|
CYCLOPHOSPHAMIDE 200 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$4,720.45
|
|
|
Service Code
|
HCPCS J9075
|
| Hospital Charge Code |
194691
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$4,248.40 |
| Rate for Payer: Aetna American Axle |
$3,068.29
|
| Rate for Payer: Aetna American Axle |
$738.97
|
| Rate for Payer: Aetna Commercial |
$966.35
|
| Rate for Payer: Aetna Commercial |
$4,012.38
|
| Rate for Payer: Aetna Medicare |
$0.80
|
| Rate for Payer: Aetna Medicare |
$0.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$738.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,068.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.96
|
| Rate for Payer: BCBS Complete |
$0.42
|
| Rate for Payer: BCBS Complete |
$0.42
|
| Rate for Payer: BCBS MAPPO |
$0.77
|
| Rate for Payer: BCBS MAPPO |
$0.77
|
| Rate for Payer: BCBS Trust/PPO |
$1.88
|
| Rate for Payer: BCBS Trust/PPO |
$1.88
|
| Rate for Payer: BCN Commercial |
$1.88
|
| Rate for Payer: BCN Commercial |
$1.88
|
| Rate for Payer: BCN Medicare Advantage |
$0.77
|
| Rate for Payer: BCN Medicare Advantage |
$0.77
|
| Rate for Payer: Cash Price |
$909.50
|
| Rate for Payer: Cash Price |
$3,776.36
|
| Rate for Payer: Cash Price |
$3,776.36
|
| Rate for Payer: Cash Price |
$909.50
|
| Rate for Payer: Cofinity Advantage |
$3,304.32
|
| Rate for Payer: Cofinity Advantage |
$795.82
|
| Rate for Payer: Cofinity Commercial |
$977.72
|
| Rate for Payer: Cofinity Commercial |
$4,059.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$909.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,776.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.77
|
| Rate for Payer: Healthscope Commercial |
$1,023.19
|
| Rate for Payer: Healthscope Commercial |
$4,248.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,304.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$795.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$852.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,540.34
|
| Rate for Payer: Mclaren Medicaid |
$0.77
|
| Rate for Payer: Mclaren Medicaid |
$0.77
|
| Rate for Payer: Mclaren Medicare |
$0.77
|
| Rate for Payer: Mclaren Medicare |
$0.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.81
|
| Rate for Payer: Meridian Medicaid |
$0.81
|
| Rate for Payer: Meridian Medicaid |
$0.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$966.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,012.38
|
| Rate for Payer: Nomi Health Commercial |
$2.31
|
| Rate for Payer: Nomi Health Commercial |
$2.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,540.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$852.66
|
| Rate for Payer: PACE Medicare |
$0.73
|
| Rate for Payer: PACE Medicare |
$0.73
|
| Rate for Payer: PACE SWMI |
$0.77
|
| Rate for Payer: PACE SWMI |
$0.77
|
| Rate for Payer: PHP Commercial |
$966.35
|
| Rate for Payer: PHP Commercial |
$4,012.38
|
| Rate for Payer: PHP Medicare Advantage |
$0.77
|
| Rate for Payer: PHP Medicare Advantage |
$0.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1.53
|
| Rate for Payer: Priority Health Medicare |
$0.77
|
| Rate for Payer: Priority Health Medicare |
$0.77
|
| Rate for Payer: Priority Health SBD |
$716.23
|
| Rate for Payer: Priority Health SBD |
$2,973.88
|
| Rate for Payer: Priority Health Tiered Network |
$1.22
|
| Rate for Payer: Priority Health Tiered Network |
$1.22
|
| Rate for Payer: Railroad Medicare Medicare |
$0.77
|
| Rate for Payer: Railroad Medicare Medicare |
$0.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC Core |
$0.97
|
| Rate for Payer: UHC Core |
$0.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.77
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UHC Medicaid |
$0.40
|
| Rate for Payer: UHC Medicaid |
$0.40
|
| Rate for Payer: UHCCP Medicaid |
$0.40
|
| Rate for Payer: UHCCP Medicaid |
$0.40
|
| Rate for Payer: UMR Bronson Commercial |
$420.65
|
| Rate for Payer: UMR Bronson Commercial |
$1,746.57
|
| Rate for Payer: VA VA |
$0.77
|
| Rate for Payer: VA VA |
$0.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,540.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$852.66
|
|
|
CYCLOPHOSPHAMIDE 200 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,384.25
|
|
|
Service Code
|
HCPCS J9071
|
| Hospital Charge Code |
194691
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$609.07 |
| Max. Negotiated Rate |
$1,245.83 |
| Rate for Payer: Aetna American Axle |
$899.76
|
| Rate for Payer: Aetna American Axle |
$1,581.71
|
| Rate for Payer: Aetna Commercial |
$1,176.61
|
| Rate for Payer: Aetna Commercial |
$2,068.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$899.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,581.71
|
| Rate for Payer: Cash Price |
$1,107.40
|
| Rate for Payer: Cash Price |
$1,946.72
|
| Rate for Payer: Cofinity Advantage |
$1,703.38
|
| Rate for Payer: Cofinity Advantage |
$968.98
|
| Rate for Payer: Cofinity Commercial |
$2,092.72
|
| Rate for Payer: Cofinity Commercial |
$1,190.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,107.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,946.72
|
| Rate for Payer: Healthscope Commercial |
$1,245.83
|
| Rate for Payer: Healthscope Commercial |
$2,190.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,703.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$968.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,038.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,825.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,176.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,068.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,038.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,825.05
|
| Rate for Payer: PHP Commercial |
$1,176.61
|
| Rate for Payer: PHP Commercial |
$2,068.39
|
| Rate for Payer: Priority Health SBD |
$1,533.04
|
| Rate for Payer: Priority Health SBD |
$872.08
|
| Rate for Payer: UMR Bronson Commercial |
$609.07
|
| Rate for Payer: UMR Bronson Commercial |
$1,070.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,038.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,825.05
|
|
|
CYCLOPHOSPHAMIDE 200 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,929.38
|
|
|
Service Code
|
HCPCS J9071
|
| Hospital Charge Code |
194691
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$2,636.44 |
| Rate for Payer: Aetna American Axle |
$1,904.10
|
| Rate for Payer: Aetna American Axle |
$899.76
|
| Rate for Payer: Aetna American Axle |
$1,581.71
|
| Rate for Payer: Aetna Commercial |
$2,489.97
|
| Rate for Payer: Aetna Commercial |
$2,068.39
|
| Rate for Payer: Aetna Commercial |
$1,176.61
|
| Rate for Payer: Aetna Medicare |
$0.54
|
| Rate for Payer: Aetna Medicare |
$0.54
|
| Rate for Payer: Aetna Medicare |
$0.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,904.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$899.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,581.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.65
|
| Rate for Payer: BCBS Complete |
$0.29
|
| Rate for Payer: BCBS Complete |
$0.29
|
| Rate for Payer: BCBS Complete |
$0.29
|
| Rate for Payer: BCBS MAPPO |
$0.52
|
| Rate for Payer: BCBS MAPPO |
$0.52
|
| Rate for Payer: BCBS MAPPO |
$0.52
|
| Rate for Payer: BCBS Trust/PPO |
$1.94
|
| Rate for Payer: BCBS Trust/PPO |
$1.94
|
| Rate for Payer: BCBS Trust/PPO |
$1.94
|
| Rate for Payer: BCN Commercial |
$1.94
|
| Rate for Payer: BCN Commercial |
$1.94
|
| Rate for Payer: BCN Commercial |
$1.94
|
| Rate for Payer: BCN Medicare Advantage |
