|
LURASIDONE 20 MG TABLET
|
Facility
|
OP
|
$103.17
|
|
|
Service Code
|
NDC 67877063830
|
| Hospital Charge Code |
158952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.17 |
| Max. Negotiated Rate |
$92.85 |
| Rate for Payer: Aetna American Axle |
$67.06
|
| Rate for Payer: Aetna Commercial |
$87.69
|
| Rate for Payer: Aetna Medicare |
$51.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.06
|
| Rate for Payer: BCBS Complete |
$41.27
|
| Rate for Payer: Cash Price |
$82.54
|
| Rate for Payer: Cofinity Advantage |
$72.22
|
| Rate for Payer: Cofinity Commercial |
$88.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.54
|
| Rate for Payer: Healthscope Commercial |
$92.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.38
|
| Rate for Payer: PHP Commercial |
$87.69
|
| Rate for Payer: Priority Health SBD |
$65.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.06
|
| Rate for Payer: UHC Core |
$53.75
|
| Rate for Payer: UHC Exchange |
$40.55
|
| Rate for Payer: UMR Bronson Commercial |
$38.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.38
|
|
|
LURASIDONE 20 MG TABLET
|
Facility
|
OP
|
$119.15
|
|
|
Service Code
|
NDC 31722008030
|
| Hospital Charge Code |
158952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.09 |
| Max. Negotiated Rate |
$107.23 |
| Rate for Payer: Aetna American Axle |
$77.45
|
| Rate for Payer: Aetna Commercial |
$101.28
|
| Rate for Payer: Aetna Medicare |
$59.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.45
|
| Rate for Payer: BCBS Complete |
$47.66
|
| Rate for Payer: Cash Price |
$95.32
|
| Rate for Payer: Cofinity Advantage |
$83.41
|
| Rate for Payer: Cofinity Commercial |
$102.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.32
|
| Rate for Payer: Healthscope Commercial |
$107.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.36
|
| Rate for Payer: PHP Commercial |
$101.28
|
| Rate for Payer: Priority Health SBD |
$75.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.45
|
| Rate for Payer: UHC Core |
$62.08
|
| Rate for Payer: UHC Exchange |
$46.83
|
| Rate for Payer: UMR Bronson Commercial |
$44.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.36
|
|
|
LURASIDONE 20 MG TABLET
|
Facility
|
IP
|
$119.15
|
|
|
Service Code
|
NDC 31722008030
|
| Hospital Charge Code |
158952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.43 |
| Max. Negotiated Rate |
$107.23 |
| Rate for Payer: Aetna American Axle |
$77.45
|
| Rate for Payer: Aetna Commercial |
$101.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.45
|
| Rate for Payer: Cash Price |
$95.32
|
| Rate for Payer: Cofinity Advantage |
$83.41
|
| Rate for Payer: Cofinity Commercial |
$102.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.32
|
| Rate for Payer: Healthscope Commercial |
$107.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.36
|
| Rate for Payer: PHP Commercial |
$101.28
|
| Rate for Payer: Priority Health SBD |
$75.06
|
| Rate for Payer: UMR Bronson Commercial |
$52.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.36
|
|
|
LURASIDONE 40 MG TABLET
|
Facility
|
IP
|
$89.28
|
|
|
Service Code
|
NDC 72205020830
|
| Hospital Charge Code |
107668
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$80.35 |
| Rate for Payer: Aetna American Axle |
$58.03
|
| Rate for Payer: Aetna Commercial |
$75.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.03
|
| Rate for Payer: Cash Price |
$71.42
|
| Rate for Payer: Cofinity Advantage |
$62.50
|
| Rate for Payer: Cofinity Commercial |
$76.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.42
|
| Rate for Payer: Healthscope Commercial |
$80.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.96
|
| Rate for Payer: PHP Commercial |
$75.89
|
| Rate for Payer: Priority Health SBD |
$56.25
|
| Rate for Payer: UMR Bronson Commercial |
$39.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.96
|
|
|
LURASIDONE 40 MG TABLET
|
Facility
|
IP
|
$72.72
|
|
|
Service Code
|
NDC 67877063930
|
| Hospital Charge Code |
107668
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$65.45 |
| Rate for Payer: Aetna American Axle |
$47.27
|
| Rate for Payer: Aetna Commercial |
$61.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.27
|
| Rate for Payer: Cash Price |
$58.18
|
| Rate for Payer: Cofinity Advantage |
$50.90
|
| Rate for Payer: Cofinity Commercial |
