|
DACARBAZINE 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$233.75
|
|
|
Service Code
|
HCPCS J9130
|
| Hospital Charge Code |
2090
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$210.38 |
| Rate for Payer: Aetna American Axle |
$151.94
|
| Rate for Payer: Aetna Commercial |
$198.69
|
| Rate for Payer: Aetna Medicare |
$116.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.94
|
| Rate for Payer: BCBS Complete |
$93.50
|
| Rate for Payer: BCBS Trust/PPO |
$13.11
|
| Rate for Payer: BCN Commercial |
$13.11
|
| Rate for Payer: Cash Price |
$187.00
|
| Rate for Payer: Cash Price |
$187.00
|
| Rate for Payer: Cofinity Advantage |
$163.62
|
| Rate for Payer: Cofinity Commercial |
$201.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.00
|
| Rate for Payer: Healthscope Commercial |
$210.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$163.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.31
|
| Rate for Payer: PHP Commercial |
$198.69
|
| Rate for Payer: Priority Health SBD |
$147.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.80
|
| Rate for Payer: UHC Core |
$6.80
|
| Rate for Payer: UHC Exchange |
$6.80
|
| Rate for Payer: UMR Bronson Commercial |
$86.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.31
|
|
|
DACARBAZINE 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$233.75
|
|
|
Service Code
|
HCPCS J9130
|
| Hospital Charge Code |
2090
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$102.85 |
| Max. Negotiated Rate |
$210.38 |
| Rate for Payer: Aetna American Axle |
$151.94
|
| Rate for Payer: Aetna Commercial |
$198.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.94
|
| Rate for Payer: Cash Price |
$187.00
|
| Rate for Payer: Cofinity Advantage |
$163.62
|
| Rate for Payer: Cofinity Commercial |
$201.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.00
|
| Rate for Payer: Healthscope Commercial |
$210.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$163.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.31
|
| Rate for Payer: PHP Commercial |
$198.69
|
| Rate for Payer: Priority Health SBD |
$147.26
|
| Rate for Payer: UMR Bronson Commercial |
$102.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.31
|
|
|
DACARBAZINE 200 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$190.75
|
|
|
Service Code
|
HCPCS J9130
|
| Hospital Charge Code |
2091
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$83.93 |
| Max. Negotiated Rate |
$171.68 |
| Rate for Payer: Aetna American Axle |
$123.99
|
| Rate for Payer: Aetna American Axle |
$146.11
|
| Rate for Payer: Aetna Commercial |
$162.14
|
| Rate for Payer: Aetna Commercial |
$191.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.11
|
| Rate for Payer: Cash Price |
$152.60
|
| Rate for Payer: Cash Price |
$179.83
|
| Rate for Payer: Cofinity Advantage |
$157.35
|
| Rate for Payer: Cofinity Advantage |
$133.53
|
| Rate for Payer: Cofinity Commercial |
$193.32
|
| Rate for Payer: Cofinity Commercial |
$164.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.83
|
| Rate for Payer: Healthscope Commercial |
$171.68
|
| Rate for Payer: Healthscope Commercial |
$202.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$143.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.59
|
| Rate for Payer: PHP Commercial |
$162.14
|
| Rate for Payer: PHP Commercial |
$191.07
|
| Rate for Payer: Priority Health SBD |
$141.62
|
| Rate for Payer: Priority Health SBD |
$120.17
|
| Rate for Payer: UMR Bronson Commercial |
$83.93
|
| Rate for Payer: UMR Bronson Commercial |
$98.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.59
|
|
|
DACARBAZINE 200 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$190.75
|
|
|
Service Code
|
HCPCS J9130
|
| Hospital Charge Code |
2091
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$171.68 |
| Rate for Payer: Aetna American Axle |
$123.99
|
| Rate for Payer: Aetna American Axle |
$105.34
|
| Rate for Payer: Aetna American Axle |
$146.11
|
| Rate for Payer: Aetna Commercial |
$162.14
|
| Rate for Payer: Aetna Commercial |
$191.07
|
| Rate for Payer: Aetna Commercial |
$137.75
|
| Rate for Payer: Aetna Medicare |
$95.38
|
| Rate for Payer: Aetna Medicare |
$81.03
|
| Rate for Payer: Aetna Medicare |
$112.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.11
|
| Rate for Payer: BCBS Complete |
$64.82
|
| Rate for Payer: BCBS Complete |
$76.30
|
| Rate for Payer: BCBS Complete |
$89.92
|
| Rate for Payer: BCBS Trust/PPO |
$13.11
|
| Rate for Payer: BCBS Trust/PPO |
$13.11
|
| Rate for Payer: BCBS Trust/PPO |
$13.11
|
| Rate for Payer: BCN Commercial |
$13.11
|
| Rate for Payer: BCN Commercial |
$13.11
|
| Rate for Payer: BCN Commercial |
$13.11
|
| Rate for Payer: Cash Price |
$129.65
|
| Rate for Payer: Cash Price |
$129.65
|
| Rate for Payer: Cash Price |
$179.83
|
| Rate for Payer: Cash Price |
$179.83
|
| Rate for Payer: Cash Price |
$152.60
|
| Rate for Payer: Cash Price |
$152.60
|
| Rate for Payer: Cofinity Advantage |
$157.35
|
| Rate for Payer: Cofinity Advantage |
$133.53
|
| Rate for Payer: Cofinity Advantage |
$113.44
|
| Rate for Payer: Cofinity Commercial |
$139.37
|
| Rate for Payer: Cofinity Commercial |
$164.04
|
| Rate for Payer: Cofinity Commercial |
$193.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.60
|
| Rate for Payer: Healthscope Commercial |
$145.85
|
| Rate for Payer: Healthscope Commercial |
$171.68
|
| Rate for Payer: Healthscope Commercial |
$202.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$179.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$143.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.59
|
| Rate for Payer: PHP Commercial |
$162.14
|
| Rate for Payer: PHP Commercial |
$137.75
|
| Rate for Payer: PHP Commercial |
$191.07
|
| Rate for Payer: Priority Health SBD |
$102.10
|
| Rate for Payer: Priority Health SBD |
$141.62
|
