|
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 |
$40.11 |
| 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 |
$77.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25,136.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.54
|
| Rate for Payer: BCBS Complete |
$42.11
|
| Rate for Payer: BCBS MAPPO |
$74.83
|
| Rate for Payer: BCBS Trust/PPO |
$201.74
|
| Rate for Payer: BCN Commercial |
$201.74
|
| Rate for Payer: BCN Medicare Advantage |
$74.83
|
| 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 |
$74.83
|
| 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 |
$40.11
|
| Rate for Payer: Mclaren Medicare |
$74.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.57
|
| Rate for Payer: Meridian Medicaid |
$42.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32,870.45
|
| Rate for Payer: Nomi Health Commercial |
$224.49
|
| Rate for Payer: PACE Medicare |
$71.09
|
| Rate for Payer: PACE SWMI |
$74.83
|
| Rate for Payer: PHP Commercial |
$32,870.45
|
| Rate for Payer: PHP Medicare Advantage |
$74.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25,136.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$214.67
|
| Rate for Payer: Priority Health Medicare |
$74.83
|
| Rate for Payer: Priority Health Narrow Network |
$171.74
|
| Rate for Payer: Priority Health SBD |
$24,362.81
|
| Rate for Payer: Railroad Medicare Medicare |
$74.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.83
|
| Rate for Payer: UHC Exchange |
$143.01
|
| Rate for Payer: UHC Medicare Advantage |
$74.83
|
| Rate for Payer: UHCCP Medicaid |
$40.11
|
| Rate for Payer: UMR Bronson Commercial |
$14,308.31
|
| Rate for Payer: VA VA |
$74.83
|
| 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 |
$31.50 |
| Max. Negotiated Rate |
$48,299.85 |
| Rate for Payer: Aetna American Axle |
$34,883.22
|
| Rate for Payer: Aetna Commercial |
$45,616.52
|
| Rate for Payer: Aetna Medicare |
$61.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34,883.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.46
|
| Rate for Payer: BCBS Complete |
$33.08
|
| Rate for Payer: BCBS MAPPO |
$58.77
|
| Rate for Payer: BCBS Trust/PPO |
$161.22
|
| Rate for Payer: BCN Commercial |
$161.22
|
| Rate for Payer: BCN Medicare Advantage |
$58.77
|
| 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 |
$58.77
|
| 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 |
$31.50
|
| Rate for Payer: Mclaren Medicare |
$58.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.71
|
| Rate for Payer: Meridian Medicaid |
$33.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45,616.52
|
| Rate for Payer: Nomi Health Commercial |
$176.31
|
| Rate for Payer: PACE Medicare |
$55.83
|
| Rate for Payer: PACE SWMI |
$58.77
|
| Rate for Payer: PHP Commercial |
$45,616.52
|
| Rate for Payer: PHP Medicare Advantage |
$58.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34,883.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$172.10
|
| Rate for Payer: Priority Health Medicare |
$58.77
|
| Rate for Payer: Priority Health Narrow Network |
$137.68
|
| Rate for Payer: Priority Health SBD |
$33,809.90
|
| Rate for Payer: Railroad Medicare Medicare |
$58.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.77
|
| Rate for Payer: UHC Exchange |
$112.32
|
| Rate for Payer: UHC Medicare Advantage |
$58.77
|
| Rate for Payer: UHCCP Medicaid |
$31.50
|
| Rate for Payer: UMR Bronson Commercial |
$19,856.60
|
| Rate for Payer: VA VA |
$58.77
|
| 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 |
$45,616.52
|
| 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 |
$45,616.52
|
| Rate for Payer: PHP Commercial |
$45,616.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34,883.22
|
| Rate for Payer: Priority Health SBD |
$33,809.90
|
| 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
|
$893.92
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
91282
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$804.53 |
| Rate for Payer: Aetna American Axle |
$581.05
|
| Rate for Payer: Aetna American Axle |
$288.18
|
| Rate for Payer: Aetna American Axle |
$255.73
|
| Rate for Payer: Aetna American Axle |
