|
CYCLOPHOSPHAMIDE 200 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,149.02
|
|
|
Service Code
|
HCPCS J9073
|
| Hospital Charge Code |
194691
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$945.57 |
| Max. Negotiated Rate |
$1,934.12 |
| Rate for Payer: Aetna American Axle |
$1,396.86
|
| Rate for Payer: Aetna Commercial |
$1,826.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,396.86
|
| Rate for Payer: Cash Price |
$1,719.22
|
| Rate for Payer: Cofinity Commercial |
$1,504.31
|
| Rate for Payer: Cofinity Commercial |
$1,848.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,504.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,719.22
|
| Rate for Payer: Healthscope Commercial |
$1,934.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,504.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,611.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,826.67
|
| Rate for Payer: PHP Commercial |
$1,826.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,396.86
|
| Rate for Payer: Priority Health SBD |
$1,353.88
|
| Rate for Payer: UMR Bronson Commercial |
$945.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,611.76
|
|
|
CYCLOPHOSPHAMIDE 200 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,136.88
|
|
|
Service Code
|
HCPCS J9075
|
| Hospital Charge Code |
194691
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$1,023.19 |
| Rate for Payer: Aetna American Axle |
$738.97
|
| Rate for Payer: Aetna American Axle |
$1,390.94
|
| Rate for Payer: Aetna Commercial |
$1,818.92
|
| Rate for Payer: Aetna Commercial |
$966.35
|
| Rate for Payer: Aetna Medicare |
$0.92
|
| Rate for Payer: Aetna Medicare |
$0.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$738.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,390.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.10
|
| Rate for Payer: BCBS Complete |
$0.50
|
| Rate for Payer: BCBS Complete |
$0.50
|
| Rate for Payer: BCBS MAPPO |
$0.88
|
| Rate for Payer: BCBS MAPPO |
$0.88
|
| Rate for Payer: BCBS Trust/PPO |
$2.70
|
| Rate for Payer: BCBS Trust/PPO |
$2.70
|
| Rate for Payer: BCN Commercial |
$2.70
|
| Rate for Payer: BCN Commercial |
$2.70
|
| Rate for Payer: BCN Medicare Advantage |
$0.88
|
| Rate for Payer: BCN Medicare Advantage |
$0.88
|
| Rate for Payer: Cash Price |
$1,711.92
|
| Rate for Payer: Cash Price |
$909.50
|
| Rate for Payer: Cash Price |
$1,711.92
|
| Rate for Payer: Cash Price |
$909.50
|
| Rate for Payer: Cofinity Commercial |
$1,497.93
|
| Rate for Payer: Cofinity Commercial |
$795.82
|
| Rate for Payer: Cofinity Commercial |
$977.72
|
| Rate for Payer: Cofinity Commercial |
$1,840.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$795.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,497.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$909.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,711.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.88
|
| Rate for Payer: Healthscope Commercial |
$1,023.19
|
| Rate for Payer: Healthscope Commercial |
$1,925.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,497.93
|
| 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 |
$1,604.92
|
| Rate for Payer: Mclaren Medicaid |
$0.47
|
| Rate for Payer: Mclaren Medicaid |
$0.47
|
| Rate for Payer: Mclaren Medicare |
$0.88
|
| Rate for Payer: Mclaren Medicare |
$0.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.92
|
| Rate for Payer: Meridian Medicaid |
$0.50
|
| Rate for Payer: Meridian Medicaid |
$0.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$966.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,818.92
|
| Rate for Payer: Nomi Health Commercial |
$2.64
|
| Rate for Payer: Nomi Health Commercial |
$2.64
|
| Rate for Payer: PACE Medicare |
$0.84
|
| Rate for Payer: PACE Medicare |
$0.84
|
| Rate for Payer: PACE SWMI |
$0.88
|
| Rate for Payer: PACE SWMI |
$0.88
|
| Rate for Payer: PHP Commercial |
$966.35
|
| Rate for Payer: PHP Commercial |
$1,818.92
|
| Rate for Payer: PHP Medicare Advantage |
$0.88
|
| Rate for Payer: PHP Medicare Advantage |
$0.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$738.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,390.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.90
|
| Rate for Payer: Priority Health Medicare |
$0.88
|
| Rate for Payer: Priority Health Medicare |
$0.88
|
| Rate for Payer: Priority Health Narrow Network |
$2.32
|
| Rate for Payer: Priority Health Narrow Network |
$2.32
|
| Rate for Payer: Priority Health SBD |
$716.23
|
| Rate for Payer: Priority Health SBD |
$1,348.14
|
| Rate for Payer: Railroad Medicare Medicare |
$0.88
|
| Rate for Payer: Railroad Medicare Medicare |
$0.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.88
|
| Rate for Payer: UHC Exchange |
$1.68
|
| Rate for Payer: UHC Exchange |
$1.68
|
| Rate for Payer: UHC Medicare Advantage |
$0.88
|
