cash Price |
$858.00
|
| Rate for Payer: Cofinity Commercial |
$750.75
|
| Rate for Payer: Cofinity Commercial |
$922.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$858.00
|
| Rate for Payer: Healthscope Commercial |
$965.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$750.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$804.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$911.62
|
| Rate for Payer: PHP Commercial |
$911.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$750.75
|
| Rate for Payer: Priority Health SBD |
$675.68
|
| Rate for Payer: UMR Bronson Commercial |
$471.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$804.38
|
|
|
MORPHINE ER 60 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$872.43
|
|
|
Service Code
|
NDC 0904-6559-61
|
| Hospital Charge Code |
20922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$383.87 |
| Max. Negotiated Rate |
$785.19 |
| Rate for Payer: Aetna American Axle |
$567.08
|
| Rate for Payer: Aetna Commercial |
$741.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$567.08
|
| Rate for Payer: Cash Price |
$697.94
|
| Rate for Payer: Cofinity Commercial |
$610.70
|
| Rate for Payer: Cofinity Commercial |
$750.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$697.94
|
| Rate for Payer: Healthscope Commercial |
$785.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$610.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$654.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$741.57
|
| Rate for Payer: PHP Commercial |
$741.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$610.70
|
| Rate for Payer: Priority Health SBD |
$549.63
|
| Rate for Payer: UMR Bronson Commercial |
$383.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$654.32
|
|
|
MORPHINE INHALATION (VARIABLE DOSE)
|
Facility
|
IP
|
$11.62
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
300139
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.11 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Aetna American Axle |
$7.55
|
| Rate for Payer: Aetna Commercial |
$9.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.55
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cofinity Commercial |
$8.13
|
| Rate for Payer: Cofinity Commercial |
$9.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$10.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.88
|
| Rate for Payer: PHP Commercial |
$9.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.13
|
| Rate for Payer: Priority Health SBD |
$7.32
|
| Rate for Payer: UMR Bronson Commercial |
$5.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.72
|
|
|
MORPHINE (PF) 0.5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$36.35
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
29464
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.99 |
| Max. Negotiated Rate |
$32.72 |
| Rate for Payer: Aetna American Axle |
$23.63
|
| Rate for Payer: Aetna American Axle |
$83.17
|
| Rate for Payer: Aetna Commercial |
$108.76
|
| Rate for Payer: Aetna Commercial |
$30.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.63
|
| Rate for Payer: Cash Price |
$102.36
|
| Rate for Payer: Cash Price |
$29.08
|
| Rate for Payer: Cofinity Commercial |
$110.04
|
| Rate for Payer: Cofinity Commercial |
$25.44
|
| Rate for Payer: Cofinity Commercial |
$31.26
|
| Rate for Payer: Cofinity Commercial |
$89.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.08
|
| Rate for Payer: Healthscope Commercial |
$115.16
|
| Rate for Payer: Healthscope Commercial |
$32.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$89.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$108.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.90
|
| Rate for Payer: PHP Commercial |
$108.76
|
| Rate for Payer: PHP Commercial |
$30.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.44
|
| Rate for Payer: Priority Health SBD |
$80.61
|
| Rate for Payer: Priority Health SBD |
$22.90
|
| Rate for Payer: UMR Bronson Commercial |
$15.99
|
| Rate for Payer: UMR Bronson Commercial |
$56.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.96
|
|
|
MORPHINE (PF) 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$670.25
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
77009
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$294.91 |
| Max. Negotiated Rate |
$603.22 |
| Rate for Payer: Aetna American Axle |
$435.66
|
| Rate for Payer: Aetna Commercial |
$569.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$435.66
|
| Rate for Payer: Cash Price |
$536.20
|
| Rate for Payer: Cofinity Commercial |
$469.18
|
| Rate for Payer: Cofinity Commercial |
$576.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$536.20
|
| Rate for Payer: Healthscope Commercial |
$603.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$469.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$502.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$569.71