| Rate for Payer: Priority Health SBD |
$120.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.80
|
| Rate for Payer: UHC Core |
$6.80
|
| Rate for Payer: UHC Core |
$6.80
|
| Rate for Payer: UHC Core |
$6.80
|
| Rate for Payer: UHC Exchange |
$6.80
|
| Rate for Payer: UHC Exchange |
$6.80
|
| Rate for Payer: UHC Exchange |
$6.80
|
| Rate for Payer: UMR Bronson Commercial |
$83.17
|
| Rate for Payer: UMR Bronson Commercial |
$59.96
|
| Rate for Payer: UMR Bronson Commercial |
$70.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.59
|
|
|
DACTINOMYCIN 0.5 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,087.81
|
|
|
Service Code
|
HCPCS J9120
|
| Hospital Charge Code |
28912
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$918.64 |
| Max. Negotiated Rate |
$1,879.03 |
| Rate for Payer: Aetna American Axle |
$1,357.08
|
| Rate for Payer: Aetna American Axle |
$1,085.38
|
| Rate for Payer: Aetna American Axle |
$1,926.94
|
| Rate for Payer: Aetna American Axle |
$1,004.98
|
| Rate for Payer: Aetna American Axle |
$7,904.88
|
| Rate for Payer: Aetna Commercial |
$10,337.15
|
| Rate for Payer: Aetna Commercial |
$1,419.35
|
| Rate for Payer: Aetna Commercial |
$1,774.64
|
| Rate for Payer: Aetna Commercial |
$2,519.85
|
| Rate for Payer: Aetna Commercial |
$1,314.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,357.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,085.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,004.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,904.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,926.94
|
| Rate for Payer: Cash Price |
$1,335.86
|
| Rate for Payer: Cash Price |
$1,236.90
|
| Rate for Payer: Cash Price |
$2,371.62
|
| Rate for Payer: Cash Price |
$1,670.25
|
| Rate for Payer: Cash Price |
$9,729.08
|
| Rate for Payer: Cofinity Advantage |
$8,512.94
|
| Rate for Payer: Cofinity Advantage |
$2,075.17
|
| Rate for Payer: Cofinity Advantage |
$1,082.29
|
| Rate for Payer: Cofinity Advantage |
$1,461.47
|
| Rate for Payer: Cofinity Advantage |
$1,168.87
|
| Rate for Payer: Cofinity Commercial |
$2,549.50
|
| Rate for Payer: Cofinity Commercial |
$10,458.76
|
| Rate for Payer: Cofinity Commercial |
$1,329.67
|
| Rate for Payer: Cofinity Commercial |
$1,436.05
|
| Rate for Payer: Cofinity Commercial |
$1,795.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,670.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,729.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,335.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,236.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,371.62
|
| Rate for Payer: Healthscope Commercial |
$10,945.22
|
| Rate for Payer: Healthscope Commercial |
$1,391.52
|
| Rate for Payer: Healthscope Commercial |
$1,502.84
|
| Rate for Payer: Healthscope Commercial |
$1,879.03
|
| Rate for Payer: Healthscope Commercial |
$2,668.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,082.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,075.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,512.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,168.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,461.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,121.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,159.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,252.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,565.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,223.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,337.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,774.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,419.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,314.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,519.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,121.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,252.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,159.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,223.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,565.86
|
| Rate for Payer: PHP Commercial |
$1,419.35
|
| Rate for Payer: PHP Commercial |
$10,337.15
|
| Rate for Payer: PHP Commercial |
$1,774.64
|
| Rate for Payer: PHP Commercial |
$2,519.85
|
| Rate for Payer: PHP Commercial |
$1,314.21
|
| Rate for Payer: Priority Health SBD |
$1,315.32
|
| Rate for Payer: Priority Health SBD |
$1,867.65
|
| Rate for Payer: Priority Health SBD |
$974.06
|
| Rate for Payer: Priority Health SBD |
$7,661.65
|
| Rate for Payer: Priority Health SBD |
$1,051.99
|
| Rate for Payer: UMR Bronson Commercial |
$680.30
|
| Rate for Payer: UMR Bronson Commercial |
$1,304.39
|
| Rate for Payer: UMR Bronson Commercial |
$734.72
|
| Rate for Payer: UMR Bronson Commercial |
$5,350.99
|
| Rate for Payer: UMR Bronson Commercial |
$918.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,565.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,252.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,223.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,121.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,159.60
|
|
|
DACTINOMYCIN 0.5 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$12,161.35
|
|
|
Service Code
|
HCPCS J9120
|
| Hospital Charge Code |
28912
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$176.60 |
| Max. Negotiated Rate |
$10,945.22 |
| Rate for Payer: Aetna American Axle |
$7,904.88
|
| Rate for Payer: Aetna American Axle |
$1,085.38
|
| Rate for Payer: Aetna American Axle |
$1,926.94
|
| Rate for Payer: Aetna American Axle |
$1,357.08
|
| Rate for Payer: Aetna American Axle |
$1,004.98
|
| Rate for Payer: Aetna Commercial |
$2,519.85
|
| Rate for Payer: Aetna Commercial |
$10,337.15
|
| Rate for Payer: Aetna Commercial |
$1,419.35
|
| Rate for Payer: Aetna Commercial |
$1,314.21
|
| Rate for Payer: Aetna Commercial |
$1,774.64
|