| Rate for Payer: UHC Medicare Advantage |
$0.88
|
| Rate for Payer: UHCCP Medicaid |
$0.47
|
| Rate for Payer: UHCCP Medicaid |
$0.47
|
| Rate for Payer: UMR Bronson Commercial |
$420.65
|
| Rate for Payer: UMR Bronson Commercial |
$791.76
|
| Rate for Payer: VA VA |
$0.88
|
| Rate for Payer: VA VA |
$0.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$852.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,604.92
|
|
|
CYCLOPHOSPHAMIDE 200 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,384.25
|
|
|
Service Code
|
HCPCS J9071
|
| Hospital Charge Code |
194691
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1,245.82 |
| Rate for Payer: Aetna American Axle |
$899.76
|
| Rate for Payer: Aetna American Axle |
$1,581.71
|
| Rate for Payer: Aetna American Axle |
$1,904.10
|
| Rate for Payer: Aetna Commercial |
$2,489.97
|
| Rate for Payer: Aetna Commercial |
$1,176.61
|
| Rate for Payer: Aetna Commercial |
$2,068.39
|
| Rate for Payer: Aetna Medicare |
$0.73
|
| Rate for Payer: Aetna Medicare |
$0.73
|
| Rate for Payer: Aetna Medicare |
$0.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,581.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$899.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,904.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.88
|
| Rate for Payer: BCBS Complete |
$0.39
|
| Rate for Payer: BCBS Complete |
$0.39
|
| Rate for Payer: BCBS Complete |
$0.39
|
| Rate for Payer: BCBS MAPPO |
$0.70
|
| Rate for Payer: BCBS MAPPO |
$0.70
|
| Rate for Payer: BCBS MAPPO |
$0.70
|
| Rate for Payer: BCBS Trust/PPO |
$3.12
|
| Rate for Payer: BCBS Trust/PPO |
$3.12
|
| Rate for Payer: BCBS Trust/PPO |
$3.12
|
| Rate for Payer: BCN Commercial |
$3.12
|
| Rate for Payer: BCN Commercial |
$3.12
|
| Rate for Payer: BCN Commercial |
$3.12
|
| Rate for Payer: BCN Medicare Advantage |
$0.70
|
| Rate for Payer: BCN Medicare Advantage |
$0.70
|
| Rate for Payer: BCN Medicare Advantage |
$0.70
|
| Rate for Payer: Cash Price |
$2,343.50
|
| Rate for Payer: Cash Price |
$1,107.40
|
| 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 |
$1,946.72
|
| Rate for Payer: Cofinity Commercial |
$2,519.27
|
| Rate for Payer: Cofinity Commercial |
$968.98
|
| Rate for Payer: Cofinity Commercial |
$1,190.46
|
| Rate for Payer: Cofinity Commercial |
$2,092.72
|
| Rate for Payer: Cofinity Commercial |
$1,703.38
|
| Rate for Payer: Cofinity Commercial |
$2,050.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,050.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,703.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$968.98
|
| 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 |
$0.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.70
|
| Rate for Payer: Healthscope Commercial |
$1,245.82
|
| Rate for Payer: Healthscope Commercial |
$2,636.44
|
| Rate for Payer: Healthscope Commercial |
$2,190.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,050.57
|
| 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 |
$2,197.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,825.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,038.19
|
| Rate for Payer: Mclaren Medicaid |
$0.38
|
| Rate for Payer: Mclaren Medicaid |
$0.38
|
| Rate for Payer: Mclaren Medicaid |
$0.38
|
| Rate for Payer: Mclaren Medicare |
$0.70
|
| Rate for Payer: Mclaren Medicare |
$0.70
|
| Rate for Payer: Mclaren Medicare |
$0.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.74
|
| Rate for Payer: Meridian Medicaid |
$0.39
|
| Rate for Payer: Meridian Medicaid |
$0.39
|
| Rate for Payer: Meridian Medicaid |
$0.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,489.97
|
| 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: Nomi Health Commercial |
$2.10
|
| Rate for Payer: Nomi Health Commercial |
$2.10
|
| Rate for Payer: Nomi Health Commercial |
$2.10
|
| Rate for Payer: PACE Medicare |
$0.67
|
| Rate for Payer: PACE Medicare |
$0.67
|
| Rate for Payer: PACE Medicare |
$0.67
|
| Rate for Payer: PACE SWMI |
$0.70
|
| Rate for Payer: PACE SWMI |
$0.70
|
| Rate for Payer: PACE SWMI |
$0.70
|
| Rate for Payer: PHP Commercial |
$2,068.39
|
| Rate for Payer: PHP Commercial |
$1,176.61
|
| Rate for Payer: PHP Commercial |
$2,489.97
|
| Rate for Payer: PHP Medicare Advantage |
$0.70
|
| Rate for Payer: PHP Medicare Advantage |
$0.70
|
| Rate for Payer: PHP Medicare Advantage |
$0.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,904.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,581.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$899.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.34
|
| Rate for Payer: Priority Health Medicare |
$0.70
|
| Rate for Payer: Priority Health Medicare |
$0.70
|
| Rate for Payer: Priority Health Medicare |
$0.70
|
| Rate for Payer: Priority Health Narrow Network |
$2.67
|
| Rate for Payer: Priority Health Narrow Network |
