|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$5.10
|
|
|
Service Code
|
NDC 00121478505
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Aetna American Axle |
$3.31
|
| Rate for Payer: Aetna Commercial |
$4.33
|
| Rate for Payer: Aetna Medicare |
$2.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.31
|
| Rate for Payer: BCBS Complete |
$2.04
|
| Rate for Payer: Cash Price |
$4.08
|
| Rate for Payer: Cofinity Commercial |
$3.57
|
| Rate for Payer: Cofinity Commercial |
$4.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.08
|
| Rate for Payer: Healthscope Commercial |
$4.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.33
|
| Rate for Payer: PHP Commercial |
$4.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.31
|
| Rate for Payer: Priority Health SBD |
$3.21
|
| Rate for Payer: UMR Bronson Commercial |
$1.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.83
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$107.61
|
|
|
Service Code
|
NDC 00121086816
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.82 |
| Max. Negotiated Rate |
$96.85 |
| Rate for Payer: Aetna American Axle |
$69.95
|
| Rate for Payer: Aetna Commercial |
$91.47
|
| Rate for Payer: Aetna Medicare |
$53.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.95
|
| Rate for Payer: BCBS Complete |
$43.04
|
| Rate for Payer: Cash Price |
$86.09
|
| Rate for Payer: Cofinity Commercial |
$75.33
|
| Rate for Payer: Cofinity Commercial |
$92.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.09
|
| Rate for Payer: Healthscope Commercial |
$96.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.47
|
| Rate for Payer: PHP Commercial |
$91.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.95
|
| Rate for Payer: Priority Health SBD |
$67.79
|
| Rate for Payer: UMR Bronson Commercial |
$39.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.71
|
|
|
NYSTATIN (BULK) 100 MILLION UNIT POWDER
|
Facility
|
IP
|
$446.25
|
|
|
Service Code
|
NDC 09900001984
|
| Hospital Charge Code |
120073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.35 |
| Max. Negotiated Rate |
$401.62 |
| Rate for Payer: Aetna American Axle |
$290.06
|
| Rate for Payer: Aetna Commercial |
$379.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.06
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cofinity Commercial |
$312.38
|
| Rate for Payer: Cofinity Commercial |
$383.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$312.38
|
| 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: Multiplan/Beech St/PHCS Commercial |
$379.31
|
| Rate for Payer: PHP Commercial |
$379.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.06
|
| Rate for Payer: Priority Health SBD |
$281.14
|
| Rate for Payer: UMR Bronson Commercial |
$196.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.69
|
|
|
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 Commercial |
$312.38
|
| Rate for Payer: Cofinity Commercial |
$383.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$312.38
|
| 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: Multiplan/Beech St/PHCS Commercial |
$379.31
|
| Rate for Payer: PHP Commercial |
$379.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.06
|
| Rate for Payer: Priority Health SBD |
$281.14
|
| Rate for Payer: UMR Bronson Commercial |
$165.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.69
|
|
|
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 Commercial |
$124.95
|
| Rate for Payer: Cofinity Commercial |
$153.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$124.95
|
| 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: PHP Commercial |
$151.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.03
|
| Rate for Payer: Priority Health SBD |
$112.45
|
| 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
|
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 Commercial |
$124.95
|
| Rate for Payer: Cofinity Commercial |
$153.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$124.95
|
| 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: PHP Commercial |
$151.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.03
|
| 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) 150 MILLION UNIT POWDER
|
Facility
|
OP
|
$122.50
|
|
|
Service Code
|
NDC 51552004101
|
| Hospital Charge Code |
116152
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.33 |
| Max. Negotiated Rate |
$110.25 |
| Rate for Payer: Aetna American Axle |
$79.62
|
| Rate for Payer: Aetna Commercial |
$104.12
|
| Rate for Payer: Aetna Medicare |