$287.03
|
| 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 Commercial |
$376.86
|
| Rate for Payer: Aetna Medicare |
$221.68
|
| Rate for Payer: Aetna Medicare |
$220.79
|
| Rate for Payer: Aetna Medicare |
$196.72
|
| Rate for Payer: Aetna Medicare |
$446.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.03
|
| Rate for Payer: BCBS Complete |
$177.34
|
| Rate for Payer: BCBS Complete |
$157.37
|
| Rate for Payer: BCBS Complete |
$357.57
|
| Rate for Payer: BCBS Complete |
$176.63
|
| Rate for Payer: BCBS Trust/PPO |
$2.30
|
| Rate for Payer: BCBS Trust/PPO |
$2.30
|
| Rate for Payer: BCBS Trust/PPO |
$2.30
|
| Rate for Payer: BCBS Trust/PPO |
$2.30
|
| Rate for Payer: BCN Commercial |
$2.30
|
| Rate for Payer: BCN Commercial |
$2.30
|
| Rate for Payer: BCN Commercial |
$2.30
|
| Rate for Payer: BCN Commercial |
$2.30
|
| Rate for Payer: Cash Price |
$353.26
|
| Rate for Payer: Cash Price |
$715.14
|
| Rate for Payer: Cash Price |
$354.69
|
| Rate for Payer: Cash Price |
$353.26
|
| Rate for Payer: Cash Price |
$314.74
|
| Rate for Payer: Cash Price |
$314.74
|
| Rate for Payer: Cash Price |
$354.69
|
| Rate for Payer: Cash Price |
$715.14
|
| Rate for Payer: Cofinity Commercial |
$768.77
|
| Rate for Payer: Cofinity Commercial |
$379.76
|
| Rate for Payer: Cofinity Commercial |
$275.40
|
| Rate for Payer: Cofinity Commercial |
$338.35
|
| Rate for Payer: Cofinity Commercial |
$309.11
|
| Rate for Payer: Cofinity Commercial |
$310.35
|
| Rate for Payer: Cofinity Commercial |
$381.29
|
| Rate for Payer: Cofinity Commercial |
$625.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$309.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$310.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$275.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$625.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.26
|
| 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 |
$314.74
|
| Rate for Payer: Healthscope Commercial |
$354.09
|
| Rate for Payer: Healthscope Commercial |
$804.53
|
| Rate for Payer: Healthscope Commercial |
$399.02
|
| Rate for Payer: Healthscope Commercial |
$397.42
|
| 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 |
$309.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$625.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$670.44
|
| 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 |
$331.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$375.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$759.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$334.42
|
| Rate for Payer: PHP Commercial |
$759.83
|
| Rate for Payer: PHP Commercial |
$375.34
|
| Rate for Payer: PHP Commercial |
$334.42
|
| Rate for Payer: PHP Commercial |
$376.86
|
| 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 Cigna Priority Health |
$288.18
|
| Rate for Payer: Priority Health SBD |
$247.86
|
| Rate for Payer: Priority Health SBD |
$279.32
|
| Rate for Payer: Priority Health SBD |
$278.20
|
| Rate for Payer: Priority Health SBD |
$563.17
|
| Rate for Payer: UMR Bronson Commercial |
$145.57
|
| Rate for Payer: UMR Bronson Commercial |
$164.04
|
| Rate for Payer: UMR Bronson Commercial |
$330.75
|
| Rate for Payer: UMR Bronson Commercial |
$163.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$331.18
|
| 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
|
$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 |
$331.18
|
| 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 |
$331.18
|
| 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 |
$2.30 |
| 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 |
$11.19
|
| Rate for Payer: Aetna American Axle |
$77.23
|
| Rate for Payer: Aetna American Axle |
$17.49
|
| 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 Commercial |
$18.92
|
| Rate for Payer: Aetna Medicare |
$8.60
|
| Rate for Payer: Aetna Medicare |
$11.13
|
| Rate for Payer: Aetna Medicare |
$8.46
|
| Rate for Payer: Aetna Medicare |
$59.40
|
| Rate for Payer: Aetna Medicare |
$13.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.47
|
| 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) |