$2.67
|
| Rate for Payer: Priority Health Narrow Network |
$2.67
|
| Rate for Payer: Priority Health SBD |
$872.08
|
| Rate for Payer: Priority Health SBD |
$1,533.04
|
| Rate for Payer: Priority Health SBD |
$1,845.51
|
| Rate for Payer: Railroad Medicare Medicare |
$0.70
|
| Rate for Payer: Railroad Medicare Medicare |
$0.70
|
| Rate for Payer: Railroad Medicare Medicare |
$0.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.70
|
| Rate for Payer: UHC Exchange |
$1.34
|
| Rate for Payer: UHC Exchange |
$1.34
|
| Rate for Payer: UHC Exchange |
$1.34
|
| Rate for Payer: UHC Medicare Advantage |
$0.70
|
| Rate for Payer: UHC Medicare Advantage |
$0.70
|
| Rate for Payer: UHC Medicare Advantage |
$0.70
|
| Rate for Payer: UHCCP Medicaid |
$0.38
|
| Rate for Payer: UHCCP Medicaid |
$0.38
|
| Rate for Payer: UHCCP Medicaid |
$0.38
|
| 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 |
$0.70
|
| Rate for Payer: VA VA |
$0.70
|
| Rate for Payer: VA VA |
$0.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,038.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,197.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,825.05
|
|
|
CYCLOPHOSPHAMIDE 50 MG CAPSULE
|
Facility
|
IP
|
$1,007.51
|
|
|
Service Code
|
HCPCS J8530
|
| Hospital Charge Code |
171088
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$443.30 |
| Max. Negotiated Rate |
$906.76 |
| Rate for Payer: Aetna American Axle |
$654.88
|
| Rate for Payer: Aetna American Axle |
$3,074.31
|
| Rate for Payer: Aetna Commercial |
$856.38
|
| Rate for Payer: Aetna Commercial |
$4,020.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$654.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,074.31
|
| Rate for Payer: Cash Price |
$806.01
|
| Rate for Payer: Cash Price |
$3,783.77
|
| Rate for Payer: Cofinity Commercial |
$4,067.55
|
| Rate for Payer: Cofinity Commercial |
$3,310.80
|
| Rate for Payer: Cofinity Commercial |
$705.26
|
| Rate for Payer: Cofinity Commercial |
$866.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$705.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,310.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$806.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,783.77
|
| Rate for Payer: Healthscope Commercial |
$906.76
|
| Rate for Payer: Healthscope Commercial |
$4,256.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$705.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,310.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$755.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,547.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,020.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$856.38
|
| Rate for Payer: PHP Commercial |
$4,020.25
|
| Rate for Payer: PHP Commercial |
$856.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$654.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,074.31
|
| Rate for Payer: Priority Health SBD |
$634.73
|
| Rate for Payer: Priority Health SBD |
$2,979.72
|
| Rate for Payer: UMR Bronson Commercial |
$443.30
|
| Rate for Payer: UMR Bronson Commercial |
$2,081.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$755.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,547.28
|
|
|
CYCLOPHOSPHAMIDE 50 MG CAPSULE
|
Facility
|
OP
|
$1,007.51
|
|
|
Service Code
|
HCPCS J8530
|
| Hospital Charge Code |
171088
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$906.76 |
| Rate for Payer: Aetna American Axle |
$654.88
|
| Rate for Payer: Aetna American Axle |
$3,074.31
|
| Rate for Payer: Aetna Commercial |
$4,020.25
|
| Rate for Payer: Aetna Commercial |
$856.38
|
| Rate for Payer: Aetna Medicare |
$503.76
|
| Rate for Payer: Aetna Medicare |
$2,364.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$654.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,074.31
|
| Rate for Payer: BCBS Complete |
$1,891.88
|
| Rate for Payer: BCBS Complete |
$403.00
|
| Rate for Payer: BCBS Trust/PPO |
$2.36
|
| Rate for Payer: BCBS Trust/PPO |
$2.36
|
| Rate for Payer: BCN Commercial |
$2.36
|
| Rate for Payer: BCN Commercial |
$2.36
|
| Rate for Payer: Cash Price |
$3,783.77
|
| Rate for Payer: Cash Price |
$3,783.77
|
| Rate for Payer: Cash Price |
$806.01
|
| Rate for Payer: Cash Price |
$806.01
|
| Rate for Payer: Cofinity Commercial |
$4,067.55
|
| Rate for Payer: Cofinity Commercial |
$705.26
|
| Rate for Payer: Cofinity Commercial |
$3,310.80
|
| Rate for Payer: Cofinity Commercial |
$866.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$705.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,310.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,783.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$806.01
|
| Rate for Payer: Healthscope Commercial |
$4,256.74
|
| Rate for Payer: Healthscope Commercial |