$62.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.18
|
| Rate for Payer: Healthscope Commercial |
$65.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.54
|
| Rate for Payer: PHP Commercial |
$61.81
|
| Rate for Payer: Priority Health SBD |
$45.81
|
| Rate for Payer: UMR Bronson Commercial |
$32.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.54
|
|
|
LURASIDONE 40 MG TABLET
|
Facility
|
IP
|
$89.28
|
|
|
Service Code
|
NDC 68180067106
|
| Hospital Charge Code |
107668
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$80.35 |
| Rate for Payer: Aetna American Axle |
$58.03
|
| Rate for Payer: Aetna Commercial |
$75.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.03
|
| Rate for Payer: Cash Price |
$71.42
|
| Rate for Payer: Cofinity Advantage |
$62.50
|
| Rate for Payer: Cofinity Commercial |
$76.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.42
|
| Rate for Payer: Healthscope Commercial |
$80.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.96
|
| Rate for Payer: PHP Commercial |
$75.89
|
| Rate for Payer: Priority Health SBD |
$56.25
|
| Rate for Payer: UMR Bronson Commercial |
$39.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.96
|
|
|
LURASIDONE 40 MG TABLET
|
Facility
|
OP
|
$72.72
|
|
|
Service Code
|
NDC 67877063930
|
| Hospital Charge Code |
107668
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.91 |
| Max. Negotiated Rate |
$65.45 |
| Rate for Payer: Aetna American Axle |
$47.27
|
| Rate for Payer: Aetna Commercial |
$61.81
|
| Rate for Payer: Aetna Medicare |
$36.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.27
|
| Rate for Payer: BCBS Complete |
$29.09
|
| Rate for Payer: Cash Price |
$58.18
|
| Rate for Payer: Cofinity Advantage |
$50.90
|
| Rate for Payer: Cofinity Commercial |
$62.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.18
|
| Rate for Payer: Healthscope Commercial |
$65.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.54
|
| Rate for Payer: PHP Commercial |
$61.81
|
| Rate for Payer: Priority Health SBD |
$45.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.27
|
| Rate for Payer: UHC Core |
$37.89
|
| Rate for Payer: UHC Exchange |
$28.58
|
| Rate for Payer: UMR Bronson Commercial |
$26.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.54
|
|
|
LURASIDONE 40 MG TABLET
|
Facility
|
OP
|
$5,028.19
|
|
|
Service Code
|
NDC 63402030430
|
| Hospital Charge Code |
107668
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,860.43 |
| Max. Negotiated Rate |
$4,525.37 |
| Rate for Payer: Aetna American Axle |
$3,268.32
|
| Rate for Payer: Aetna Commercial |
$4,273.96
|
| Rate for Payer: Aetna Medicare |
$2,514.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,268.32
|
| Rate for Payer: BCBS Complete |
$2,011.28
|
| Rate for Payer: Cash Price |
$4,022.55
|
| Rate for Payer: Cofinity Advantage |
$3,519.73
|
| Rate for Payer: Cofinity Commercial |
$4,324.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,022.55
|
| Rate for Payer: Healthscope Commercial |
$4,525.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,519.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,771.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,022.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,273.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,771.14
|
| Rate for Payer: PHP Commercial |
$4,273.96
|
| Rate for Payer: Priority Health SBD |
$3,167.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,268.32
|
| Rate for Payer: UHC Core |
$2,619.69
|
| Rate for Payer: UHC Exchange |
$1,976.08
|
| Rate for Payer: UMR Bronson Commercial |
$1,860.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,771.14
|
|
|
LURASIDONE 40 MG TABLET
|
Facility
|
IP
|
$5,028.19
|
|
|
Service Code
|
NDC 63402030430
|
| Hospital Charge Code |
107668
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,212.40 |
| Max. Negotiated Rate |
$4,525.37 |
| Rate for Payer: Aetna American Axle |
$3,268.32
|
| Rate for Payer: Aetna Commercial |
$4,273.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,268.32
|
| Rate for Payer: Cash Price |
$4,022.55
|
| Rate for Payer: Cofinity Advantage |
$3,519.73
|
| Rate for Payer: Cofinity Commercial |
$4,324.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,022.55
|
| Rate for Payer: Healthscope Commercial |
