|
NYSTATIN (BULK) 100 MILLION UNIT POWDER
|
Facility
|
IP
|
$178.50
|
|
|
Service Code
|
NDC 62991278501
|
| Hospital Charge Code |
120073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.54 |
| Max. Negotiated Rate |
$160.65 |
| Rate for Payer: Aetna American Axle |
$116.03
|
| Rate for Payer: Aetna Commercial |
$151.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.03
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cofinity Advantage |
$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 Commercial |
$151.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.88
|
| Rate for Payer: PHP Commercial |
$151.72
|
| Rate for Payer: Priority Health SBD |
$112.45
|
| Rate for Payer: UMR Bronson Commercial |
$78.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.88
|
|
|
NYSTATIN (BULK) 100 MILLION UNIT POWDER
|
Facility
|
OP
|
$178.50
|
|
|
Service Code
|
NDC 62991278501
|
| Hospital Charge Code |
120073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.05 |
| Max. Negotiated Rate |
$160.65 |
| Rate for Payer: Aetna American Axle |
$116.03
|
| Rate for Payer: Aetna Commercial |
$151.72
|
| Rate for Payer: Aetna Medicare |
$89.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.03
|
| Rate for Payer: BCBS Complete |
$71.40
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$142.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.88
|
| Rate for Payer: PHP Commercial |
$151.72
|
| Rate for Payer: Priority Health SBD |
$112.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.03
|
| Rate for Payer: UHC Core |
$93.00
|
| Rate for Payer: UHC Exchange |
$70.15
|
| Rate for Payer: UMR Bronson Commercial |
$66.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.88
|
|
|
NYSTATIN (BULK) 100 MILLION UNIT POWDER
|
Facility
|
OP
|
$446.25
|
|
|
Service Code
|
NDC 09900001984
|
| Hospital Charge Code |
120073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.11 |
| Max. Negotiated Rate |
$401.62 |
| Rate for Payer: Aetna American Axle |
$290.06
|
| Rate for Payer: Aetna Commercial |
$379.31
|
| Rate for Payer: Aetna Medicare |
$223.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.06
|
| Rate for Payer: BCBS Complete |
$178.50
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cofinity Advantage |
$312.38
|
| Rate for Payer: Cofinity Commercial |
$383.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.00
|
| Rate for Payer: Healthscope Commercial |
$401.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$312.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$334.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$357.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.69
|
| Rate for Payer: PHP Commercial |
$379.31
|
| Rate for Payer: Priority Health SBD |
$281.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$290.06
|
| Rate for Payer: UHC Core |
$232.50
|
| Rate for Payer: UHC Exchange |
$175.38
|
| Rate for Payer: UMR Bronson Commercial |
$165.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.69
|
|
|
OB/GYN SPEC KZOO ONLY - NITROUS OXIDE ADMIN
|
Professional
|
Both
|
$63.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$47.25 |
| Rate for Payer: Aetna Medicare |
$31.50
|
| Rate for Payer: BCBS Complete |
$25.20
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.25
|
| Rate for Payer: UMR Bronson Commercial |
$28.98
|
|
|
OBINUTUZUMAB 1,000 MG/40 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$42,431.94
|
|
|
Service Code
|
HCPCS J9301
|
| Hospital Charge Code |
168805
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18,670.05 |
| Max. Negotiated Rate |
$38,188.75 |
| Rate for Payer: Aetna American Axle |
$27,580.76
|
| Rate for Payer: Aetna Commercial |
$36,067.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27,580.76
|
| Rate for Payer: Cash Price |
$33,945.55
|
| Rate for Payer: Cofinity Advantage |
$29,702.36
|
| Rate for Payer: Cofinity Commercial |
$36,491.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33,945.55
|
| Rate for Payer: Healthscope Commercial |
$38,188.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29,702.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31,823.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36,067.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31,823.96
|
| Rate for Payer: PHP Commercial |
$36,067.15
|
| Rate for Payer: Priority Health SBD |
$26,732.12
|
| Rate for Payer: UMR Bronson Commercial |
$18,670.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31,823.96
|
|
|
OBINUTUZUMAB 1,000 MG/40 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$42,431.94
|
|
|
Service Code
|
HCPCS J9301
|
| Hospital Charge Code |
168805
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.79 |
| Max. Negotiated Rate |
$38,188.75 |
| Rate for Payer: Aetna American Axle |