| Rate for Payer: Aetna Medicare |
$351.18
|
| Rate for Payer: Aetna Medicare |
$351.18
|
| Rate for Payer: Aetna Medicare |
$351.18
|
| Rate for Payer: Aetna Medicare |
$351.18
|
| Rate for Payer: Aetna Medicare |
$351.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,085.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,004.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,904.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,926.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,357.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$422.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$422.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$422.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$422.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$422.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$422.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$422.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$422.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$422.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$422.09
|
| Rate for Payer: BCBS Complete |
$185.45
|
| Rate for Payer: BCBS Complete |
$185.45
|
| Rate for Payer: BCBS Complete |
$185.45
|
| Rate for Payer: BCBS Complete |
$185.45
|
| Rate for Payer: BCBS Complete |
$185.45
|
| Rate for Payer: BCBS MAPPO |
$337.67
|
| Rate for Payer: BCBS MAPPO |
$337.67
|
| Rate for Payer: BCBS MAPPO |
$337.67
|
| Rate for Payer: BCBS MAPPO |
$337.67
|
| Rate for Payer: BCBS MAPPO |
$337.67
|
| Rate for Payer: BCBS Trust/PPO |
$998.67
|
| Rate for Payer: BCBS Trust/PPO |
$998.67
|
| Rate for Payer: BCBS Trust/PPO |
$998.67
|
| Rate for Payer: BCBS Trust/PPO |
$998.67
|
| Rate for Payer: BCBS Trust/PPO |
$998.67
|
| Rate for Payer: BCN Commercial |
$998.67
|
| Rate for Payer: BCN Commercial |
$998.67
|
| Rate for Payer: BCN Commercial |
$998.67
|
| Rate for Payer: BCN Commercial |
$998.67
|
| Rate for Payer: BCN Commercial |
$998.67
|
| Rate for Payer: BCN Medicare Advantage |
$337.67
|
| Rate for Payer: BCN Medicare Advantage |
$337.67
|
| Rate for Payer: BCN Medicare Advantage |
$337.67
|
| Rate for Payer: BCN Medicare Advantage |
$337.67
|
| Rate for Payer: BCN Medicare Advantage |
$337.67
|
| Rate for Payer: Cash Price |
$9,729.08
|
| Rate for Payer: Cash Price |
$9,729.08
|
| Rate for Payer: Cash Price |
$2,371.62
|
| Rate for Payer: Cash Price |
$1,670.25
|
| Rate for Payer: Cash Price |
$1,236.90
|
| Rate for Payer: Cash Price |
$2,371.62
|
| Rate for Payer: Cash Price |
$1,670.25
|
| Rate for Payer: Cash Price |
$1,335.86
|
| Rate for Payer: Cash Price |
$1,335.86
|
| Rate for Payer: Cash Price |
$1,236.90
|
| Rate for Payer: Cofinity Advantage |
$8,512.94
|
| Rate for Payer: Cofinity Advantage |
$1,168.87
|
| Rate for Payer: Cofinity Advantage |
$2,075.17
|
| Rate for Payer: Cofinity Advantage |
$1,461.47
|
| Rate for Payer: Cofinity Advantage |
$1,082.29
|
| Rate for Payer: Cofinity Commercial |
$1,795.52
|
| Rate for Payer: Cofinity Commercial |
$10,458.76
|
| Rate for Payer: Cofinity Commercial |
$2,549.50
|
| Rate for Payer: Cofinity Commercial |
$1,436.05
|
| Rate for Payer: Cofinity Commercial |
$1,329.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,729.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,236.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,335.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,670.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,371.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$337.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$337.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$337.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$337.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$337.67
|
| Rate for Payer: Healthscope Commercial |
$2,668.08
|
| Rate for Payer: Healthscope Commercial |
$10,945.22
|
| Rate for Payer: Healthscope Commercial |
$1,879.03
|
| Rate for Payer: Healthscope Commercial |
$1,502.84
|
| Rate for Payer: Healthscope Commercial |
$1,391.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,461.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,512.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,082.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,075.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,168.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,252.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,565.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,159.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,121.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,223.40
|
| Rate for Payer: Mclaren Medicaid |
$337.67
|
| Rate for Payer: Mclaren Medicaid |
$337.67
|
| Rate for Payer: Mclaren Medicaid |
$337.67
|
| Rate for Payer: Mclaren Medicaid |
$337.67
|
| Rate for Payer: Mclaren Medicaid |
$337.67
|
| Rate for Payer: Mclaren Medicare |
$337.67
|
| Rate for Payer: Mclaren Medicare |
$337.67
|
| Rate for Payer: Mclaren Medicare |
$337.67
|
| Rate for Payer: Mclaren Medicare |
$337.67
|
| Rate for Payer: Mclaren Medicare |
$337.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$354.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$354.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$354.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$354.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$354.55
|
| Rate for Payer: Meridian Medicaid |
$354.55
|
| Rate for Payer: Meridian Medicaid |
$354.55
|
| Rate for Payer: Meridian Medicaid |
$354.55
|
| Rate for Payer: Meridian Medicaid |
$354.55
|
| Rate for Payer: Meridian Medicaid |
