|
ATROPINE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$44.37
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
195981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.42 |
| Max. Negotiated Rate |
$39.93 |
| Rate for Payer: Aetna American Axle |
$28.84
|
| Rate for Payer: Aetna Commercial |
$37.71
|
| Rate for Payer: Aetna Medicare |
$22.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.84
|
| Rate for Payer: BCBS Complete |
$17.75
|
| Rate for Payer: Cash Price |
$35.50
|
| Rate for Payer: Cofinity Commercial |
$31.06
|
| Rate for Payer: Cofinity Commercial |
$38.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.50
|
| Rate for Payer: Healthscope Commercial |
$39.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.71
|
| Rate for Payer: PHP Commercial |
$37.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.84
|
| Rate for Payer: Priority Health SBD |
$27.95
|
| Rate for Payer: UMR Bronson Commercial |
$16.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.28
|
|
|
AUGMENTATION, MANDIBULAR BODY OR ANGLE; PROSTHETIC MATERIAL
|
Facility
|
OP
|
$16,240.34
|
|
|
Service Code
|
CPT 21125
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,092.41 |
| Max. Negotiated Rate |
$16,240.34 |
| Rate for Payer: Aetna Medicare |
$6,000.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,211.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,211.77
|
| Rate for Payer: BCBS Complete |
$3,247.03
|
| Rate for Payer: BCBS MAPPO |
$5,769.42
|
| Rate for Payer: BCN Medicare Advantage |
$5,769.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,769.42
|
| Rate for Payer: Mclaren Medicaid |
$3,092.41
|
| Rate for Payer: Mclaren Medicare |
$5,769.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,057.89
|
| Rate for Payer: Meridian Medicaid |
$3,247.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,634.83
|
| Rate for Payer: PACE Medicare |
$5,480.95
|
| Rate for Payer: PACE SWMI |
$5,769.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,769.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,092.41
|
| Rate for Payer: Priority Health Medicare |
$5,769.42
|
| Rate for Payer: Railroad Medicare Medicare |
$5,769.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,240.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,769.42
|
| Rate for Payer: UHC Exchange |
$11,025.94
|
| Rate for Payer: UHC Medicare Advantage |
$5,769.42
|
| Rate for Payer: UHCCP Medicaid |
$3,092.41
|
| Rate for Payer: VA VA |
$5,769.42
|
|
|
AVALGLUCOSIDASE ALFA-NGPT 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$6,231.68
|
|
|
Service Code
|
HCPCS J0219
|
| Hospital Charge Code |
198019
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,741.94 |
| Max. Negotiated Rate |
$5,608.51 |
| Rate for Payer: Aetna American Axle |
$4,050.59
|
| Rate for Payer: Aetna Commercial |
$5,296.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,050.59
|
| Rate for Payer: Cash Price |
$4,985.34
|
| Rate for Payer: Cofinity Commercial |
$4,362.18
|
| Rate for Payer: Cofinity Commercial |
$5,359.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,362.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,985.34
|
| Rate for Payer: Healthscope Commercial |
$5,608.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,362.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,673.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,296.93
|
| Rate for Payer: PHP Commercial |
$5,296.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,050.59
|
| Rate for Payer: Priority Health SBD |
$3,925.96
|
| Rate for Payer: UMR Bronson Commercial |
$2,741.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,673.76
|
|
|
AVALGLUCOSIDASE ALFA-NGPT 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,231.68
|
|
|
Service Code
|
HCPCS J0219
|
| Hospital Charge Code |
198019
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.37 |
| Max. Negotiated Rate |
$5,608.51 |
| Rate for Payer: Aetna American Axle |
$4,050.59
|
| Rate for Payer: Aetna Commercial |
$5,296.93
|
| Rate for Payer: Aetna Medicare |
$84.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,050.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$101.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$101.14
|
| Rate for Payer: BCBS Complete |
$45.54
|
| Rate for Payer: BCBS MAPPO |
$80.91
|
| Rate for Payer: BCN Medicare Advantage |
$80.91
|
| Rate for Payer: Cash Price |
$4,985.34
|
| Rate for Payer: Cash Price |
$4,985.34
|
| Rate for Payer: Cofinity Commercial |
$5,359.24
|
| Rate for Payer: Cofinity Commercial |
$4,362.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,362.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,985.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.91
|
| Rate for Payer: Healthscope Commercial |
$5,608.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,362.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,673.76
|
| Rate for Payer: Mclaren Medicaid |
$43.37
|
| Rate for Payer: Mclaren Medicare |
$80.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.96
|
| Rate for Payer: Meridian Medicaid |
$45.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,296.93
|
| Rate for Payer: PACE Medicare |
$76.86
|
| Rate for Payer: PACE SWMI |
$80.91
|
| Rate for Payer: PHP Commercial |
$5,296.93
|
| Rate for Payer: PHP Medicare Advantage |
$80.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,050.59
|
| Rate for Payer: Priority Health Medicare |
$80.91
|
| Rate for Payer: Priority Health SBD |
$3,925.96
|
| Rate for Payer: Railroad Medicare Medicare |