$27,580.76
|
| Rate for Payer: Aetna Commercial |
$36,067.15
|
| Rate for Payer: Aetna Medicare |
$85.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27,580.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$102.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$102.26
|
| Rate for Payer: BCBS Complete |
$44.93
|
| Rate for Payer: BCBS MAPPO |
$81.81
|
| Rate for Payer: BCBS Trust/PPO |
$264.67
|
| Rate for Payer: BCN Commercial |
$264.67
|
| Rate for Payer: BCN Medicare Advantage |
$81.81
|
| Rate for Payer: Cash Price |
$33,945.55
|
| Rate for Payer: Cash Price |
$33,945.55
|
| Rate for Payer: Cofinity Advantage |
$29,702.36
|
| Rate for Payer: Cofinity Commercial |
$36,491.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33,945.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.81
|
| Rate for Payer: Healthscope Commercial |
$38,188.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29,702.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31,823.96
|
| Rate for Payer: Mclaren Medicaid |
$81.81
|
| Rate for Payer: Mclaren Medicare |
$81.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.90
|
| Rate for Payer: Meridian Medicaid |
$85.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$89.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36,067.15
|
| Rate for Payer: Nomi Health Commercial |
$245.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31,823.96
|
| Rate for Payer: PACE Medicare |
$77.72
|
| Rate for Payer: PACE SWMI |
$81.81
|
| Rate for Payer: PHP Commercial |
$36,067.15
|
| Rate for Payer: PHP Medicare Advantage |
$81.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$249.14
|
| Rate for Payer: Priority Health Medicare |
$81.81
|
| Rate for Payer: Priority Health SBD |
$26,732.12
|
| Rate for Payer: Priority Health Tiered Network |
$199.31
|
| Rate for Payer: Railroad Medicare Medicare |
$81.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.69
|
| Rate for Payer: UHC Core |
$134.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$81.81
|
| Rate for Payer: UHC Exchange |
$134.69
|
| Rate for Payer: UHC Medicaid |
$42.79
|
| Rate for Payer: UHCCP Medicaid |
$42.79
|
| Rate for Payer: UMR Bronson Commercial |
$15,699.82
|
| Rate for Payer: VA VA |
$81.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31,823.96
|
|
|
OBSESSIVE COMPULSIVE DISORDERS
|
Facility
|
IP
|
$7,274.80
|
|
|
Service Code
|
APR-DRG 7624
|
| Min. Negotiated Rate |
$6,928.38 |
| Max. Negotiated Rate |
$7,274.80 |
| Rate for Payer: BCBS Complete |
$7,274.80
|
| Rate for Payer: Mclaren Medicaid |
$6,928.38
|
| Rate for Payer: Meridian Medicaid |
$7,274.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,928.38
|
| Rate for Payer: UHC Medicaid |
$6,928.38
|
| Rate for Payer: UHCCP Medicaid |
$6,928.38
|
|
|
OBSESSIVE COMPULSIVE DISORDERS
|
Facility
|
IP
|
$3,161.61
|
|
|
Service Code
|
APR-DRG 7621
|
| Min. Negotiated Rate |
$3,011.06 |
| Max. Negotiated Rate |
$3,161.61 |
| Rate for Payer: BCBS Complete |
$3,161.61
|
| Rate for Payer: Mclaren Medicaid |
$3,011.06
|
| Rate for Payer: Meridian Medicaid |
$3,161.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,011.06
|
| Rate for Payer: UHC Medicaid |
$3,011.06
|
| Rate for Payer: UHCCP Medicaid |
$3,011.06
|
|
|
OBSESSIVE COMPULSIVE DISORDERS
|
Facility
|
IP
|
$3,954.59
|
|
|
Service Code
|
APR-DRG 7622
|
| Min. Negotiated Rate |
$3,766.27 |
| Max. Negotiated Rate |
$3,954.59 |
| Rate for Payer: BCBS Complete |
$3,954.59
|
| Rate for Payer: Mclaren Medicaid |
$3,766.27
|
| Rate for Payer: Meridian Medicaid |
$3,954.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,766.27
|
| Rate for Payer: UHC Medicaid |
$3,766.27
|
| Rate for Payer: UHCCP Medicaid |
$3,766.27
|
|
|
OBSESSIVE COMPULSIVE DISORDERS
|
Facility
|
IP
|
$5,817.78
|
|
|
Service Code
|
APR-DRG 7623
|
| Min. Negotiated Rate |
$5,540.74 |
| Max. Negotiated Rate |
$5,817.78 |
| Rate for Payer: BCBS Complete |
$5,817.78
|
| Rate for Payer: Mclaren Medicaid |
$5,540.74
|
| Rate for Payer: Meridian Medicaid |
$5,817.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,540.74
|
| Rate for Payer: UHC Medicaid |
$5,540.74
|
| Rate for Payer: UHCCP Medicaid |
$5,540.74
|
|
|
OCRELIZUMAB 30 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$91,205.39
|
|
|
Service Code
|
HCPCS J2350
|
| Hospital Charge Code |
182454
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40,130.37 |
| Max. Negotiated Rate |
$82,084.85 |
| Rate for Payer: Aetna American Axle |
$59,283.50
|
| Rate for Payer: Aetna Commercial |
$77,524.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59,283.50
|
| Rate for Payer: Cash Price |
$72,964.31
|
| Rate for Payer: Cofinity Advantage |
$63,843.77
|
| Rate for Payer: Cofinity Commercial |
$78,436.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72,964.31