$77.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.19
|
| Rate for Payer: BCBS Complete |
$6.77
|
| Rate for Payer: BCBS Complete |
$47.52
|
| Rate for Payer: BCBS Complete |
$8.90
|
| Rate for Payer: BCBS Complete |
$10.76
|
| Rate for Payer: BCBS Complete |
$6.88
|
| Rate for Payer: BCBS Trust/PPO |
$2.30
|
| Rate for Payer: BCBS Trust/PPO |
$2.30
|
| Rate for Payer: BCBS Trust/PPO |
$2.30
|
| Rate for Payer: BCBS Trust/PPO |
$2.30
|
| Rate for Payer: BCBS Trust/PPO |
$2.30
|
| Rate for Payer: BCN Commercial |
$2.30
|
| Rate for Payer: BCN Commercial |
$2.30
|
| Rate for Payer: BCN Commercial |
$2.30
|
| Rate for Payer: BCN Commercial |
$2.30
|
| Rate for Payer: BCN Commercial |
$2.30
|
| Rate for Payer: Cash Price |
$13.54
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cash Price |
$95.05
|
| Rate for Payer: Cash Price |
$13.54
|
| Rate for Payer: Cash Price |
$95.05
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cash Price |
$21.53
|
| Rate for Payer: Cash Price |
$21.53
|
| Rate for Payer: Cash Price |
$17.81
|
| Rate for Payer: Cash Price |
$17.81
|
| Rate for Payer: Cofinity Commercial |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$23.14
|
| 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 |
$18.84
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$15.58
|
| Rate for Payer: Cofinity Commercial |
$14.55
|
| Rate for Payer: Cofinity Commercial |
$83.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$83.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.77
|
| 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 |
$95.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.81
|
| Rate for Payer: Healthscope Commercial |
$20.03
|
| Rate for Payer: Healthscope Commercial |
$106.93
|
| Rate for Payer: Healthscope Commercial |
$15.23
|
| Rate for Payer: Healthscope Commercial |
$15.49
|
| Rate for Payer: Healthscope Commercial |
$24.22
|
| 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 |
$15.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.91
|
| 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 |
$18.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.99
|
| Rate for Payer: PHP Commercial |
$22.87
|
| Rate for Payer: PHP Commercial |
$18.92
|
| Rate for Payer: PHP Commercial |
$14.38
|
| Rate for Payer: PHP Commercial |
$100.99
|
| Rate for Payer: PHP Commercial |
$14.63
|
| 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 |
$11.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.00
|
| Rate for Payer: Priority Health SBD |
$10.66
|
| Rate for Payer: Priority Health SBD |
$16.95
|
| Rate for Payer: Priority Health SBD |
$14.02
|
| Rate for Payer: Priority Health SBD |
$74.85
|
| Rate for Payer: Priority Health SBD |
$10.84
|
| Rate for Payer: UMR Bronson Commercial |
$43.96
|
| Rate for Payer: UMR Bronson Commercial |
$6.37
|
| Rate for Payer: UMR Bronson Commercial |
$6.26
|
| Rate for Payer: UMR Bronson Commercial |
$8.24
|
| Rate for Payer: UMR Bronson Commercial |
$9.96
|
| 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 |
$20.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.11
|
|
|
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 |
$2.30 |
| 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 |
$2.30
|
| Rate for Payer: BCN Commercial |
$2.30
|
| Rate for Payer: Cash Price |
$79.71
|
| Rate for Payer: Cash Price |
$79.71
|
| Rate for Payer: Cofinity Commercial |
$69.75
|
| Rate for Payer: Cofinity Commercial |
$85.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.75
|
| 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: PHP Commercial |
$84.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.77
|
| Rate for Payer: Priority Health SBD |
$62.77
|
| 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: Cofinity Commercial |
$69.75
|
| Rate for Payer: Cofinity Commercial |
$85.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.75
|
| 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: 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: PHP Commercial |
$84.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.77
|
| 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 Commercial |