$80.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.91
|
| Rate for Payer: UHC Exchange |
$154.63
|
| Rate for Payer: UHC Medicare Advantage |
$80.91
|
| Rate for Payer: UHCCP Medicaid |
$43.37
|
| Rate for Payer: UMR Bronson Commercial |
$2,305.72
|
| Rate for Payer: VA VA |
$80.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,673.76
|
|
|
AVELUMAB 20 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$9,680.20
|
|
|
Service Code
|
HCPCS J9023
|
| Hospital Charge Code |
182436
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,259.29 |
| Max. Negotiated Rate |
$8,712.18 |
| Rate for Payer: Aetna American Axle |
$6,292.13
|
| Rate for Payer: Aetna Commercial |
$8,228.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,292.13
|
| Rate for Payer: Cash Price |
$7,744.16
|
| Rate for Payer: Cofinity Commercial |
$6,776.14
|
| Rate for Payer: Cofinity Commercial |
$8,324.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,776.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,744.16
|
| Rate for Payer: Healthscope Commercial |
$8,712.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,776.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,260.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,228.17
|
| Rate for Payer: PHP Commercial |
$8,228.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,292.13
|
| Rate for Payer: Priority Health SBD |
$6,098.53
|
| Rate for Payer: UMR Bronson Commercial |
$4,259.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,260.15
|
|
|
AVELUMAB 20 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$9,680.20
|
|
|
Service Code
|
HCPCS J9023
|
| Hospital Charge Code |
182436
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.65 |
| Max. Negotiated Rate |
$8,712.18 |
| Rate for Payer: Aetna American Axle |
$6,292.13
|
| Rate for Payer: Aetna Commercial |
$8,228.17
|
| Rate for Payer: Aetna Medicare |
$104.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,292.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$125.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$125.11
|
| Rate for Payer: BCBS Complete |
$56.33
|
| Rate for Payer: BCBS MAPPO |
$100.09
|
| Rate for Payer: BCN Medicare Advantage |
$100.09
|
| Rate for Payer: Cash Price |
$7,744.16
|
| Rate for Payer: Cash Price |
$7,744.16
|
| Rate for Payer: Cofinity Commercial |
$8,324.97
|
| Rate for Payer: Cofinity Commercial |
$6,776.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,776.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,744.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.09
|
| Rate for Payer: Healthscope Commercial |
$8,712.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,776.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,260.15
|
| Rate for Payer: Mclaren Medicaid |
$53.65
|
| Rate for Payer: Mclaren Medicare |
$100.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.09
|
| Rate for Payer: Meridian Medicaid |
$56.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,228.17
|
| Rate for Payer: PACE Medicare |
$95.09
|
| Rate for Payer: PACE SWMI |
$100.09
|
| Rate for Payer: PHP Commercial |
$8,228.17
|
| Rate for Payer: PHP Medicare Advantage |
$100.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,292.13
|
| Rate for Payer: Priority Health Medicare |
$100.09
|
| Rate for Payer: Priority Health SBD |
$6,098.53
|
| Rate for Payer: Railroad Medicare Medicare |
$100.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$281.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.09
|
| Rate for Payer: UHC Exchange |
$191.28
|
| Rate for Payer: UHC Medicare Advantage |
$100.09
|
| Rate for Payer: UHCCP Medicaid |
$53.65
|
| Rate for Payer: UMR Bronson Commercial |
$3,581.67
|
| Rate for Payer: VA VA |
$100.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,260.15
|
|
|
AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; SINGLE
|
Facility
|
OP
|
$545.50
|
|
|
Service Code
|
CPT 11730
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$545.50 |
| Rate for Payer: Aetna Medicare |
$201.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Exchange |
$370.35
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$103.87
|
| Rate for Payer: VA VA |
$193.79
|
|
|
AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; SINGLE
|
Facility
|
OP
|
$545.50
|
|
|
Service Code
|
CPT 11730
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$545.50 |
| Rate for Payer: Aetna Medicare |
$201.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Exchange |
$370.35
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$103.87
|
| Rate for Payer: VA VA |
$193.79
|
|
|
AXILLARY LYMPHADENECTOMY; COMPLETE
|
Facility
|
OP
|
$16,017.15
|
|
|
Service Code
|
CPT 38745
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,049.91 |
| Max. Negotiated Rate |
$16,017.15 |
| Rate for Payer: Aetna Medicare |
$5,917.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,112.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,112.66
|
| Rate for Payer: BCBS Complete |
$3,202.41
|
| Rate for Payer: BCBS MAPPO |
$5,690.13
|
| Rate for Payer: BCN Medicare Advantage |
$5,690.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,690.13
|
| Rate for Payer: Mclaren Medicaid |
$3,049.91
|
| Rate for Payer: Mclaren Medicare |
$5,690.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,974.64
|
| Rate for Payer: Meridian Medicaid |
$3,202.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,543.65
|
| Rate for Payer: PACE Medicare |
$5,405.62
|
| Rate for Payer: PACE SWMI |
$5,690.13
|
| Rate for Payer: PHP Medicare Advantage |
