|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$5.49
|
|
|
Service Code
|
NDC 66689-037-01
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$4.94 |
| Rate for Payer: Aetna American Axle |
$3.57
|
| Rate for Payer: Aetna Commercial |
$4.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.57
|
| Rate for Payer: Cash Price |
$4.39
|
| Rate for Payer: Cofinity Commercial |
$3.84
|
| Rate for Payer: Cofinity Commercial |
$4.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.39
|
| Rate for Payer: Healthscope Commercial |
$4.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.67
|
| Rate for Payer: PHP Commercial |
$4.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.84
|
| Rate for Payer: Priority Health SBD |
$3.46
|
| Rate for Payer: UMR Bronson Commercial |
$2.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.12
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$3.93
|
|
|
Service Code
|
NDC 0904-7276-70
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$3.54 |
| Rate for Payer: Aetna American Axle |
$2.55
|
| Rate for Payer: Aetna Commercial |
$3.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.55
|
| Rate for Payer: Cash Price |
$3.14
|
| Rate for Payer: Cofinity Commercial |
$2.75
|
| Rate for Payer: Cofinity Commercial |
$3.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.14
|
| Rate for Payer: Healthscope Commercial |
$3.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.34
|
| Rate for Payer: PHP Commercial |
$3.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.75
|
| Rate for Payer: Priority Health SBD |
$2.48
|
| Rate for Payer: UMR Bronson Commercial |
$1.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.95
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$5.49
|
|
|
Service Code
|
NDC 66689-037-50
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$4.94 |
| Rate for Payer: Aetna American Axle |
$3.57
|
| Rate for Payer: Aetna Commercial |
$4.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.57
|
| Rate for Payer: Cash Price |
$4.39
|
| Rate for Payer: Cofinity Commercial |
$3.84
|
| Rate for Payer: Cofinity Commercial |
$4.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.39
|
| Rate for Payer: Healthscope Commercial |
$4.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.67
|
| Rate for Payer: PHP Commercial |
$4.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.84
|
| Rate for Payer: Priority Health SBD |
$3.46
|
| Rate for Payer: UMR Bronson Commercial |
$2.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.12
|
|
|
NYSTATIN (BULK) 100 MILLION UNIT POWDER
|
Facility
|
IP
|
$178.50
|
|
|
Service Code
|
NDC 62991-2785-1
|
| Hospital Charge Code |
120073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.54 |
| Max. Negotiated Rate |
$160.65 |
| Rate for Payer: Aetna American Axle |
$116.02
|
| Rate for Payer: Aetna Commercial |
$151.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.02
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cofinity Commercial |
$124.95
|
| Rate for Payer: Cofinity Commercial |
$153.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.80
|
| Rate for Payer: Healthscope Commercial |
$160.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$151.72
|
| Rate for Payer: PHP Commercial |
$151.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.95
|
| Rate for Payer: Priority Health SBD |
$112.46
|
| Rate for Payer: UMR Bronson Commercial |
$78.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.88
|
|
|
NYSTATIN (BULK) 150 MILLION UNIT POWDER
|
Facility
|
IP
|
$122.50
|
|
|
Service Code
|
NDC 51552-0041-1
|
| Hospital Charge Code |
116152
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.90 |
| Max. Negotiated Rate |
$110.25 |
| Rate for Payer: Aetna American Axle |
$79.62
|
| Rate for Payer: Aetna Commercial |
$104.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.62
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: Cofinity Commercial |
$105.35
|
| Rate for Payer: Cofinity Commercial |
$85.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.00
|
| Rate for Payer: Healthscope Commercial |
$110.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$104.12
|
| Rate for Payer: PHP Commercial |
$104.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.75
|
| Rate for Payer: Priority Health SBD |
$77.18
|
| Rate for Payer: UMR Bronson Commercial |
$53.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.88
|
|
|
NYSTATIN-TETRACYCLN-HC-DIPHENHYD 1.2 GRAM-1.5 GRAM-0.06 GRAM MOUTHWASH
|
Facility
|
IP
|
$9.72
|
|
|
Service Code
|
NDC 9900-0007-08
|
| Hospital Charge Code |
107723
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.28 |
| Max. Negotiated Rate |
$8.75 |
| Rate for Payer: Aetna American Axle |
$6.32
|
| Rate for Payer: Aetna Commercial |
$8.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.32
|
| Rate for Payer: Cash Price |