$43.78
|
| Rate for Payer: Cofinity Commercial |
$35.64
|
| Rate for Payer: Cofinity Commercial |
$34.01
|
| Rate for Payer: Cofinity Commercial |
$41.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.64
|
| 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: Multiplan/Beech St/PHCS Commercial |
$43.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.30
|
| Rate for Payer: PHP Commercial |
$43.27
|
| Rate for Payer: PHP Commercial |
$41.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.09
|
| Rate for Payer: Priority Health SBD |
$30.61
|
| Rate for Payer: Priority Health SBD |
$32.07
|
| 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 |
$2.30 |
| Max. Negotiated Rate |
$43.73 |
| Rate for Payer: Aetna American Axle |
$31.58
|
| Rate for Payer: Aetna American Axle |
$33.09
|
| Rate for Payer: Aetna Commercial |
$43.27
|
| Rate for Payer: Aetna Commercial |
$41.30
|
| Rate for Payer: Aetna Medicare |
$24.30
|
| Rate for Payer: Aetna Medicare |
$25.46
|
| 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 |
$2.30
|
| Rate for Payer: BCBS Trust/PPO |
$2.30
|
| Rate for Payer: BCN Commercial |
$2.30
|
| Rate for Payer: BCN Commercial |
$2.30
|
| Rate for Payer: Cash Price |
$40.73
|
| Rate for Payer: Cash Price |
$40.73
|
| Rate for Payer: Cash Price |
$38.87
|
| Rate for Payer: Cash Price |
$38.87
|
| Rate for Payer: Cofinity Commercial |
$43.78
|
| Rate for Payer: Cofinity Commercial |
$34.01
|
| Rate for Payer: Cofinity Commercial |
$35.64
|
| Rate for Payer: Cofinity Commercial |
$41.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.87
|
| Rate for Payer: Healthscope Commercial |
$45.82
|
| Rate for Payer: Healthscope Commercial |
$43.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.27
|
| Rate for Payer: PHP Commercial |
$41.30
|
| Rate for Payer: PHP Commercial |
$43.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.09
|
| Rate for Payer: Priority Health SBD |
$32.07
|
| Rate for Payer: Priority Health SBD |
$30.61
|
| 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 |
$38.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.44
|
|
|
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 |
$2.30 |
| 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 |
$9.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.11
|
| Rate for Payer: BCBS Complete |
$7.45
|
| Rate for Payer: BCBS Trust/PPO |
$2.30
|
| Rate for Payer: BCN Commercial |
$2.30
|
| Rate for Payer: Cash Price |
$14.90
|
| Rate for Payer: Cash Price |
$14.90
|
| Rate for Payer: Cofinity Commercial |
$13.04
|
| Rate for Payer: Cofinity Commercial |
$16.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.04
|
| 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: PHP Commercial |
$15.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.11
|
| Rate for Payer: Priority Health SBD |
$11.74
|
| 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 Commercial |
$13.04
|
| Rate for Payer: Cofinity Commercial |
$16.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.04
|
| 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: PHP Commercial |
$15.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.11
|
| Rate for Payer: Priority Health SBD |
$11.74
|
| Rate for Payer: UMR Bronson Commercial |
$8.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.97
|
|
|
OCTREOTIDE,MICROSPHERES ER 10 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE
|
Facility
|
IP
|
$8,842.60
|
|
|
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 Commercial |
$6,189.82
|
| Rate for Payer: Cofinity Commercial |
$7,604.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,189.82
|
| 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: PHP Commercial |
$7,516.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,747.69
|
| 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
|
|
|
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 |
$117.05 |
| 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 |
$227.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,747.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.96
|
| Rate for Payer: BCBS Complete |
$122.90
|
| Rate for Payer: BCBS MAPPO |