|
| Rate for Payer: Healthscope Commercial |
$82,084.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63,843.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68,404.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77,524.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68,404.04
|
| Rate for Payer: PHP Commercial |
$77,524.58
|
| Rate for Payer: Priority Health SBD |
$57,459.40
|
| Rate for Payer: UMR Bronson Commercial |
$40,130.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68,404.04
|
|
|
OCRELIZUMAB 30 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$91,205.39
|
|
|
Service Code
|
HCPCS J2350
|
| Hospital Charge Code |
182454
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.17 |
| Max. Negotiated Rate |
$82,084.85 |
| Rate for Payer: Aetna American Axle |
$59,283.50
|
| Rate for Payer: Aetna Commercial |
$77,524.58
|
| Rate for Payer: Aetna Medicare |
$61.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59,283.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$74.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$74.50
|
| Rate for Payer: BCBS Complete |
$32.73
|
| Rate for Payer: BCBS MAPPO |
$59.60
|
| Rate for Payer: BCBS Trust/PPO |
$192.36
|
| Rate for Payer: BCN Commercial |
$192.36
|
| Rate for Payer: BCN Medicare Advantage |
$59.60
|
| Rate for Payer: Cash Price |
$72,964.31
|
| Rate for Payer: Cash Price |
$72,964.31
|
| Rate for Payer: Cofinity Advantage |
$63,843.77
|
| Rate for Payer: Cofinity Commercial |
$78,436.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72,964.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.60
|
| Rate for Payer: Healthscope Commercial |
$82,084.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63,843.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68,404.04
|
| Rate for Payer: Mclaren Medicaid |
$59.60
|
| Rate for Payer: Mclaren Medicare |
$59.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.58
|
| Rate for Payer: Meridian Medicaid |
$62.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$65.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77,524.58
|
| Rate for Payer: Nomi Health Commercial |
$178.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68,404.04
|
| Rate for Payer: PACE Medicare |
$56.62
|
| Rate for Payer: PACE SWMI |
$59.60
|
| Rate for Payer: PHP Commercial |
$77,524.58
|
| Rate for Payer: PHP Medicare Advantage |
$59.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$187.38
|
| Rate for Payer: Priority Health Medicare |
$59.60
|
| Rate for Payer: Priority Health SBD |
$57,459.40
|
| Rate for Payer: Priority Health Tiered Network |
$149.90
|
| Rate for Payer: Railroad Medicare Medicare |
$59.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.88
|
| Rate for Payer: UHC Core |
$97.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$59.60
|
| Rate for Payer: UHC Exchange |
$97.88
|
| Rate for Payer: UHC Medicaid |
$31.17
|
| Rate for Payer: UHCCP Medicaid |
$31.17
|
| Rate for Payer: UMR Bronson Commercial |
$33,745.99
|
| Rate for Payer: VA VA |
$59.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68,404.04
|
|
|
OCRELIZUMAB 920 MG-HYALURONIDASE-OCSQ 23,000 UNIT/23 ML SUBCUT SOLN
|
Facility
|
OP
|
$112,914.31
|
|
|
Service Code
|
HCPCS J2351
|
| Hospital Charge Code |
208666
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.47 |
| Max. Negotiated Rate |
$101,622.88 |
| Rate for Payer: Aetna American Axle |
$73,394.30
|
| Rate for Payer: Aetna Commercial |
$95,977.16
|
| Rate for Payer: Aetna Medicare |
$48.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73,394.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.49
|
| Rate for Payer: BCBS Complete |
$25.70
|
| Rate for Payer: BCBS MAPPO |
$46.79
|
| Rate for Payer: BCBS Trust/PPO |
$152.54
|
| Rate for Payer: BCN Commercial |
$152.54
|
| Rate for Payer: BCN Medicare Advantage |
$46.79
|
| Rate for Payer: Cash Price |
$90,331.45
|
| Rate for Payer: Cash Price |
$90,331.45
|
| Rate for Payer: Cofinity Advantage |
$79,040.02
|
| Rate for Payer: Cofinity Commercial |
$97,106.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90,331.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.79
|
| Rate for Payer: Healthscope Commercial |
$101,622.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79,040.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84,685.73
|
| Rate for Payer: Mclaren Medicaid |
$46.79
|
| Rate for Payer: Mclaren Medicare |
$46.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.13
|
| Rate for Payer: Meridian Medicaid |
$49.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95,977.16
|
| Rate for Payer: Nomi Health Commercial |
$140.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84,685.73
|
| Rate for Payer: PACE Medicare |
$44.45
|