$5,690.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,049.91
|
| Rate for Payer: Priority Health Medicare |
$5,690.13
|
| Rate for Payer: Railroad Medicare Medicare |
$5,690.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,017.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,690.13
|
| Rate for Payer: UHC Exchange |
$10,874.41
|
| Rate for Payer: UHC Medicare Advantage |
$5,690.13
|
| Rate for Payer: UHCCP Medicaid |
$3,049.91
|
| Rate for Payer: VA VA |
$5,690.13
|
|
|
AXILLARY LYMPHADENECTOMY; SUPERFICIAL
|
Facility
|
OP
|
$16,017.15
|
|
|
Service Code
|
CPT 38740
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,049.91 |
| Max. Negotiated Rate |
$16,017.15 |
| Rate for Payer: Aetna Medicare |
$5,917.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,112.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,112.66
|
| Rate for Payer: BCBS Complete |
$3,202.41
|
| Rate for Payer: BCBS MAPPO |
$5,690.13
|
| Rate for Payer: BCN Medicare Advantage |
$5,690.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,690.13
|
| Rate for Payer: Mclaren Medicaid |
$3,049.91
|
| Rate for Payer: Mclaren Medicare |
$5,690.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,974.64
|
| Rate for Payer: Meridian Medicaid |
$3,202.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,543.65
|
| Rate for Payer: PACE Medicare |
$5,405.62
|
| Rate for Payer: PACE SWMI |
$5,690.13
|
| Rate for Payer: PHP Medicare Advantage |
$5,690.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,049.91
|
| Rate for Payer: Priority Health Medicare |
$5,690.13
|
| Rate for Payer: Railroad Medicare Medicare |
$5,690.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,017.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,690.13
|
| Rate for Payer: UHC Exchange |
$10,874.41
|
| Rate for Payer: UHC Medicare Advantage |
$5,690.13
|
| Rate for Payer: UHCCP Medicaid |
$3,049.91
|
| Rate for Payer: VA VA |
$5,690.13
|
|
|
AZACITIDINE 100 MG/10 ML SOLN
|
Facility
|
IP
|
$267.38
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
168892
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$117.65 |
| Max. Negotiated Rate |
$240.64 |
| Rate for Payer: Aetna American Axle |
$173.80
|
| Rate for Payer: Aetna American Axle |
$173.09
|
| Rate for Payer: Aetna American Axle |
$1,708.02
|
| Rate for Payer: Aetna American Axle |
$297.55
|
| Rate for Payer: Aetna Commercial |
$227.27
|
| Rate for Payer: Aetna Commercial |
$389.10
|
| Rate for Payer: Aetna Commercial |
$226.35
|
| Rate for Payer: Aetna Commercial |
$2,233.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,708.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.80
|
| Rate for Payer: Cash Price |
$213.04
|
| Rate for Payer: Cash Price |
$213.90
|
| Rate for Payer: Cash Price |
$2,102.18
|
| Rate for Payer: Cash Price |
$366.22
|
| Rate for Payer: Cofinity Commercial |
$1,839.41
|
| Rate for Payer: Cofinity Commercial |
$393.68
|
| Rate for Payer: Cofinity Commercial |
$320.44
|
| Rate for Payer: Cofinity Commercial |
$187.17
|
| Rate for Payer: Cofinity Commercial |
$186.41
|
| Rate for Payer: Cofinity Commercial |
$229.02
|
| Rate for Payer: Cofinity Commercial |
$229.95
|
| Rate for Payer: Cofinity Commercial |
$2,259.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$320.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,839.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,102.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.04
|
| Rate for Payer: Healthscope Commercial |
$240.64
|
| Rate for Payer: Healthscope Commercial |
$2,364.96
|
| Rate for Payer: Healthscope Commercial |
$239.67
|
| Rate for Payer: Healthscope Commercial |
$411.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,839.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$186.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,970.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,233.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.27
|
| Rate for Payer: PHP Commercial |
$227.27
|
| Rate for Payer: PHP Commercial |
$389.10
|
| Rate for Payer: PHP Commercial |
$2,233.57
|
| Rate for Payer: PHP Commercial |
$226.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,708.02
|
| Rate for Payer: Priority Health SBD |
$288.40
|
| Rate for Payer: Priority Health SBD |
$1,655.47
|
| Rate for Payer: Priority Health SBD |
$167.77
|
| Rate for Payer: Priority Health SBD |
$168.45
|
| Rate for Payer: UMR Bronson Commercial |
$117.65
|
| Rate for Payer: UMR Bronson Commercial |
$201.42
|
| Rate for Payer: UMR Bronson Commercial |
$117.17
|
| Rate for Payer: UMR Bronson Commercial |
$1,156.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,970.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.53
|
|
|
AZACITIDINE 100 MG/10 ML SOLN
|
Facility
|
OP
|
$266.30
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
168892
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$98.53 |
| Max. Negotiated Rate |
$239.67 |
| Rate for Payer: Aetna American Axle |
$173.09
|
| Rate for Payer: Aetna American Axle |
$297.55
|
| Rate for Payer: Aetna American Axle |
$1,708.02
|
| Rate for Payer: Aetna American Axle |
$173.80
|
| Rate for Payer: Aetna Commercial |
$389.10
|
| Rate for Payer: Aetna Commercial |
$226.35
|
| Rate for Payer: Aetna Commercial |
$227.27
|
| Rate for Payer: Aetna Commercial |
$2,233.57
|
| Rate for Payer: Aetna Medicare |
$133.69
|
| Rate for Payer: Aetna Medicare |
$1,313.87
|
| Rate for Payer: Aetna Medicare |
$228.88
|
| Rate for Payer: Aetna Medicare |
$133.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,708.02