$4,525.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,519.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,771.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,273.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,771.14
|
| Rate for Payer: PHP Commercial |
$4,273.96
|
| Rate for Payer: Priority Health SBD |
$3,167.76
|
| Rate for Payer: UMR Bronson Commercial |
$2,212.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,771.14
|
|
|
LURASIDONE 40 MG TABLET
|
Facility
|
OP
|
$89.28
|
|
|
Service Code
|
NDC 68180067106
|
| Hospital Charge Code |
107668
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.03 |
| Max. Negotiated Rate |
$80.35 |
| Rate for Payer: Aetna American Axle |
$58.03
|
| Rate for Payer: Aetna Commercial |
$75.89
|
| Rate for Payer: Aetna Medicare |
$44.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.03
|
| Rate for Payer: BCBS Complete |
$35.71
|
| Rate for Payer: Cash Price |
$71.42
|
| Rate for Payer: Cofinity Advantage |
$62.50
|
| Rate for Payer: Cofinity Commercial |
$76.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.42
|
| Rate for Payer: Healthscope Commercial |
$80.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.96
|
| Rate for Payer: PHP Commercial |
$75.89
|
| Rate for Payer: Priority Health SBD |
$56.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.03
|
| Rate for Payer: UHC Core |
$46.51
|
| Rate for Payer: UHC Exchange |
$35.09
|
| Rate for Payer: UMR Bronson Commercial |
$33.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.96
|
|
|
LURASIDONE 40 MG TABLET
|
Facility
|
OP
|
$89.28
|
|
|
Service Code
|
NDC 72205020830
|
| Hospital Charge Code |
107668
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.03 |
| Max. Negotiated Rate |
$80.35 |
| Rate for Payer: Aetna American Axle |
$58.03
|
| Rate for Payer: Aetna Commercial |
$75.89
|
| Rate for Payer: Aetna Medicare |
$44.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.03
|
| Rate for Payer: BCBS Complete |
$35.71
|
| Rate for Payer: Cash Price |
$71.42
|
| Rate for Payer: Cofinity Advantage |
$62.50
|
| Rate for Payer: Cofinity Commercial |
$76.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.42
|
| Rate for Payer: Healthscope Commercial |
$80.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.96
|
| Rate for Payer: PHP Commercial |
$75.89
|
| Rate for Payer: Priority Health SBD |
$56.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.03
|
| Rate for Payer: UHC Core |
$46.51
|
| Rate for Payer: UHC Exchange |
$35.09
|
| Rate for Payer: UMR Bronson Commercial |
$33.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.96
|
|
|
LURASIDONE 40 MG TABLET
|
Facility
|
IP
|
$73.53
|
|
|
Service Code
|
NDC 31722008130
|
| Hospital Charge Code |
107668
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.35 |
| Max. Negotiated Rate |
$66.18 |
| Rate for Payer: Aetna American Axle |
$47.79
|
| Rate for Payer: Aetna Commercial |
$62.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.79
|
| Rate for Payer: Cash Price |
$58.82
|
| Rate for Payer: Cofinity Advantage |
$51.47
|
| Rate for Payer: Cofinity Commercial |
$63.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.82
|
| Rate for Payer: Healthscope Commercial |
$66.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.15
|
| Rate for Payer: PHP Commercial |
$62.50
|
| Rate for Payer: Priority Health SBD |
$46.32
|
| Rate for Payer: UMR Bronson Commercial |
$32.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.15
|
|
|
LURASIDONE 40 MG TABLET
|
Facility
|
OP
|
$73.53
|
|
|
Service Code
|
NDC 31722008130
|
| Hospital Charge Code |
107668
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.21 |
| Max. Negotiated Rate |
$66.18 |
| Rate for Payer: Aetna American Axle |
$47.79
|
| Rate for Payer: Aetna Commercial |
$62.50
|
| Rate for Payer: Aetna Medicare |
$36.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.79
|
| Rate for Payer: BCBS Complete |
$29.41
|
| Rate for Payer: Cash Price |
$58.82
|
| Rate for Payer: Cofinity Advantage |
$51.47
|
| Rate for Payer: Cofinity Commercial |
$63.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.82
|
| Rate for Payer: Healthscope Commercial |
$66.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.15
|
| Rate for Payer: PHP Commercial |
$62.50
|
| Rate for Payer: Priority Health SBD |