| Rate for Payer: PACE SWMI |
$46.79
|
| Rate for Payer: PHP Commercial |
$95,977.16
|
| Rate for Payer: PHP Medicare Advantage |
$46.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$148.97
|
| Rate for Payer: Priority Health Medicare |
$46.79
|
| Rate for Payer: Priority Health SBD |
$71,136.02
|
| Rate for Payer: Priority Health Tiered Network |
$119.18
|
| Rate for Payer: Railroad Medicare Medicare |
$46.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.63
|
| Rate for Payer: UHC Core |
$77.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$46.79
|
| Rate for Payer: UHC Exchange |
$77.63
|
| Rate for Payer: UHC Medicaid |
$24.47
|
| Rate for Payer: UHCCP Medicaid |
$24.47
|
| Rate for Payer: UMR Bronson Commercial |
$41,778.29
|
| Rate for Payer: VA VA |
$46.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84,685.73
|
|
|
OCTREOTIDE ACETATE 1,000 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$893.92
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
91282
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$804.53 |
| Rate for Payer: Aetna American Axle |
$581.05
|
| Rate for Payer: Aetna American Axle |
$255.73
|
| Rate for Payer: Aetna American Axle |
$288.18
|
| Rate for Payer: Aetna American Axle |
$292.49
|
| Rate for Payer: Aetna Commercial |
$759.83
|
| Rate for Payer: Aetna Commercial |
$382.49
|
| Rate for Payer: Aetna Commercial |
$334.42
|
| Rate for Payer: Aetna Commercial |
$376.86
|
| Rate for Payer: Aetna Medicare |
$225.00
|
| Rate for Payer: Aetna Medicare |
$221.68
|
| Rate for Payer: Aetna Medicare |
$446.96
|
| Rate for Payer: Aetna Medicare |
$196.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.49
|
| Rate for Payer: BCBS Complete |
$157.37
|
| Rate for Payer: BCBS Complete |
$177.34
|
| Rate for Payer: BCBS Complete |
$180.00
|
| Rate for Payer: BCBS Complete |
$357.57
|
| Rate for Payer: BCBS Trust/PPO |
$2.13
|
| Rate for Payer: BCBS Trust/PPO |
$2.13
|
| Rate for Payer: BCBS Trust/PPO |
$2.13
|
| Rate for Payer: BCBS Trust/PPO |
$2.13
|
| Rate for Payer: BCN Commercial |
$2.13
|
| Rate for Payer: BCN Commercial |
$2.13
|
| Rate for Payer: BCN Commercial |
$2.13
|
| Rate for Payer: BCN Commercial |
$2.13
|
| Rate for Payer: Cash Price |
$359.99
|
| Rate for Payer: Cash Price |
$715.14
|
| Rate for Payer: Cash Price |
$314.74
|
| Rate for Payer: Cash Price |
$715.14
|
| Rate for Payer: Cash Price |
$359.99
|
| Rate for Payer: Cash Price |
$354.69
|
| Rate for Payer: Cash Price |
$354.69
|
| Rate for Payer: Cash Price |
$314.74
|
| Rate for Payer: Cofinity Advantage |
$625.74
|
| Rate for Payer: Cofinity Advantage |
$314.99
|
| Rate for Payer: Cofinity Advantage |
$310.35
|
| Rate for Payer: Cofinity Advantage |
$275.40
|
| Rate for Payer: Cofinity Commercial |
$381.29
|
| Rate for Payer: Cofinity Commercial |
$386.99
|
| Rate for Payer: Cofinity Commercial |
$768.77
|
| Rate for Payer: Cofinity Commercial |
$338.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.99
|
| 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 |
$314.74
|
| Rate for Payer: Healthscope Commercial |
$404.99
|
| Rate for Payer: Healthscope Commercial |
$354.09
|
| Rate for Payer: Healthscope Commercial |
$399.02
|
| Rate for Payer: Healthscope Commercial |
$804.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$310.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$275.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$314.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$625.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$332.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$670.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$715.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$354.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$314.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$359.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$334.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$759.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$337.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$332.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$670.44
|
| Rate for Payer: PHP Commercial |
$334.42
|
| Rate for Payer: PHP Commercial |
$382.49
|
| Rate for Payer: PHP Commercial |
$759.83
|
| Rate for Payer: PHP Commercial |
$376.86
|
| Rate for Payer: Priority Health SBD |
$283.49
|
| Rate for Payer: Priority Health SBD |
$247.86
|
| Rate for Payer: Priority Health SBD |
$279.32
|
| Rate for Payer: Priority Health SBD |
$563.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.09
|
| Rate for Payer: UHC Core |
$1.09
|
| Rate for Payer: UHC Core |
$1.09
|
| Rate for Payer: UHC Core |
$1.09
|
| Rate for Payer: UHC Core |
$1.09
|
| Rate for Payer: UHC Exchange |
$1.09
|
| Rate for Payer: UHC Exchange |