$906.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,310.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$705.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,547.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$755.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$856.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,020.25
|
| Rate for Payer: PHP Commercial |
$856.38
|
| Rate for Payer: PHP Commercial |
$4,020.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$654.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,074.31
|
| Rate for Payer: Priority Health SBD |
$2,979.72
|
| Rate for Payer: Priority Health SBD |
$634.73
|
| Rate for Payer: UMR Bronson Commercial |
$372.78
|
| Rate for Payer: UMR Bronson Commercial |
$1,749.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,547.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$755.63
|
|
|
CYCLOSPORINE 100 MG CAPSULE
|
Facility
|
IP
|
$1,811.86
|
|
|
Service Code
|
HCPCS J7502
|
| Hospital Charge Code |
9706
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$797.22 |
| Max. Negotiated Rate |
$1,630.67 |
| Rate for Payer: Aetna American Axle |
$1,177.71
|
| Rate for Payer: Aetna American Axle |
$39.26
|
| Rate for Payer: Aetna Commercial |
$1,540.08
|
| Rate for Payer: Aetna Commercial |
$51.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,177.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.26
|
| Rate for Payer: Cash Price |
$1,449.49
|
| Rate for Payer: Cash Price |
$48.32
|
| Rate for Payer: Cofinity Commercial |
$51.94
|
| Rate for Payer: Cofinity Commercial |
$42.28
|
| Rate for Payer: Cofinity Commercial |
$1,268.30
|
| Rate for Payer: Cofinity Commercial |
$1,558.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,268.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,449.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.32
|
| Rate for Payer: Healthscope Commercial |
$1,630.67
|
| Rate for Payer: Healthscope Commercial |
$54.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,268.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,358.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,540.08
|
| Rate for Payer: PHP Commercial |
$51.34
|
| Rate for Payer: PHP Commercial |
$1,540.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,177.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.26
|
| Rate for Payer: Priority Health SBD |
$1,141.47
|
| Rate for Payer: Priority Health SBD |
$38.05
|
| Rate for Payer: UMR Bronson Commercial |
$797.22
|
| Rate for Payer: UMR Bronson Commercial |
$26.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,358.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.30
|
|
|
CYCLOSPORINE 100 MG CAPSULE
|
Facility
|
OP
|
$1,811.86
|
|
|
Service Code
|
HCPCS J7502
|
| Hospital Charge Code |
9706
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.43 |
| Max. Negotiated Rate |
$1,630.67 |
| Rate for Payer: Aetna American Axle |
$1,177.71
|
| Rate for Payer: Aetna American Axle |
$39.26
|
| Rate for Payer: Aetna Commercial |
$51.34
|
| Rate for Payer: Aetna Commercial |
$1,540.08
|
| Rate for Payer: Aetna Medicare |
$905.93
|
| Rate for Payer: Aetna Medicare |
$30.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,177.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.26
|
| Rate for Payer: BCBS Complete |
$24.16
|
| Rate for Payer: BCBS Complete |
$724.74
|
| Rate for Payer: BCBS Trust/PPO |
$6.43
|
| Rate for Payer: BCBS Trust/PPO |
$6.43
|
| Rate for Payer: BCN Commercial |
$6.43
|
| Rate for Payer: BCN Commercial |
$6.43
|
| Rate for Payer: Cash Price |
$48.32
|
| Rate for Payer: Cash Price |
$48.32
|
| Rate for Payer: Cash Price |
$1,449.49
|
| Rate for Payer: Cash Price |
$1,449.49
|
| Rate for Payer: Cofinity Commercial |
$51.94
|
| Rate for Payer: Cofinity Commercial |
$1,268.30
|
| Rate for Payer: Cofinity Commercial |
$42.28
|
| Rate for Payer: Cofinity Commercial |
$1,558.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,268.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,449.49
|
| Rate for Payer: Healthscope Commercial |
$54.36
|
| Rate for Payer: Healthscope Commercial |
$1,630.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,268.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,358.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,540.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.34
|
| Rate for Payer: PHP Commercial |
$1,540.08
|
| Rate for Payer: PHP Commercial |
$51.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,177.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.26
|
| Rate for Payer: Priority Health SBD |
$38.05
|
| Rate for Payer: Priority Health SBD |
$1,141.47
|
| Rate for Payer: UMR Bronson Commercial |
$670.39
|
| Rate for Payer: UMR Bronson Commercial |
$22.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,358.90
|
|
|
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 |
$146.81
|
| Rate for Payer: Aetna Commercial |
$137.57