$7.78
|
| Rate for Payer: Cofinity Commercial |
$6.80
|
| Rate for Payer: Cofinity Commercial |
$8.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.78
|
| Rate for Payer: Healthscope Commercial |
$8.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.26
|
| Rate for Payer: PHP Commercial |
$8.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.80
|
| Rate for Payer: Priority Health SBD |
$6.12
|
| Rate for Payer: UMR Bronson Commercial |
$4.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.29
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$37.12
|
|
|
Service Code
|
NDC 45802-880-14
|
| Hospital Charge Code |
5754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.33 |
| Max. Negotiated Rate |
$33.41 |
| Rate for Payer: Aetna American Axle |
$24.13
|
| Rate for Payer: Aetna Commercial |
$31.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.13
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cofinity Commercial |
$25.98
|
| Rate for Payer: Cofinity Commercial |
$31.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.70
|
| Rate for Payer: Healthscope Commercial |
$33.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.55
|
| Rate for Payer: PHP Commercial |
$31.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.98
|
| Rate for Payer: Priority Health SBD |
$23.39
|
| Rate for Payer: UMR Bronson Commercial |
$16.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.84
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$40.74
|
|
|
Service Code
|
NDC 45802-880-94
|
| Hospital Charge Code |
5754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$36.67 |
| Rate for Payer: Aetna American Axle |
$26.48
|
| Rate for Payer: Aetna Commercial |
$34.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.48
|
| Rate for Payer: Cash Price |
$32.59
|
| Rate for Payer: Cofinity Commercial |
$28.52
|
| Rate for Payer: Cofinity Commercial |
$35.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.59
|
| Rate for Payer: Healthscope Commercial |
$36.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.63
|
| Rate for Payer: PHP Commercial |
$34.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.52
|
| Rate for Payer: Priority Health SBD |
$25.67
|
| Rate for Payer: UMR Bronson Commercial |
$17.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.56
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$95.76
|
|
|
Service Code
|
NDC 68462-314-35
|
| Hospital Charge Code |
5754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.13 |
| Max. Negotiated Rate |
$86.18 |
| Rate for Payer: Aetna American Axle |
$62.24
|
| Rate for Payer: Aetna Commercial |
$81.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.24
|
| Rate for Payer: Cash Price |
$76.61
|
| Rate for Payer: Cofinity Commercial |
$67.03
|
| Rate for Payer: Cofinity Commercial |
$82.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.61
|
| Rate for Payer: Healthscope Commercial |
$86.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.40
|
| Rate for Payer: PHP Commercial |
$81.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.03
|
| Rate for Payer: Priority Health SBD |
$60.33
|
| Rate for Payer: UMR Bronson Commercial |
$42.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.82
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$95.76
|
|
|
Service Code
|
NDC 51672-1263-2
|
| Hospital Charge Code |
5754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.13 |
| Max. Negotiated Rate |
$86.18 |
| Rate for Payer: Aetna American Axle |
$62.24
|
| Rate for Payer: Aetna Commercial |
$81.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.24
|
| Rate for Payer: Cash Price |
$76.61
|
| Rate for Payer: Cofinity Commercial |
$67.03
|
| Rate for Payer: Cofinity Commercial |
$82.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.61
|
| Rate for Payer: Healthscope Commercial |
$86.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.40
|
| Rate for Payer: PHP Commercial |
$81.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.03
|
| Rate for Payer: Priority Health SBD |
$60.33
|
| Rate for Payer: UMR Bronson Commercial |
$42.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.82
|
|
|
OB/GYN SPEC KZOO ONLY - NITROUS OXIDE ADMIN
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 00563
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: BCBS Complete |
$24.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.00
|
| Rate for Payer: UMR Bronson Commercial |
$27.60
|
|
|
OBINUTUZUMAB 1,000 MG/40 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$33,305.39
|
|
|
Service Code
|
HCPCS J9301
|
| Hospital Charge Code |
168805
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.48 |
| Max. Negotiated Rate |
$29,974.85 |
| Rate for Payer: Aetna American Axle |
$21,648.50
|
| Rate for Payer: Aetna Commercial |
$28,309.58
|
| Rate for Payer: Aetna Medicare |