|
| Rate for Payer: BCBS Complete |
$1,051.09
|
| Rate for Payer: BCBS Complete |
$183.11
|
| Rate for Payer: BCBS Complete |
$106.95
|
| Rate for Payer: BCBS Complete |
$106.52
|
| Rate for Payer: Cash Price |
$213.04
|
| Rate for Payer: Cash Price |
$213.90
|
| Rate for Payer: Cash Price |
$2,102.18
|
| Rate for Payer: Cash Price |
$366.22
|
| Rate for Payer: Cofinity Commercial |
$229.02
|
| Rate for Payer: Cofinity Commercial |
$393.68
|
| Rate for Payer: Cofinity Commercial |
$1,839.41
|
| Rate for Payer: Cofinity Commercial |
$229.95
|
| Rate for Payer: Cofinity Commercial |
$187.17
|
| Rate for Payer: Cofinity Commercial |
$320.44
|
| Rate for Payer: Cofinity Commercial |
$2,259.85
|
| Rate for Payer: Cofinity Commercial |
$186.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,839.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$320.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,102.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.04
|
| Rate for Payer: Healthscope Commercial |
$240.64
|
| Rate for Payer: Healthscope Commercial |
$2,364.96
|
| Rate for Payer: Healthscope Commercial |
$239.67
|
| Rate for Payer: Healthscope Commercial |
$411.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$186.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,839.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,970.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,233.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.27
|
| Rate for Payer: PHP Commercial |
$227.27
|
| Rate for Payer: PHP Commercial |
$226.35
|
| Rate for Payer: PHP Commercial |
$389.10
|
| Rate for Payer: PHP Commercial |
$2,233.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,708.02
|
| Rate for Payer: Priority Health SBD |
$168.45
|
| Rate for Payer: Priority Health SBD |
$288.40
|
| Rate for Payer: Priority Health SBD |
$167.77
|
| Rate for Payer: Priority Health SBD |
$1,655.47
|
| Rate for Payer: UMR Bronson Commercial |
$98.93
|
| Rate for Payer: UMR Bronson Commercial |
$98.53
|
| Rate for Payer: UMR Bronson Commercial |
$169.37
|
| Rate for Payer: UMR Bronson Commercial |
$972.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,970.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.72
|
|
|
AZACITIDINE 100 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$267.38
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
78420
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$98.93 |
| Max. Negotiated Rate |
$240.64 |
| Rate for Payer: Aetna American Axle |
$173.80
|
| Rate for Payer: Aetna American Axle |
$212.80
|
| Rate for Payer: Aetna American Axle |
$198.35
|
| Rate for Payer: Aetna American Axle |
$216.87
|
| Rate for Payer: Aetna American Axle |
$186.35
|
| Rate for Payer: Aetna American Axle |
$297.55
|
| Rate for Payer: Aetna American Axle |
$1,708.02
|
| Rate for Payer: Aetna American Axle |
$281.50
|
| Rate for Payer: Aetna American Axle |
$180.29
|
| Rate for Payer: Aetna American Axle |
$173.09
|
| Rate for Payer: Aetna Commercial |
$226.35
|
| Rate for Payer: Aetna Commercial |
$368.11
|
| Rate for Payer: Aetna Commercial |
$2,233.57
|
| Rate for Payer: Aetna Commercial |
$283.59
|
| Rate for Payer: Aetna Commercial |
$243.69
|
| Rate for Payer: Aetna Commercial |
$227.27
|
| Rate for Payer: Aetna Commercial |
$259.38
|
| Rate for Payer: Aetna Commercial |
$278.28
|
| Rate for Payer: Aetna Commercial |
$235.76
|
| Rate for Payer: Aetna Commercial |
$389.10
|
| Rate for Payer: Aetna Medicare |
$138.69
|
| Rate for Payer: Aetna Medicare |
$1,313.87
|
| Rate for Payer: Aetna Medicare |
$133.69
|
| Rate for Payer: Aetna Medicare |
$166.82
|
| Rate for Payer: Aetna Medicare |
$163.69
|
| Rate for Payer: Aetna Medicare |
$216.53
|
| Rate for Payer: Aetna Medicare |
$143.35
|
| Rate for Payer: Aetna Medicare |
$228.88
|
| Rate for Payer: Aetna Medicare |
$152.57
|
| Rate for Payer: Aetna Medicare |
$133.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,708.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.35
|
| Rate for Payer: BCBS Complete |
$1,051.09
|
| Rate for Payer: BCBS Complete |
$173.23
|
| Rate for Payer: BCBS Complete |
$183.11
|
| Rate for Payer: BCBS Complete |
$106.52
|
| Rate for Payer: BCBS Complete |
$122.06
|
| Rate for Payer: BCBS Complete |
$114.68
|
| Rate for Payer: BCBS Complete |
$106.95
|
| Rate for Payer: BCBS Complete |
$110.95
|
| Rate for Payer: BCBS Complete |
$133.46
|
| Rate for Payer: BCBS Complete |
$130.96
|
| Rate for Payer: Cash Price |
$221.90
|
| Rate for Payer: Cash Price |
$213.90
|
| Rate for Payer: Cash Price |
$2,102.18
|
| Rate for Payer: Cash Price |
$213.04
|
| Rate for Payer: Cash Price |
$229.36
|
| Rate for Payer: Cash Price |
$244.12
|
| Rate for Payer: Cash Price |
$261.91
|
| Rate for Payer: Cash Price |
$266.91
|
| Rate for Payer: Cash Price |
$346.46
|
| Rate for Payer: Cash Price |
$366.22
|
| Rate for Payer: Cofinity Commercial |
$262.43
|
| Rate for Payer: Cofinity Commercial |
$213.60
|
| Rate for Payer: Cofinity Commercial |
$303.15
|
| Rate for Payer: Cofinity Commercial |
$229.95
|
| Rate for Payer: Cofinity Commercial |
$1,839.41
|
| Rate for Payer: Cofinity Commercial |
$281.56
|
| Rate for Payer: Cofinity Commercial |
$200.69
|
| Rate for Payer: Cofinity Commercial |
$246.56
|
| Rate for Payer: Cofinity Commercial |
$194.16
|
| Rate for Payer: Cofinity Commercial |
$229.17
|
| Rate for Payer: Cofinity Commercial |
$238.54
|
| Rate for Payer: Cofinity Commercial |
$229.02
|
| Rate for Payer: Cofinity Commercial |
$393.68