|
| Rate for Payer: Aetna Commercial |
$191.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.81
|
| Rate for Payer: Cash Price |
$129.48
|
| Rate for Payer: Cash Price |
$180.69
|
| Rate for Payer: Cofinity Commercial |
$194.24
|
| Rate for Payer: Cofinity Commercial |
$158.10
|
| Rate for Payer: Cofinity Commercial |
$113.30
|
| Rate for Payer: Cofinity Commercial |
$139.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$113.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$158.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.69
|
| Rate for Payer: Healthscope Commercial |
$145.66
|
| Rate for Payer: Healthscope Commercial |
$203.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$158.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.57
|
| Rate for Payer: PHP Commercial |
$191.98
|
| Rate for Payer: PHP Commercial |
$137.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.81
|
| Rate for Payer: Priority Health SBD |
$101.97
|
| Rate for Payer: Priority Health SBD |
$142.29
|
| Rate for Payer: UMR Bronson Commercial |
$71.21
|
| Rate for Payer: UMR Bronson Commercial |
$99.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.40
|
|
|
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 |
$192.39 |
| Rate for Payer: Aetna American Axle |
$105.20
|
| Rate for Payer: Aetna American Axle |
$146.81
|
| Rate for Payer: Aetna Commercial |
$191.98
|
| Rate for Payer: Aetna Commercial |
$137.57
|
| Rate for Payer: Aetna Medicare |
$80.92
|
| Rate for Payer: Aetna Medicare |
$112.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.81
|
| Rate for Payer: BCBS Complete |
$90.34
|
| Rate for Payer: BCBS Complete |
$64.74
|
| Rate for Payer: BCBS Trust/PPO |
$192.39
|
| Rate for Payer: BCBS Trust/PPO |
$192.39
|
| Rate for Payer: BCN Commercial |
$192.39
|
| Rate for Payer: BCN Commercial |
$192.39
|
| Rate for Payer: Cash Price |
$180.69
|
| Rate for Payer: Cash Price |
$180.69
|
| Rate for Payer: Cash Price |
$129.48
|
| Rate for Payer: Cash Price |
$129.48
|
| Rate for Payer: Cofinity Commercial |
$194.24
|
| Rate for Payer: Cofinity Commercial |
$113.30
|
| Rate for Payer: Cofinity Commercial |
$158.10
|
| Rate for Payer: Cofinity Commercial |
$139.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$113.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$158.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.48
|
| Rate for Payer: Healthscope Commercial |
$203.27
|
| Rate for Payer: Healthscope Commercial |
$145.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$158.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.98
|
| Rate for Payer: PHP Commercial |
$137.57
|
| Rate for Payer: PHP Commercial |
$191.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.81
|
| Rate for Payer: Priority Health SBD |
$142.29
|
| Rate for Payer: Priority Health SBD |
$101.97
|
| Rate for Payer: UMR Bronson Commercial |
$59.88
|
| Rate for Payer: UMR Bronson Commercial |
$83.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.39
|
|
|
CYCLOSPORINE 25 MG CAPSULE
|
Facility
|
OP
|
$273.46
|
|
|
Service Code
|
HCPCS J7515
|
| Hospital Charge Code |
9707
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$246.11 |
| Rate for Payer: Aetna American Axle |
$177.75
|
| Rate for Payer: Aetna American Axle |
$295.09
|
| Rate for Payer: Aetna Commercial |
$385.89
|
| Rate for Payer: Aetna Commercial |
$232.44
|
| Rate for Payer: Aetna Medicare |
$136.73
|
| Rate for Payer: Aetna Medicare |
$227.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$295.09
|
| Rate for Payer: BCBS Complete |
$181.60
|
| Rate for Payer: BCBS Complete |
$109.38
|
| Rate for Payer: BCBS Trust/PPO |
$2.28
|
| Rate for Payer: BCBS Trust/PPO |
$2.28
|
| Rate for Payer: BCN Commercial |
$2.28
|
| Rate for Payer: BCN Commercial |
$2.28
|
| Rate for Payer: Cash Price |
$363.19
|
| Rate for Payer: Cash Price |
$363.19
|
| Rate for Payer: Cash Price |
$218.77
|
| Rate for Payer: Cash Price |
$218.77
|
| Rate for Payer: Cofinity Commercial |
$390.43
|
| Rate for Payer: Cofinity Commercial |
$191.42
|
| Rate for Payer: Cofinity Commercial |
$317.79
|
| Rate for Payer: Cofinity Commercial |
$235.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$191.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$317.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$363.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.77
|
| Rate for Payer: Healthscope Commercial |
$408.59
|
| Rate for Payer: Healthscope Commercial |
$246.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$317.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$191.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$340.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$385.89
|
| Rate for Payer: PHP Commercial |
$232.44
|
| Rate for Payer: PHP Commercial |
$385.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$295.09