$73.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21,648.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.93
|
| Rate for Payer: BCBS Complete |
$40.40
|
| Rate for Payer: BCBS MAPPO |
$70.34
|
| Rate for Payer: BCBS Trust/PPO |
$227.28
|
| Rate for Payer: BCN Medicare Advantage |
$70.34
|
| Rate for Payer: Cash Price |
$26,644.31
|
| Rate for Payer: Cash Price |
$26,644.31
|
| Rate for Payer: Cofinity Commercial |
$23,313.77
|
| Rate for Payer: Cofinity Commercial |
$28,642.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26,644.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.34
|
| Rate for Payer: Healthscope Commercial |
$29,974.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23,313.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24,979.04
|
| Rate for Payer: Mclaren Medicaid |
$38.48
|
| Rate for Payer: Mclaren Medicare |
$70.34
|
| Rate for Payer: Meridian Medicaid |
$40.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$73.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28,309.58
|
| Rate for Payer: PACE Medicare |
$66.82
|
| Rate for Payer: PACE SWMI |
$70.34
|
| Rate for Payer: PHP Commercial |
$28,309.58
|
| Rate for Payer: PHP Medicare Advantage |
$70.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23,313.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$206.43
|
| Rate for Payer: Priority Health Medicare |
$70.34
|
| Rate for Payer: Priority Health Narrow Network |
$165.14
|
| Rate for Payer: Priority Health SBD |
$20,982.40
|
| Rate for Payer: Railroad Medicare Medicare |
$70.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.34
|
| Rate for Payer: UHC Medicare Advantage |
$72.45
|
| Rate for Payer: UMR Bronson Commercial |
$12,322.99
|
| Rate for Payer: VA VA |
$70.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24,979.04
|
|
|
OBINUTUZUMAB 1,000 MG/40 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$33,305.39
|
|
|
Service Code
|
HCPCS J9301
|
| Hospital Charge Code |
168805
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14,654.37 |
| Max. Negotiated Rate |
$29,974.85 |
| Rate for Payer: Aetna American Axle |
$21,648.50
|
| Rate for Payer: Aetna Commercial |
$28,309.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21,648.50
|
| Rate for Payer: Cash Price |
$26,644.31
|
| Rate for Payer: Cofinity Commercial |
$23,313.77
|
| Rate for Payer: Cofinity Commercial |
$28,642.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26,644.31
|
| Rate for Payer: Healthscope Commercial |
$29,974.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23,313.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24,979.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28,309.58
|
| Rate for Payer: PHP Commercial |
$28,309.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23,313.77
|
| Rate for Payer: Priority Health SBD |
$20,982.40
|
| Rate for Payer: UMR Bronson Commercial |
$14,654.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24,979.04
|
|
|
OCRELIZUMAB 30 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$51,257.39
|
|
|
Service Code
|
HCPCS J2350
|
| Hospital Charge Code |
182454
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.68 |
| Max. Negotiated Rate |
$46,131.65 |
| Rate for Payer: Aetna American Axle |
$33,317.30
|
| Rate for Payer: Aetna Commercial |
$43,568.78
|
| Rate for Payer: Aetna Medicare |
$62.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33,317.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$74.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$74.69
|
| Rate for Payer: BCBS Complete |
$34.32
|
| Rate for Payer: BCBS MAPPO |
$59.75
|
| Rate for Payer: BCBS Trust/PPO |
$193.06
|
| Rate for Payer: BCN Medicare Advantage |
$59.75
|
| Rate for Payer: Cash Price |
$41,005.91
|
| Rate for Payer: Cash Price |
$41,005.91
|
| Rate for Payer: Cofinity Commercial |
$44,081.36
|
| Rate for Payer: Cofinity Commercial |
$35,880.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41,005.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.75
|
| Rate for Payer: Healthscope Commercial |
$46,131.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35,880.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38,443.04
|
| Rate for Payer: Mclaren Medicaid |
$32.68
|
| Rate for Payer: Mclaren Medicare |
$59.75
|
| Rate for Payer: Meridian Medicaid |
$34.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$62.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43,568.78
|
| Rate for Payer: PACE Medicare |
$56.76
|
| Rate for Payer: PACE SWMI |
$59.75
|
| Rate for Payer: PHP Commercial |
$43,568.78
|
| Rate for Payer: PHP Medicare Advantage |
$59.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35,880.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$177.82
|
| Rate for Payer: Priority Health Medicare |
$59.75
|
| Rate for Payer: Priority Health Narrow Network |
$142.26
|