$1.09
|
| Rate for Payer: UHC Exchange |
$1.09
|
| Rate for Payer: UHC Exchange |
$1.09
|
| Rate for Payer: UMR Bronson Commercial |
$330.75
|
| Rate for Payer: UMR Bronson Commercial |
$145.57
|
| Rate for Payer: UMR Bronson Commercial |
$164.04
|
| Rate for Payer: UMR Bronson Commercial |
$166.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$670.44
|
|
|
OCTREOTIDE ACETATE 1,000 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$449.99
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
91282
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$198.00 |
| Max. Negotiated Rate |
$404.99 |
| Rate for Payer: Aetna American Axle |
$292.49
|
| Rate for Payer: Aetna American Axle |
$288.18
|
| Rate for Payer: Aetna American Axle |
$581.05
|
| Rate for Payer: Aetna American Axle |
$255.73
|
| Rate for Payer: Aetna Commercial |
$759.83
|
| Rate for Payer: Aetna Commercial |
$382.49
|
| Rate for Payer: Aetna Commercial |
$334.42
|
| Rate for Payer: Aetna Commercial |
$376.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.73
|
| Rate for Payer: Cash Price |
$314.74
|
| Rate for Payer: Cash Price |
$715.14
|
| Rate for Payer: Cash Price |
$354.69
|
| Rate for Payer: Cash Price |
$359.99
|
| Rate for Payer: Cofinity Advantage |
$310.35
|
| Rate for Payer: Cofinity Advantage |
$275.40
|
| Rate for Payer: Cofinity Advantage |
$314.99
|
| Rate for Payer: Cofinity Advantage |
$625.74
|
| Rate for Payer: Cofinity Commercial |
$386.99
|
| Rate for Payer: Cofinity Commercial |
$338.35
|
| Rate for Payer: Cofinity Commercial |
$381.29
|
| Rate for Payer: Cofinity Commercial |
$768.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$314.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$715.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.69
|
| Rate for Payer: Healthscope Commercial |
$399.02
|
| Rate for Payer: Healthscope Commercial |
$804.53
|
| Rate for Payer: Healthscope Commercial |
$404.99
|
| Rate for Payer: Healthscope Commercial |
$354.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$314.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$275.40
|
| 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: Lakeland Regional Health Systems Commercial |
$332.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$670.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$759.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$334.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$670.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$332.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$337.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.07
|
| Rate for Payer: PHP Commercial |
$334.42
|
| Rate for Payer: PHP Commercial |
$382.49
|
| Rate for Payer: PHP Commercial |
$376.86
|
| Rate for Payer: PHP Commercial |
$759.83
|
| Rate for Payer: Priority Health SBD |
$563.17
|
| Rate for Payer: Priority Health SBD |
$247.86
|
| Rate for Payer: Priority Health SBD |
$283.49
|
| Rate for Payer: Priority Health SBD |
$279.32
|
| Rate for Payer: UMR Bronson Commercial |
$195.08
|
| Rate for Payer: UMR Bronson Commercial |
$198.00
|
| Rate for Payer: UMR Bronson Commercial |
$173.11
|
| Rate for Payer: UMR Bronson Commercial |
$393.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.49
|
| 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
|
OP
|
$118.81
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
91279
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$106.93 |
| Rate for Payer: Aetna American Axle |
$77.23
|
| Rate for Payer: Aetna American Axle |
$14.47
|
| Rate for Payer: Aetna American Axle |
$11.19
|
| Rate for Payer: Aetna American Axle |
$11.12
|
| Rate for Payer: Aetna American Axle |
$17.49
|
| Rate for Payer: Aetna Commercial |
$100.99
|
| Rate for Payer: Aetna Commercial |
$14.54
|
| Rate for Payer: Aetna Commercial |
$22.87
|
| Rate for Payer: Aetna Commercial |
$18.92
|
| Rate for Payer: Aetna Commercial |
$14.63
|
| Rate for Payer: Aetna Medicare |
$13.46
|
| Rate for Payer: Aetna Medicare |
$8.55
|
| Rate for Payer: Aetna Medicare |
$59.41
|
| Rate for Payer: Aetna Medicare |
$8.61
|
| Rate for Payer: Aetna Medicare |
$11.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.49
|
| Rate for Payer: BCBS Complete |
$8.90
|
| Rate for Payer: BCBS Complete |
$47.52
|
| Rate for Payer: BCBS Complete |
$6.84
|
| Rate for Payer: BCBS Complete |
$6.88
|
| Rate for Payer: BCBS Complete |
$10.76
|
| Rate for Payer: BCBS Trust/PPO |
$2.13
|
| Rate for Payer: BCBS Trust/PPO |
$2.13
|
| Rate for Payer: BCBS Trust/PPO |
$2.13
|
| Rate for Payer: BCBS Trust/PPO |
$2.13
|
| Rate for Payer: BCBS Trust/PPO |
$2.13
|
| Rate for Payer: BCN Commercial |
$2.13
|
| Rate for Payer: BCN Commercial |
$2.13
|
| Rate for Payer: BCN Commercial |