$354.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$388.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$388.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$388.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$388.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$388.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$371.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$371.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$371.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$371.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$371.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,314.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,337.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,419.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,774.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,519.85
|
| Rate for Payer: Nomi Health Commercial |
$1,013.01
|
| Rate for Payer: Nomi Health Commercial |
$1,013.01
|
| Rate for Payer: Nomi Health Commercial |
$1,013.01
|
| Rate for Payer: Nomi Health Commercial |
$1,013.01
|
| Rate for Payer: Nomi Health Commercial |
$1,013.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,223.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,159.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,252.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,565.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,121.01
|
| Rate for Payer: PACE Medicare |
$320.79
|
| Rate for Payer: PACE Medicare |
$320.79
|
| Rate for Payer: PACE Medicare |
$320.79
|
| Rate for Payer: PACE Medicare |
$320.79
|
| Rate for Payer: PACE Medicare |
$320.79
|
| Rate for Payer: PACE SWMI |
$337.67
|
| Rate for Payer: PACE SWMI |
$337.67
|
| Rate for Payer: PACE SWMI |
$337.67
|
| Rate for Payer: PACE SWMI |
$337.67
|
| Rate for Payer: PACE SWMI |
$337.67
|
| Rate for Payer: PHP Commercial |
$1,774.64
|
| Rate for Payer: PHP Commercial |
$1,419.35
|
| Rate for Payer: PHP Commercial |
$10,337.15
|
| Rate for Payer: PHP Commercial |
$1,314.21
|
| Rate for Payer: PHP Commercial |
$2,519.85
|
| Rate for Payer: PHP Medicare Advantage |
$337.67
|
| Rate for Payer: PHP Medicare Advantage |
$337.67
|
| Rate for Payer: PHP Medicare Advantage |
$337.67
|
| Rate for Payer: PHP Medicare Advantage |
$337.67
|
| Rate for Payer: PHP Medicare Advantage |
$337.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$176.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$176.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$176.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$176.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$176.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,035.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,035.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,035.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,035.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,035.56
|
| Rate for Payer: Priority Health Medicare |
$337.67
|
| Rate for Payer: Priority Health Medicare |
$337.67
|
| Rate for Payer: Priority Health Medicare |
$337.67
|
| Rate for Payer: Priority Health Medicare |
$337.67
|
| Rate for Payer: Priority Health Medicare |
$337.67
|
| Rate for Payer: Priority Health SBD |
$1,315.32
|
| Rate for Payer: Priority Health SBD |
$1,051.99
|
| Rate for Payer: Priority Health SBD |
$974.06
|
| Rate for Payer: Priority Health SBD |
$1,867.65
|
| Rate for Payer: Priority Health SBD |
$7,661.65
|
| Rate for Payer: Priority Health Tiered Network |
$828.45
|
| Rate for Payer: Priority Health Tiered Network |
$828.45
|
| Rate for Payer: Priority Health Tiered Network |
$828.45
|
| Rate for Payer: Priority Health Tiered Network |
$828.45
|
| Rate for Payer: Priority Health Tiered Network |
$828.45
|
| Rate for Payer: Railroad Medicare Medicare |
$337.67
|
| Rate for Payer: Railroad Medicare Medicare |
$337.67
|
| Rate for Payer: Railroad Medicare Medicare |
$337.67
|
| Rate for Payer: Railroad Medicare Medicare |
$337.67
|
| Rate for Payer: Railroad Medicare Medicare |
$337.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$508.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$508.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$508.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$508.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$508.18
|
| Rate for Payer: UHC Core |
$508.18
|
| Rate for Payer: UHC Core |
$508.18
|
| Rate for Payer: UHC Core |
$508.18
|
| Rate for Payer: UHC Core |
$508.18
|
| Rate for Payer: UHC Core |
$508.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$337.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$337.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$337.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$337.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$337.67
|
| Rate for Payer: UHC Exchange |
$508.18
|
| Rate for Payer: UHC Exchange |
$508.18
|
| Rate for Payer: UHC Exchange |
$508.18
|
| Rate for Payer: UHC Exchange |
$508.18
|
| Rate for Payer: UHC Exchange |
$508.18
|
| Rate for Payer: UHC Medicaid |
$176.60
|
| Rate for Payer: UHC Medicaid |
$176.60
|
| Rate for Payer: UHC Medicaid |
$176.60
|
| Rate for Payer: UHC Medicaid |
$176.60
|
| Rate for Payer: UHC Medicaid |
$176.60
|
| Rate for Payer: UHCCP Medicaid |
$176.60
|
| Rate for Payer: UHCCP Medicaid |
$176.60
|
| Rate for Payer: UHCCP Medicaid |
$176.60
|
| Rate for Payer: UHCCP Medicaid |
$176.60
|
| Rate for Payer: UHCCP Medicaid |
$176.60
|
| Rate for Payer: UMR Bronson Commercial |
$617.83
|
| Rate for Payer: UMR Bronson Commercial |
$1,096.88
|
| Rate for Payer: UMR Bronson Commercial |
$772.49
|
| Rate for Payer: UMR Bronson Commercial |
$4,499.70
|
| Rate for Payer: UMR Bronson Commercial |
$572.07
|
| Rate for Payer: VA VA |
$337.67
|
| Rate for Payer: VA VA |
$337.67
|
| Rate for Payer: VA VA |
$337.67
|
| Rate for Payer: VA VA |
$337.67
|
| Rate for Payer: VA VA |
$337.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,565.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,252.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,121.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,159.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,223.40