| Rate for Payer: Priority Health SBD |
$32,292.16
|
| Rate for Payer: Railroad Medicare Medicare |
$59.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$59.75
|
| Rate for Payer: UHC Medicare Advantage |
$61.54
|
| Rate for Payer: UMR Bronson Commercial |
$18,965.23
|
| Rate for Payer: VA VA |
$59.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38,443.04
|
|
|
OCRELIZUMAB 30 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$51,257.39
|
|
|
Service Code
|
HCPCS J2350
|
| Hospital Charge Code |
182454
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22,553.25 |
| Max. Negotiated Rate |
$46,131.65 |
| Rate for Payer: Aetna American Axle |
$33,317.30
|
| Rate for Payer: Aetna Commercial |
$43,568.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33,317.30
|
| Rate for Payer: Cash Price |
$41,005.91
|
| Rate for Payer: Cofinity Commercial |
$44,081.36
|
| Rate for Payer: Cofinity Commercial |
$35,880.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41,005.91
|
| Rate for Payer: Healthscope Commercial |
$46,131.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35,880.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38,443.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43,568.78
|
| Rate for Payer: PHP Commercial |
$43,568.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35,880.17
|
| Rate for Payer: Priority Health SBD |
$32,292.16
|
| Rate for Payer: UMR Bronson Commercial |
$22,553.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38,443.04
|
|
|
OCTREOTIDE ACETATE 1,000 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$893.92
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
91282
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$393.32 |
| Max. Negotiated Rate |
$804.53 |
| Rate for Payer: Aetna American Axle |
$581.05
|
| Rate for Payer: Aetna American Axle |
$288.18
|
| Rate for Payer: Aetna American Axle |
$590.28
|
| Rate for Payer: Aetna Commercial |
$759.83
|
| Rate for Payer: Aetna Commercial |
$376.86
|
| Rate for Payer: Aetna Commercial |
$771.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$590.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.05
|
| Rate for Payer: Cash Price |
$726.50
|
| Rate for Payer: Cash Price |
$715.14
|
| Rate for Payer: Cash Price |
$354.69
|
| Rate for Payer: Cofinity Commercial |
$625.74
|
| Rate for Payer: Cofinity Commercial |
$310.35
|
| Rate for Payer: Cofinity Commercial |
$381.29
|
| Rate for Payer: Cofinity Commercial |
$780.98
|
| Rate for Payer: Cofinity Commercial |
$635.68
|
| Rate for Payer: Cofinity Commercial |
$768.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$715.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$726.50
|
| Rate for Payer: Healthscope Commercial |
$804.53
|
| Rate for Payer: Healthscope Commercial |
$399.02
|
| Rate for Payer: Healthscope Commercial |
$817.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$310.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$625.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$635.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$332.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$681.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$670.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$376.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$771.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$759.83
|
| Rate for Payer: PHP Commercial |
$759.83
|
| Rate for Payer: PHP Commercial |
$376.86
|
| Rate for Payer: PHP Commercial |
$771.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$625.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$310.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$635.68
|
| Rate for Payer: Priority Health SBD |
$279.32
|
| Rate for Payer: Priority Health SBD |
$563.17
|
| Rate for Payer: Priority Health SBD |
$572.12
|
| Rate for Payer: UMR Bronson Commercial |
$393.32
|
| Rate for Payer: UMR Bronson Commercial |
$399.57
|
| Rate for Payer: UMR Bronson Commercial |
$195.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$681.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$670.44
|
|
|
OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$23.61
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
91279
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.39 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Aetna American Axle |
$15.35
|
| Rate for Payer: Aetna American Axle |
$17.49
|
| Rate for Payer: Aetna American Axle |
$73.66
|
| Rate for Payer: Aetna American Axle |
$11.19
|
| Rate for Payer: Aetna American Axle |
$15.43
|
| Rate for Payer: Aetna Commercial |
$96.32
|
| Rate for Payer: Aetna Commercial |
$22.87
|
| Rate for Payer: Aetna Commercial |
$20.18
|
| Rate for Payer: Aetna Commercial |
$20.07
|
| Rate for Payer: Aetna Commercial |
$14.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.43
|