$2.13
|
| Rate for Payer: BCN Commercial |
$2.13
|
| Rate for Payer: BCN Commercial |
$2.13
|
| Rate for Payer: Cash Price |
$17.81
|
| Rate for Payer: Cash Price |
$21.53
|
| Rate for Payer: Cash Price |
$13.69
|
| Rate for Payer: Cash Price |
$95.05
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cash Price |
$95.05
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cash Price |
$17.81
|
| Rate for Payer: Cash Price |
$13.69
|
| Rate for Payer: Cash Price |
$21.53
|
| Rate for Payer: Cofinity Advantage |
$15.58
|
| Rate for Payer: Cofinity Advantage |
$11.98
|
| Rate for Payer: Cofinity Advantage |
$12.05
|
| Rate for Payer: Cofinity Advantage |
$18.84
|
| Rate for Payer: Cofinity Advantage |
$83.17
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$102.18
|
| Rate for Payer: Cofinity Commercial |
$14.71
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$23.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.77
|
| Rate for Payer: Healthscope Commercial |
$15.49
|
| Rate for Payer: Healthscope Commercial |
$24.22
|
| Rate for Payer: Healthscope Commercial |
$20.03
|
| Rate for Payer: Healthscope Commercial |
$106.93
|
| Rate for Payer: Healthscope Commercial |
$15.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.18
|
| Rate for Payer: PHP Commercial |
$14.54
|
| Rate for Payer: PHP Commercial |
$14.63
|
| Rate for Payer: PHP Commercial |
$22.87
|
| Rate for Payer: PHP Commercial |
$18.92
|
| Rate for Payer: PHP Commercial |
$100.99
|
| Rate for Payer: Priority Health SBD |
$10.84
|
| Rate for Payer: Priority Health SBD |
$74.85
|
| Rate for Payer: Priority Health SBD |
$14.02
|
| Rate for Payer: Priority Health SBD |
$16.95
|
| Rate for Payer: Priority Health SBD |
$10.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.09
|
| Rate for Payer: UHC Core |
$1.09
|
| Rate for Payer: UHC Core |
$1.09
|
| Rate for Payer: UHC Core |
$1.09
|
| Rate for Payer: UHC Core |
$1.09
|
| Rate for Payer: UHC Core |
$1.09
|
| Rate for Payer: UHC Exchange |
$1.09
|
| Rate for Payer: UHC Exchange |
$1.09
|
| Rate for Payer: UHC Exchange |
$1.09
|
| Rate for Payer: UHC Exchange |
$1.09
|
| Rate for Payer: UHC Exchange |
$1.09
|
| Rate for Payer: UMR Bronson Commercial |
$43.96
|
| Rate for Payer: UMR Bronson Commercial |
$8.24
|
| Rate for Payer: UMR Bronson Commercial |
$6.37
|
| Rate for Payer: UMR Bronson Commercial |
$9.96
|
| Rate for Payer: UMR Bronson Commercial |
$6.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.11
|
|
|
OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$22.26
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
91279
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.79 |
| Max. Negotiated Rate |
$20.03 |
| Rate for Payer: Aetna American Axle |
$14.47
|
| Rate for Payer: Aetna American Axle |
$11.19
|
| Rate for Payer: Aetna American Axle |
$17.49
|
| Rate for Payer: Aetna American Axle |
$11.12
|
| Rate for Payer: Aetna American Axle |
$77.23
|
| Rate for Payer: Aetna Commercial |
$100.99
|
| Rate for Payer: Aetna Commercial |
$14.63
|
| Rate for Payer: Aetna Commercial |
$18.92
|
| Rate for Payer: Aetna Commercial |
$22.87
|
| Rate for Payer: Aetna Commercial |
$14.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.49
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cash Price |
$13.69
|
| Rate for Payer: Cash Price |
$21.53
|
| Rate for Payer: Cash Price |
$17.81
|
| Rate for Payer: Cash Price |
$95.05
|
| Rate for Payer: Cofinity Advantage |
$83.17
|
| Rate for Payer: Cofinity Advantage |
$18.84
|
| Rate for Payer: Cofinity Advantage |
$11.98
|
| Rate for Payer: Cofinity Advantage |
$15.58
|
| Rate for Payer: Cofinity Advantage |
$12.05
|
| Rate for Payer: Cofinity Commercial |
$23.14
|
| Rate for Payer: Cofinity Commercial |
$102.18
|
| Rate for Payer: Cofinity Commercial |
$14.71
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.53
|
| Rate for Payer: Healthscope Commercial |
$106.93
|
| Rate for Payer: Healthscope Commercial |
$15.40
|
| Rate for Payer: Healthscope Commercial |
$15.49
|
| Rate for Payer: Healthscope Commercial |
$20.03
|
| Rate for Payer: Healthscope Commercial |
$24.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.70
|
| Rate for Payer: PHP Commercial |
$14.63
|
| Rate for Payer: PHP Commercial |
$100.99
|
| Rate for Payer: PHP Commercial |
$18.92
|
| Rate for Payer: PHP Commercial |
$22.87
|
| Rate for Payer: PHP Commercial |
$14.54
|
| Rate for Payer: Priority Health SBD |
$14.02
|
| Rate for Payer: Priority Health SBD |
$16.95
|
| Rate for Payer: Priority Health SBD |
$10.78
|
| Rate for Payer: Priority Health SBD |
$74.85
|
| Rate for Payer: Priority Health SBD |
$10.84
|
| Rate for Payer: UMR Bronson Commercial |
$7.53
|
| Rate for Payer: UMR Bronson Commercial |
$11.84
|
| Rate for Payer: UMR Bronson Commercial |