|
|
|
DALBAVANCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$6,744.00
|
|
|
Service Code
|
HCPCS J0875
|
| Hospital Charge Code |
171111
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,967.36 |
| Max. Negotiated Rate |
$6,069.60 |
| Rate for Payer: Aetna American Axle |
$4,383.60
|
| Rate for Payer: Aetna Commercial |
$5,732.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,383.60
|
| Rate for Payer: Cash Price |
$5,395.20
|
| Rate for Payer: Cofinity Advantage |
$4,720.80
|
| Rate for Payer: Cofinity Commercial |
$5,799.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,395.20
|
| Rate for Payer: Healthscope Commercial |
$6,069.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,720.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,058.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,732.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,058.00
|
| Rate for Payer: PHP Commercial |
$5,732.40
|
| Rate for Payer: Priority Health SBD |
$4,248.72
|
| Rate for Payer: UMR Bronson Commercial |
$2,967.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,058.00
|
|
|
DALBAVANCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,744.00
|
|
|
Service Code
|
HCPCS J0875
|
| Hospital Charge Code |
171111
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.84 |
| Max. Negotiated Rate |
$6,069.60 |
| Rate for Payer: Aetna American Axle |
$4,383.60
|
| Rate for Payer: Aetna Commercial |
$5,732.40
|
| Rate for Payer: Aetna Medicare |
$15.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,383.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.75
|
| Rate for Payer: BCBS Complete |
$8.24
|
| Rate for Payer: BCBS MAPPO |
$15.00
|
| Rate for Payer: BCBS Trust/PPO |
$50.54
|
| Rate for Payer: BCN Commercial |
$50.54
|
| Rate for Payer: BCN Medicare Advantage |
$15.00
|
| Rate for Payer: Cash Price |
$5,395.20
|
| Rate for Payer: Cash Price |
$5,395.20
|
| Rate for Payer: Cofinity Advantage |
$4,720.80
|
| Rate for Payer: Cofinity Commercial |
$5,799.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,395.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.00
|
| Rate for Payer: Healthscope Commercial |
$6,069.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,720.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,058.00
|
| Rate for Payer: Mclaren Medicaid |
$15.00
|
| Rate for Payer: Mclaren Medicare |
$15.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.75
|
| Rate for Payer: Meridian Medicaid |
$15.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,732.40
|
| Rate for Payer: Nomi Health Commercial |
$45.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,058.00
|
| Rate for Payer: PACE Medicare |
$14.25
|
| Rate for Payer: PACE SWMI |
$15.00
|
| Rate for Payer: PHP Commercial |
$5,732.40
|
| Rate for Payer: PHP Medicare Advantage |
$15.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$49.25
|
| Rate for Payer: Priority Health Medicare |
$15.00
|
| Rate for Payer: Priority Health SBD |
$4,248.72
|
| Rate for Payer: Priority Health Tiered Network |
$39.40
|
| Rate for Payer: Railroad Medicare Medicare |
$15.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.72
|
| Rate for Payer: UHC Core |
$25.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15.00
|
| Rate for Payer: UHC Exchange |
$25.72
|
| Rate for Payer: UHC Medicaid |
$7.84
|
| Rate for Payer: UHCCP Medicaid |
$7.84
|
| Rate for Payer: UMR Bronson Commercial |
$2,495.28
|
| Rate for Payer: VA VA |
$15.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,058.00
|
|
|
DANAZOL 100 MG CAPSULE
|
Facility
|
OP
|
$1,310.17
|
|
|
Service Code
|
NDC 00555063402
|
| Hospital Charge Code |
9714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$484.76 |
| Max. Negotiated Rate |
$1,179.15 |
| Rate for Payer: Aetna American Axle |
$851.61
|
| Rate for Payer: Aetna Commercial |
$1,113.64
|
| Rate for Payer: Aetna Medicare |
$655.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$851.61
|
| Rate for Payer: BCBS Complete |
$524.07
|
| Rate for Payer: Cash Price |
$1,048.14
|
| Rate for Payer: Cofinity Advantage |
$917.12
|
| Rate for Payer: Cofinity Commercial |
$1,126.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,048.14
|
| Rate for Payer: Healthscope Commercial |
$1,179.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$917.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$982.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,048.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,113.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$982.63
|
| Rate for Payer: PHP Commercial |
$1,113.64
|
| Rate for Payer: Priority Health SBD |
$825.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$851.61
|
| Rate for Payer: UHC Core |
$682.60
|
| Rate for Payer: UHC Exchange |
$514.90
|
| Rate for Payer: UMR Bronson Commercial |
$484.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$982.63
|
|
|
DANAZOL 100 MG CAPSULE
|
Facility
|
IP
|
$1,310.17
|
|
|
Service Code
|
NDC 00555063402
|
| Hospital Charge Code |
9714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$576.47 |
| Max. Negotiated Rate |
$1,179.15 |
| Rate for Payer: Aetna American Axle |
$851.61
|
| Rate for Payer: Aetna Commercial |
$1,113.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$851.61
|
| Rate for Payer: Cash Price |
$1,048.14
|
| Rate for Payer: Cofinity Advantage |
$917.12
|
| Rate for Payer: Cofinity Commercial |
$1,126.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,048.14
|
| Rate for Payer: Healthscope Commercial |
$1,179.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$917.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$982.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,113.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$982.63