| Rate for Payer: Cash Price |
$18.99
|
| Rate for Payer: Cash Price |
$90.66
|
| Rate for Payer: Cash Price |
$21.53
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cash Price |
$18.89
|
| Rate for Payer: Cofinity Commercial |
$12.05
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$20.30
|
| Rate for Payer: Cofinity Commercial |
$79.32
|
| Rate for Payer: Cofinity Commercial |
$18.84
|
| Rate for Payer: Cofinity Commercial |
$20.42
|
| Rate for Payer: Cofinity Commercial |
$23.14
|
| Rate for Payer: Cofinity Commercial |
$16.62
|
| Rate for Payer: Cofinity Commercial |
$16.53
|
| Rate for Payer: Cofinity Commercial |
$97.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.53
|
| Rate for Payer: Healthscope Commercial |
$15.49
|
| Rate for Payer: Healthscope Commercial |
$101.99
|
| Rate for Payer: Healthscope Commercial |
$21.25
|
| Rate for Payer: Healthscope Commercial |
$21.37
|
| Rate for Payer: Healthscope Commercial |
$24.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.63
|
| Rate for Payer: PHP Commercial |
$20.18
|
| Rate for Payer: PHP Commercial |
$96.32
|
| Rate for Payer: PHP Commercial |
$14.63
|
| Rate for Payer: PHP Commercial |
$22.87
|
| Rate for Payer: PHP Commercial |
$20.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.84
|
| Rate for Payer: Priority Health SBD |
$14.96
|
| Rate for Payer: Priority Health SBD |
$10.84
|
| Rate for Payer: Priority Health SBD |
$16.95
|
| Rate for Payer: Priority Health SBD |
$14.87
|
| Rate for Payer: Priority Health SBD |
$71.39
|
| Rate for Payer: UMR Bronson Commercial |
$10.39
|
| Rate for Payer: UMR Bronson Commercial |
$7.57
|
| Rate for Payer: UMR Bronson Commercial |
$10.45
|
| Rate for Payer: UMR Bronson Commercial |
$11.84
|
| Rate for Payer: UMR Bronson Commercial |
$49.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.18
|
|
|
OCTREOTIDE ACETATE 200 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$99.64
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
25123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.84 |
| Max. Negotiated Rate |
$89.68 |
| Rate for Payer: Aetna American Axle |
$64.77
|
| Rate for Payer: Aetna Commercial |
$84.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.77
|
| Rate for Payer: Cash Price |
$79.71
|
| Rate for Payer: Cofinity Commercial |
$69.75
|
| Rate for Payer: Cofinity Commercial |
$85.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.71
|
| Rate for Payer: Healthscope Commercial |
$89.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$84.69
|
| Rate for Payer: PHP Commercial |
$84.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.75
|
| Rate for Payer: Priority Health SBD |
$62.77
|
| Rate for Payer: UMR Bronson Commercial |
$43.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.73
|
|
|
OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$48.59
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
91281
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.38 |
| Max. Negotiated Rate |
$43.73 |
| Rate for Payer: Aetna American Axle |
$31.58
|
| Rate for Payer: Aetna American Axle |
$33.09
|
| Rate for Payer: Aetna Commercial |
$43.27
|
| Rate for Payer: Aetna Commercial |
$41.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.09
|
| Rate for Payer: Cash Price |
$38.87
|
| Rate for Payer: Cash Price |
$40.73
|
| Rate for Payer: Cofinity Commercial |
$35.64
|
| Rate for Payer: Cofinity Commercial |
$41.79
|
| Rate for Payer: Cofinity Commercial |
$43.78
|
| Rate for Payer: Cofinity Commercial |
$34.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.87
|
| Rate for Payer: Healthscope Commercial |
$45.82
|
| Rate for Payer: Healthscope Commercial |
$43.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.30
|
| Rate for Payer: PHP Commercial |
$41.30
|
| Rate for Payer: PHP Commercial |
$43.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.01
|
| Rate for Payer: Priority Health SBD |
$30.61
|
| Rate for Payer: Priority Health SBD |
$32.07
|
| Rate for Payer: UMR Bronson Commercial |
$22.40
|
| Rate for Payer: UMR Bronson Commercial |
$21.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.44
|
|
|
OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$18.63
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
91278
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$16.77 |
| Rate for Payer: Aetna American Axle |
$12.11
|
| Rate for Payer: Aetna Commercial |
$15.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.11
|
| Rate for Payer: Cash Price |
$14.90
|
| Rate for Payer: Cofinity Commercial |
$13.04
|
| Rate for Payer: Cofinity Commercial |
$16.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.90
|
| Rate for Payer: Healthscope Commercial |
$16.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.84
|
| Rate for Payer: PHP Commercial |
$15.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.04
|