$0.52
|
| Rate for Payer: BCN Medicare Advantage |
$0.52
|
| Rate for Payer: BCN Medicare Advantage |
$0.52
|
| Rate for Payer: Cash Price |
$1,946.72
|
| Rate for Payer: Cash Price |
$2,343.50
|
| Rate for Payer: Cash Price |
$1,107.40
|
| Rate for Payer: Cash Price |
$2,343.50
|
| Rate for Payer: Cash Price |
$1,946.72
|
| Rate for Payer: Cash Price |
$1,107.40
|
| Rate for Payer: Cofinity Advantage |
$968.98
|
| Rate for Payer: Cofinity Advantage |
$1,703.38
|
| Rate for Payer: Cofinity Advantage |
$2,050.57
|
| Rate for Payer: Cofinity Commercial |
$2,092.72
|
| Rate for Payer: Cofinity Commercial |
$2,519.27
|
| Rate for Payer: Cofinity Commercial |
$1,190.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,107.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,946.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,343.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.52
|
| Rate for Payer: Healthscope Commercial |
$1,245.83
|
| Rate for Payer: Healthscope Commercial |
$2,190.06
|
| Rate for Payer: Healthscope Commercial |
$2,636.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,703.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$968.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,050.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,825.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,197.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,038.19
|
| Rate for Payer: Mclaren Medicaid |
$0.52
|
| Rate for Payer: Mclaren Medicaid |
$0.52
|
| Rate for Payer: Mclaren Medicaid |
$0.52
|
| Rate for Payer: Mclaren Medicare |
$0.52
|
| Rate for Payer: Mclaren Medicare |
$0.52
|
| Rate for Payer: Mclaren Medicare |
$0.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.55
|
| Rate for Payer: Meridian Medicaid |
$0.55
|
| Rate for Payer: Meridian Medicaid |
$0.55
|
| Rate for Payer: Meridian Medicaid |
$0.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,176.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,068.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,489.97
|
| Rate for Payer: Nomi Health Commercial |
$1.56
|
| Rate for Payer: Nomi Health Commercial |
$1.56
|
| Rate for Payer: Nomi Health Commercial |
$1.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,038.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,825.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,197.03
|
| Rate for Payer: PACE Medicare |
$0.49
|
| Rate for Payer: PACE Medicare |
$0.49
|
| Rate for Payer: PACE Medicare |
$0.49
|
| Rate for Payer: PACE SWMI |
$0.52
|
| Rate for Payer: PACE SWMI |
$0.52
|
| Rate for Payer: PACE SWMI |
$0.52
|
| Rate for Payer: PHP Commercial |
$2,489.97
|
| Rate for Payer: PHP Commercial |
$1,176.61
|
| Rate for Payer: PHP Commercial |
$2,068.39
|
| Rate for Payer: PHP Medicare Advantage |
$0.52
|
| Rate for Payer: PHP Medicare Advantage |
$0.52
|
| Rate for Payer: PHP Medicare Advantage |
$0.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1.99
|
| Rate for Payer: Priority Health Medicare |
$0.52
|
| Rate for Payer: Priority Health Medicare |
$0.52
|
| Rate for Payer: Priority Health Medicare |
$0.52
|
| Rate for Payer: Priority Health SBD |
$1,845.51
|
| Rate for Payer: Priority Health SBD |
$1,533.04
|
| Rate for Payer: Priority Health SBD |
$872.08
|
| Rate for Payer: Priority Health Tiered Network |
$1.59
|
| Rate for Payer: Priority Health Tiered Network |
$1.59
|
| Rate for Payer: Priority Health Tiered Network |
$1.59
|
| Rate for Payer: Railroad Medicare Medicare |
$0.52
|
| Rate for Payer: Railroad Medicare Medicare |
$0.52
|
| Rate for Payer: Railroad Medicare Medicare |
$0.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.01
|
| Rate for Payer: UHC Core |
$1.01
|
| Rate for Payer: UHC Core |
$1.01
|
| Rate for Payer: UHC Core |
$1.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.52
|
| Rate for Payer: UHC Exchange |
$1.01
|
| Rate for Payer: UHC Exchange |
$1.01
|
| Rate for Payer: UHC Exchange |
$1.01
|
| Rate for Payer: UHC Medicaid |
$0.27
|
| Rate for Payer: UHC Medicaid |
$0.27
|
| Rate for Payer: UHC Medicaid |
$0.27
|
| Rate for Payer: UHCCP Medicaid |
$0.27
|
| Rate for Payer: UHCCP Medicaid |
$0.27
|
| Rate for Payer: UHCCP Medicaid |
$0.27
|
| Rate for Payer: UMR Bronson Commercial |
$900.36
|
| Rate for Payer: UMR Bronson Commercial |
$512.17
|
| Rate for Payer: UMR Bronson Commercial |
$1,083.87
|
| Rate for Payer: VA VA |
$0.52
|
| Rate for Payer: VA VA |
$0.52
|
| Rate for Payer: VA VA |
$0.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,038.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,197.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,825.05
|
|
|
CYCLOPHOSPHAMIDE 200 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,149.02
|
|
|
Service Code
|
HCPCS J9073
|
| Hospital Charge Code |
194691
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1,934.12 |
| Rate for Payer: Aetna American Axle |
$1,396.86
|
| Rate for Payer: Aetna American Axle |
$713.95
|
| Rate for Payer: Aetna American Axle |
$1,346.29
|
| Rate for Payer: Aetna Commercial |
$1,826.67
|
| Rate for Payer: Aetna Commercial |
$1,760.54
|
| Rate for Payer: Aetna Commercial |
$933.63
|
| Rate for Payer: Aetna Medicare |
$0.52
|
| Rate for Payer: Aetna Medicare |
$0.52
|
| Rate for Payer: Aetna Medicare |
$0.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,396.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$713.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,346.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.63
|
| Rate for Payer: BCBS Complete |
$0.27
|
| Rate for Payer: BCBS Complete |
$0.27
|
| Rate for Payer: BCBS Complete |
$0.27
|
| Rate for Payer: BCBS MAPPO |
$0.50
|
| Rate for Payer: BCBS MAPPO |
$0.50
|
| Rate for Payer: BCBS MAPPO |
$0.50
|
| Rate for Payer: BCBS Trust/PPO |
$2.23
|
| Rate for Payer: BCBS Trust/PPO |
$2.23
|
| Rate for Payer: BCBS Trust/PPO |
$2.23
|
| Rate for Payer: BCN Commercial |
$2.23
|
| Rate for Payer: BCN Commercial |
$2.23
|
| Rate for Payer: BCN Commercial |
$2.23
|
| Rate for Payer: BCN Medicare Advantage |
$0.50
|
| Rate for Payer: BCN Medicare Advantage |
$0.50
|
| Rate for Payer: BCN Medicare Advantage |
$0.50
|
| Rate for Payer: Cash Price |
$1,656.98
|
| Rate for Payer: Cash Price |
$1,719.22
|
| Rate for Payer: Cash Price |
$878.71
|
| Rate for Payer: Cash Price |
$1,719.22
|
| Rate for Payer: Cash Price |
$1,656.98
|
| Rate for Payer: Cash Price |
$878.71
|
| Rate for Payer: Cofinity Advantage |
$768.87
|
| Rate for Payer: Cofinity Advantage |
$1,449.85
|
| Rate for Payer: Cofinity Advantage |
$1,504.31
|
| Rate for Payer: Cofinity Commercial |
$1,781.25
|
| Rate for Payer: Cofinity Commercial |
$1,848.16
|
| Rate for Payer: Cofinity Commercial |
$944.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$878.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,656.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,719.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.50
|
| Rate for Payer: Healthscope Commercial |
$988.55
|
| Rate for Payer: Healthscope Commercial |
$1,864.10
|
| Rate for Payer: Healthscope Commercial |
$1,934.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,449.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$768.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,504.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,553.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,611.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$823.79
|
| Rate for Payer: Mclaren Medicaid |