|
| Rate for Payer: PHP Commercial |
$1,113.64
|
| Rate for Payer: Priority Health SBD |
$825.41
|
| Rate for Payer: UMR Bronson Commercial |
$576.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$982.63
|
|
|
DANTROLENE 20 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$292.65
|
|
|
Service Code
|
NDC 42023012306
|
| Hospital Charge Code |
9716
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$108.28 |
| Max. Negotiated Rate |
$263.38 |
| Rate for Payer: Aetna American Axle |
$190.22
|
| Rate for Payer: Aetna Commercial |
$248.75
|
| Rate for Payer: Aetna Medicare |
$146.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.22
|
| Rate for Payer: BCBS Complete |
$117.06
|
| Rate for Payer: Cash Price |
$234.12
|
| Rate for Payer: Cofinity Advantage |
$204.85
|
| Rate for Payer: Cofinity Commercial |
$251.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.12
|
| Rate for Payer: Healthscope Commercial |
$263.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$204.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$219.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$234.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$219.49
|
| Rate for Payer: PHP Commercial |
$248.75
|
| Rate for Payer: Priority Health SBD |
$184.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.22
|
| Rate for Payer: UHC Core |
$152.47
|
| Rate for Payer: UHC Exchange |
$115.01
|
| Rate for Payer: UMR Bronson Commercial |
$108.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$219.49
|
|
|
DANTROLENE 20 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$292.65
|
|
|
Service Code
|
NDC 42023012306
|
| Hospital Charge Code |
9716
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$128.77 |
| Max. Negotiated Rate |
$263.38 |
| Rate for Payer: Aetna American Axle |
$190.22
|
| Rate for Payer: Aetna Commercial |
$248.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.22
|
| Rate for Payer: Cash Price |
$234.12
|
| Rate for Payer: Cofinity Advantage |
$204.85
|
| Rate for Payer: Cofinity Commercial |
$251.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.12
|
| Rate for Payer: Healthscope Commercial |
$263.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$204.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$219.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$219.49
|
| Rate for Payer: PHP Commercial |
$248.75
|
| Rate for Payer: Priority Health SBD |
$184.37
|
| Rate for Payer: UMR Bronson Commercial |
$128.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$219.49
|
|
|
DANTROLENE 20 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$187.30
|
|
|
Service Code
|
NDC 00143929701
|
| Hospital Charge Code |
9716
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$168.57 |
| Rate for Payer: Aetna American Axle |
$121.75
|
| Rate for Payer: Aetna Commercial |
$159.21
|
| Rate for Payer: Aetna Medicare |
$93.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.75
|
| Rate for Payer: BCBS Complete |
$74.92
|
| Rate for Payer: Cash Price |
$149.84
|
| Rate for Payer: Cofinity Advantage |
$131.11
|
| Rate for Payer: Cofinity Commercial |
$161.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.84
|
| Rate for Payer: Healthscope Commercial |
$168.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$131.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$140.47
|
| Rate for Payer: PHP Commercial |
$159.21
|
| Rate for Payer: Priority Health SBD |
$118.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.75
|
| Rate for Payer: UHC Core |
$97.58
|
| Rate for Payer: UHC Exchange |
$73.61
|
| Rate for Payer: UMR Bronson Commercial |
$69.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.47
|
|
|
DANTROLENE 20 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$187.30
|
|
|
Service Code
|
NDC 00143929701
|
| Hospital Charge Code |
9716
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$82.41 |
| Max. Negotiated Rate |
$168.57 |
| Rate for Payer: Aetna American Axle |
$121.75
|
| Rate for Payer: Aetna Commercial |
$159.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.75
|
| Rate for Payer: Cash Price |
$149.84
|
| Rate for Payer: Cofinity Advantage |
$131.11
|
| Rate for Payer: Cofinity Commercial |
$161.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.84
|
| Rate for Payer: Healthscope Commercial |
$168.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$131.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$140.47
|
| Rate for Payer: PHP Commercial |
$159.21
|
| Rate for Payer: Priority Health SBD |
$118.00
|
| Rate for Payer: UMR Bronson Commercial |
$82.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.47
|
|
|
DANTROLENE 25 MG CAPSULE
|
Facility
|
IP
|
$382.85
|
|
|
Service Code
|
NDC 00115441101
|
| Hospital Charge Code |
9718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.45 |
| Max. Negotiated Rate |
$344.56 |
| Rate for Payer: Aetna American Axle |
$248.85
|
| Rate for Payer: Aetna Commercial |
$325.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.85
|
| Rate for Payer: Cash Price |
$306.28
|
| Rate for Payer: Cofinity Advantage |
$268.00
|
| Rate for Payer: Cofinity Commercial |
$329.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.28
|
| Rate for Payer: Healthscope Commercial |
$344.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$268.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$287.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$287.14
|
| Rate for Payer: PHP Commercial |
$325.42
|
| Rate for Payer: Priority Health SBD |
$241.20
|
| Rate for Payer: UMR Bronson Commercial |
$168.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$287.14
|
|
|
DANTROLENE 25 MG CAPSULE
|
Facility
|
OP
|
$382.85
|
|
|
Service Code
|
NDC 00115441101
|
| Hospital Charge Code |
9718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.65 |
| Max. Negotiated Rate |