$46.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.79
|
| Rate for Payer: UHC Core |
$38.31
|
| Rate for Payer: UHC Exchange |
$28.90
|
| Rate for Payer: UMR Bronson Commercial |
$27.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.15
|
|
|
LURBINECTEDIN 4 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21,450.00
|
|
|
Service Code
|
HCPCS J9223
|
| Hospital Charge Code |
194141
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$110.93 |
| Max. Negotiated Rate |
$19,305.00 |
| Rate for Payer: Aetna American Axle |
$13,942.50
|
| Rate for Payer: Aetna Commercial |
$18,232.50
|
| Rate for Payer: Aetna Medicare |
$220.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,942.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$265.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$265.12
|
| Rate for Payer: BCBS Complete |
$116.49
|
| Rate for Payer: BCBS MAPPO |
$212.10
|
| Rate for Payer: BCBS Trust/PPO |
$683.50
|
| Rate for Payer: BCN Commercial |
$683.50
|
| Rate for Payer: BCN Medicare Advantage |
$212.10
|
| Rate for Payer: Cash Price |
$17,160.00
|
| Rate for Payer: Cash Price |
$17,160.00
|
| Rate for Payer: Cofinity Advantage |
$15,015.00
|
| Rate for Payer: Cofinity Commercial |
$18,447.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,160.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$212.10
|
| Rate for Payer: Healthscope Commercial |
$19,305.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15,015.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16,087.50
|
| Rate for Payer: Mclaren Medicaid |
$212.10
|
| Rate for Payer: Mclaren Medicare |
$212.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$222.71
|
| Rate for Payer: Meridian Medicaid |
$222.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$243.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$233.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,232.50
|
| Rate for Payer: Nomi Health Commercial |
$636.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16,087.50
|
| Rate for Payer: PACE Medicare |
$201.50
|
| Rate for Payer: PACE SWMI |
$212.10
|
| Rate for Payer: PHP Commercial |
$18,232.50
|
| Rate for Payer: PHP Medicare Advantage |
$212.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$653.28
|
| Rate for Payer: Priority Health Medicare |
$212.10
|
| Rate for Payer: Priority Health SBD |
$13,513.50
|
| Rate for Payer: Priority Health Tiered Network |
$522.62
|
| Rate for Payer: Railroad Medicare Medicare |
$212.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$347.79
|
| Rate for Payer: UHC Core |
$347.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$212.10
|
| Rate for Payer: UHC Exchange |
$347.79
|
| Rate for Payer: UHC Medicaid |
$110.93
|
| Rate for Payer: UHCCP Medicaid |
$110.93
|
| Rate for Payer: UMR Bronson Commercial |
$7,936.50
|
| Rate for Payer: VA VA |
$212.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16,087.50
|
|
|
LURBINECTEDIN 4 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21,450.00
|
|
|
Service Code
|
HCPCS J9223
|
| Hospital Charge Code |
194141
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,438.00 |
| Max. Negotiated Rate |
$19,305.00 |
| Rate for Payer: Aetna American Axle |
$13,942.50
|
| Rate for Payer: Aetna Commercial |
$18,232.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,942.50
|
| Rate for Payer: Cash Price |
$17,160.00
|
| Rate for Payer: Cofinity Advantage |
$15,015.00
|
| Rate for Payer: Cofinity Commercial |
$18,447.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,160.00
|
| Rate for Payer: Healthscope Commercial |
$19,305.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15,015.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16,087.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,232.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16,087.50
|
| Rate for Payer: PHP Commercial |
$18,232.50
|
| Rate for Payer: Priority Health SBD |
$13,513.50
|
| Rate for Payer: UMR Bronson Commercial |
$9,438.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16,087.50
|
|
|
LUSPATERCEPT-AAMT 25 MG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$18,202.00
|
|
|
Service Code
|
HCPCS J0896
|
| Hospital Charge Code |
192114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8,008.88 |
| Max. Negotiated Rate |
$16,381.80 |
| Rate for Payer: Aetna American Axle |