|
| Rate for Payer: PHP Commercial |
$569.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$469.18
|
| Rate for Payer: Priority Health SBD |
$422.26
|
| Rate for Payer: UMR Bronson Commercial |
$294.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$502.69
|
|
|
MORPHINE (PF) 1 MG/ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$66.50
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
159447
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.26 |
| Max. Negotiated Rate |
$59.85 |
| Rate for Payer: Aetna American Axle |
$43.22
|
| Rate for Payer: Aetna Commercial |
$56.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.22
|
| Rate for Payer: Cash Price |
$53.20
|
| Rate for Payer: Cofinity Commercial |
$46.55
|
| Rate for Payer: Cofinity Commercial |
$57.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.20
|
| Rate for Payer: Healthscope Commercial |
$59.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.52
|
| Rate for Payer: PHP Commercial |
$56.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.55
|
| Rate for Payer: Priority Health SBD |
$41.90
|
| Rate for Payer: UMR Bronson Commercial |
$29.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.88
|
|
|
MORPHINE (PF) 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
15852
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.72 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Aetna American Axle |
$24.70
|
| Rate for Payer: Aetna Commercial |
$32.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.70
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cofinity Commercial |
$26.60
|
| Rate for Payer: Cofinity Commercial |
$32.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.40
|
| Rate for Payer: Healthscope Commercial |
$34.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.30
|
| Rate for Payer: PHP Commercial |
$32.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.60
|
| Rate for Payer: Priority Health SBD |
$23.94
|
| Rate for Payer: UMR Bronson Commercial |
$16.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.50
|
|
|
MORPHINE (PF) 25 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$1,041.92
|
|
|
Service Code
|
NDC 0641-6040-01
|
| Hospital Charge Code |
27392
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$458.44 |
| Max. Negotiated Rate |
$937.73 |
| Rate for Payer: Aetna American Axle |
$677.25
|
| Rate for Payer: Aetna Commercial |
$885.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$677.25
|
| Rate for Payer: Cash Price |
$833.54
|
| Rate for Payer: Cofinity Commercial |
$729.34
|
| Rate for Payer: Cofinity Commercial |
$896.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$833.54
|
| Rate for Payer: Healthscope Commercial |
$937.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$729.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$781.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$885.63
|
| Rate for Payer: PHP Commercial |
$885.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$729.34
|
| Rate for Payer: Priority Health SBD |
$656.41
|
| Rate for Payer: UMR Bronson Commercial |
$458.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$781.44
|
|
|
MORPHINE (PF) 2 MG/2 ML (1 MG/ML) IN 0.9% SODIUM CHLORIDE INJ SYRINGE
|
Facility
|
IP
|
$31.50
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
159461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.86 |
| Max. Negotiated Rate |
$28.35 |
| Rate for Payer: Aetna American Axle |
$20.48
|
| Rate for Payer: Aetna Commercial |
$26.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.48
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cofinity Commercial |
$22.05
|
| Rate for Payer: Cofinity Commercial |
$27.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.20
|
| Rate for Payer: Healthscope Commercial |
$28.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.78
|
| Rate for Payer: PHP Commercial |
$26.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.05
|
| Rate for Payer: Priority Health SBD |
$19.84
|
| Rate for Payer: UMR Bronson Commercial |
$13.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.62
|
|
|
MORPHINE SULFATE 100 MG/0.5 ML TOPICAL GEL
|
Facility
|
IP
|
$17.49
|
|
|
Service Code
|
NDC 9900-0003-72
|
| Hospital Charge Code |
161534
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.70 |
| Max. Negotiated Rate |
$15.74 |
| Rate for Payer: Aetna American Axle |
$11.37
|
| Rate for Payer: Aetna Commercial |
$14.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.37
|
| Rate for Payer: Cash Price |
$13.99
|
| Rate for Payer: Cofinity Commercial |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$15.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.99
|
| Rate for Payer: Healthscope Commercial |
$15.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.87
|
| Rate for Payer: PHP Commercial |