$0.50
|
| Rate for Payer: Mclaren Medicaid |
$0.50
|
| Rate for Payer: Mclaren Medicaid |
$0.50
|
| Rate for Payer: Mclaren Medicare |
$0.50
|
| Rate for Payer: Mclaren Medicare |
$0.50
|
| Rate for Payer: Mclaren Medicare |
$0.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.53
|
| Rate for Payer: Meridian Medicaid |
$0.53
|
| Rate for Payer: Meridian Medicaid |
$0.53
|
| Rate for Payer: Meridian Medicaid |
$0.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$933.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,760.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,826.67
|
| Rate for Payer: Nomi Health Commercial |
$1.50
|
| Rate for Payer: Nomi Health Commercial |
$1.50
|
| Rate for Payer: Nomi Health Commercial |
$1.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$823.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,553.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,611.77
|
| Rate for Payer: PACE Medicare |
$0.48
|
| Rate for Payer: PACE Medicare |
$0.48
|
| Rate for Payer: PACE Medicare |
$0.48
|
| Rate for Payer: PACE SWMI |
$0.50
|
| Rate for Payer: PACE SWMI |
$0.50
|
| Rate for Payer: PACE SWMI |
$0.50
|
| Rate for Payer: PHP Commercial |
$1,826.67
|
| Rate for Payer: PHP Commercial |
$933.63
|
| Rate for Payer: PHP Commercial |
$1,760.54
|
| Rate for Payer: PHP Medicare Advantage |
$0.50
|
| Rate for Payer: PHP Medicare Advantage |
$0.50
|
| Rate for Payer: PHP Medicare Advantage |
$0.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2.48
|
| Rate for Payer: Priority Health Medicare |
$0.50
|
| Rate for Payer: Priority Health Medicare |
$0.50
|
| Rate for Payer: Priority Health Medicare |
$0.50
|
| Rate for Payer: Priority Health SBD |
$1,353.88
|
| Rate for Payer: Priority Health SBD |
$1,304.87
|
| Rate for Payer: Priority Health SBD |
$691.99
|
| Rate for Payer: Priority Health Tiered Network |
$1.98
|
| Rate for Payer: Priority Health Tiered Network |
$1.98
|
| Rate for Payer: Priority Health Tiered Network |
$1.98
|
| Rate for Payer: Railroad Medicare Medicare |
$0.50
|
| Rate for Payer: Railroad Medicare Medicare |
$0.50
|
| Rate for Payer: Railroad Medicare Medicare |
$0.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.16
|
| Rate for Payer: UHC Core |
$1.16
|
| Rate for Payer: UHC Core |
$1.16
|
| Rate for Payer: UHC Core |
$1.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.50
|
| Rate for Payer: UHC Exchange |
$1.16
|
| Rate for Payer: UHC Exchange |
$1.16
|
| Rate for Payer: UHC Exchange |
$1.16
|
| Rate for Payer: UHC Medicaid |
$0.26
|
| Rate for Payer: UHC Medicaid |
$0.26
|
| Rate for Payer: UHC Medicaid |
$0.26
|
| Rate for Payer: UHCCP Medicaid |
$0.26
|
| Rate for Payer: UHCCP Medicaid |
$0.26
|
| Rate for Payer: UHCCP Medicaid |
$0.26
|
| Rate for Payer: UMR Bronson Commercial |
$766.35
|
| Rate for Payer: UMR Bronson Commercial |
$406.40
|
| Rate for Payer: UMR Bronson Commercial |
$795.14
|
| Rate for Payer: VA VA |
$0.50
|
| Rate for Payer: VA VA |
$0.50
|
| Rate for Payer: VA VA |
$0.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$823.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,611.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,553.41
|
|
|
CYCLOPHOSPHAMIDE 200 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,136.88
|
|
|
Service Code
|
HCPCS J9075
|
| Hospital Charge Code |
194691
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$500.23 |
| Max. Negotiated Rate |
$1,023.19 |
| Rate for Payer: Aetna American Axle |
$738.97
|
| Rate for Payer: Aetna American Axle |
$3,068.29
|
| Rate for Payer: Aetna Commercial |
$966.35
|
| Rate for Payer: Aetna Commercial |
$4,012.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$738.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,068.29
|
| Rate for Payer: Cash Price |
$909.50
|
| Rate for Payer: Cash Price |
$3,776.36
|
| Rate for Payer: Cofinity Advantage |
$3,304.32
|
| Rate for Payer: Cofinity Advantage |
$795.82
|
| Rate for Payer: Cofinity Commercial |
$4,059.59
|
| Rate for Payer: Cofinity Commercial |
$977.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$909.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,776.36
|
| Rate for Payer: Healthscope Commercial |
$1,023.19
|
| Rate for Payer: Healthscope Commercial |
$4,248.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,304.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$795.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$852.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,540.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$966.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,012.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$852.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,540.34
|
| Rate for Payer: PHP Commercial |
$966.35
|
| Rate for Payer: PHP Commercial |
$4,012.38
|
| Rate for Payer: Priority Health SBD |
$2,973.88
|
| Rate for Payer: Priority Health SBD |
$716.23
|
| Rate for Payer: UMR Bronson Commercial |
$500.23
|
| Rate for Payer: UMR Bronson Commercial |
$2,077.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$852.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,540.34
|
|
|
CYCLOPHOSPHAMIDE 200 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,071.22
|
|
|
Service Code
|
HCPCS J9073
|
| Hospital Charge Code |
194691
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$911.34 |
| Max. Negotiated Rate |
$1,864.10 |
| Rate for Payer: Aetna American Axle |
$1,346.29
|
| Rate for Payer: Aetna American Axle |
$1,396.86
|
| Rate for Payer: Aetna Commercial |
$1,760.54
|
| Rate for Payer: Aetna Commercial |
$1,826.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,346.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,396.86
|
| Rate for Payer: Cash Price |
$1,656.98
|
| Rate for Payer: Cash Price |
$1,719.22
|
| Rate for Payer: Cofinity Advantage |
$1,504.31
|
| Rate for Payer: Cofinity Advantage |
$1,449.85
|
| Rate for Payer: Cofinity Commercial |
$1,848.16
|
| Rate for Payer: Cofinity Commercial |
$1,781.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,656.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,719.22
|
| Rate for Payer: Healthscope Commercial |
$1,864.10
|
| Rate for Payer: Healthscope Commercial |
$1,934.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,504.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,449.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,553.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,611.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,760.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,826.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,553.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,611.77
|
| Rate for Payer: PHP Commercial |
$1,760.54
|
| Rate for Payer: PHP Commercial |
$1,826.67
|
| Rate for Payer: Priority Health SBD |
$1,353.88
|
| Rate for Payer: Priority Health SBD |
$1,304.87
|
| Rate for Payer: UMR Bronson Commercial |
$911.34
|
| Rate for Payer: UMR Bronson Commercial |
$945.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,553.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,611.77
|
|
|
CYCLOPHOSPHAMIDE 500 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$8,093.23
|
|
|
Service Code
|
HCPCS J9072
|
| Hospital Charge Code |
204614
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$7,283.91 |
| Rate for Payer: Aetna American Axle |
$5,260.60
|
| Rate for Payer: Aetna Commercial |
$6,879.25
|
| Rate for Payer: Aetna Medicare |