$61.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.62
|
| Rate for Payer: BCBS Complete |
$49.00
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: Cofinity Commercial |
$105.35
|
| Rate for Payer: Cofinity Commercial |
$85.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$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 Commercial |
$104.12
|
| Rate for Payer: PHP Commercial |
$104.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.62
|
| Rate for Payer: Priority Health SBD |
$77.17
|
| Rate for Payer: UMR Bronson Commercial |
$45.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.88
|
|
|
NYSTATIN (BULK) 150 MILLION UNIT POWDER
|
Facility
|
IP
|
$122.50
|
|
|
Service Code
|
NDC 51552004101
|
| 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: Cofinity Medicare Advantage |
$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 Commercial |
$104.12
|
| Rate for Payer: PHP Commercial |
$104.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.62
|
| Rate for Payer: Priority Health SBD |
$77.17
|
| Rate for Payer: UMR Bronson Commercial |
$53.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.88
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM
|
Facility
|
OP
|
$38.12
|
|
|
Service Code
|
NDC 45802088014
|
| Hospital Charge Code |
5754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.10 |
| Max. Negotiated Rate |
$34.31 |
| Rate for Payer: Aetna American Axle |
$24.78
|
| Rate for Payer: Aetna Commercial |
$32.40
|
| Rate for Payer: Aetna Medicare |
$19.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.78
|
| Rate for Payer: BCBS Complete |
$15.25
|
| Rate for Payer: Cash Price |
$30.50
|
| Rate for Payer: Cofinity Commercial |
$26.68
|
| Rate for Payer: Cofinity Commercial |
$32.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.50
|
| Rate for Payer: Healthscope Commercial |
$34.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.40
|
| Rate for Payer: PHP Commercial |
$32.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.78
|
| Rate for Payer: Priority Health SBD |
$24.02
|
| Rate for Payer: UMR Bronson Commercial |
$14.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.59
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$38.12
|
|
|
Service Code
|
NDC 45802088014
|
| Hospital Charge Code |
5754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.77 |
| Max. Negotiated Rate |
$34.31 |
| Rate for Payer: Aetna American Axle |
$24.78
|
| Rate for Payer: Aetna Commercial |
$32.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.78
|
| Rate for Payer: Cash Price |
$30.50
|
| Rate for Payer: Cofinity Commercial |
$26.68
|
| Rate for Payer: Cofinity Commercial |
$32.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.50
|
| Rate for Payer: Healthscope Commercial |
$34.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.40
|
| Rate for Payer: PHP Commercial |
$32.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.78
|
| Rate for Payer: Priority Health SBD |
$24.02
|
| Rate for Payer: UMR Bronson Commercial |
$16.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.59
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$95.76
|
|
|
Service Code
|
NDC 68462031435
|
| 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: Cofinity Medicare Advantage |
$67.03
|
| 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 Commercial |
$81.40
|
| Rate for Payer: PHP Commercial |
$81.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.24
|
| 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
|
OP
|
$95.76
|
|
|
Service Code
|
NDC 51672126302
|
| Hospital Charge Code |
5754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.43 |
| Max. Negotiated Rate |
$86.18 |
| Rate for Payer: Aetna American Axle |
$62.24
|
| Rate for Payer: Aetna Commercial |
$81.40
|
| Rate for Payer: Aetna Medicare |
$47.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.24
|
| Rate for Payer: BCBS Complete |
$38.30
|
| Rate for Payer: Cash Price |
$76.61
|
| Rate for Payer: Cofinity Commercial |
$67.03
|
| Rate for Payer: Cofinity Commercial |
$82.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.03
|
| 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 Commercial |
$81.40
|
| Rate for Payer: PHP Commercial |
$81.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.24
|
| Rate for Payer: Priority Health SBD |
$60.33
|
| Rate for Payer: UMR Bronson Commercial |
$35.43
|
| 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 51672126302
|
| 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: Cofinity Medicare Advantage |
$67.03
|