$14.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.24
|
| Rate for Payer: Priority Health SBD |
$11.02
|
| Rate for Payer: UMR Bronson Commercial |
$7.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.12
|
|
|
MORPHINE SULFATE 30 MG/0.5 ML TOPICAL GEL
|
Facility
|
IP
|
$13.20
|
|
|
Service Code
|
NDC 9900-0003-71
|
| Hospital Charge Code |
161533
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.81 |
| Max. Negotiated Rate |
$11.88 |
| Rate for Payer: Aetna American Axle |
$8.58
|
| Rate for Payer: Aetna Commercial |
$11.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.58
|
| Rate for Payer: Cash Price |
$10.56
|
| Rate for Payer: Cofinity Commercial |
$11.35
|
| Rate for Payer: Cofinity Commercial |
$9.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.56
|
| Rate for Payer: Healthscope Commercial |
$11.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.22
|
| Rate for Payer: PHP Commercial |
$11.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.24
|
| Rate for Payer: Priority Health SBD |
$8.32
|
| Rate for Payer: UMR Bronson Commercial |
$5.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.90
|
|
|
MORPHINE VARIABLE DOSE
|
Facility
|
OP
|
$11.68
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
150710
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.32 |
| Max. Negotiated Rate |
$15.07 |
| Rate for Payer: Aetna American Axle |
$7.59
|
| Rate for Payer: Aetna Commercial |
$9.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.59
|
| Rate for Payer: BCBS Complete |
$4.67
|
| Rate for Payer: BCBS Trust/PPO |
$15.07
|
| Rate for Payer: Cash Price |
$9.34
|
| Rate for Payer: Cash Price |
$9.34
|
| Rate for Payer: Cofinity Commercial |
$10.04
|
| Rate for Payer: Cofinity Commercial |
$8.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.34
|
| Rate for Payer: Healthscope Commercial |
$10.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.93
|
| Rate for Payer: PHP Commercial |
$9.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.18
|
| Rate for Payer: Priority Health SBD |
$7.36
|
| Rate for Payer: UMR Bronson Commercial |
$4.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.76
|
|
|
MORPHINE VARIABLE DOSE
|
Facility
|
IP
|
$11.62
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
150710
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.11 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Aetna American Axle |
$7.55
|
| Rate for Payer: Aetna Commercial |
$9.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.55
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cofinity Commercial |
$8.13
|
| Rate for Payer: Cofinity Commercial |
$9.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$10.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.88
|
| Rate for Payer: PHP Commercial |
$9.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.13
|
| Rate for Payer: Priority Health SBD |
$7.32
|
| Rate for Payer: UMR Bronson Commercial |
$5.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.72
|
|
|
MOSUNETUZUMAB-AXGB 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,707.34
|
|
|
Service Code
|
HCPCS J9350
|
| Hospital Charge Code |
202489
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,191.23 |
| Max. Negotiated Rate |
$2,436.61 |
| Rate for Payer: Aetna American Axle |
$1,759.77
|
| Rate for Payer: Aetna American Axle |
$52,793.04
|
| Rate for Payer: Aetna Commercial |
$69,037.05
|
| Rate for Payer: Aetna Commercial |
$2,301.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,759.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52,793.04
|
| Rate for Payer: Cash Price |
$2,165.87
|
| Rate for Payer: Cash Price |
$64,976.05
|
| Rate for Payer: Cofinity Commercial |
$1,895.14
|
| Rate for Payer: Cofinity Commercial |
$2,328.31
|
| Rate for Payer: Cofinity Commercial |
$69,849.25
|
| Rate for Payer: Cofinity Commercial |
$56,854.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64,976.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,165.87
|
| Rate for Payer: Healthscope Commercial |
$73,098.05
|
| Rate for Payer: Healthscope Commercial |
$2,436.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,895.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56,854.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60,915.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,030.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69,037.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,301.24
|
| Rate for Payer: PHP Commercial |
$69,037.05
|
| Rate for Payer: PHP Commercial |
$2,301.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56,854.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,895.14
|
| Rate for Payer: Priority Health SBD |
$51,168.64
|
| Rate for Payer: Priority Health SBD |
$1,705.62
|
| Rate for Payer: UMR Bronson Commercial |
$1,191.23
|