| Rate for Payer: Priority Health SBD |
$11.74
|
| Rate for Payer: UMR Bronson Commercial |
$8.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.97
|
|
|
OCTREOTIDE,MICROSPHERES ER 10 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE
|
Facility
|
IP
|
$8,106.93
|
|
|
Service Code
|
HCPCS J2353
|
| Hospital Charge Code |
161516
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,567.05 |
| Max. Negotiated Rate |
$7,296.24 |
| Rate for Payer: Aetna American Axle |
$5,269.50
|
| Rate for Payer: Aetna Commercial |
$6,890.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,269.50
|
| Rate for Payer: Cash Price |
$6,485.54
|
| Rate for Payer: Cofinity Commercial |
$6,971.96
|
| Rate for Payer: Cofinity Commercial |
$5,674.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,485.54
|
| Rate for Payer: Healthscope Commercial |
$7,296.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,674.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,080.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,890.89
|
| Rate for Payer: PHP Commercial |
$6,890.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,674.85
|
| Rate for Payer: Priority Health SBD |
$5,107.37
|
| Rate for Payer: UMR Bronson Commercial |
$3,567.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,080.20
|
|
|
OCTREOTIDE,MICROSPHERES ER 10 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE
|
Facility
|
OP
|
$8,106.93
|
|
|
Service Code
|
HCPCS J2353
|
| Hospital Charge Code |
161516
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$115.32 |
| Max. Negotiated Rate |
$7,296.24 |
| Rate for Payer: Aetna American Axle |
$5,269.50
|
| Rate for Payer: Aetna Commercial |
$6,890.89
|
| Rate for Payer: Aetna Medicare |
$219.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,269.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$263.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$263.54
|
| Rate for Payer: BCBS Complete |
$121.10
|
| Rate for Payer: BCBS MAPPO |
$210.83
|
| Rate for Payer: BCBS Trust/PPO |
$681.28
|
| Rate for Payer: BCN Medicare Advantage |
$210.83
|
| Rate for Payer: Cash Price |
$6,485.54
|
| Rate for Payer: Cash Price |
$6,485.54
|
| Rate for Payer: Cofinity Commercial |
$6,971.96
|
| Rate for Payer: Cofinity Commercial |
$5,674.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,485.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$210.83
|
| Rate for Payer: Healthscope Commercial |
$7,296.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,674.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,080.20
|
| Rate for Payer: Mclaren Medicaid |
$115.32
|
| Rate for Payer: Mclaren Medicare |
$210.83
|
| Rate for Payer: Meridian Medicaid |
$121.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$221.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$242.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,890.89
|
| Rate for Payer: PACE Medicare |
$200.29
|
| Rate for Payer: PACE SWMI |
$210.83
|
| Rate for Payer: PHP Commercial |
$6,890.89
|
| Rate for Payer: PHP Medicare Advantage |
$210.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$115.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,674.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$608.39
|
| Rate for Payer: Priority Health Medicare |
$210.83
|
| Rate for Payer: Priority Health Narrow Network |
$486.71
|
| Rate for Payer: Priority Health SBD |
$5,107.37
|
| Rate for Payer: Railroad Medicare Medicare |
$210.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$210.83
|
| Rate for Payer: UHC Medicare Advantage |
$217.15
|
| Rate for Payer: UMR Bronson Commercial |
$2,999.56
|
| Rate for Payer: VA VA |
$210.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,080.20
|
|
|
OCTREOTIDE,MICROSPHERES ER 20 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE
|
Facility
|
IP
|
$10,621.47
|
|
|
Service Code
|
HCPCS J2353
|
| Hospital Charge Code |
161512
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,673.45 |
| Max. Negotiated Rate |
$9,559.32 |
| Rate for Payer: Aetna American Axle |
$6,903.96
|
| Rate for Payer: Aetna Commercial |
$9,028.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,903.96
|
| Rate for Payer: Cash Price |
$8,497.18
|
| Rate for Payer: Cofinity Commercial |
$7,435.03
|
| Rate for Payer: Cofinity Commercial |
$9,134.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,497.18
|
| Rate for Payer: Healthscope Commercial |
$9,559.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,435.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,966.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,028.25
|
| Rate for Payer: PHP Commercial |
$9,028.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,435.03
|
| Rate for Payer: Priority Health SBD |
$6,691.53
|
| Rate for Payer: UMR Bronson Commercial |
$4,673.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,966.10