| 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 Commercial |
$81.40
|
| Rate for Payer: PHP Commercial |
$81.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.24
|
| 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
|
$41.79
|
|
|
Service Code
|
NDC 45802088094
|
| Hospital Charge Code |
5754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.39 |
| Max. Negotiated Rate |
$37.61 |
| Rate for Payer: Aetna American Axle |
$27.16
|
| Rate for Payer: Aetna Commercial |
$35.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.16
|
| Rate for Payer: Cash Price |
$33.43
|
| Rate for Payer: Cofinity Commercial |
$29.25
|
| Rate for Payer: Cofinity Commercial |
$35.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.43
|
| Rate for Payer: Healthscope Commercial |
$37.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.52
|
| Rate for Payer: PHP Commercial |
$35.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.16
|
| Rate for Payer: Priority Health SBD |
$26.33
|
| Rate for Payer: UMR Bronson Commercial |
$18.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.34
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM
|
Facility
|
OP
|
$95.76
|
|
|
Service Code
|
NDC 68462031435
|
| Hospital Charge Code |
5754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.43 |
| Max. Negotiated Rate |
$86.18 |
| Rate for Payer: Aetna American Axle |
$62.24
|
| Rate for Payer: Aetna Commercial |
$81.40
|
| Rate for Payer: Aetna Medicare |
$47.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.24
|
| Rate for Payer: BCBS Complete |
$38.30
|
| Rate for Payer: Cash Price |
$76.61
|
| Rate for Payer: Cofinity Commercial |
$67.03
|
| Rate for Payer: Cofinity Commercial |
$82.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.03
|
| 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 Commercial |
$81.40
|
| Rate for Payer: PHP Commercial |
$81.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.24
|
| Rate for Payer: Priority Health SBD |
$60.33
|
| Rate for Payer: UMR Bronson Commercial |
$35.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.82
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM
|
Facility
|
OP
|
$41.79
|
|
|
Service Code
|
NDC 45802088094
|
| Hospital Charge Code |
5754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.46 |
| Max. Negotiated Rate |
$37.61 |
| Rate for Payer: Aetna American Axle |
$27.16
|
| Rate for Payer: Aetna Commercial |
$35.52
|
| Rate for Payer: Aetna Medicare |
$20.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.16
|
| Rate for Payer: BCBS Complete |
$16.72
|
| Rate for Payer: Cash Price |
$33.43
|
| Rate for Payer: Cofinity Commercial |
$29.25
|
| Rate for Payer: Cofinity Commercial |
$35.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.43
|
| Rate for Payer: Healthscope Commercial |
$37.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.52
|
| Rate for Payer: PHP Commercial |
$35.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.16
|
| Rate for Payer: Priority Health SBD |
$26.33
|
| Rate for Payer: UMR Bronson Commercial |
$15.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.34
|
|
|
OB/GYN SPEC KZOO ONLY - NITROUS OXIDE ADMIN
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS 00563
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$39.65 |
| Rate for Payer: Aetna Medicare |
$30.50
|
| Rate for Payer: BCBS Complete |
$24.40
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.65
|
| Rate for Payer: UMR Bronson Commercial |
$28.06
|
|
|
OBINUTUZUMAB 1,000 MG/40 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$38,671.12
|
|
|
Service Code
|
HCPCS J9301
|
| Hospital Charge Code |
168805
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.34 |
| Max. Negotiated Rate |
$34,804.01 |
| Rate for Payer: Aetna American Axle |
$25,136.23
|
| Rate for Payer: Aetna Commercial |
$32,870.45
|
| Rate for Payer: Aetna Medicare |
$82.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25,136.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$98.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$98.75
|
| Rate for Payer: BCBS Complete |
$44.46
|
| Rate for Payer: BCBS MAPPO |
$79.00
|
| Rate for Payer: BCN Medicare Advantage |
$79.00
|
| Rate for Payer: Cash Price |
$30,936.90
|
| Rate for Payer: Cash Price |
$30,936.90
|
| Rate for Payer: Cofinity Commercial |
$33,257.16
|
| Rate for Payer: Cofinity Commercial |
$27,069.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$27,069.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30,936.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.00