|
| Rate for Payer: Priority Health SBD |
$286.01
|
| Rate for Payer: Priority Health SBD |
$172.28
|
| Rate for Payer: UMR Bronson Commercial |
$101.18
|
| Rate for Payer: UMR Bronson Commercial |
$167.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$340.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.10
|
|
|
CYCLOSPORINE 25 MG CAPSULE
|
Facility
|
IP
|
$273.46
|
|
|
Service Code
|
HCPCS J7515
|
| Hospital Charge Code |
9707
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$120.32 |
| Max. Negotiated Rate |
$246.11 |
| Rate for Payer: Aetna American Axle |
$177.75
|
| Rate for Payer: Aetna American Axle |
$295.09
|
| Rate for Payer: Aetna Commercial |
$232.44
|
| Rate for Payer: Aetna Commercial |
$385.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$295.09
|
| Rate for Payer: Cash Price |
$218.77
|
| Rate for Payer: Cash Price |
$363.19
|
| Rate for Payer: Cofinity Commercial |
$390.43
|
| Rate for Payer: Cofinity Commercial |
$317.79
|
| Rate for Payer: Cofinity Commercial |
$191.42
|
| Rate for Payer: Cofinity Commercial |
$235.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$191.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$317.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$363.19
|
| Rate for Payer: Healthscope Commercial |
$246.11
|
| Rate for Payer: Healthscope Commercial |
$408.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$191.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$317.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$340.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$385.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.44
|
| Rate for Payer: PHP Commercial |
$385.89
|
| Rate for Payer: PHP Commercial |
$232.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$295.09
|
| Rate for Payer: Priority Health SBD |
$172.28
|
| Rate for Payer: Priority Health SBD |
$286.01
|
| Rate for Payer: UMR Bronson Commercial |
$120.32
|
| Rate for Payer: UMR Bronson Commercial |
$199.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$340.49
|
|
|
CYCLOSPORINE MODIFIED 100 MG CAPSULE
|
Facility
|
IP
|
$386.73
|
|
|
Service Code
|
HCPCS J7502
|
| Hospital Charge Code |
28843
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$170.16 |
| Max. Negotiated Rate |
$348.06 |
| Rate for Payer: Aetna American Axle |
$251.37
|
| Rate for Payer: Aetna American Axle |
$142.56
|
| Rate for Payer: Aetna American Axle |
$717.97
|
| Rate for Payer: Aetna American Axle |
$4.76
|
| Rate for Payer: Aetna Commercial |
$328.72
|
| Rate for Payer: Aetna Commercial |
$6.22
|
| Rate for Payer: Aetna Commercial |
$186.42
|
| Rate for Payer: Aetna Commercial |
$938.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$717.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.37
|
| Rate for Payer: Cash Price |
$175.46
|
| Rate for Payer: Cash Price |
$309.38
|
| Rate for Payer: Cash Price |
$883.66
|
| Rate for Payer: Cash Price |
$5.86
|
| Rate for Payer: Cofinity Commercial |
$773.20
|
| Rate for Payer: Cofinity Commercial |
$6.30
|
| Rate for Payer: Cofinity Commercial |
$5.12
|
| Rate for Payer: Cofinity Commercial |
$270.71
|
| Rate for Payer: Cofinity Commercial |
$153.52
|
| Rate for Payer: Cofinity Commercial |
$188.62
|
| Rate for Payer: Cofinity Commercial |
$332.59
|
| Rate for Payer: Cofinity Commercial |
$949.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$153.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$270.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$773.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$883.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.46
|
| Rate for Payer: Healthscope Commercial |
$348.06
|
| Rate for Payer: Healthscope Commercial |
$994.11
|
| Rate for Payer: Healthscope Commercial |
$197.39
|
| Rate for Payer: Healthscope Commercial |
$6.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$773.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$153.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$270.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$828.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$938.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.72
|
| Rate for Payer: PHP Commercial |
$328.72
|
| Rate for Payer: PHP Commercial |
$6.22
|
| Rate for Payer: PHP Commercial |
$938.88
|
| Rate for Payer: PHP Commercial |
$186.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.97
|
| Rate for Payer: Priority Health SBD |
$4.61
|
| Rate for Payer: Priority Health SBD |
$695.88
|
| Rate for Payer: Priority Health SBD |
$138.17
|
| Rate for Payer: Priority Health SBD |
$243.64
|
| Rate for Payer: UMR Bronson Commercial |
$170.16
|
| Rate for Payer: UMR Bronson Commercial |
$3.22
|
| Rate for Payer: UMR Bronson Commercial |
$96.50
|
| Rate for Payer: UMR Bronson Commercial |