$9.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,260.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.38
|
| Rate for Payer: BCBS Complete |
$5.00
|
| Rate for Payer: BCBS MAPPO |
$9.10
|
| Rate for Payer: BCBS Trust/PPO |
$29.15
|
| Rate for Payer: BCN Commercial |
$29.15
|
| Rate for Payer: BCN Medicare Advantage |
$9.10
|
| Rate for Payer: Cash Price |
$6,474.58
|
| Rate for Payer: Cash Price |
$6,474.58
|
| Rate for Payer: Cofinity Advantage |
$5,665.26
|
| Rate for Payer: Cofinity Commercial |
$6,960.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,474.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.10
|
| Rate for Payer: Healthscope Commercial |
$7,283.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,665.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,069.92
|
| Rate for Payer: Mclaren Medicaid |
$9.10
|
| Rate for Payer: Mclaren Medicare |
$9.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.55
|
| Rate for Payer: Meridian Medicaid |
$9.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,879.25
|
| Rate for Payer: Nomi Health Commercial |
$27.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,069.92
|
| Rate for Payer: PACE Medicare |
$8.64
|
| Rate for Payer: PACE SWMI |
$9.10
|
| Rate for Payer: PHP Commercial |
$6,879.25
|
| Rate for Payer: PHP Medicare Advantage |
$9.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$28.72
|
| Rate for Payer: Priority Health Medicare |
$9.10
|
| Rate for Payer: Priority Health SBD |
$5,098.73
|
| Rate for Payer: Priority Health Tiered Network |
$22.98
|
| Rate for Payer: Railroad Medicare Medicare |
$9.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.83
|
| Rate for Payer: UHC Core |
$14.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9.10
|
| Rate for Payer: UHC Exchange |
$14.83
|
| Rate for Payer: UHC Medicaid |
$4.76
|
| Rate for Payer: UHCCP Medicaid |
$4.76
|
| Rate for Payer: UMR Bronson Commercial |
$2,994.50
|
| Rate for Payer: VA VA |
$9.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,069.92
|
|
|
CYCLOPHOSPHAMIDE 50 MG CAPSULE
|
Facility
|
OP
|
$4,729.71
|
|
|
Service Code
|
HCPCS J8530
|
| Hospital Charge Code |
171088
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$4,256.74 |
| Rate for Payer: Aetna American Axle |
$3,074.31
|
| Rate for Payer: Aetna American Axle |
$640.45
|
| Rate for Payer: Aetna Commercial |
$4,020.25
|
| Rate for Payer: Aetna Commercial |
$837.51
|
| Rate for Payer: Aetna Medicare |
$2,364.86
|
| Rate for Payer: Aetna Medicare |
$492.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,074.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$640.45
|
| Rate for Payer: BCBS Complete |
$394.12
|
| Rate for Payer: BCBS Complete |
$1,891.88
|
| Rate for Payer: BCBS Trust/PPO |
$5.89
|
| Rate for Payer: BCBS Trust/PPO |
$5.89
|
| Rate for Payer: BCN Commercial |
$5.89
|
| Rate for Payer: BCN Commercial |
$5.89
|
| Rate for Payer: Cash Price |
$3,783.77
|
| Rate for Payer: Cash Price |
$788.25
|
| Rate for Payer: Cash Price |
$3,783.77
|
| Rate for Payer: Cash Price |
$788.25
|
| Rate for Payer: Cofinity Advantage |
$3,310.80
|
| Rate for Payer: Cofinity Advantage |
$689.72
|
| Rate for Payer: Cofinity Commercial |
$4,067.55
|
| Rate for Payer: Cofinity Commercial |
$847.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,783.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$788.25
|
| Rate for Payer: Healthscope Commercial |
$4,256.74
|
| Rate for Payer: Healthscope Commercial |
$886.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,310.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$689.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,547.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$738.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,783.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$788.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,020.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$837.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$738.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,547.28
|
| Rate for Payer: PHP Commercial |
$4,020.25
|
| Rate for Payer: PHP Commercial |
$837.51
|
| Rate for Payer: Priority Health SBD |
$2,979.72
|
| Rate for Payer: Priority Health SBD |
$620.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.00
|
| Rate for Payer: UHC Core |
$3.00
|
| Rate for Payer: UHC Core |
$3.00
|
| Rate for Payer: UHC Exchange |
$3.00
|
| Rate for Payer: UHC Exchange |
$3.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,749.99
|
| Rate for Payer: UMR Bronson Commercial |
$364.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,547.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$738.98
|
|
|
CYCLOPHOSPHAMIDE 50 MG CAPSULE
|
Facility
|
IP
|
$4,729.71
|
|
|
Service Code
|
HCPCS J8530
|
| Hospital Charge Code |
171088
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,081.07 |
| Max. Negotiated Rate |
$4,256.74 |
| Rate for Payer: Aetna American Axle |
$3,074.31
|
| Rate for Payer: Aetna American Axle |
$640.45
|
| Rate for Payer: Aetna Commercial |
$4,020.25
|
| Rate for Payer: Aetna Commercial |
$837.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,074.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$640.45
|
| Rate for Payer: Cash Price |
$3,783.77
|
| Rate for Payer: Cash Price |
$788.25
|
| Rate for Payer: Cofinity Advantage |
$689.72
|
| Rate for Payer: Cofinity Advantage |
$3,310.80
|
| Rate for Payer: Cofinity Commercial |
$847.37
|
| Rate for Payer: Cofinity Commercial |
$4,067.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,783.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$788.25
|
| Rate for Payer: Healthscope Commercial |
$4,256.74
|
| Rate for Payer: Healthscope Commercial |
$886.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$689.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,310.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,547.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$738.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,020.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$837.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,547.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$738.98
|
| Rate for Payer: PHP Commercial |
$4,020.25
|
| Rate for Payer: PHP Commercial |
$837.51
|
| Rate for Payer: Priority Health SBD |
$620.75
|
| Rate for Payer: Priority Health SBD |
$2,979.72
|
| Rate for Payer: UMR Bronson Commercial |
$2,081.07
|
| Rate for Payer: UMR Bronson Commercial |
$433.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,547.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$738.98
|
|
|
CYCLOSPORINE 100 MG CAPSULE
|
Facility
|
OP
|
$1,922.75
|
|
|
Service Code
|
HCPCS J7502
|
| Hospital Charge Code |
9706
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$1,730.47 |
| Rate for Payer: Aetna American Axle |
$1,249.79
|
| Rate for Payer: Aetna American Axle |
$41.66
|
| Rate for Payer: Aetna Commercial |
$1,634.34
|
| Rate for Payer: Aetna Commercial |
$54.48
|
| Rate for Payer: Aetna Medicare |
$961.38
|
| Rate for Payer: Aetna Medicare |
$32.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,249.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.66
|
| Rate for Payer: BCBS Complete |
$25.64
|
| Rate for Payer: BCBS Complete |
$769.10
|
| Rate for Payer: BCBS Trust/PPO |
$5.86
|
| Rate for Payer: BCBS Trust/PPO |
$5.86
|
| Rate for Payer: BCN Commercial |
$5.86
|
| Rate for Payer: BCN Commercial |
$5.86
|
| Rate for Payer: Cash Price |