|
| Rate for Payer: Healthscope Commercial |
$34,804.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27,069.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29,003.34
|
| Rate for Payer: Mclaren Medicaid |
$42.34
|
| Rate for Payer: Mclaren Medicare |
$79.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.95
|
| Rate for Payer: Meridian Medicaid |
$44.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32,870.45
|
| Rate for Payer: PACE Medicare |
$75.05
|
| Rate for Payer: PACE SWMI |
$79.00
|
| Rate for Payer: PHP Commercial |
$32,870.45
|
| Rate for Payer: PHP Medicare Advantage |
$79.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25,136.23
|
| Rate for Payer: Priority Health Medicare |
$79.00
|
| Rate for Payer: Priority Health SBD |
$24,362.81
|
| Rate for Payer: Railroad Medicare Medicare |
$79.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$222.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.00
|
| Rate for Payer: UHC Exchange |
$150.98
|
| Rate for Payer: UHC Medicare Advantage |
$79.00
|
| Rate for Payer: UHCCP Medicaid |
$42.34
|
| Rate for Payer: UMR Bronson Commercial |
$14,308.31
|
| Rate for Payer: VA VA |
$79.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29,003.34
|
|
|
OBINUTUZUMAB 1,000 MG/40 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$38,671.12
|
|
|
Service Code
|
HCPCS J9301
|
| Hospital Charge Code |
168805
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17,015.29 |
| Max. Negotiated Rate |
$34,804.01 |
| Rate for Payer: Aetna American Axle |
$25,136.23
|
| Rate for Payer: Aetna Commercial |
$32,870.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25,136.23
|
| Rate for Payer: Cash Price |
$30,936.90
|
| Rate for Payer: Cofinity Commercial |
$27,069.78
|
| Rate for Payer: Cofinity Commercial |
$33,257.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$27,069.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30,936.90
|
| Rate for Payer: Healthscope Commercial |
$34,804.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27,069.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29,003.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32,870.45
|
| Rate for Payer: PHP Commercial |
$32,870.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25,136.23
|
| Rate for Payer: Priority Health SBD |
$24,362.81
|
| Rate for Payer: UMR Bronson Commercial |
$17,015.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29,003.34
|
|
|
OCRELIZUMAB 30 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$53,666.50
|
|
|
Service Code
|
HCPCS J2350
|
| Hospital Charge Code |
182454
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.84 |
| Max. Negotiated Rate |
$48,299.85 |
| Rate for Payer: Aetna American Axle |
$34,883.22
|
| Rate for Payer: Aetna Commercial |
$45,616.53
|
| Rate for Payer: Aetna Medicare |
$61.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34,883.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$74.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$74.26
|
| Rate for Payer: BCBS Complete |
$33.44
|
| Rate for Payer: BCBS MAPPO |
$59.41
|
| Rate for Payer: BCN Medicare Advantage |
$59.41
|
| Rate for Payer: Cash Price |
$42,933.20
|
| Rate for Payer: Cash Price |
$42,933.20
|
| Rate for Payer: Cofinity Commercial |
$46,153.19
|
| Rate for Payer: Cofinity Commercial |
$37,566.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$37,566.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42,933.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.41
|
| Rate for Payer: Healthscope Commercial |
$48,299.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37,566.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40,249.88
|
| Rate for Payer: Mclaren Medicaid |
$31.84
|
| Rate for Payer: Mclaren Medicare |
$59.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.38
|
| Rate for Payer: Meridian Medicaid |
$33.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45,616.53
|
| Rate for Payer: PACE Medicare |
$56.44
|
| Rate for Payer: PACE SWMI |
$59.41
|
| Rate for Payer: PHP Commercial |
$45,616.53
|
| Rate for Payer: PHP Medicare Advantage |
$59.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34,883.22
|
| Rate for Payer: Priority Health Medicare |
$59.41
|
| Rate for Payer: Priority Health SBD |
$33,809.89
|
| Rate for Payer: Railroad Medicare Medicare |
$59.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$59.41
|
| Rate for Payer: UHC Exchange |
$113.54
|
| Rate for Payer: UHC Medicare Advantage |
$59.41
|
| Rate for Payer: UHCCP Medicaid |