$344.56 |
| Rate for Payer: Aetna American Axle |
$248.85
|
| Rate for Payer: Aetna Commercial |
$325.42
|
| Rate for Payer: Aetna Medicare |
$191.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.85
|
| Rate for Payer: BCBS Complete |
$153.14
|
| Rate for Payer: Cash Price |
$306.28
|
| Rate for Payer: Cofinity Advantage |
$268.00
|
| Rate for Payer: Cofinity Commercial |
$329.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.28
|
| Rate for Payer: Healthscope Commercial |
$344.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$268.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$287.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$306.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$287.14
|
| Rate for Payer: PHP Commercial |
$325.42
|
| Rate for Payer: Priority Health SBD |
$241.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.85
|
| Rate for Payer: UHC Core |
$199.46
|
| Rate for Payer: UHC Exchange |
$150.46
|
| Rate for Payer: UMR Bronson Commercial |
$141.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$287.14
|
|
|
DAPAGLIFLOZIN PROPANEDIOL 10 MG TABLET
|
Facility
|
IP
|
$1,338.55
|
|
|
Service Code
|
NDC 66993045730
|
| Hospital Charge Code |
169524
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$588.96 |
| Max. Negotiated Rate |
$1,204.69 |
| Rate for Payer: Aetna American Axle |
$870.06
|
| Rate for Payer: Aetna Commercial |
$1,137.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$870.06
|
| Rate for Payer: Cash Price |
$1,070.84
|
| Rate for Payer: Cofinity Advantage |
$936.99
|
| Rate for Payer: Cofinity Commercial |
$1,151.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,070.84
|
| Rate for Payer: Healthscope Commercial |
$1,204.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$936.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,003.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,137.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,003.91
|
| Rate for Payer: PHP Commercial |
$1,137.77
|
| Rate for Payer: Priority Health SBD |
$843.29
|
| Rate for Payer: UMR Bronson Commercial |
$588.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,003.91
|
|
|
DAPAGLIFLOZIN PROPANEDIOL 10 MG TABLET
|
Facility
|
OP
|
$1,400.16
|
|
|
Service Code
|
NDC 00310621030
|
| Hospital Charge Code |
169524
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$518.06 |
| Max. Negotiated Rate |
$1,260.14 |
| Rate for Payer: Aetna American Axle |
$910.10
|
| Rate for Payer: Aetna Commercial |
$1,190.14
|
| Rate for Payer: Aetna Medicare |
$700.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$910.10
|
| Rate for Payer: BCBS Complete |
$560.06
|
| Rate for Payer: Cash Price |
$1,120.13
|
| Rate for Payer: Cofinity Advantage |
$980.11
|
| Rate for Payer: Cofinity Commercial |
$1,204.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,120.13
|
| Rate for Payer: Healthscope Commercial |
$1,260.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$980.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,050.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,120.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,190.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,050.12
|
| Rate for Payer: PHP Commercial |
$1,190.14
|
| Rate for Payer: Priority Health SBD |
$882.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$910.10
|
| Rate for Payer: UHC Core |
$729.48
|
| Rate for Payer: UHC Exchange |
$550.26
|
| Rate for Payer: UMR Bronson Commercial |
$518.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,050.12
|
|
|
DAPAGLIFLOZIN PROPANEDIOL 10 MG TABLET
|
Facility
|
OP
|
$300.70
|
|
|
Service Code
|
NDC 00310621095
|
| Hospital Charge Code |
169524
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.26 |
| Max. Negotiated Rate |
$270.63 |
| Rate for Payer: Aetna American Axle |
$195.46
|
| Rate for Payer: Aetna Commercial |
$255.59
|
| Rate for Payer: Aetna Medicare |
$150.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.46
|
| Rate for Payer: BCBS Complete |
$120.28
|
| Rate for Payer: Cash Price |
$240.56
|
| Rate for Payer: Cofinity Advantage |
$210.49
|
| Rate for Payer: Cofinity Commercial |
$258.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.56
|
| Rate for Payer: Healthscope Commercial |
$270.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$240.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.53
|
| Rate for Payer: PHP Commercial |
$255.59
|
| Rate for Payer: Priority Health SBD |
$189.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.46
|
| Rate for Payer: UHC Core |
$156.66
|
| Rate for Payer: UHC Exchange |
$118.18
|
| Rate for Payer: UMR Bronson Commercial |
$111.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.53
|
|
|
DAPAGLIFLOZIN PROPANEDIOL 10 MG TABLET
|
Facility
|
IP
|
$1,400.16
|
|
|
Service Code
|
NDC 00310621030
|
| Hospital Charge Code |
169524
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$616.07 |
| Max. Negotiated Rate |
$1,260.14 |
| Rate for Payer: Aetna American Axle |
$910.10
|
| Rate for Payer: Aetna Commercial |
$1,190.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$910.10
|
| Rate for Payer: Cash Price |
$1,120.13
|
| Rate for Payer: Cofinity Advantage |
$980.11
|
| Rate for Payer: Cofinity Commercial |
$1,204.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,120.13
|
| Rate for Payer: Healthscope Commercial |
$1,260.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$980.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,050.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,190.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,050.12
|
| Rate for Payer: PHP Commercial |
$1,190.14
|
| Rate for Payer: Priority Health SBD |
$882.10
|
| Rate for Payer: UMR Bronson Commercial |
$616.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,050.12
|
|
|
DAPAGLIFLOZIN PROPANEDIOL 10 MG TABLET