$11,831.30
|
| Rate for Payer: Aetna Commercial |
$15,471.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,831.30
|
| Rate for Payer: Cash Price |
$14,561.60
|
| Rate for Payer: Cofinity Advantage |
$12,741.40
|
| Rate for Payer: Cofinity Commercial |
$15,653.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,561.60
|
| Rate for Payer: Healthscope Commercial |
$16,381.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,741.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,651.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,471.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,651.50
|
| Rate for Payer: PHP Commercial |
$15,471.70
|
| Rate for Payer: Priority Health SBD |
$11,467.26
|
| Rate for Payer: UMR Bronson Commercial |
$8,008.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,651.50
|
|
|
LUSPATERCEPT-AAMT 25 MG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$18,202.00
|
|
|
Service Code
|
HCPCS J0896
|
| Hospital Charge Code |
192114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.36 |
| Max. Negotiated Rate |
$16,381.80 |
| Rate for Payer: Aetna American Axle |
$11,831.30
|
| Rate for Payer: Aetna Commercial |
$15,471.70
|
| Rate for Payer: Aetna Medicare |
$44.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,831.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.44
|
| Rate for Payer: BCBS Complete |
$23.48
|
| Rate for Payer: BCBS MAPPO |
$42.75
|
| Rate for Payer: BCBS Trust/PPO |
$138.70
|
| Rate for Payer: BCN Commercial |
$138.70
|
| Rate for Payer: BCN Medicare Advantage |
$42.75
|
| Rate for Payer: Cash Price |
$14,561.60
|
| Rate for Payer: Cash Price |
$14,561.60
|
| Rate for Payer: Cofinity Advantage |
$12,741.40
|
| Rate for Payer: Cofinity Commercial |
$15,653.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,561.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.75
|
| Rate for Payer: Healthscope Commercial |
$16,381.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,741.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,651.50
|
| Rate for Payer: Mclaren Medicaid |
$42.75
|
| Rate for Payer: Mclaren Medicare |
$42.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.89
|
| Rate for Payer: Meridian Medicaid |
$44.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$47.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,471.70
|
| Rate for Payer: Nomi Health Commercial |
$128.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,651.50
|
| Rate for Payer: PACE Medicare |
$40.61
|
| Rate for Payer: PACE SWMI |
$42.75
|
| Rate for Payer: PHP Commercial |
$15,471.70
|
| Rate for Payer: PHP Medicare Advantage |
$42.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$132.40
|
| Rate for Payer: Priority Health Medicare |
$42.75
|
| Rate for Payer: Priority Health SBD |
$11,467.26
|
| Rate for Payer: Priority Health Tiered Network |
$105.92
|
| Rate for Payer: Railroad Medicare Medicare |
$42.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.57
|
| Rate for Payer: UHC Core |
$70.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$42.75
|
| Rate for Payer: UHC Exchange |
$70.57
|
| Rate for Payer: UHC Medicaid |
$22.36
|
| Rate for Payer: UHCCP Medicaid |
$22.36
|
| Rate for Payer: UMR Bronson Commercial |
$6,734.74
|
| Rate for Payer: VA VA |
$42.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,651.50
|
|
|
LUSPATERCEPT-AAMT 75 MG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$54,605.00
|
|
|
Service Code
|
HCPCS J0896
|
| Hospital Charge Code |
192115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24,026.20 |
| Max. Negotiated Rate |
$49,144.50 |
| Rate for Payer: Aetna American Axle |
$35,493.25
|
| Rate for Payer: Aetna Commercial |
$46,414.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35,493.25
|
| Rate for Payer: Cash Price |
$43,684.00
|
| Rate for Payer: Cofinity Advantage |
$38,223.50
|
| Rate for Payer: Cofinity Commercial |
$46,960.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43,684.00
|
| Rate for Payer: Healthscope Commercial |
$49,144.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38,223.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40,953.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46,414.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40,953.75
|
| Rate for Payer: PHP Commercial |