$31.84
|
| Rate for Payer: UMR Bronson Commercial |
$19,856.60
|
| Rate for Payer: VA VA |
$59.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40,249.88
|
|
|
OCRELIZUMAB 30 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$53,666.50
|
|
|
Service Code
|
HCPCS J2350
|
| Hospital Charge Code |
182454
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23,613.26 |
| Max. Negotiated Rate |
$48,299.85 |
| Rate for Payer: Aetna American Axle |
$34,883.22
|
| Rate for Payer: Aetna Commercial |
$45,616.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34,883.22
|
| Rate for Payer: Cash Price |
$42,933.20
|
| Rate for Payer: Cofinity Commercial |
$37,566.55
|
| Rate for Payer: Cofinity Commercial |
$46,153.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$37,566.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42,933.20
|
| Rate for Payer: Healthscope Commercial |
$48,299.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37,566.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40,249.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45,616.53
|
| Rate for Payer: PHP Commercial |
$45,616.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34,883.22
|
| Rate for Payer: Priority Health SBD |
$33,809.89
|
| Rate for Payer: UMR Bronson Commercial |
$23,613.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40,249.88
|
|
|
OCTREOTIDE ACETATE 1,000 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$441.58
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
91282
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$163.38 |
| Max. Negotiated Rate |
$397.42 |
| Rate for Payer: Aetna American Axle |
$287.03
|
| 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 Commercial |
$759.83
|
| Rate for Payer: Aetna Commercial |
$375.34
|
| Rate for Payer: Aetna Commercial |
$376.86
|
| Rate for Payer: Aetna Commercial |
$334.42
|
| Rate for Payer: Aetna Medicare |
$221.68
|
| Rate for Payer: Aetna Medicare |
$196.72
|
| Rate for Payer: Aetna Medicare |
$446.96
|
| Rate for Payer: Aetna Medicare |
$220.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.73
|
| Rate for Payer: BCBS Complete |
$157.37
|
| Rate for Payer: BCBS Complete |
$357.57
|
| Rate for Payer: BCBS Complete |
$177.34
|
| Rate for Payer: BCBS Complete |
$176.63
|
| Rate for Payer: Cash Price |
$353.26
|
| Rate for Payer: Cash Price |
$354.69
|
| Rate for Payer: Cash Price |
$314.74
|
| Rate for Payer: Cash Price |
$715.14
|
| Rate for Payer: Cofinity Commercial |
$379.76
|
| Rate for Payer: Cofinity Commercial |
$768.77
|
| Rate for Payer: Cofinity Commercial |
$275.40
|
| Rate for Payer: Cofinity Commercial |
$381.29
|
| Rate for Payer: Cofinity Commercial |
$310.35
|
| Rate for Payer: Cofinity Commercial |
$625.74
|
| Rate for Payer: Cofinity Commercial |
$338.35
|
| Rate for Payer: Cofinity Commercial |
$309.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$275.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$309.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$310.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$625.74
|
| 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: Encore Health Key Benefits Commercial |
$353.26
|
| Rate for Payer: Healthscope Commercial |
$399.02
|
| Rate for Payer: Healthscope Commercial |
$354.09
|
| Rate for Payer: Healthscope Commercial |
$397.42
|
| Rate for Payer: Healthscope Commercial |
$804.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$625.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$310.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$309.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$275.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$331.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$332.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$670.44
|
| 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 |
$375.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.86
|
| Rate for Payer: PHP Commercial |
$376.86
|
| Rate for Payer: PHP Commercial |
$375.34
|
| Rate for Payer: PHP Commercial |
$759.83
|
| Rate for Payer: PHP Commercial |
$334.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$581.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.73
|
| Rate for Payer: Priority Health SBD |
$279.32
|
| Rate for Payer: Priority Health SBD |
$563.17
|
| Rate for Payer: Priority Health SBD |
$278.20
|
| Rate for Payer: Priority Health SBD |
$247.86
|
| Rate for Payer: UMR Bronson Commercial |
$164.04
|
| Rate for Payer: UMR Bronson Commercial |
$163.38
|