| Rate for Payer: UMR Bronson Commercial |
$35,736.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,030.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60,915.04
|
|
|
MOSUNETUZUMAB-AXGB 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$81,220.06
|
|
|
Service Code
|
HCPCS J9350
|
| Hospital Charge Code |
202489
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$344.41 |
| Max. Negotiated Rate |
$73,098.05 |
| Rate for Payer: Aetna American Axle |
$52,793.04
|
| Rate for Payer: Aetna American Axle |
$1,759.77
|
| Rate for Payer: Aetna Commercial |
$69,037.05
|
| Rate for Payer: Aetna Commercial |
$2,301.24
|
| Rate for Payer: Aetna Medicare |
$654.82
|
| Rate for Payer: Aetna Medicare |
$654.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,759.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52,793.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$787.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$787.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$787.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$787.04
|
| Rate for Payer: BCBS Complete |
$361.66
|
| Rate for Payer: BCBS Complete |
$361.66
|
| Rate for Payer: BCBS MAPPO |
$629.64
|
| Rate for Payer: BCBS MAPPO |
$629.64
|
| Rate for Payer: BCBS Trust/PPO |
$2,034.68
|
| Rate for Payer: BCBS Trust/PPO |
$2,034.68
|
| Rate for Payer: BCN Medicare Advantage |
$629.64
|
| Rate for Payer: BCN Medicare Advantage |
$629.64
|
| Rate for Payer: Cash Price |
$2,165.87
|
| Rate for Payer: Cash Price |
$2,165.87
|
| Rate for Payer: Cash Price |
$64,976.05
|
| Rate for Payer: Cash Price |
$64,976.05
|
| Rate for Payer: Cofinity Commercial |
$56,854.04
|
| Rate for Payer: Cofinity Commercial |
$1,895.14
|
| Rate for Payer: Cofinity Commercial |
$2,328.31
|
| Rate for Payer: Cofinity Commercial |
$69,849.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64,976.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,165.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$629.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$629.64
|
| Rate for Payer: Healthscope Commercial |
$73,098.05
|
| Rate for Payer: Healthscope Commercial |
$2,436.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,895.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56,854.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,030.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60,915.04
|
| Rate for Payer: Mclaren Medicaid |
$344.41
|
| Rate for Payer: Mclaren Medicaid |
$344.41
|
| Rate for Payer: Mclaren Medicare |
$629.64
|
| Rate for Payer: Mclaren Medicare |
$629.64
|
| Rate for Payer: Meridian Medicaid |
$361.66
|
| Rate for Payer: Meridian Medicaid |
$361.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$661.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$661.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$724.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$724.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69,037.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,301.24
|
| Rate for Payer: PACE Medicare |
$598.15
|
| Rate for Payer: PACE Medicare |
$598.15
|
| Rate for Payer: PACE SWMI |
$629.64
|
| Rate for Payer: PACE SWMI |
$629.64
|
| Rate for Payer: PHP Commercial |
$69,037.05
|
| Rate for Payer: PHP Commercial |
$2,301.24
|
| Rate for Payer: PHP Medicare Advantage |
$629.64
|
| Rate for Payer: PHP Medicare Advantage |
$629.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$344.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$344.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56,854.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,895.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,849.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,849.35
|
| Rate for Payer: Priority Health Medicare |
$629.64
|
| Rate for Payer: Priority Health Medicare |
$629.64
|
| Rate for Payer: Priority Health Narrow Network |
$1,479.48
|
| Rate for Payer: Priority Health Narrow Network |
$1,479.48
|
| Rate for Payer: Priority Health SBD |
$1,705.62
|
| Rate for Payer: Priority Health SBD |
$51,168.64
|
| Rate for Payer: Railroad Medicare Medicare |
$629.64
|
| Rate for Payer: Railroad Medicare Medicare |
$629.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$629.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$629.64
|
| Rate for Payer: UHC Medicare Advantage |
$648.52
|
| Rate for Payer: UHC Medicare Advantage |
$648.52
|
| Rate for Payer: UMR Bronson Commercial |
$1,001.72
|
| Rate for Payer: UMR Bronson Commercial |
$30,051.42
|
| Rate for Payer: VA VA |
$629.64
|
| Rate for Payer: VA VA |
$629.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,030.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60,915.04
|
|
|
MOUTH PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$25,237.05
|
|
|
Service Code
|
MS-DRG 137
|
| Min. Negotiated Rate |
$11,502.23 |