$7.57
|
| Rate for Payer: UMR Bronson Commercial |
$52.28
|
| Rate for Payer: UMR Bronson Commercial |
$9.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.83
|
|
|
OCTREOTIDE ACETATE 200 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$99.64
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
25123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$89.68 |
| Rate for Payer: Aetna American Axle |
$64.77
|
| Rate for Payer: Aetna Commercial |
$84.69
|
| Rate for Payer: Aetna Medicare |
$49.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.77
|
| Rate for Payer: BCBS Complete |
$39.86
|
| Rate for Payer: BCBS Trust/PPO |
$2.13
|
| Rate for Payer: BCN Commercial |
$2.13
|
| Rate for Payer: Cash Price |
$79.71
|
| Rate for Payer: Cash Price |
$79.71
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$79.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.73
|
| Rate for Payer: PHP Commercial |
$84.69
|
| Rate for Payer: Priority Health SBD |
$62.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.09
|
| Rate for Payer: UHC Core |
$1.09
|
| Rate for Payer: UHC Exchange |
$1.09
|
| Rate for Payer: UMR Bronson Commercial |
$36.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.73
|
|
|
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 Advantage |
$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 Commercial |
$84.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.73
|
| Rate for Payer: PHP Commercial |
$84.69
|
| 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 |
$41.30
|
| Rate for Payer: Aetna Commercial |
$43.27
|
| 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 Advantage |
$35.64
|
| Rate for Payer: Cofinity Advantage |
$34.01
|
| Rate for Payer: Cofinity Commercial |
$43.78
|
| Rate for Payer: Cofinity Commercial |
$41.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.73
|
| Rate for Payer: Healthscope Commercial |
$43.73
|
| Rate for Payer: Healthscope Commercial |
$45.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.01
|
| 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 Commercial |
$41.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.18
|
| Rate for Payer: PHP Commercial |
$41.30
|
| Rate for Payer: PHP Commercial |
$43.27
|
| Rate for Payer: Priority Health SBD |
$32.07
|
| Rate for Payer: Priority Health SBD |
$30.61
|
| Rate for Payer: UMR Bronson Commercial |
$21.38
|
| Rate for Payer: UMR Bronson Commercial |
$22.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.18
|
|
|
OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$48.59
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
91281
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.09 |
| 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 |
$41.30
|
| Rate for Payer: Aetna Commercial |
$43.27
|
| Rate for Payer: Aetna Medicare |
$24.30
|
| Rate for Payer: Aetna Medicare |
$25.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.09
|
| Rate for Payer: BCBS Complete |
$20.36
|
| Rate for Payer: BCBS Complete |
$19.44
|
| Rate for Payer: BCBS Trust/PPO |
$2.13
|
| Rate for Payer: BCBS Trust/PPO |
$2.13
|
| Rate for Payer: BCN Commercial |
$2.13
|
| Rate for Payer: BCN Commercial |
$2.13
|
| Rate for Payer: Cash Price |
$38.87
|
| Rate for Payer: Cash Price |
$40.73
|
| Rate for Payer: Cash Price |
$38.87
|
| Rate for Payer: Cash Price |
$40.73
|
| Rate for Payer: Cofinity Advantage |
$34.01
|
| Rate for Payer: Cofinity Advantage |
$35.64
|
| Rate for Payer: Cofinity Commercial |
$41.79
|
| Rate for Payer: Cofinity Commercial |
$43.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.73
|
| Rate for Payer: Healthscope Commercial |
$43.73
|
| Rate for Payer: Healthscope Commercial |
$45.82
|
| 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: MI Amish Medical Board Commercial |
$38.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.44
|
| Rate for Payer: PHP Commercial |
$41.30
|
| Rate for Payer: PHP Commercial |
$43.27
|
| Rate for Payer: Priority Health SBD |
$30.61
|
| Rate for Payer: Priority Health SBD |
$32.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.09
|
| Rate for Payer: UHC Core |
$1.09
|
| Rate for Payer: UHC Core |
$1.09
|
| Rate for Payer: UHC Exchange |
$1.09
|
| Rate for Payer: UHC Exchange |
$1.09
|
| Rate for Payer: UMR Bronson Commercial |
$17.98
|
| Rate for Payer: UMR Bronson Commercial |
$18.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.18
|
|
|
OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$18.63
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
91278
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$16.77 |
| Rate for Payer: Aetna American Axle |
$12.11
|
| Rate for Payer: Aetna Commercial |
$15.84
|
| Rate for Payer: Aetna Medicare |
$9.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.11