|
| Rate for Payer: Cofinity Commercial |
$320.44
|
| Rate for Payer: Cofinity Commercial |
$2,259.85
|
| Rate for Payer: Cofinity Commercial |
$372.44
|
| Rate for Payer: Cofinity Commercial |
$186.41
|
| Rate for Payer: Cofinity Commercial |
$187.17
|
| Rate for Payer: Cofinity Commercial |
$286.93
|
| Rate for Payer: Cofinity Commercial |
$233.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$320.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$233.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$213.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$229.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,839.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$303.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$194.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,102.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$346.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.91
|
| Rate for Payer: Healthscope Commercial |
$258.03
|
| Rate for Payer: Healthscope Commercial |
$294.65
|
| Rate for Payer: Healthscope Commercial |
$300.28
|
| Rate for Payer: Healthscope Commercial |
$274.63
|
| Rate for Payer: Healthscope Commercial |
$249.63
|
| Rate for Payer: Healthscope Commercial |
$389.76
|
| Rate for Payer: Healthscope Commercial |
$411.99
|
| Rate for Payer: Healthscope Commercial |
$239.67
|
| Rate for Payer: Healthscope Commercial |
$2,364.96
|
| Rate for Payer: Healthscope Commercial |
$240.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$229.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$303.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,839.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$186.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,970.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$324.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$368.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,233.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.28
|
| Rate for Payer: PHP Commercial |
$389.10
|
| Rate for Payer: PHP Commercial |
$226.35
|
| Rate for Payer: PHP Commercial |
$2,233.57
|
| Rate for Payer: PHP Commercial |
$278.28
|
| Rate for Payer: PHP Commercial |
$368.11
|
| Rate for Payer: PHP Commercial |
$227.27
|
| Rate for Payer: PHP Commercial |
$283.59
|
| Rate for Payer: PHP Commercial |
$243.69
|
| Rate for Payer: PHP Commercial |
$235.76
|
| Rate for Payer: PHP Commercial |
$259.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,708.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.35
|
| Rate for Payer: Priority Health SBD |
$180.62
|
| Rate for Payer: Priority Health SBD |
$174.74
|
| Rate for Payer: Priority Health SBD |
$192.24
|
| Rate for Payer: Priority Health SBD |
$206.26
|
| Rate for Payer: Priority Health SBD |
$288.40
|
| Rate for Payer: Priority Health SBD |
$210.19
|
| Rate for Payer: Priority Health SBD |
$272.83
|
| Rate for Payer: Priority Health SBD |
$168.45
|
| Rate for Payer: Priority Health SBD |
$1,655.47
|
| Rate for Payer: Priority Health SBD |
$167.77
|
| Rate for Payer: UMR Bronson Commercial |
$112.91
|
| Rate for Payer: UMR Bronson Commercial |
$102.63
|
| Rate for Payer: UMR Bronson Commercial |
$121.13
|
| Rate for Payer: UMR Bronson Commercial |
$123.45
|
| Rate for Payer: UMR Bronson Commercial |
$106.08
|
| Rate for Payer: UMR Bronson Commercial |
$98.53
|
| Rate for Payer: UMR Bronson Commercial |
$169.37
|
| Rate for Payer: UMR Bronson Commercial |
$972.26
|
| Rate for Payer: UMR Bronson Commercial |
$98.93
|
| Rate for Payer: UMR Bronson Commercial |
$160.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$324.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,970.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.23
|
|
|
AZACITIDINE 100 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$327.39
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
78420
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$144.05 |
| Max. Negotiated Rate |
$294.65 |
| Rate for Payer: Aetna American Axle |
$212.80
|
| Rate for Payer: Aetna American Axle |
$1,708.02
|
| Rate for Payer: Aetna American Axle |
$173.09
|
| Rate for Payer: Aetna American Axle |
$297.55
|
| Rate for Payer: Aetna American Axle |
$173.80
|
| Rate for Payer: Aetna Commercial |
$278.28
|
| Rate for Payer: Aetna Commercial |
$226.35
|
| Rate for Payer: Aetna Commercial |
$2,233.57
|
| Rate for Payer: Aetna Commercial |
$389.10
|
| Rate for Payer: Aetna Commercial |
$227.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,708.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.09
|
| Rate for Payer: Cash Price |
$261.91
|
| Rate for Payer: Cash Price |
$366.22
|
| Rate for Payer: Cash Price |
$213.04
|
| Rate for Payer: Cash Price |
$213.90
|
| Rate for Payer: Cash Price |
$2,102.18
|
| Rate for Payer: Cofinity Commercial |
$320.44
|
| Rate for Payer: Cofinity Commercial |
$1,839.41
|
| Rate for Payer: Cofinity Commercial |
$281.56
|
| Rate for Payer: Cofinity Commercial |
$229.17
|
| Rate for Payer: Cofinity Commercial |
$187.17
|
| Rate for Payer: Cofinity Commercial |
$186.41
|
| Rate for Payer: Cofinity Commercial |
$229.02
|
| Rate for Payer: Cofinity Commercial |
$229.95
|
| Rate for Payer: Cofinity Commercial |
$2,259.85
|
| Rate for Payer: Cofinity Commercial |
$393.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$229.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,839.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$320.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,102.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.90