$46,414.25
|
| Rate for Payer: Priority Health SBD |
$34,401.15
|
| Rate for Payer: UMR Bronson Commercial |
$24,026.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40,953.75
|
|
|
LUSPATERCEPT-AAMT 75 MG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$54,605.00
|
|
|
Service Code
|
HCPCS J0896
|
| Hospital Charge Code |
192115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.36 |
| Max. Negotiated Rate |
$49,144.50 |
| Rate for Payer: Aetna American Axle |
$35,493.25
|
| Rate for Payer: Aetna Commercial |
$46,414.25
|
| Rate for Payer: Aetna Medicare |
$44.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35,493.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.44
|
| Rate for Payer: BCBS Complete |
$23.48
|
| Rate for Payer: BCBS MAPPO |
$42.75
|
| Rate for Payer: BCBS Trust/PPO |
$138.70
|
| Rate for Payer: BCN Commercial |
$138.70
|
| Rate for Payer: BCN Medicare Advantage |
$42.75
|
| Rate for Payer: Cash Price |
$43,684.00
|
| Rate for Payer: Cash Price |
$43,684.00
|
| Rate for Payer: Cofinity Advantage |
$38,223.50
|
| Rate for Payer: Cofinity Commercial |
$46,960.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43,684.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.75
|
| Rate for Payer: Healthscope Commercial |
$49,144.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38,223.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40,953.75
|
| Rate for Payer: Mclaren Medicaid |
$42.75
|
| Rate for Payer: Mclaren Medicare |
$42.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.89
|
| Rate for Payer: Meridian Medicaid |
$44.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$47.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46,414.25
|
| Rate for Payer: Nomi Health Commercial |
$128.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40,953.75
|
| Rate for Payer: PACE Medicare |
$40.61
|
| Rate for Payer: PACE SWMI |
$42.75
|
| Rate for Payer: PHP Commercial |
$46,414.25
|
| Rate for Payer: PHP Medicare Advantage |
$42.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$132.40
|
| Rate for Payer: Priority Health Medicare |
$42.75
|
| Rate for Payer: Priority Health SBD |
$34,401.15
|
| Rate for Payer: Priority Health Tiered Network |
$105.92
|
| Rate for Payer: Railroad Medicare Medicare |
$42.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.57
|
| Rate for Payer: UHC Core |
$70.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$42.75
|
| Rate for Payer: UHC Exchange |
$70.57
|
| Rate for Payer: UHC Medicaid |
$22.36
|
| Rate for Payer: UHCCP Medicaid |
$22.36
|
| Rate for Payer: UMR Bronson Commercial |
$20,203.85
|
| Rate for Payer: VA VA |
$42.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40,953.75
|
|
|
LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR
|
Facility
|
IP
|
$4,613.18
|
|
|
Service Code
|
APR-DRG 6941
|
| Min. Negotiated Rate |
$4,393.51 |
| Max. Negotiated Rate |
$4,613.18 |
| Rate for Payer: BCBS Complete |
$4,613.18
|
| Rate for Payer: Mclaren Medicaid |
$4,393.51
|
| Rate for Payer: Meridian Medicaid |
$4,613.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,393.51
|
| Rate for Payer: UHC Medicaid |
$4,393.51
|
| Rate for Payer: UHCCP Medicaid |
$4,393.51
|
|
|
LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR
|
Facility
|
IP
|
$8,398.28
|
|
|
Service Code
|
APR-DRG 6943
|
| Min. Negotiated Rate |
$7,998.36 |
| Max. Negotiated Rate |
$8,398.28 |
| Rate for Payer: BCBS Complete |
$8,398.28
|
| Rate for Payer: Mclaren Medicaid |
$7,998.36
|
| Rate for Payer: Meridian Medicaid |
$8,398.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,998.36
|
| Rate for Payer: UHC Medicaid |
$7,998.36
|
| Rate for Payer: UHCCP Medicaid |
$7,998.36
|
|
|
LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR
|
Facility
|
IP
|
$12,410.37
|
|
|
Service Code
|
APR-DRG 6944
|
| Min. Negotiated Rate |
$11,819.40 |
| Max. Negotiated Rate |
$12,410.37 |
| Rate for Payer: BCBS Complete |
$12,410.37
|
| Rate for Payer: Mclaren Medicaid |
$11,819.40
|
| Rate for Payer: Meridian Medicaid |
$12,410.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,819.40
|
| Rate for Payer: UHC Medicaid |
$11,819.40
|
| Rate for Payer: UHCCP Medicaid |
$11,819.40
|
|
|
LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR
|
Facility
|
IP
|
$6,701.55
|
|
|
Service Code