|
| Rate for Payer: BCBS Complete |
$7.45
|
| Rate for Payer: BCBS Trust/PPO |
$2.13
|
| Rate for Payer: BCN Commercial |
$2.13
|
| Rate for Payer: Cash Price |
$14.90
|
| Rate for Payer: Cash Price |
$14.90
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$14.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.97
|
| Rate for Payer: PHP Commercial |
$15.84
|
| Rate for Payer: Priority Health SBD |
$11.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.09
|
| Rate for Payer: UHC Core |
$1.09
|
| Rate for Payer: UHC Exchange |
$1.09
|
| Rate for Payer: UMR Bronson Commercial |
$6.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.97
|
|
|
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 Advantage |
$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 Commercial |
$15.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.97
|
| Rate for Payer: PHP Commercial |
$15.84
|
| 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
|
OP
|
$8,842.60
|
|
|
Service Code
|
HCPCS J2353
|
| Hospital Charge Code |
161516
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$98.51 |
| Max. Negotiated Rate |
$7,958.34 |
| Rate for Payer: Aetna American Axle |
$5,747.69
|
| Rate for Payer: Aetna Commercial |
$7,516.21
|
| Rate for Payer: Aetna Medicare |
$195.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,747.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$235.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$235.44
|
| Rate for Payer: BCBS Complete |
$103.44
|
| Rate for Payer: BCBS MAPPO |
$188.35
|
| Rate for Payer: BCBS Trust/PPO |
$645.81
|
| Rate for Payer: BCN Commercial |
$645.81
|
| Rate for Payer: BCN Medicare Advantage |
$188.35
|
| Rate for Payer: Cash Price |
$7,074.08
|
| Rate for Payer: Cash Price |
$7,074.08
|
| Rate for Payer: Cofinity Advantage |
$6,189.82
|
| Rate for Payer: Cofinity Commercial |
$7,604.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,074.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$188.35
|
| Rate for Payer: Healthscope Commercial |
$7,958.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,189.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,631.95
|
| Rate for Payer: Mclaren Medicaid |
$188.35
|
| Rate for Payer: Mclaren Medicare |
$188.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$197.77
|
| Rate for Payer: Meridian Medicaid |
$197.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$216.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$207.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,516.21
|
| Rate for Payer: Nomi Health Commercial |
$565.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,631.95
|
| Rate for Payer: PACE Medicare |
$178.93
|
| Rate for Payer: PACE SWMI |
$188.35
|
| Rate for Payer: PHP Commercial |
$7,516.21
|
| Rate for Payer: PHP Medicare Advantage |
$188.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$98.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$642.09
|
| Rate for Payer: Priority Health Medicare |
$188.35
|
| Rate for Payer: Priority Health SBD |
$5,570.84
|
| Rate for Payer: Priority Health Tiered Network |
$513.67
|
| Rate for Payer: Railroad Medicare Medicare |
$188.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$328.63
|
| Rate for Payer: UHC Core |
$328.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$188.35
|
| Rate for Payer: UHC Exchange |
$328.63
|
| Rate for Payer: UHC Medicaid |
$98.51
|
| Rate for Payer: UHCCP Medicaid |
$98.51
|
| Rate for Payer: UMR Bronson Commercial |
$3,271.76
|
| Rate for Payer: VA VA |
$188.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,631.95
|
|
|
OCTREOTIDE,MICROSPHERES ER 10 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE
|
Facility
|
IP
|
$8,842.60
|
|
|
Service Code
|
HCPCS J2353
|
| Hospital Charge Code |
161516
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,890.74 |
| Max. Negotiated Rate |
$7,958.34 |
| Rate for Payer: Aetna American Axle |
$5,747.69
|
| Rate for Payer: Aetna Commercial |
$7,516.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,747.69
|
| Rate for Payer: Cash Price |
$7,074.08
|
| Rate for Payer: Cofinity Advantage |
$6,189.82
|
| Rate for Payer: Cofinity Commercial |
$7,604.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,074.08
|
| Rate for Payer: Healthscope Commercial |
$7,958.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,189.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,631.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,516.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,631.95
|
| Rate for Payer: PHP Commercial |
$7,516.21
|
| Rate for Payer: Priority Health SBD |
$5,570.84
|
| Rate for Payer: UMR Bronson Commercial |
$3,890.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,631.95
|
|