$1,538.20
|
| Rate for Payer: Cash Price |
$51.28
|
| Rate for Payer: Cash Price |
$1,538.20
|
| Rate for Payer: Cash Price |
$51.28
|
| Rate for Payer: Cofinity Advantage |
$1,345.92
|
| Rate for Payer: Cofinity Advantage |
$44.87
|
| Rate for Payer: Cofinity Commercial |
$1,653.57
|
| Rate for Payer: Cofinity Commercial |
$55.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,538.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.28
|
| Rate for Payer: Healthscope Commercial |
$1,730.47
|
| Rate for Payer: Healthscope Commercial |
$57.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,345.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,442.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,538.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,634.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,442.06
|
| Rate for Payer: PHP Commercial |
$1,634.34
|
| Rate for Payer: PHP Commercial |
$54.48
|
| Rate for Payer: Priority Health SBD |
$1,211.33
|
| Rate for Payer: Priority Health SBD |
$40.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.99
|
| Rate for Payer: UHC Core |
$2.99
|
| Rate for Payer: UHC Core |
$2.99
|
| Rate for Payer: UHC Exchange |
$2.99
|
| Rate for Payer: UHC Exchange |
$2.99
|
| Rate for Payer: UMR Bronson Commercial |
$711.42
|
| Rate for Payer: UMR Bronson Commercial |
$23.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,442.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.08
|
|
|
CYCLOSPORINE 100 MG CAPSULE
|
Facility
|
IP
|
$1,922.75
|
|
|
Service Code
|
HCPCS J7502
|
| Hospital Charge Code |
9706
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$846.01 |
| Max. Negotiated Rate |
$1,730.47 |
| Rate for Payer: Aetna American Axle |
$1,249.79
|
| Rate for Payer: Aetna American Axle |
$41.66
|
| Rate for Payer: Aetna Commercial |
$1,634.34
|
| Rate for Payer: Aetna Commercial |
$54.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,249.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.66
|
| Rate for Payer: Cash Price |
$1,538.20
|
| Rate for Payer: Cash Price |
$51.28
|
| Rate for Payer: Cofinity Advantage |
$44.87
|
| Rate for Payer: Cofinity Advantage |
$1,345.92
|
| Rate for Payer: Cofinity Commercial |
$55.13
|
| Rate for Payer: Cofinity Commercial |
$1,653.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,538.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.28
|
| Rate for Payer: Healthscope Commercial |
$1,730.47
|
| Rate for Payer: Healthscope Commercial |
$57.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,345.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,442.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,634.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,442.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.08
|
| Rate for Payer: PHP Commercial |
$1,634.34
|
| Rate for Payer: PHP Commercial |
$54.48
|
| Rate for Payer: Priority Health SBD |
$40.38
|
| Rate for Payer: Priority Health SBD |
$1,211.33
|
| Rate for Payer: UMR Bronson Commercial |
$846.01
|
| Rate for Payer: UMR Bronson Commercial |
$28.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,442.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.08
|
|
|
CYCLOSPORINE 250 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$161.85
|
|
|
Service Code
|
HCPCS J7516
|
| Hospital Charge Code |
9705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.21 |
| Max. Negotiated Rate |
$145.66 |
| Rate for Payer: Aetna American Axle |
$105.20
|
| Rate for Payer: Aetna American Axle |
$155.79
|
| Rate for Payer: Aetna Commercial |
$137.57
|
| Rate for Payer: Aetna Commercial |
$203.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.79
|
| Rate for Payer: Cash Price |
$129.48
|
| Rate for Payer: Cash Price |
$191.74
|
| Rate for Payer: Cofinity Advantage |
$167.78
|
| Rate for Payer: Cofinity Advantage |
$113.30
|
| Rate for Payer: Cofinity Commercial |
$206.12
|
| Rate for Payer: Cofinity Commercial |
$139.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.74
|
| Rate for Payer: Healthscope Commercial |
$145.66
|
| Rate for Payer: Healthscope Commercial |
$215.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$167.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.76
|
| Rate for Payer: PHP Commercial |
$137.57
|
| Rate for Payer: PHP Commercial |
$203.73
|
| Rate for Payer: Priority Health SBD |
$151.00
|
| Rate for Payer: Priority Health SBD |
$101.97
|
| Rate for Payer: UMR Bronson Commercial |
$71.21
|
| Rate for Payer: UMR Bronson Commercial |
$105.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.76
|
|
|
CYCLOSPORINE 250 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$161.85
|
|
|
Service Code
|
HCPCS J7516
|
| Hospital Charge Code |
9705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.88 |
| Max. Negotiated Rate |
$238.92 |
| Rate for Payer: Aetna American Axle |
$105.20
|
| Rate for Payer: Aetna American Axle |
$155.79
|
| Rate for Payer: Aetna Commercial |
$137.57
|
| Rate for Payer: Aetna Commercial |
$203.73
|
| Rate for Payer: Aetna Medicare |
$80.92
|
| Rate for Payer: Aetna Medicare |
$119.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.79
|
| Rate for Payer: BCBS Complete |
$95.87
|
| Rate for Payer: BCBS Complete |
$64.74
|
| Rate for Payer: BCBS Trust/PPO |
$238.92
|
| Rate for Payer: BCBS Trust/PPO |
$238.92
|
| Rate for Payer: BCN Commercial |
$238.92
|
| Rate for Payer: BCN Commercial |
$238.92
|
| Rate for Payer: Cash Price |
$129.48
|
| Rate for Payer: Cash Price |
$191.74
|
| Rate for Payer: Cash Price |
$129.48
|
| Rate for Payer: Cash Price |
$191.74
|
| Rate for Payer: Cofinity Advantage |
$113.30
|
| Rate for Payer: Cofinity Advantage |
$167.78
|
| Rate for Payer: Cofinity Commercial |
$139.19
|
| Rate for Payer: Cofinity Commercial |
$206.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.74
|
| Rate for Payer: Healthscope Commercial |
$145.66
|
| Rate for Payer: Healthscope Commercial |
$215.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$167.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$191.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.39
|
| Rate for Payer: PHP Commercial |
$137.57
|
| Rate for Payer: PHP Commercial |
$203.73
|
| Rate for Payer: Priority Health SBD |
$101.97
|
| Rate for Payer: Priority Health SBD |
$151.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.57
|
| Rate for Payer: UHC Core |
$121.57
|
| Rate for Payer: UHC Core |
$121.57
|
| Rate for Payer: UHC Exchange |
$121.57
|
| Rate for Payer: UHC Exchange |
$121.57
|
| Rate for Payer: UMR Bronson Commercial |
$59.88
|
| Rate for Payer: UMR Bronson Commercial |
$88.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.76
|
|
|
CYCLOSPORINE 25 MG CAPSULE
|
Facility
|
OP
|
$275.62
|
|
|
Service Code
|
HCPCS J7515
|
| Hospital Charge Code |
9707
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$248.06 |
| Rate for Payer: Aetna American Axle |
$179.15
|
| Rate for Payer: Aetna American Axle |
$313.13
|
| Rate for Payer: Aetna Commercial |
$234.28
|
| Rate for Payer: Aetna Commercial |
$409.48
|
| Rate for Payer: Aetna Medicare |
$137.81
|
| Rate for Payer: Aetna Medicare |
$240.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.13
|
| Rate for Payer: BCBS Complete |
$192.70
|
| Rate for Payer: BCBS Complete |
$110.25
|
| Rate for Payer: BCBS Trust/PPO |
$1.69
|
| Rate for Payer: BCBS Trust/PPO |
$1.69
|
| Rate for Payer: BCN Commercial |
$1.69
|
| Rate for Payer: BCN Commercial |
$1.69
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cash Price |