$218.37
|
| Rate for Payer: BCBS Trust/PPO |
$579.38
|
| Rate for Payer: BCN Commercial |
$579.38
|
| Rate for Payer: BCN Medicare Advantage |
$218.37
|
| Rate for Payer: Cash Price |
$7,074.08
|
| Rate for Payer: Cash Price |
$7,074.08
|
| Rate for Payer: Cofinity Commercial |
$7,604.64
|
| Rate for Payer: Cofinity Commercial |
$6,189.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,189.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,074.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.37
|
| 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 |
$117.05
|
| Rate for Payer: Mclaren Medicare |
$218.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$229.29
|
| Rate for Payer: Meridian Medicaid |
$122.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$251.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,516.21
|
| Rate for Payer: Nomi Health Commercial |
$655.11
|
| Rate for Payer: PACE Medicare |
$207.45
|
| Rate for Payer: PACE SWMI |
$218.37
|
| Rate for Payer: PHP Commercial |
$7,516.21
|
| Rate for Payer: PHP Medicare Advantage |
$218.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$117.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,747.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$618.45
|
| Rate for Payer: Priority Health Medicare |
$218.37
|
| Rate for Payer: Priority Health Narrow Network |
$494.76
|
| Rate for Payer: Priority Health SBD |
$5,570.84
|
| Rate for Payer: Railroad Medicare Medicare |
$218.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$614.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$218.37
|
| Rate for Payer: UHC Exchange |
$417.33
|
| Rate for Payer: UHC Medicare Advantage |
$218.37
|
| Rate for Payer: UHCCP Medicaid |
$117.05
|
| Rate for Payer: UMR Bronson Commercial |
$3,271.76
|
| Rate for Payer: VA VA |
$218.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,631.95
|
|
|
OCTREOTIDE,MICROSPHERES ER 20 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE
|
Facility
|
IP
|
$11,585.32
|
|
|
Service Code
|
HCPCS J2353
|
| Hospital Charge Code |
161512
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,097.54 |
| Max. Negotiated Rate |
$10,426.79 |
| Rate for Payer: Aetna American Axle |
$7,530.46
|
| Rate for Payer: Aetna Commercial |
$9,847.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,530.46
|
| Rate for Payer: Cash Price |
$9,268.26
|
| Rate for Payer: Cofinity Commercial |
$8,109.72
|
| Rate for Payer: Cofinity Commercial |
$9,963.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,109.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,268.26
|
| Rate for Payer: Healthscope Commercial |
$10,426.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,109.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,688.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,847.52
|
| Rate for Payer: PHP Commercial |
$9,847.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,530.46
|
| Rate for Payer: Priority Health SBD |
$7,298.75
|
| Rate for Payer: UMR Bronson Commercial |
$5,097.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,688.99
|
|
|
OCTREOTIDE,MICROSPHERES ER 20 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE
|
Facility
|
OP
|
$11,585.32
|
|
|
Service Code
|
HCPCS J2353
|
| Hospital Charge Code |
161512
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$117.05 |
| Max. Negotiated Rate |
$10,426.79 |
| Rate for Payer: Aetna American Axle |
$7,530.46
|
| Rate for Payer: Aetna Commercial |
$9,847.52
|
| Rate for Payer: Aetna Medicare |
$227.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,530.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.96
|
| Rate for Payer: BCBS Complete |
$122.90
|
| Rate for Payer: BCBS MAPPO |
$218.37
|
| Rate for Payer: BCBS Trust/PPO |
$579.38
|
| Rate for Payer: BCN Commercial |
$579.38
|
| Rate for Payer: BCN Medicare Advantage |
$218.37
|
| Rate for Payer: Cash Price |
$9,268.26
|
| Rate for Payer: Cash Price |
$9,268.26
|
| Rate for Payer: Cofinity Commercial |
$9,963.38
|
| Rate for Payer: Cofinity Commercial |