|
Facility
|
IP
|
$300.70
|
|
|
Service Code
|
NDC 00310621095
|
| Hospital Charge Code |
169524
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.31 |
| Max. Negotiated Rate |
$270.63 |
| Rate for Payer: Aetna American Axle |
$195.46
|
| Rate for Payer: Aetna Commercial |
$255.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.46
|
| Rate for Payer: Cash Price |
$240.56
|
| Rate for Payer: Cofinity Advantage |
$210.49
|
| Rate for Payer: Cofinity Commercial |
$258.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.56
|
| Rate for Payer: Healthscope Commercial |
$270.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.53
|
| Rate for Payer: PHP Commercial |
$255.59
|
| Rate for Payer: Priority Health SBD |
$189.44
|
| Rate for Payer: UMR Bronson Commercial |
$132.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.53
|
|
|
DAPAGLIFLOZIN PROPANEDIOL 10 MG TABLET
|
Facility
|
OP
|
$1,338.55
|
|
|
Service Code
|
NDC 66993045730
|
| Hospital Charge Code |
169524
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$495.26 |
| Max. Negotiated Rate |
$1,204.69 |
| Rate for Payer: Aetna American Axle |
$870.06
|
| Rate for Payer: Aetna Commercial |
$1,137.77
|
| Rate for Payer: Aetna Medicare |
$669.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$870.06
|
| Rate for Payer: BCBS Complete |
$535.42
|
| Rate for Payer: Cash Price |
$1,070.84
|
| Rate for Payer: Cofinity Advantage |
$936.99
|
| Rate for Payer: Cofinity Commercial |
$1,151.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,070.84
|
| Rate for Payer: Healthscope Commercial |
$1,204.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$936.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,003.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,070.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,137.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,003.91
|
| Rate for Payer: PHP Commercial |
$1,137.77
|
| Rate for Payer: Priority Health SBD |
$843.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$870.06
|
| Rate for Payer: UHC Core |
$697.38
|
| Rate for Payer: UHC Exchange |
$526.05
|
| Rate for Payer: UMR Bronson Commercial |
$495.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,003.91
|
|
|
DAPAGLIFLOZIN PROPANEDIOL 5 MG TABLET
|
Facility
|
IP
|
$1,333.45
|
|
|
Service Code
|
NDC 66993045630
|
| Hospital Charge Code |
169523
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$586.72 |
| Max. Negotiated Rate |
$1,200.11 |
| Rate for Payer: Aetna American Axle |
$866.74
|
| Rate for Payer: Aetna Commercial |
$1,133.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$866.74
|
| Rate for Payer: Cash Price |
$1,066.76
|
| Rate for Payer: Cofinity Advantage |
$933.41
|
| Rate for Payer: Cofinity Commercial |
$1,146.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,066.76
|
| Rate for Payer: Healthscope Commercial |
$1,200.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$933.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,000.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,133.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,000.09
|
| Rate for Payer: PHP Commercial |
$1,133.43
|
| Rate for Payer: Priority Health SBD |
$840.07
|
| Rate for Payer: UMR Bronson Commercial |
$586.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,000.09
|
|
|
DAPAGLIFLOZIN PROPANEDIOL 5 MG TABLET
|
Facility
|
OP
|
$1,333.45
|
|
|
Service Code
|
NDC 66993045630
|
| Hospital Charge Code |
169523
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$493.38 |
| Max. Negotiated Rate |
$1,200.11 |
| Rate for Payer: Aetna American Axle |
$866.74
|
| Rate for Payer: Aetna Commercial |
$1,133.43
|
| Rate for Payer: Aetna Medicare |
$666.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$866.74
|
| Rate for Payer: BCBS Complete |
$533.38
|
| Rate for Payer: Cash Price |
$1,066.76
|
| Rate for Payer: Cofinity Advantage |
$933.41
|
| Rate for Payer: Cofinity Commercial |
$1,146.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,066.76
|
| Rate for Payer: Healthscope Commercial |
$1,200.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$933.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,000.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,066.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,133.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,000.09
|
| Rate for Payer: PHP Commercial |
$1,133.43
|
| Rate for Payer: Priority Health SBD |
$840.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$866.74
|
| Rate for Payer: UHC Core |
$694.73
|
| Rate for Payer: UHC Exchange |
$524.05
|
| Rate for Payer: UMR Bronson Commercial |
$493.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,000.09
|
|
|
DAPSONE 100 MG TABLET
|
Facility
|
OP
|
$132.63
|
|
|
Service Code
|
NDC 70954013610
|
| Hospital Charge Code |
2131
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.07 |
| Max. Negotiated Rate |
$119.37 |
| Rate for Payer: Aetna American Axle |
$86.21
|
| Rate for Payer: Aetna Commercial |
$112.74
|
| Rate for Payer: Aetna Medicare |
$66.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.21
|
| Rate for Payer: BCBS Complete |
$53.05
|
| Rate for Payer: Cash Price |
$106.10
|
| Rate for Payer: Cofinity Advantage |
$92.84
|
| Rate for Payer: Cofinity Commercial |
$114.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.10
|
| Rate for Payer: Healthscope Commercial |
$119.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$106.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.47
|
| Rate for Payer: PHP Commercial |
$112.74
|
| Rate for Payer: Priority Health SBD |
$83.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.21
|
| Rate for Payer: UHC Core |
$69.10
|
| Rate for Payer: UHC Exchange |
$52.12
|
| Rate for Payer: UMR Bronson Commercial |
$49.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.47
|
|