$385.39
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cash Price |
$385.39
|
| Rate for Payer: Cofinity Advantage |
$192.93
|
| Rate for Payer: Cofinity Advantage |
$337.22
|
| Rate for Payer: Cofinity Commercial |
$237.03
|
| Rate for Payer: Cofinity Commercial |
$414.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.39
|
| Rate for Payer: Healthscope Commercial |
$248.06
|
| Rate for Payer: Healthscope Commercial |
$433.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$337.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$361.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$220.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$385.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$409.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$361.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.72
|
| Rate for Payer: PHP Commercial |
$234.28
|
| Rate for Payer: PHP Commercial |
$409.48
|
| Rate for Payer: Priority Health SBD |
$173.64
|
| Rate for Payer: Priority Health SBD |
$303.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.87
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: UHC Exchange |
$0.87
|
| Rate for Payer: UHC Exchange |
$0.87
|
| Rate for Payer: UMR Bronson Commercial |
$101.98
|
| Rate for Payer: UMR Bronson Commercial |
$178.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$361.31
|
|
|
CYCLOSPORINE 25 MG CAPSULE
|
Facility
|
IP
|
$275.62
|
|
|
Service Code
|
HCPCS J7515
|
| Hospital Charge Code |
9707
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$121.27 |
| Max. Negotiated Rate |
$248.06 |
| Rate for Payer: Aetna American Axle |
$179.15
|
| Rate for Payer: Aetna American Axle |
$313.13
|
| Rate for Payer: Aetna Commercial |
$234.28
|
| Rate for Payer: Aetna Commercial |
$409.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.13
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cash Price |
$385.39
|
| Rate for Payer: Cofinity Advantage |
$337.22
|
| Rate for Payer: Cofinity Advantage |
$192.93
|
| Rate for Payer: Cofinity Commercial |
$414.30
|
| Rate for Payer: Cofinity Commercial |
$237.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.39
|
| Rate for Payer: Healthscope Commercial |
$248.06
|
| Rate for Payer: Healthscope Commercial |
$433.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$337.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$361.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$409.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$361.31
|
| Rate for Payer: PHP Commercial |
$234.28
|
| Rate for Payer: PHP Commercial |
$409.48
|
| Rate for Payer: Priority Health SBD |
$303.50
|
| Rate for Payer: Priority Health SBD |
$173.64
|
| Rate for Payer: UMR Bronson Commercial |
$121.27
|
| Rate for Payer: UMR Bronson Commercial |
$211.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$361.31
|
|
|
CYCLOSPORINE MODIFIED 100 MG CAPSULE
|
Facility
|
OP
|
$7.40
|
|
|
Service Code
|
HCPCS J7502
|
| Hospital Charge Code |
28843
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$6.66 |
| Rate for Payer: Aetna American Axle |
$4.81
|
| Rate for Payer: Aetna American Axle |
$804.84
|
| Rate for Payer: Aetna American Axle |
$144.14
|
| Rate for Payer: Aetna American Axle |
$263.93
|
| Rate for Payer: Aetna Commercial |
$6.29
|
| Rate for Payer: Aetna Commercial |
$345.13
|
| Rate for Payer: Aetna Commercial |
$1,052.48
|
| Rate for Payer: Aetna Commercial |
$188.50
|
| Rate for Payer: Aetna Medicare |
$203.02
|
| Rate for Payer: Aetna Medicare |
$110.88
|
| Rate for Payer: Aetna Medicare |
$3.70
|
| Rate for Payer: Aetna Medicare |
$619.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$804.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.93
|
| Rate for Payer: BCBS Complete |
$495.28
|
| Rate for Payer: BCBS Complete |
$88.70
|
| Rate for Payer: BCBS Complete |
$162.42
|
| Rate for Payer: BCBS Complete |
$2.96
|
| Rate for Payer: BCBS Trust/PPO |
$5.86
|
| Rate for Payer: BCBS Trust/PPO |
$5.86
|
| Rate for Payer: BCBS Trust/PPO |
$5.86
|
| Rate for Payer: BCBS Trust/PPO |
$5.86
|
| Rate for Payer: BCN Commercial |
$5.86
|
| Rate for Payer: BCN Commercial |
$5.86
|
| Rate for Payer: BCN Commercial |
$5.86
|
| Rate for Payer: BCN Commercial |
$5.86
|
| Rate for Payer: Cash Price |
$324.83
|
| Rate for Payer: Cash Price |
$5.92
|
| Rate for Payer: Cash Price |
$990.57
|
| Rate for Payer: Cash Price |
$5.92
|
| Rate for Payer: Cash Price |
$324.83
|
| Rate for Payer: Cash Price |
$177.41
|
| Rate for Payer: Cash Price |
$177.41
|
| Rate for Payer: Cash Price |
$990.57
|
| Rate for Payer: Cofinity Advantage |
$5.18
|
| Rate for Payer: Cofinity Advantage |
$284.23
|
| Rate for Payer: Cofinity Advantage |
$155.23
|
| Rate for Payer: Cofinity Advantage |
$866.75
|
| Rate for Payer: Cofinity Commercial |
$190.71
|
| Rate for Payer: Cofinity Commercial |
$349.19
|
| Rate for Payer: Cofinity Commercial |
$6.36
|
| Rate for Payer: Cofinity Commercial |
$1,064.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$990.57
|
| Rate for Payer: Healthscope Commercial |
$365.44
|
| Rate for Payer: Healthscope Commercial |
$1,114.39
|
| Rate for Payer: Healthscope Commercial |
$199.58
|
| Rate for Payer: Healthscope Commercial |
$6.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$155.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$866.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$284.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$304.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$928.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$177.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$990.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$324.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,052.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$928.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.55
|
| Rate for Payer: PHP Commercial |
$1,052.48
|
| Rate for Payer: PHP Commercial |
$345.13
|
| Rate for Payer: PHP Commercial |
$6.29
|
| Rate for Payer: PHP Commercial |
$188.50
|
| Rate for Payer: Priority Health SBD |
$255.81
|
| Rate for Payer: Priority Health SBD |
$780.07
|
| Rate for Payer: Priority Health SBD |
$139.71
|
| Rate for Payer: Priority Health SBD |
$4.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.99
|
| Rate for Payer: UHC Core |
$2.99
|
| Rate for Payer: UHC Core |
$2.99
|
| Rate for Payer: UHC Core |
$2.99
|
| Rate for Payer: UHC Core |
$2.99
|
| Rate for Payer: UHC Exchange |
$2.99
|
| Rate for Payer: UHC Exchange |
$2.99
|
| Rate for Payer: UHC Exchange |
$2.99
|
| Rate for Payer: UHC Exchange |
$2.99
|
| Rate for Payer: UMR Bronson Commercial |
$2.74
|
| Rate for Payer: UMR Bronson Commercial |
$458.14
|
| Rate for Payer: UMR Bronson Commercial |
$82.05
|
| Rate for Payer: UMR Bronson Commercial |
$150.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$304.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$928.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.55
|
|
|
CYCLOSPORINE MODIFIED 100 MG CAPSULE
|
Facility
|
IP
|
$406.04
|
|
|
Service Code
|
HCPCS J7502
|
| Hospital Charge Code |
28843
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$178.66 |
| Max. Negotiated Rate |
$365.44 |
| Rate for Payer: Aetna American Axle |
$263.93
|
| Rate for Payer: Aetna American Axle |
$144.14
|
| Rate for Payer: Aetna American Axle |
$4.81
|
| Rate for Payer: Aetna American Axle |
$804.84
|
| Rate for Payer: Aetna Commercial |
$6.29
|
| Rate for Payer: Aetna Commercial |
$345.13