| Rate for Payer: UMR Bronson Commercial |
$330.75
|
| Rate for Payer: UMR Bronson Commercial |
$145.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$670.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$331.19
|
|
|
OCTREOTIDE ACETATE 1,000 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$443.36
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
91282
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$195.08 |
| Max. Negotiated Rate |
$399.02 |
| Rate for Payer: Aetna American Axle |
$288.18
|
| Rate for Payer: Aetna American Axle |
$287.03
|
| Rate for Payer: Aetna American Axle |
$255.73
|
| Rate for Payer: Aetna American Axle |
$581.05
|
| Rate for Payer: Aetna Commercial |
$376.86
|
| Rate for Payer: Aetna Commercial |
$759.83
|
| Rate for Payer: Aetna Commercial |
$375.34
|
| Rate for Payer: Aetna Commercial |
$334.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.18
|
| Rate for Payer: Cash Price |
$353.26
|
| Rate for Payer: Cash Price |
$354.69
|
| Rate for Payer: Cash Price |
$314.74
|
| Rate for Payer: Cash Price |
$715.14
|
| Rate for Payer: Cofinity Commercial |
$275.40
|
| Rate for Payer: Cofinity Commercial |
$768.77
|
| Rate for Payer: Cofinity Commercial |
$625.74
|
| Rate for Payer: Cofinity Commercial |
$310.35
|
| Rate for Payer: Cofinity Commercial |
$309.11
|
| Rate for Payer: Cofinity Commercial |
$379.76
|
| Rate for Payer: Cofinity Commercial |
$381.29
|
| Rate for Payer: Cofinity Commercial |
$338.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$309.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$310.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$625.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$275.40
|
| 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: Encore Health Key Benefits Commercial |
$353.26
|
| Rate for Payer: Healthscope Commercial |
$399.02
|
| Rate for Payer: Healthscope Commercial |
$354.09
|
| Rate for Payer: Healthscope Commercial |
$397.42
|
| Rate for Payer: Healthscope Commercial |
$804.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$275.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$309.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$625.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$310.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$331.19
|
| 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: 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 |
$375.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.86
|
| Rate for Payer: PHP Commercial |
$376.86
|
| Rate for Payer: PHP Commercial |
$759.83
|
| Rate for Payer: PHP Commercial |
$334.42
|
| Rate for Payer: PHP Commercial |
$375.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$581.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.73
|
| Rate for Payer: Priority Health SBD |
$563.17
|
| Rate for Payer: Priority Health SBD |
$247.86
|
| Rate for Payer: Priority Health SBD |
$278.20
|
| Rate for Payer: Priority Health SBD |
$279.32
|
| Rate for Payer: UMR Bronson Commercial |
$195.08
|
| Rate for Payer: UMR Bronson Commercial |
$393.32
|
| Rate for Payer: UMR Bronson Commercial |
$194.30
|
| Rate for Payer: UMR Bronson Commercial |
$173.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$670.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$331.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.52
|
|
|
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 |
$77.23
|
| Rate for Payer: Aetna American Axle |
$11.00
|
| Rate for Payer: Aetna American Axle |
$17.49
|
| Rate for Payer: Aetna American Axle |
$11.19
|
| Rate for Payer: Aetna Commercial |
$18.92
|
| Rate for Payer: Aetna Commercial |
$14.38
|
| Rate for Payer: Aetna Commercial |
$100.99
|
| Rate for Payer: Aetna Commercial |
$22.87
|
| Rate for Payer: Aetna Commercial |
$14.63
|
| 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) |
$17.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.00
|
| Rate for Payer: Cash Price |
$17.81
|
| Rate for Payer: Cash Price |
$21.53
|
| Rate for Payer: Cash Price |
$13.54
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cash Price |
$95.05
|
| Rate for Payer: Cofinity Commercial |
$18.84
|
| Rate for Payer: Cofinity Commercial |
$102.18
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$15.58
|
| Rate for Payer: Cofinity Commercial |
$12.05
|
| Rate for Payer: Cofinity Commercial |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$14.55
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$83.17
|
| Rate for Payer: Cofinity Commercial |