| Max. Negotiated Rate |
$25,237.05 |
| Rate for Payer: Aetna Medicare |
$12,591.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,134.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,134.51
|
| Rate for Payer: BCBS MAPPO |
$12,107.61
|
| Rate for Payer: BCBS Trust/PPO |
$25,237.05
|
| Rate for Payer: BCN Medicare Advantage |
$12,107.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,107.61
|
| Rate for Payer: Mclaren Medicare |
$12,107.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,712.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,923.75
|
| Rate for Payer: PACE Medicare |
$11,502.23
|
| Rate for Payer: PACE SWMI |
$12,107.61
|
| Rate for Payer: PHP Medicare Advantage |
$12,107.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,592.32
|
| Rate for Payer: Priority Health Medicare |
$12,107.61
|
| Rate for Payer: Priority Health Narrow Network |
$17,273.86
|
| Rate for Payer: Railroad Medicare Medicare |
$12,107.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,952.69
|
| Rate for Payer: UHC Core |
$18,820.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,107.61
|
| Rate for Payer: UHC Exchange |
$14,962.74
|
| Rate for Payer: UHC Medicare Advantage |
$12,470.84
|
| Rate for Payer: VA VA |
$12,107.61
|
|
|
MOUTH PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$14,519.54
|
|
|
Service Code
|
MS-DRG 138
|
| Min. Negotiated Rate |
$6,824.30 |
| Max. Negotiated Rate |
$14,519.54 |
| Rate for Payer: Aetna Medicare |
$7,470.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,979.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,979.34
|
| Rate for Payer: BCBS MAPPO |
$7,183.47
|
| Rate for Payer: BCBS Trust/PPO |
$14,519.54
|
| Rate for Payer: BCN Medicare Advantage |
$7,183.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,183.47
|
| Rate for Payer: Mclaren Medicare |
$7,183.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,542.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,260.99
|
| Rate for Payer: PACE Medicare |
$6,824.30
|
| Rate for Payer: PACE SWMI |
$7,183.47
|
| Rate for Payer: PHP Medicare Advantage |
$7,183.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,422.73
|
| Rate for Payer: Priority Health Medicare |
$7,183.47
|
| Rate for Payer: Priority Health Narrow Network |
$9,938.18
|
| Rate for Payer: Railroad Medicare Medicare |
$7,183.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,205.39
|
| Rate for Payer: UHC Core |
$10,828.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,183.47
|
| Rate for Payer: UHC Exchange |
$8,608.52
|
| Rate for Payer: UHC Medicare Advantage |
$7,398.97
|
| Rate for Payer: VA VA |
$7,183.47
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
IP
|
$30.14
|
|
|
Service Code
|
NDC 72266-158-01
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.26 |
| Max. Negotiated Rate |
$27.13 |
| Rate for Payer: Aetna American Axle |
$19.59
|
| Rate for Payer: Aetna Commercial |
$25.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.59
|
| Rate for Payer: Cash Price |
$24.11
|
| Rate for Payer: Cofinity Commercial |
$21.10
|
| Rate for Payer: Cofinity Commercial |
$25.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.11
|
| Rate for Payer: Healthscope Commercial |
$27.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.62
|
| Rate for Payer: PHP Commercial |
$25.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.10
|
| Rate for Payer: Priority Health SBD |
$18.99
|
| Rate for Payer: UMR Bronson Commercial |
$13.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.60
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
IP
|
$108.96
|
|
|
Service Code
|
NDC 65862-840-03
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.94 |
| Max. Negotiated Rate |
$98.06 |
| Rate for Payer: Aetna American Axle |
$70.82
|
| Rate for Payer: Aetna Commercial |
$92.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.82
|
| Rate for Payer: Cash Price |
$87.17
|
| Rate for Payer: Cofinity Commercial |
$76.27
|
| Rate for Payer: Cofinity Commercial |
$93.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.17
|
| Rate for Payer: Healthscope Commercial |
$98.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$92.62
|
| Rate for Payer: PHP Commercial |
$92.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.27
|
| Rate for Payer: Priority Health SBD |
$68.64
|
| Rate for Payer: UMR Bronson Commercial |
$47.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.72
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
IP
|
$654.02
|
|
|
Service Code
|
NDC 0078-0939-26
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$287.77 |
| Max. Negotiated Rate |
$588.62 |
| Rate for Payer: Aetna American Axle |
$425.11
|
| Rate for Payer: Aetna Commercial |
$555.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$425.11
|
| Rate for Payer: Cash Price |
$523.22
|