|
| Rate for Payer: Healthscope Commercial |
$239.67
|
| Rate for Payer: Healthscope Commercial |
$294.65
|
| Rate for Payer: Healthscope Commercial |
$240.64
|
| Rate for Payer: Healthscope Commercial |
$411.99
|
| Rate for Payer: Healthscope Commercial |
$2,364.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$229.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,839.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$186.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,970.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,233.57
|
| Rate for Payer: PHP Commercial |
$2,233.57
|
| Rate for Payer: PHP Commercial |
$389.10
|
| Rate for Payer: PHP Commercial |
$227.27
|
| Rate for Payer: PHP Commercial |
$278.28
|
| Rate for Payer: PHP Commercial |
$226.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,708.02
|
| Rate for Payer: Priority Health SBD |
$288.40
|
| Rate for Payer: Priority Health SBD |
$168.45
|
| Rate for Payer: Priority Health SBD |
$167.77
|
| Rate for Payer: Priority Health SBD |
$1,655.47
|
| Rate for Payer: Priority Health SBD |
$206.26
|
| Rate for Payer: UMR Bronson Commercial |
$1,156.20
|
| Rate for Payer: UMR Bronson Commercial |
$117.17
|
| Rate for Payer: UMR Bronson Commercial |
$144.05
|
| Rate for Payer: UMR Bronson Commercial |
$201.42
|
| Rate for Payer: UMR Bronson Commercial |
$117.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,970.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.54
|
|
|
AZATHIOPRINE 50 MG TABLET
|
Facility
|
IP
|
$2.66
|
|
|
Service Code
|
HCPCS J7500
|
| Hospital Charge Code |
9183
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$2.39 |
| Rate for Payer: Aetna American Axle |
$1.73
|
| Rate for Payer: Aetna American Axle |
$143.88
|
| Rate for Payer: Aetna American Axle |
$165.49
|
| Rate for Payer: Aetna American Axle |
$266.76
|
| Rate for Payer: Aetna American Axle |
$172.85
|
| Rate for Payer: Aetna Commercial |
$2.26
|
| Rate for Payer: Aetna Commercial |
$216.41
|
| Rate for Payer: Aetna Commercial |
$188.15
|
| Rate for Payer: Aetna Commercial |
$348.84
|
| Rate for Payer: Aetna Commercial |
$226.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.49
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cash Price |
$328.32
|
| Rate for Payer: Cash Price |
$203.68
|
| Rate for Payer: Cash Price |
$212.74
|
| Rate for Payer: Cash Price |
$177.08
|
| Rate for Payer: Cofinity Commercial |
$287.28
|
| Rate for Payer: Cofinity Commercial |
$154.94
|
| Rate for Payer: Cofinity Commercial |
$2.29
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$186.14
|
| Rate for Payer: Cofinity Commercial |
$178.22
|
| Rate for Payer: Cofinity Commercial |
$218.96
|
| Rate for Payer: Cofinity Commercial |
$228.69
|
| Rate for Payer: Cofinity Commercial |
$190.36
|
| Rate for Payer: Cofinity Commercial |
$352.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$154.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$287.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$328.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.74
|
| Rate for Payer: Healthscope Commercial |
$229.14
|
| Rate for Payer: Healthscope Commercial |
$2.39
|
| Rate for Payer: Healthscope Commercial |
$239.33
|
| Rate for Payer: Healthscope Commercial |
$369.36
|
| Rate for Payer: Healthscope Commercial |
$199.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$186.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$287.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$307.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.15
|
| Rate for Payer: PHP Commercial |
$188.15
|
| Rate for Payer: PHP Commercial |
$348.84
|
| Rate for Payer: PHP Commercial |
$226.03
|
| Rate for Payer: PHP Commercial |
$2.26
|
| Rate for Payer: PHP Commercial |
$216.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.88
|
| Rate for Payer: Priority Health SBD |
$258.55
|
| Rate for Payer: Priority Health SBD |
$167.53
|
| Rate for Payer: Priority Health SBD |
$160.40
|
| Rate for Payer: Priority Health SBD |
$139.45
|
| Rate for Payer: Priority Health SBD |
$1.68
|
| Rate for Payer: UMR Bronson Commercial |
$97.39
|
| Rate for Payer: UMR Bronson Commercial |
$112.02
|
| Rate for Payer: UMR Bronson Commercial |
$1.17
|
| Rate for Payer: UMR Bronson Commercial |
$180.58
|
| Rate for Payer: UMR Bronson Commercial |
$117.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$307.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.00
|
|
|
AZATHIOPRINE 50 MG TABLET
|
Facility
|
OP
|
$254.60
|
|
|
Service Code
|
HCPCS J7500
|
| Hospital Charge Code |
9183
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$94.20 |
| Max. Negotiated Rate |
$229.14 |
| Rate for Payer: Aetna American Axle |
$165.49
|
| Rate for Payer: Aetna American Axle |
$1.73
|
| Rate for Payer: Aetna American Axle |
$266.76
|
| Rate for Payer: Aetna American Axle |
$143.88
|
| Rate for Payer: Aetna American Axle |
$172.85
|
| Rate for Payer: Aetna Commercial |
$188.15
|
| Rate for Payer: Aetna Commercial |
$348.84
|
| Rate for Payer: Aetna Commercial |
$226.03
|
| Rate for Payer: Aetna Commercial |
$2.26
|
| Rate for Payer: Aetna Commercial |
$216.41
|
| Rate for Payer: Aetna Medicare |
$1.33
|
| Rate for Payer: Aetna Medicare |
$127.30
|
| Rate for Payer: Aetna Medicare |
$205.20
|
| Rate for Payer: Aetna Medicare |
$132.96
|
| Rate for Payer: Aetna Medicare |
$110.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.73
|
| Rate for Payer: BCBS Complete |
$164.16
|
| Rate for Payer: BCBS Complete |
$88.54