$486.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$828.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.05
|
|
|
CYCLOSPORINE MODIFIED 100 MG CAPSULE
|
Facility
|
OP
|
$7.32
|
|
|
Service Code
|
HCPCS J7502
|
| Hospital Charge Code |
28843
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$6.59 |
| Rate for Payer: Aetna American Axle |
$4.76
|
| Rate for Payer: Aetna American Axle |
$251.37
|
| Rate for Payer: Aetna American Axle |
$717.97
|
| Rate for Payer: Aetna American Axle |
$142.56
|
| Rate for Payer: Aetna Commercial |
$6.22
|
| Rate for Payer: Aetna Commercial |
$186.42
|
| Rate for Payer: Aetna Commercial |
$938.88
|
| Rate for Payer: Aetna Commercial |
$328.72
|
| Rate for Payer: Aetna Medicare |
$193.36
|
| Rate for Payer: Aetna Medicare |
$109.66
|
| Rate for Payer: Aetna Medicare |
$552.28
|
| Rate for Payer: Aetna Medicare |
$3.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$717.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.56
|
| Rate for Payer: BCBS Complete |
$154.69
|
| Rate for Payer: BCBS Complete |
$441.83
|
| Rate for Payer: BCBS Complete |
$2.93
|
| Rate for Payer: BCBS Complete |
$87.73
|
| Rate for Payer: BCBS Trust/PPO |
$6.43
|
| Rate for Payer: BCBS Trust/PPO |
$6.43
|
| Rate for Payer: BCBS Trust/PPO |
$6.43
|
| Rate for Payer: BCBS Trust/PPO |
$6.43
|
| Rate for Payer: BCN Commercial |
$6.43
|
| Rate for Payer: BCN Commercial |
$6.43
|
| Rate for Payer: BCN Commercial |
$6.43
|
| Rate for Payer: BCN Commercial |
$6.43
|
| Rate for Payer: Cash Price |
$175.46
|
| Rate for Payer: Cash Price |
$5.86
|
| Rate for Payer: Cash Price |
$309.38
|
| Rate for Payer: Cash Price |
$175.46
|
| Rate for Payer: Cash Price |
$883.66
|
| Rate for Payer: Cash Price |
$883.66
|
| Rate for Payer: Cash Price |
$309.38
|
| Rate for Payer: Cash Price |
$5.86
|
| Rate for Payer: Cofinity Commercial |
$6.30
|
| Rate for Payer: Cofinity Commercial |
$188.62
|
| Rate for Payer: Cofinity Commercial |
$773.20
|
| Rate for Payer: Cofinity Commercial |
$949.93
|
| Rate for Payer: Cofinity Commercial |
$153.52
|
| Rate for Payer: Cofinity Commercial |
$270.71
|
| Rate for Payer: Cofinity Commercial |
$332.59
|
| Rate for Payer: Cofinity Commercial |
$5.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$153.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$270.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$773.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$883.66
|
| Rate for Payer: Healthscope Commercial |
$994.11
|
| Rate for Payer: Healthscope Commercial |
$6.59
|
| Rate for Payer: Healthscope Commercial |
$348.06
|
| Rate for Payer: Healthscope Commercial |
$197.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$270.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$773.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$153.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$828.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$938.88
|
| Rate for Payer: PHP Commercial |
$6.22
|
| Rate for Payer: PHP Commercial |
$186.42
|
| Rate for Payer: PHP Commercial |
$938.88
|
| Rate for Payer: PHP Commercial |
$328.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.37
|
| Rate for Payer: Priority Health SBD |
$695.88
|
| Rate for Payer: Priority Health SBD |
$243.64
|
| Rate for Payer: Priority Health SBD |
$138.17
|
| Rate for Payer: Priority Health SBD |
$4.61
|
| Rate for Payer: UMR Bronson Commercial |
$408.69
|
| Rate for Payer: UMR Bronson Commercial |
$143.09
|
| Rate for Payer: UMR Bronson Commercial |
$2.71
|
| Rate for Payer: UMR Bronson Commercial |
$81.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$828.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.49
|
|
|
CYCLOSPORINE MODIFIED 100 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$1,898.23
|
|
|
Service Code
|
HCPCS J7502
|
| Hospital Charge Code |
28844
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.43 |
| Max. Negotiated Rate |
$1,708.41 |
| Rate for Payer: Aetna American Axle |
$1,233.85
|
| Rate for Payer: Aetna Commercial |
$1,613.50
|
| Rate for Payer: Aetna Medicare |
$949.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,233.85
|
| Rate for Payer: BCBS Complete |
$759.29
|
| Rate for Payer: BCBS Trust/PPO |
$6.43
|
| Rate for Payer: BCN Commercial |
$6.43
|
| Rate for Payer: Cash Price |
$1,518.58
|
| Rate for Payer: Cash Price |
$1,518.58
|
| Rate for Payer: Cofinity Commercial |
$1,328.76
|
| Rate for Payer: Cofinity Commercial |
$1,632.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,328.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,518.58
|
| Rate for Payer: Healthscope Commercial |
$1,708.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,328.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,423.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,613.50
|
| Rate for Payer: PHP Commercial |
$1,613.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,233.85