$23.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$83.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.77
|
| Rate for Payer: Healthscope Commercial |
$15.23
|
| Rate for Payer: Healthscope Commercial |
$20.03
|
| Rate for Payer: Healthscope Commercial |
$15.49
|
| Rate for Payer: Healthscope Commercial |
$24.22
|
| Rate for Payer: Healthscope Commercial |
$106.93
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$12.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.11
|
| 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 |
$14.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.99
|
| Rate for Payer: PHP Commercial |
$100.99
|
| Rate for Payer: PHP Commercial |
$22.87
|
| Rate for Payer: PHP Commercial |
$14.63
|
| Rate for Payer: PHP Commercial |
$18.92
|
| Rate for Payer: PHP Commercial |
$14.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.23
|
| Rate for Payer: Priority Health SBD |
$16.95
|
| Rate for Payer: Priority Health SBD |
$10.84
|
| Rate for Payer: Priority Health SBD |
$10.66
|
| Rate for Payer: Priority Health SBD |
$74.85
|
| Rate for Payer: Priority Health SBD |
$14.02
|
| Rate for Payer: UMR Bronson Commercial |
$52.28
|
| Rate for Payer: UMR Bronson Commercial |
$7.44
|
| Rate for Payer: UMR Bronson Commercial |
$9.79
|
| Rate for Payer: UMR Bronson Commercial |
$11.84
|
| Rate for Payer: UMR Bronson Commercial |
$7.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.70
|
|
|
OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$16.92
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
91279
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$15.23 |
| Rate for Payer: Aetna American Axle |
$11.00
|
| Rate for Payer: Aetna American Axle |
$14.47
|
| Rate for Payer: Aetna American Axle |
$17.49
|
| Rate for Payer: Aetna American Axle |
$77.23
|
| Rate for Payer: Aetna American Axle |
$11.19
|
| Rate for Payer: Aetna Commercial |
$100.99
|
| Rate for Payer: Aetna Commercial |
$22.87
|
| Rate for Payer: Aetna Commercial |
$14.63
|
| Rate for Payer: Aetna Commercial |
$18.92
|
| Rate for Payer: Aetna Commercial |
$14.38
|
| Rate for Payer: Aetna Medicare |
$11.13
|
| Rate for Payer: Aetna Medicare |
$8.46
|
| Rate for Payer: Aetna Medicare |
$13.46
|
| Rate for Payer: Aetna Medicare |
$8.61
|
| Rate for Payer: Aetna Medicare |
$59.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.47
|
| Rate for Payer: BCBS Complete |
$10.76
|
| Rate for Payer: BCBS Complete |
$47.52
|
| Rate for Payer: BCBS Complete |
$8.90
|
| Rate for Payer: BCBS Complete |
$6.88
|
| Rate for Payer: BCBS Complete |
$6.77
|
| Rate for Payer: Cash Price |
$21.53
|
| Rate for Payer: Cash Price |
$95.05
|
| Rate for Payer: Cash Price |
$13.54
|
| Rate for Payer: Cash Price |
$17.81
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cofinity Commercial |
$18.84
|
| Rate for Payer: Cofinity Commercial |
$14.55
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$102.18
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$12.05
|
| Rate for Payer: Cofinity Commercial |
$15.58
|
| Rate for Payer: Cofinity Commercial |
$83.17
|
| Rate for Payer: Cofinity Commercial |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$23.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$83.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.77
|
| Rate for Payer: Healthscope Commercial |
$106.93
|
| 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 |
$15.23
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$11.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.84
|
| 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 |
$12.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.63
|
| 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 |
$22.87
|
| Rate for Payer: PHP Commercial |
$18.92
|
| Rate for Payer: PHP Commercial |
$14.63
|
| Rate for Payer: PHP Commercial |
$100.99
|
| Rate for Payer: PHP Commercial |
$14.38
|
| Rate for Payer: PHP Commercial |
$22.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.00
|
| Rate for Payer: Priority Health SBD |
$10.66
|
| Rate for Payer: Priority Health SBD |
$74.85
|
| Rate for Payer: Priority Health SBD |
$10.84
|
| Rate for Payer: Priority Health SBD |
$14.02
|
| Rate for Payer: Priority Health SBD |
$16.95
|
| Rate for Payer: UMR Bronson Commercial |
$9.96
|
| Rate for Payer: UMR Bronson Commercial |
$8.24
|
| Rate for Payer: UMR Bronson Commercial |
$6.26
|
| Rate for Payer: UMR Bronson Commercial |
$43.96
|
| Rate for Payer: UMR Bronson Commercial |
$6.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.91
|
|