|
| Rate for Payer: BCBS Complete |
$1.06
|
| Rate for Payer: BCBS Complete |
$106.37
|
| Rate for Payer: BCBS Complete |
$101.84
|
| Rate for Payer: Cash Price |
$328.32
|
| Rate for Payer: Cash Price |
$177.08
|
| Rate for Payer: Cash Price |
$203.68
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cash Price |
$212.74
|
| Rate for Payer: Cofinity Commercial |
$287.28
|
| Rate for Payer: Cofinity Commercial |
$218.96
|
| Rate for Payer: Cofinity Commercial |
$2.29
|
| Rate for Payer: Cofinity Commercial |
$154.94
|
| Rate for Payer: Cofinity Commercial |
$228.69
|
| Rate for Payer: Cofinity Commercial |
$186.14
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$190.36
|
| Rate for Payer: Cofinity Commercial |
$178.22
|
| Rate for Payer: Cofinity Commercial |
$352.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$154.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$287.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$328.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.74
|
| Rate for Payer: Healthscope Commercial |
$199.22
|
| Rate for Payer: Healthscope Commercial |
$239.33
|
| Rate for Payer: Healthscope Commercial |
$369.36
|
| Rate for Payer: Healthscope Commercial |
$2.39
|
| Rate for Payer: Healthscope Commercial |
$229.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$186.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$287.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$307.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.84
|
| Rate for Payer: PHP Commercial |
$2.26
|
| Rate for Payer: PHP Commercial |
$226.03
|
| Rate for Payer: PHP Commercial |
$188.15
|
| Rate for Payer: PHP Commercial |
$216.41
|
| Rate for Payer: PHP Commercial |
$348.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.49
|
| Rate for Payer: Priority Health SBD |
$160.40
|
| Rate for Payer: Priority Health SBD |
$139.45
|
| Rate for Payer: Priority Health SBD |
$167.53
|
| Rate for Payer: Priority Health SBD |
$1.68
|
| Rate for Payer: Priority Health SBD |
$258.55
|
| Rate for Payer: UMR Bronson Commercial |
$151.85
|
| Rate for Payer: UMR Bronson Commercial |
$0.98
|
| Rate for Payer: UMR Bronson Commercial |
$94.20
|
| Rate for Payer: UMR Bronson Commercial |
$81.90
|
| Rate for Payer: UMR Bronson Commercial |
$98.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$307.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.44
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$96.62
|
|
|
Service Code
|
NDC 42806015134
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.75 |
| Max. Negotiated Rate |
$86.96 |
| Rate for Payer: Aetna American Axle |
$62.80
|
| Rate for Payer: Aetna Commercial |
$82.13
|
| Rate for Payer: Aetna Medicare |
$48.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.80
|
| Rate for Payer: BCBS Complete |
$38.65
|
| Rate for Payer: Cash Price |
$77.30
|
| Rate for Payer: Cofinity Commercial |
$67.63
|
| Rate for Payer: Cofinity Commercial |
$83.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.30
|
| Rate for Payer: Healthscope Commercial |
$86.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.13
|
| Rate for Payer: PHP Commercial |
$82.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.80
|
| Rate for Payer: Priority Health SBD |
$60.87
|
| Rate for Payer: UMR Bronson Commercial |
$35.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.47
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$116.79
|
|
|
Service Code
|
NDC 00093202631
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.39 |
| Max. Negotiated Rate |
$105.11 |
| Rate for Payer: Aetna American Axle |
$75.91
|
| Rate for Payer: Aetna Commercial |
$99.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.91
|
| Rate for Payer: Cash Price |
$93.43
|
| Rate for Payer: Cofinity Commercial |
$100.44
|
| Rate for Payer: Cofinity Commercial |
$81.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.43
|
| Rate for Payer: Healthscope Commercial |
$105.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.27
|
| Rate for Payer: PHP Commercial |
$99.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.91
|
| Rate for Payer: Priority Health SBD |
$73.58
|
| Rate for Payer: UMR Bronson Commercial |
$51.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.59
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$116.79
|
|
|
Service Code
|
NDC 00093202631
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.21 |
| Max. Negotiated Rate |
$105.11 |
| Rate for Payer: Aetna American Axle |
$75.91
|
| Rate for Payer: Aetna Commercial |
$99.27
|
| Rate for Payer: Aetna Medicare |
$58.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.91
|
| Rate for Payer: BCBS Complete |
$46.72
|
| Rate for Payer: Cash Price |
$93.43
|
| Rate for Payer: Cofinity Commercial |
$100.44
|
| Rate for Payer: Cofinity Commercial |
$81.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.43
|
| Rate for Payer: Healthscope Commercial |
$105.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.27
|
| Rate for Payer: PHP Commercial |
$99.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.91
|
| Rate for Payer: Priority Health SBD |
$73.58
|
| Rate for Payer: UMR Bronson Commercial |
$43.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.59
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$89.28
|
|
|
Service Code
|
NDC 59762314001
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.03 |
| Max. Negotiated Rate |
$80.35 |
| Rate for Payer: Aetna American Axle |
$58.03
|
| Rate for Payer: Aetna Commercial |
$75.89
|