$8,109.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,109.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,268.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.37
|
| Rate for Payer: Healthscope Commercial |
$10,426.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,109.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,688.99
|
| Rate for Payer: Mclaren Medicaid |
$117.05
|
| Rate for Payer: Mclaren Medicare |
$218.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$229.29
|
| Rate for Payer: Meridian Medicaid |
$122.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$251.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,847.52
|
| Rate for Payer: Nomi Health Commercial |
$655.11
|
| Rate for Payer: PACE Medicare |
$207.45
|
| Rate for Payer: PACE SWMI |
$218.37
|
| Rate for Payer: PHP Commercial |
$9,847.52
|
| Rate for Payer: PHP Medicare Advantage |
$218.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$117.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,530.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$618.45
|
| Rate for Payer: Priority Health Medicare |
$218.37
|
| Rate for Payer: Priority Health Narrow Network |
$494.76
|
| Rate for Payer: Priority Health SBD |
$7,298.75
|
| Rate for Payer: Railroad Medicare Medicare |
$218.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$614.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$218.37
|
| Rate for Payer: UHC Exchange |
$417.33
|
| Rate for Payer: UHC Medicare Advantage |
$218.37
|
| Rate for Payer: UHCCP Medicaid |
$117.05
|
| Rate for Payer: UMR Bronson Commercial |
$4,286.57
|
| Rate for Payer: VA VA |
$218.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,688.99
|
|
|
OCTREOTIDE,MICROSPHERES ER 30 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE
|
Facility
|
IP
|
$17,348.09
|
|
|
Service Code
|
HCPCS J2353
|
| Hospital Charge Code |
161514
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,633.16 |
| Max. Negotiated Rate |
$15,613.28 |
| Rate for Payer: Aetna American Axle |
$11,276.26
|
| Rate for Payer: Aetna Commercial |
$14,745.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,276.26
|
| Rate for Payer: Cash Price |
$13,878.47
|
| Rate for Payer: Cofinity Commercial |
$12,143.66
|
| Rate for Payer: Cofinity Commercial |
$14,919.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$12,143.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,878.47
|
| Rate for Payer: Healthscope Commercial |
$15,613.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,143.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,011.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,745.88
|
| Rate for Payer: PHP Commercial |
$14,745.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,276.26
|
| Rate for Payer: Priority Health SBD |
$10,929.30
|
| Rate for Payer: UMR Bronson Commercial |
$7,633.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,011.07
|
|
|
OCTREOTIDE,MICROSPHERES ER 30 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE
|
Facility
|
OP
|
$17,348.09
|
|
|
Service Code
|
HCPCS J2353
|
| Hospital Charge Code |
161514
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$117.05 |
| Max. Negotiated Rate |
$15,613.28 |
| Rate for Payer: Aetna American Axle |
$11,276.26
|
| Rate for Payer: Aetna Commercial |
$14,745.88
|
| Rate for Payer: Aetna Medicare |
$227.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,276.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.96
|
| Rate for Payer: BCBS Complete |
$122.90
|
| Rate for Payer: BCBS MAPPO |
$218.37
|
| Rate for Payer: BCBS Trust/PPO |
$579.38
|
| Rate for Payer: BCN Commercial |
$579.38
|
| Rate for Payer: BCN Medicare Advantage |
$218.37
|
| Rate for Payer: Cash Price |
$13,878.47
|
| Rate for Payer: Cash Price |
$13,878.47
|
| Rate for Payer: Cofinity Commercial |
$14,919.36
|
| Rate for Payer: Cofinity Commercial |
$12,143.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$12,143.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,878.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.37
|
| Rate for Payer: Healthscope Commercial |
$15,613.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,143.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,011.07