|
| Rate for Payer: Aetna Commercial |
$1,052.48
|
| Rate for Payer: Aetna Commercial |
$188.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$804.84
|
| Rate for Payer: Cash Price |
$990.57
|
| Rate for Payer: Cash Price |
$5.92
|
| Rate for Payer: Cash Price |
$177.41
|
| Rate for Payer: Cash Price |
$324.83
|
| Rate for Payer: Cofinity Advantage |
$155.23
|
| Rate for Payer: Cofinity Advantage |
$866.75
|
| Rate for Payer: Cofinity Advantage |
$284.23
|
| Rate for Payer: Cofinity Advantage |
$5.18
|
| Rate for Payer: Cofinity Commercial |
$349.19
|
| Rate for Payer: Cofinity Commercial |
$1,064.86
|
| Rate for Payer: Cofinity Commercial |
$190.71
|
| Rate for Payer: Cofinity Commercial |
$6.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$990.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.41
|
| Rate for Payer: Healthscope Commercial |
$199.58
|
| Rate for Payer: Healthscope Commercial |
$6.66
|
| Rate for Payer: Healthscope Commercial |
$365.44
|
| Rate for Payer: Healthscope Commercial |
$1,114.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$284.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$866.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$155.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$304.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$928.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,052.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$928.66
|
| Rate for Payer: PHP Commercial |
$1,052.48
|
| Rate for Payer: PHP Commercial |
$345.13
|
| Rate for Payer: PHP Commercial |
$188.50
|
| Rate for Payer: PHP Commercial |
$6.29
|
| Rate for Payer: Priority Health SBD |
$4.66
|
| Rate for Payer: Priority Health SBD |
$780.07
|
| Rate for Payer: Priority Health SBD |
$255.81
|
| Rate for Payer: Priority Health SBD |
$139.71
|
| Rate for Payer: UMR Bronson Commercial |
$97.57
|
| Rate for Payer: UMR Bronson Commercial |
$178.66
|
| Rate for Payer: UMR Bronson Commercial |
$544.81
|
| Rate for Payer: UMR Bronson Commercial |
$3.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$928.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$304.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.55
|
|
|
CYCLOSPORINE MODIFIED 100 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$2,128.00
|
|
|
Service Code
|
HCPCS J7502
|
| Hospital Charge Code |
28844
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$936.32 |
| Max. Negotiated Rate |
$1,915.20 |
| Rate for Payer: Aetna American Axle |
$1,383.20
|
| Rate for Payer: Aetna Commercial |
$1,808.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,383.20
|
| Rate for Payer: Cash Price |
$1,702.40
|
| Rate for Payer: Cofinity Advantage |
$1,489.60
|
| Rate for Payer: Cofinity Commercial |
$1,830.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,702.40
|
| Rate for Payer: Healthscope Commercial |
$1,915.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,489.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,596.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,808.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,596.00
|
| Rate for Payer: PHP Commercial |
$1,808.80
|
| Rate for Payer: Priority Health SBD |
$1,340.64
|
| Rate for Payer: UMR Bronson Commercial |
$936.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,596.00
|
|
|
CYCLOSPORINE MODIFIED 100 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$2,128.00
|
|
|
Service Code
|
HCPCS J7502
|
| Hospital Charge Code |
28844
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.86 |
| Max. Negotiated Rate |
$1,915.20 |
| Rate for Payer: Aetna American Axle |
$1,383.20
|
| Rate for Payer: Aetna Commercial |
$1,808.80
|
| Rate for Payer: Aetna Medicare |
$1,064.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,383.20
|
| Rate for Payer: BCBS Complete |
$851.20
|
| Rate for Payer: BCBS Trust/PPO |
$5.86
|
| Rate for Payer: BCN Commercial |
$5.86
|
| Rate for Payer: Cash Price |
$1,702.40
|
| Rate for Payer: Cash Price |
$1,702.40
|
| Rate for Payer: Cofinity Advantage |
$1,489.60
|
| Rate for Payer: Cofinity Commercial |
$1,830.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,702.40
|
| Rate for Payer: Healthscope Commercial |
$1,915.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,489.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,596.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,702.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,808.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,596.00
|
| Rate for Payer: PHP Commercial |
$1,808.80
|
| Rate for Payer: Priority Health SBD |
$1,340.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,383.20
|
| Rate for Payer: UHC Core |
$1,108.69
|
| Rate for Payer: UHC Exchange |
$836.30
|
| Rate for Payer: UMR Bronson Commercial |
$787.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,596.00
|
|
|
CYCLOSPORINE MODIFIED 25 MG CAPSULE
|
Facility
|
IP
|
$309.92
|
|
|
Service Code
|
HCPCS J7515
|
| Hospital Charge Code |
28842
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$136.36 |
| Max. Negotiated Rate |
$278.93 |
| Rate for Payer: Aetna American Axle |
$201.45
|
| Rate for Payer: Aetna American Axle |
$95.76
|
| Rate for Payer: Aetna American Axle |
$3.20
|
| Rate for Payer: Aetna American Axle |
$85.74
|
| Rate for Payer: Aetna Commercial |
$4.18
|
| Rate for Payer: Aetna Commercial |
$263.43
|
| Rate for Payer: Aetna Commercial |
$112.12
|
| Rate for Payer: Aetna Commercial |
$125.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.74
|
| Rate for Payer: Cash Price |
$105.53
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cash Price |
$117.86
|
| Rate for Payer: Cash Price |
$247.94
|
| Rate for Payer: Cofinity Advantage |
$103.12
|
| Rate for Payer: Cofinity Advantage |
$92.34
|
| Rate for Payer: Cofinity Advantage |
$216.94
|
| Rate for Payer: Cofinity Advantage |
$3.44
|
| Rate for Payer: Cofinity Commercial |
$266.53
|
| Rate for Payer: Cofinity Commercial |
$113.44
|
| Rate for Payer: Cofinity Commercial |
$126.70
|
| Rate for Payer: Cofinity Commercial |
$4.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.86
|
| Rate for Payer: Healthscope Commercial |
$132.59
|
| Rate for Payer: Healthscope Commercial |
$4.43
|
| Rate for Payer: Healthscope Commercial |
$278.93
|
| Rate for Payer: Healthscope Commercial |
$118.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.93
|
| Rate for Payer: PHP Commercial |
$112.12
|
| Rate for Payer: PHP Commercial |
$263.43
|
| Rate for Payer: PHP Commercial |
$125.22
|
| Rate for Payer: PHP Commercial |
$4.18
|
| Rate for Payer: Priority Health SBD |
$3.10
|
| Rate for Payer: Priority Health SBD |
$83.10
|
| Rate for Payer: Priority Health SBD |
$195.25
|
| Rate for Payer: Priority Health SBD |
$92.81
|
| Rate for Payer: UMR Bronson Commercial |
$64.82
|
| Rate for Payer: UMR Bronson Commercial |
$136.36
|
| Rate for Payer: UMR Bronson Commercial |
$58.04
|
| Rate for Payer: UMR Bronson Commercial |
$2.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.69
|
|
|
CYCLOSPORINE MODIFIED 25 MG CAPSULE
|
Facility
|
OP
|
$4.92
|
|
|
Service Code
|
HCPCS J7515
|
| Hospital Charge Code |
28842
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Aetna American Axle |
$3.20
|
| Rate for Payer: Aetna American Axle |
$85.74
|
| Rate for Payer: Aetna American Axle |
$95.76
|
| Rate for Payer: Aetna American Axle |
$201.45
|
| Rate for Payer: Aetna Commercial |
$4.18
|
| Rate for Payer: Aetna Commercial |
$263.43
|
| Rate for Payer: Aetna Commercial |