| Rate for Payer: Aetna Medicare |
$44.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.03
|
| Rate for Payer: BCBS Complete |
$35.71
|
| Rate for Payer: Cash Price |
$71.42
|
| Rate for Payer: Cofinity Commercial |
$62.50
|
| Rate for Payer: Cofinity Commercial |
$76.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.42
|
| Rate for Payer: Healthscope Commercial |
$80.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.89
|
| Rate for Payer: PHP Commercial |
$75.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.03
|
| Rate for Payer: Priority Health SBD |
$56.25
|
| Rate for Payer: UMR Bronson Commercial |
$33.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.96
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$89.28
|
|
|
Service Code
|
NDC 59762314001
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$80.35 |
| Rate for Payer: Aetna American Axle |
$58.03
|
| Rate for Payer: Aetna Commercial |
$75.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.03
|
| Rate for Payer: Cash Price |
$71.42
|
| Rate for Payer: Cofinity Commercial |
$62.50
|
| Rate for Payer: Cofinity Commercial |
$76.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.42
|
| Rate for Payer: Healthscope Commercial |
$80.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.89
|
| Rate for Payer: PHP Commercial |
$75.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.03
|
| Rate for Payer: Priority Health SBD |
$56.25
|
| Rate for Payer: UMR Bronson Commercial |
$39.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.96
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$96.62
|
|
|
Service Code
|
NDC 42806015134
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.51 |
| Max. Negotiated Rate |
$86.96 |
| Rate for Payer: Aetna American Axle |
$62.80
|
| Rate for Payer: Aetna Commercial |
$82.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.80
|
| Rate for Payer: Cash Price |
$77.30
|
| Rate for Payer: Cofinity Commercial |
$67.63
|
| Rate for Payer: Cofinity Commercial |
$83.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.30
|
| Rate for Payer: Healthscope Commercial |
$86.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.13
|
| Rate for Payer: PHP Commercial |
$82.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.80
|
| Rate for Payer: Priority Health SBD |
$60.87
|
| Rate for Payer: UMR Bronson Commercial |
$42.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.47
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$384.80
|
|
|
Service Code
|
NDC 59762306003
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.31 |
| Max. Negotiated Rate |
$346.32 |
| Rate for Payer: Aetna American Axle |
$250.12
|
| Rate for Payer: Aetna Commercial |
$327.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.12
|
| Rate for Payer: Cash Price |
$307.84
|
| Rate for Payer: Cofinity Commercial |
$269.36
|
| Rate for Payer: Cofinity Commercial |
$330.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$269.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.84
|
| Rate for Payer: Healthscope Commercial |
$346.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$269.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$288.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.08
|
| Rate for Payer: PHP Commercial |
$327.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.12
|
| Rate for Payer: Priority Health SBD |
$242.42
|
| Rate for Payer: UMR Bronson Commercial |
$169.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$288.60
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$19.68
|
|
|
Service Code
|
NDC 65862064169
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.66 |
| Max. Negotiated Rate |
$17.71 |
| Rate for Payer: Aetna American Axle |
$12.79
|
| Rate for Payer: Aetna Commercial |
$16.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.79
|
| Rate for Payer: Cash Price |
$15.74
|
| Rate for Payer: Cofinity Commercial |
$13.78
|
| Rate for Payer: Cofinity Commercial |
$16.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.74
|
| Rate for Payer: Healthscope Commercial |
$17.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.73
|
| Rate for Payer: PHP Commercial |
$16.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.79
|
| Rate for Payer: Priority Health SBD |
$12.40
|
| Rate for Payer: UMR Bronson Commercial |
$8.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.76
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$384.80
|
|
|
Service Code
|
NDC 59762306003
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.38 |
| Max. Negotiated Rate |
$346.32 |
| Rate for Payer: Aetna American Axle |
$250.12
|
| Rate for Payer: Aetna Commercial |
$327.08
|
| Rate for Payer: Aetna Medicare |
$192.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.12
|
| Rate for Payer: BCBS Complete |
$153.92
|
| Rate for Payer: Cash Price |
$307.84
|
| Rate for Payer: Cofinity Commercial |
$269.36
|
| Rate for Payer: Cofinity Commercial |
$330.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$269.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.84
|
| Rate for Payer: Healthscope Commercial |
$346.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$269.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$288.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.08
|
| Rate for Payer: PHP Commercial |
$327.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.12
|
| Rate for Payer: Priority Health SBD |
$242.42
|
| Rate for Payer: UMR Bronson Commercial |
$142.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$288.60
|
|