|
| Rate for Payer: Mclaren Medicaid |
$117.05
|
| Rate for Payer: Mclaren Medicare |
$218.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$229.29
|
| Rate for Payer: Meridian Medicaid |
$122.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$251.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,745.88
|
| Rate for Payer: Nomi Health Commercial |
$655.11
|
| Rate for Payer: PACE Medicare |
$207.45
|
| Rate for Payer: PACE SWMI |
$218.37
|
| Rate for Payer: PHP Commercial |
$14,745.88
|
| Rate for Payer: PHP Medicare Advantage |
$218.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$117.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,276.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$618.45
|
| Rate for Payer: Priority Health Medicare |
$218.37
|
| Rate for Payer: Priority Health Narrow Network |
$494.76
|
| Rate for Payer: Priority Health SBD |
$10,929.30
|
| Rate for Payer: Railroad Medicare Medicare |
$218.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$614.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$218.37
|
| Rate for Payer: UHC Exchange |
$417.33
|
| Rate for Payer: UHC Medicare Advantage |
$218.37
|
| Rate for Payer: UHCCP Medicaid |
$117.05
|
| Rate for Payer: UMR Bronson Commercial |
$6,418.79
|
| Rate for Payer: VA VA |
$218.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,011.07
|
|
|
OFATUMUMAB 100 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,641.40
|
|
|
Service Code
|
HCPCS J9302
|
| Hospital Charge Code |
100265
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,162.22 |
| Max. Negotiated Rate |
$2,377.26 |
| Rate for Payer: Aetna American Axle |
$1,716.91
|
| Rate for Payer: Aetna Commercial |
$2,245.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,716.91
|
| Rate for Payer: Cash Price |
$2,113.12
|
| Rate for Payer: Cofinity Commercial |
$1,848.98
|
| Rate for Payer: Cofinity Commercial |
$2,271.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,848.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,113.12
|
| Rate for Payer: Healthscope Commercial |
$2,377.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,848.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,981.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,245.19
|
| Rate for Payer: PHP Commercial |
$2,245.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,716.91
|
| Rate for Payer: Priority Health SBD |
$1,664.08
|
| Rate for Payer: UMR Bronson Commercial |
$1,162.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,981.05
|
|
|
OFATUMUMAB 100 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,641.40
|
|
|
Service Code
|
HCPCS J9302
|
| Hospital Charge Code |
100265
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.36 |
| Max. Negotiated Rate |
$2,377.26 |
| Rate for Payer: Aetna American Axle |
$1,716.91
|
| Rate for Payer: Aetna Commercial |
$2,245.19
|
| Rate for Payer: Aetna Medicare |
$64.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,716.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.79
|
| Rate for Payer: BCBS Complete |
$35.02
|
| Rate for Payer: BCBS MAPPO |
$62.23
|
| Rate for Payer: BCBS Trust/PPO |
$162.09
|
| Rate for Payer: BCN Commercial |
$162.09
|
| Rate for Payer: BCN Medicare Advantage |
$62.23
|
| Rate for Payer: Cash Price |
$2,113.12
|
| Rate for Payer: Cash Price |
$2,113.12
|
| Rate for Payer: Cofinity Commercial |
$2,271.60
|
| Rate for Payer: Cofinity Commercial |
$1,848.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,848.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,113.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.23
|
| Rate for Payer: Healthscope Commercial |
$2,377.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,848.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,981.05
|
| Rate for Payer: Mclaren Medicaid |
$33.36
|
| Rate for Payer: Mclaren Medicare |
$62.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.34
|
| Rate for Payer: Meridian Medicaid |
$35.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,245.19
|
| Rate for Payer: Nomi Health Commercial |
$186.69
|
| Rate for Payer: PACE Medicare |
$59.12
|