| Rate for Payer: Cofinity Commercial |
$457.81
|
| Rate for Payer: Cofinity Commercial |
$562.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$523.22
|
| Rate for Payer: Healthscope Commercial |
$588.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$457.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$490.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$555.92
|
| Rate for Payer: PHP Commercial |
$555.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$457.81
|
| Rate for Payer: Priority Health SBD |
$412.03
|
| Rate for Payer: UMR Bronson Commercial |
$287.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$490.52
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
IP
|
$563.26
|
|
|
Service Code
|
NDC 0065-4013-03
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$247.83 |
| Max. Negotiated Rate |
$506.93 |
| Rate for Payer: Aetna American Axle |
$366.12
|
| Rate for Payer: Aetna Commercial |
$478.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$366.12
|
| Rate for Payer: Cash Price |
$450.61
|
| Rate for Payer: Cofinity Commercial |
$394.28
|
| Rate for Payer: Cofinity Commercial |
$484.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$450.61
|
| Rate for Payer: Healthscope Commercial |
$506.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$394.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$422.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$478.77
|
| Rate for Payer: PHP Commercial |
$478.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$394.28
|
| Rate for Payer: Priority Health SBD |
$354.85
|
| Rate for Payer: UMR Bronson Commercial |
$247.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$422.44
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
IP
|
$91.91
|
|
|
Service Code
|
NDC 0781-7135-93
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.44 |
| Max. Negotiated Rate |
$82.72 |
| Rate for Payer: Aetna American Axle |
$59.74
|
| Rate for Payer: Aetna Commercial |
$78.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.74
|
| Rate for Payer: Cash Price |
$73.53
|
| Rate for Payer: Cofinity Commercial |
$64.34
|
| Rate for Payer: Cofinity Commercial |
$79.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.53
|
| Rate for Payer: Healthscope Commercial |
$82.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.12
|
| Rate for Payer: PHP Commercial |
$78.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.34
|
| Rate for Payer: Priority Health SBD |
$57.90
|
| Rate for Payer: UMR Bronson Commercial |
$40.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.93
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
IP
|
$61.50
|
|
|
Service Code
|
NDC 60505-0582-4
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.06 |
| Max. Negotiated Rate |
$55.35 |
| Rate for Payer: Aetna American Axle |
$39.98
|
| Rate for Payer: Aetna Commercial |
$52.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.98
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cofinity Commercial |
$43.05
|
| Rate for Payer: Cofinity Commercial |
$52.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.20
|
| Rate for Payer: Healthscope Commercial |
$55.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.28
|
| Rate for Payer: PHP Commercial |
$52.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.05
|
| Rate for Payer: Priority Health SBD |
$38.74
|
| Rate for Payer: UMR Bronson Commercial |
$27.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.12
|
|
|
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC
|
Facility
|
IP
|
$29,134.56
|
|
|
Service Code
|
MS-DRG 059
|
| Min. Negotiated Rate |
$9,177.90 |
| Max. Negotiated Rate |
$29,134.56 |
| Rate for Payer: Aetna Medicare |
$10,047.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,076.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,076.19
|
| Rate for Payer: BCBS MAPPO |
$9,660.95
|
| Rate for Payer: BCBS Trust/PPO |
$29,134.56
|
| Rate for Payer: BCN Medicare Advantage |
$9,660.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,660.95
|
| Rate for Payer: Mclaren Medicare |
$9,660.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,144.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,110.09
|
| Rate for Payer: PACE Medicare |
$9,177.90
|
| Rate for Payer: PACE SWMI |
$9,660.95
|
| Rate for Payer: PHP Medicare Advantage |
$9,660.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,036.23
|
| Rate for Payer: Priority Health Medicare |
$9,660.95
|
| Rate for Payer: Priority Health Narrow Network |
$13,628.98
|
| Rate for Payer: Railroad Medicare Medicare |
$9,660.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,109.55
|
| Rate for Payer: UHC Core |
$14,849.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,660.95
|
| Rate for Payer: UHC Exchange |
$11,805.52
|
| Rate for Payer: UHC Medicare Advantage |
$9,950.78
|
| Rate for Payer: VA VA |
$9,660.95
|
|