|
|
|
OCTREOTIDE,MICROSPHERES ER 20 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE
|
Facility
|
OP
|
$10,621.47
|
|
|
Service Code
|
HCPCS J2353
|
| Hospital Charge Code |
161512
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$115.32 |
| Max. Negotiated Rate |
$9,559.32 |
| Rate for Payer: Aetna American Axle |
$6,903.96
|
| Rate for Payer: Aetna Commercial |
$9,028.25
|
| Rate for Payer: Aetna Medicare |
$219.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,903.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$263.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$263.54
|
| Rate for Payer: BCBS Complete |
$121.10
|
| Rate for Payer: BCBS MAPPO |
$210.83
|
| Rate for Payer: BCBS Trust/PPO |
$681.28
|
| Rate for Payer: BCN Medicare Advantage |
$210.83
|
| Rate for Payer: Cash Price |
$8,497.18
|
| Rate for Payer: Cash Price |
$8,497.18
|
| Rate for Payer: Cofinity Commercial |
$9,134.46
|
| Rate for Payer: Cofinity Commercial |
$7,435.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,497.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$210.83
|
| Rate for Payer: Healthscope Commercial |
$9,559.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,435.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,966.10
|
| Rate for Payer: Mclaren Medicaid |
$115.32
|
| Rate for Payer: Mclaren Medicare |
$210.83
|
| Rate for Payer: Meridian Medicaid |
$121.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$221.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$242.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,028.25
|
| Rate for Payer: PACE Medicare |
$200.29
|
| Rate for Payer: PACE SWMI |
$210.83
|
| Rate for Payer: PHP Commercial |
$9,028.25
|
| Rate for Payer: PHP Medicare Advantage |
$210.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$115.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,435.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$608.39
|
| Rate for Payer: Priority Health Medicare |
$210.83
|
| Rate for Payer: Priority Health Narrow Network |
$486.71
|
| Rate for Payer: Priority Health SBD |
$6,691.53
|
| Rate for Payer: Railroad Medicare Medicare |
$210.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$210.83
|
| Rate for Payer: UHC Medicare Advantage |
$217.15
|
| Rate for Payer: UMR Bronson Commercial |
$3,929.94
|
| Rate for Payer: VA VA |
$210.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,966.10
|
|
|
OCTREOTIDE,MICROSPHERES ER 30 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE
|
Facility
|
OP
|
$15,904.88
|
|
|
Service Code
|
HCPCS J2353
|
| Hospital Charge Code |
161514
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$115.32 |
| Max. Negotiated Rate |
$14,314.39 |
| Rate for Payer: Aetna American Axle |
$10,338.17
|
| Rate for Payer: Aetna Commercial |
$13,519.15
|
| Rate for Payer: Aetna Medicare |
$219.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,338.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$263.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$263.54
|
| Rate for Payer: BCBS Complete |
$121.10
|
| Rate for Payer: BCBS MAPPO |
$210.83
|
| Rate for Payer: BCBS Trust/PPO |
$681.28
|
| Rate for Payer: BCN Medicare Advantage |
$210.83
|
| Rate for Payer: Cash Price |
$12,723.90
|
| Rate for Payer: Cash Price |
$12,723.90
|
| Rate for Payer: Cofinity Commercial |
$13,678.20
|
| Rate for Payer: Cofinity Commercial |
$11,133.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,723.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$210.83
|
| Rate for Payer: Healthscope Commercial |
$14,314.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,133.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,928.66
|
| Rate for Payer: Mclaren Medicaid |
$115.32
|
| Rate for Payer: Mclaren Medicare |
$210.83
|
| Rate for Payer: Meridian Medicaid |
$121.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$221.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$242.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13,519.15
|
| Rate for Payer: PACE Medicare |
$200.29
|
| Rate for Payer: PACE SWMI |
$210.83
|
| Rate for Payer: PHP Commercial |
$13,519.15
|
| Rate for Payer: PHP Medicare Advantage |
$210.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$115.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,133.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$608.39
|
| Rate for Payer: Priority Health Medicare |
$210.83
|
| Rate for Payer: Priority Health Narrow Network |
$486.71
|
| Rate for Payer: Priority Health SBD |
$10,020.07
|
| Rate for Payer: Railroad Medicare Medicare |
$210.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$210.83
|
| Rate for Payer: UHC Medicare Advantage |
$217.15
|
| Rate for Payer: UMR Bronson Commercial |
$5,884.81
|
| Rate for Payer: VA VA |
$210.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,928.66
|
|