| Rate for Payer: PACE SWMI |
$62.23
|
| Rate for Payer: PHP Commercial |
$2,245.19
|
| Rate for Payer: PHP Medicare Advantage |
$62.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,716.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$184.08
|
| Rate for Payer: Priority Health Medicare |
$62.23
|
| Rate for Payer: Priority Health Narrow Network |
$147.26
|
| Rate for Payer: Priority Health SBD |
$1,664.08
|
| Rate for Payer: Railroad Medicare Medicare |
$62.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.23
|
| Rate for Payer: UHC Exchange |
$118.93
|
| Rate for Payer: UHC Medicare Advantage |
$62.23
|
| Rate for Payer: UHCCP Medicaid |
$33.36
|
| Rate for Payer: UMR Bronson Commercial |
$977.32
|
| Rate for Payer: VA VA |
$62.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,981.05
|
|
|
OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT THAT MAY NOT REQUIRE THE PRESENCE OF A PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL
|
Facility
|
OP
|
$47.13
|
|
|
Service Code
|
CPT 99211
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8.37 |
| Max. Negotiated Rate |
$47.13 |
| Rate for Payer: BCBS Trust/PPO |
$47.13
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$47.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.21
|
| Rate for Payer: UHC Exchange |
$8.37
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$26.04
|
|
|
Service Code
|
NDC 70756060730
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.63 |
| Max. Negotiated Rate |
$23.44 |
| Rate for Payer: Aetna American Axle |
$16.93
|
| Rate for Payer: Aetna Commercial |
$22.13
|
| Rate for Payer: Aetna Medicare |
$13.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.93
|
| Rate for Payer: BCBS Complete |
$10.42
|
| Rate for Payer: Cash Price |
$20.83
|
| Rate for Payer: Cofinity Commercial |
$18.23
|
| Rate for Payer: Cofinity Commercial |
$22.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.83
|
| Rate for Payer: Healthscope Commercial |
$23.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.13
|
| Rate for Payer: PHP Commercial |
$22.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.93
|
| Rate for Payer: Priority Health SBD |
$16.41
|
| Rate for Payer: UMR Bronson Commercial |
$9.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.53
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$45.29
|
|
|
Service Code
|
NDC 64980051501
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.76 |
| Max. Negotiated Rate |
$40.76 |
| Rate for Payer: Aetna American Axle |
$29.44
|
| Rate for Payer: Aetna Commercial |
$38.50
|
| Rate for Payer: Aetna Medicare |
$22.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.44
|
| Rate for Payer: BCBS Complete |
$18.12
|
| Rate for Payer: Cash Price |
$36.23
|
| Rate for Payer: Cofinity Commercial |
$31.70
|
| Rate for Payer: Cofinity Commercial |
$38.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.23
|
| Rate for Payer: Healthscope Commercial |
$40.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.50
|
| Rate for Payer: PHP Commercial |
$38.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.44
|
| Rate for Payer: Priority Health SBD |
$28.53
|
| Rate for Payer: UMR Bronson Commercial |
$16.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.97
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$105.14
|
|
|
Service Code
|
NDC 60505056001
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.26 |
| Max. Negotiated Rate |
$94.63 |
| Rate for Payer: Aetna American Axle |
$68.34
|
| Rate for Payer: Aetna Commercial |
$89.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.34
|
| Rate for Payer: Cash Price |
$84.11
|
| Rate for Payer: Cofinity Commercial |
$73.60
|
| Rate for Payer: Cofinity Commercial |
$90.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.11
|
| Rate for Payer: Healthscope Commercial |
$94.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.37
|
| Rate for Payer: PHP Commercial |
$89.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.34
|
| Rate for Payer: Priority Health SBD |
$66.24
|
| Rate for Payer: UMR Bronson Commercial |
$46.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.86
|
|