|
APR-DRG 6942
|
| Min. Negotiated Rate |
$6,382.43 |
| Max. Negotiated Rate |
$6,701.55 |
| Rate for Payer: BCBS Complete |
$6,701.55
|
| Rate for Payer: Mclaren Medicaid |
$6,382.43
|
| Rate for Payer: Meridian Medicaid |
$6,701.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,382.43
|
| Rate for Payer: UHC Medicaid |
$6,382.43
|
| Rate for Payer: UHCCP Medicaid |
$6,382.43
|
|
|
LYMPHOCYTE,ANTI-THYMO IMMUNE GLOBULIN 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$12,850.05
|
|
|
Service Code
|
HCPCS J7504
|
| Hospital Charge Code |
10475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,654.02 |
| Max. Negotiated Rate |
$11,565.05 |
| Rate for Payer: Aetna American Axle |
$8,352.53
|
| Rate for Payer: Aetna Commercial |
$10,922.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,352.53
|
| Rate for Payer: Cash Price |
$10,280.04
|
| Rate for Payer: Cofinity Advantage |
$8,995.03
|
| Rate for Payer: Cofinity Commercial |
$11,051.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,280.04
|
| Rate for Payer: Healthscope Commercial |
$11,565.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,995.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,637.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,922.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,637.54
|
| Rate for Payer: PHP Commercial |
$10,922.54
|
| Rate for Payer: Priority Health SBD |
$8,095.53
|
| Rate for Payer: UMR Bronson Commercial |
$5,654.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,637.54
|
|
|
LYMPHOCYTE,ANTI-THYMO IMMUNE GLOBULIN 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$12,850.05
|
|
|
Service Code
|
HCPCS J7504
|
| Hospital Charge Code |
10475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,767.94 |
| Max. Negotiated Rate |
$17,211.72 |
| Rate for Payer: Aetna American Axle |
$8,352.53
|
| Rate for Payer: Aetna Commercial |
$10,922.54
|
| Rate for Payer: Aetna Medicare |
$5,504.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,352.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,615.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,615.54
|
| Rate for Payer: BCBS Complete |
$2,906.60
|
| Rate for Payer: BCBS MAPPO |
$5,292.43
|
| Rate for Payer: BCBS Trust/PPO |
$17,211.72
|
| Rate for Payer: BCN Commercial |
$17,211.72
|
| Rate for Payer: BCN Medicare Advantage |
$5,292.43
|
| Rate for Payer: Cash Price |
$10,280.04
|
| Rate for Payer: Cash Price |
$10,280.04
|
| Rate for Payer: Cofinity Advantage |
$8,995.03
|
| Rate for Payer: Cofinity Commercial |
$11,051.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,280.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,292.43
|
| Rate for Payer: Healthscope Commercial |
$11,565.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,995.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,637.54
|
| Rate for Payer: Mclaren Medicaid |
$5,292.43
|
| Rate for Payer: Mclaren Medicare |
$5,292.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,557.05
|
| Rate for Payer: Meridian Medicaid |
$5,557.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,086.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,821.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,922.54
|
| Rate for Payer: Nomi Health Commercial |
$15,877.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,637.54
|
| Rate for Payer: PACE Medicare |
$5,027.81
|
| Rate for Payer: PACE SWMI |
$5,292.43
|
| Rate for Payer: PHP Commercial |
$10,922.54
|
| Rate for Payer: PHP Medicare Advantage |
$5,292.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,767.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16,195.91
|
| Rate for Payer: Priority Health Medicare |
$5,292.43
|
| Rate for Payer: Priority Health SBD |
$8,095.53
|
| Rate for Payer: Priority Health Tiered Network |
$12,956.73
|
| Rate for Payer: Railroad Medicare Medicare |
$5,292.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,758.08
|
| Rate for Payer: UHC Core |
$8,758.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,292.43
|
| Rate for Payer: UHC Exchange |
$8,758.08
|
| Rate for Payer: UHC Medicaid |
$2,767.94
|
| Rate for Payer: UHCCP Medicaid |
$2,767.94
|
| Rate for Payer: UMR Bronson Commercial |
$4,754.52
|
| Rate for Payer: VA VA |
$5,292.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,637.54
|
|