$112.12
|
| Rate for Payer: Aetna Commercial |
$125.22
|
| Rate for Payer: Aetna Medicare |
$154.96
|
| Rate for Payer: Aetna Medicare |
$73.66
|
| Rate for Payer: Aetna Medicare |
$2.46
|
| Rate for Payer: Aetna Medicare |
$65.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.45
|
| Rate for Payer: BCBS Complete |
$52.76
|
| Rate for Payer: BCBS Complete |
$58.93
|
| Rate for Payer: BCBS Complete |
$123.97
|
| Rate for Payer: BCBS Complete |
$1.97
|
| Rate for Payer: BCBS Trust/PPO |
$1.69
|
| Rate for Payer: BCBS Trust/PPO |
$1.69
|
| Rate for Payer: BCBS Trust/PPO |
$1.69
|
| Rate for Payer: BCBS Trust/PPO |
$1.69
|
| Rate for Payer: BCN Commercial |
$1.69
|
| Rate for Payer: BCN Commercial |
$1.69
|
| Rate for Payer: BCN Commercial |
$1.69
|
| Rate for Payer: BCN Commercial |
$1.69
|
| Rate for Payer: Cash Price |
$247.94
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cash Price |
$105.53
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cash Price |
$247.94
|
| Rate for Payer: Cash Price |
$117.86
|
| Rate for Payer: Cash Price |
$117.86
|
| Rate for Payer: Cash Price |
$105.53
|
| Rate for Payer: Cofinity Advantage |
$3.44
|
| Rate for Payer: Cofinity Advantage |
$216.94
|
| Rate for Payer: Cofinity Advantage |
$103.12
|
| Rate for Payer: Cofinity Advantage |
$92.34
|
| Rate for Payer: Cofinity Commercial |
$126.70
|
| Rate for Payer: Cofinity Commercial |
$266.53
|
| Rate for Payer: Cofinity Commercial |
$4.23
|
| Rate for Payer: Cofinity Commercial |
$113.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.53
|
| Rate for Payer: Healthscope Commercial |
$278.93
|
| Rate for Payer: Healthscope Commercial |
$118.72
|
| Rate for Payer: Healthscope Commercial |
$132.59
|
| Rate for Payer: Healthscope Commercial |
$4.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$117.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.69
|
| Rate for Payer: PHP Commercial |
$112.12
|
| Rate for Payer: PHP Commercial |
$263.43
|
| Rate for Payer: PHP Commercial |
$4.18
|
| Rate for Payer: PHP Commercial |
$125.22
|
| Rate for Payer: Priority Health SBD |
$195.25
|
| Rate for Payer: Priority Health SBD |
$83.10
|
| Rate for Payer: Priority Health SBD |
$92.81
|
| Rate for Payer: Priority Health SBD |
$3.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.87
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: UHC Exchange |
$0.87
|
| Rate for Payer: UHC Exchange |
$0.87
|
| Rate for Payer: UHC Exchange |
$0.87
|
| Rate for Payer: UHC Exchange |
$0.87
|
| Rate for Payer: UMR Bronson Commercial |
$1.82
|
| Rate for Payer: UMR Bronson Commercial |
$48.81
|
| Rate for Payer: UMR Bronson Commercial |
$54.51
|
| Rate for Payer: UMR Bronson Commercial |
$114.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.69
|
|
|
CYPROHEPTADINE 2 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$1,111.55
|
|
|
Service Code
|
NDC 00527194947
|
| Hospital Charge Code |
2032
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$489.08 |
| Max. Negotiated Rate |
$1,000.39 |
| Rate for Payer: Aetna American Axle |
$722.51
|
| Rate for Payer: Aetna Commercial |
$944.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$722.51
|
| Rate for Payer: Cash Price |
$889.24
|
| Rate for Payer: Cofinity Advantage |
$778.09
|
| Rate for Payer: Cofinity Commercial |
$955.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$889.24
|
| Rate for Payer: Healthscope Commercial |
$1,000.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$778.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$833.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$944.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$833.66
|
| Rate for Payer: PHP Commercial |
$944.82
|
| Rate for Payer: Priority Health SBD |
$700.28
|
| Rate for Payer: UMR Bronson Commercial |
$489.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$833.66
|
|
|
CYPROHEPTADINE 2 MG/5 ML ORAL SYRUP
|
Facility
|
OP
|
$1,111.55
|
|
|
Service Code
|
NDC 00527194947
|
| Hospital Charge Code |
2032
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$411.27 |
| Max. Negotiated Rate |
$1,000.39 |
| Rate for Payer: Aetna American Axle |
$722.51
|
| Rate for Payer: Aetna Commercial |
$944.82
|
| Rate for Payer: Aetna Medicare |
$555.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$722.51
|
| Rate for Payer: BCBS Complete |
$444.62
|
| Rate for Payer: Cash Price |
$889.24
|
| Rate for Payer: Cofinity Advantage |
$778.09
|
| Rate for Payer: Cofinity Commercial |
$955.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$889.24
|
| Rate for Payer: Healthscope Commercial |
$1,000.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$778.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$833.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$889.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$944.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$833.66
|
| Rate for Payer: PHP Commercial |
$944.82
|
| Rate for Payer: Priority Health SBD |
$700.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$722.51
|
| Rate for Payer: UHC Core |
$579.12
|
| Rate for Payer: UHC Exchange |
$436.84
|
| Rate for Payer: UMR Bronson Commercial |
$411.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$833.66
|
|
|
CYPROHEPTADINE 4 MG TABLET
|
Facility
|
OP
|
$229.90
|
|
|
Service Code
|
NDC 52817021010
|
| Hospital Charge Code |
2033
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.06 |
| Max. Negotiated Rate |
$206.91 |
| Rate for Payer: Aetna American Axle |
$149.44
|
| Rate for Payer: Aetna Commercial |
$195.41
|
| Rate for Payer: Aetna Medicare |
$114.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.44
|
| Rate for Payer: BCBS Complete |
$91.96
|
| Rate for Payer: Cash Price |
$183.92
|
| Rate for Payer: Cofinity Advantage |
$160.93
|
| Rate for Payer: Cofinity Commercial |
$197.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.92
|
| Rate for Payer: Healthscope Commercial |
$206.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$160.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$172.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$183.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$172.43
|
| Rate for Payer: PHP Commercial |
$195.41
|
| Rate for Payer: Priority Health SBD |
$144.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.44
|
| Rate for Payer: UHC Core |
$119.78
|
| Rate for Payer: UHC Exchange |
$90.35
|
| Rate for Payer: UMR Bronson Commercial |
$85.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$172.43
|
|
|
CYPROHEPTADINE 4 MG TABLET
|
Facility
|
IP
|
$229.90
|
|
|
Service Code
|
NDC 52817021010
|
| Hospital Charge Code |
2033
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.16 |
| Max. Negotiated Rate |
$206.91 |
| Rate for Payer: Aetna American Axle |
$149.44
|
| Rate for Payer: Aetna Commercial |
$195.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.44
|
| Rate for Payer: Cash Price |
$183.92
|
| Rate for Payer: Cofinity Advantage |
$160.93
|
| Rate for Payer: Cofinity Commercial |
$197.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.92
|
| Rate for Payer: Healthscope Commercial |
$206.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$160.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$172.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$172.43
|
| Rate for Payer: PHP Commercial |
$195.41
|
| Rate for Payer: Priority Health SBD |
$144.84
|
| Rate for Payer: UMR Bronson Commercial |
$101.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$172.43
|
|