|
| Rate for Payer: Priority Health SBD |
$1,195.88
|
| Rate for Payer: UMR Bronson Commercial |
$702.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,423.67
|
|
|
CYCLOSPORINE MODIFIED 100 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$1,898.23
|
|
|
Service Code
|
HCPCS J7502
|
| Hospital Charge Code |
28844
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$835.22 |
| Max. Negotiated Rate |
$1,708.41 |
| Rate for Payer: Aetna American Axle |
$1,233.85
|
| Rate for Payer: Aetna Commercial |
$1,613.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,233.85
|
| Rate for Payer: Cash Price |
$1,518.58
|
| Rate for Payer: Cofinity Commercial |
$1,328.76
|
| Rate for Payer: Cofinity Commercial |
$1,632.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,328.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,518.58
|
| Rate for Payer: Healthscope Commercial |
$1,708.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,328.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,423.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,613.50
|
| Rate for Payer: PHP Commercial |
$1,613.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,233.85
|
| Rate for Payer: Priority Health SBD |
$1,195.88
|
| Rate for Payer: UMR Bronson Commercial |
$835.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,423.67
|
|
|
CYCLOSPORINE MODIFIED 25 MG CAPSULE
|
Facility
|
OP
|
$4.92
|
|
|
Service Code
|
HCPCS J7515
|
| Hospital Charge Code |
28842
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Cofinity Medicare Advantage |
$193.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.44
|
| Rate for Payer: Aetna American Axle |
$3.20
|
| Rate for Payer: Aetna American Axle |
$179.65
|
| Rate for Payer: Aetna American Axle |
$81.62
|
| Rate for Payer: Aetna American Axle |
$95.76
|
| Rate for Payer: Aetna Commercial |
$4.18
|
| Rate for Payer: Aetna Commercial |
$125.22
|
| Rate for Payer: Aetna Commercial |
$106.73
|
| Rate for Payer: Aetna Commercial |
$234.93
|
| Rate for Payer: Aetna Medicare |
$138.20
|
| Rate for Payer: Aetna Medicare |
$73.66
|
| Rate for Payer: Aetna Medicare |
$62.78
|
| Rate for Payer: Aetna Medicare |
$2.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.76
|
| Rate for Payer: BCBS Complete |
$110.56
|
| Rate for Payer: BCBS Complete |
$50.23
|
| Rate for Payer: BCBS Complete |
$1.97
|
| Rate for Payer: BCBS Complete |
$58.93
|
| Rate for Payer: BCBS Trust/PPO |
$2.28
|
| Rate for Payer: BCBS Trust/PPO |
$2.28
|
| Rate for Payer: BCBS Trust/PPO |
$2.28
|
| Rate for Payer: BCBS Trust/PPO |
$2.28
|
| Rate for Payer: BCN Commercial |
$2.28
|
| Rate for Payer: BCN Commercial |
$2.28
|
| Rate for Payer: BCN Commercial |
$2.28
|
| Rate for Payer: BCN Commercial |
$2.28
|
| Rate for Payer: Cash Price |
$117.86
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cash Price |
$221.11
|
| Rate for Payer: Cash Price |
$117.86
|
| Rate for Payer: Cash Price |
$100.46
|
| Rate for Payer: Cash Price |
$100.46
|
| Rate for Payer: Cash Price |
$221.11
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cofinity Commercial |
$4.23
|
| Rate for Payer: Cofinity Commercial |
$126.70
|
| Rate for Payer: Cofinity Commercial |
$107.99
|
| Rate for Payer: Cofinity Commercial |
$87.90
|
| Rate for Payer: Cofinity Commercial |
$103.12
|
| Rate for Payer: Cofinity Commercial |
$193.47
|
| Rate for Payer: Cofinity Commercial |
$237.70
|
| Rate for Payer: Cofinity Commercial |
$3.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.12
|
| 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 |
$221.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.46
|
| Rate for Payer: Healthscope Commercial |
$113.01
|
| Rate for Payer: Healthscope Commercial |
$4.43
|
| Rate for Payer: Healthscope Commercial |
$248.75
|
| Rate for Payer: Healthscope Commercial |
$132.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$193.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.90
|
| 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 |
$3.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.73
|
| Rate for Payer: PHP Commercial |
$4.18
|
| Rate for Payer: PHP Commercial |
$125.22
|
| Rate for Payer: PHP Commercial |
$106.73
|
| Rate for Payer: PHP Commercial |
$234.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.65
|
| Rate for Payer: Priority Health SBD |
$79.11
|
| Rate for Payer: Priority Health SBD |
$174.13
|
| Rate for Payer: Priority Health SBD |
$92.81
|
| Rate for Payer: Priority Health SBD |
$3.10
|
| Rate for Payer: UMR Bronson Commercial |
$46.46
|
| Rate for Payer: UMR Bronson Commercial |
$102.26
|
| Rate for Payer: UMR Bronson Commercial |
$1.82
|
| Rate for Payer: UMR Bronson Commercial |
$54.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.69
|
|
|
CYCLOSPORINE MODIFIED 25 MG CAPSULE
|
Facility
|
IP
|
$276.39
|
|
|
Service Code
|
HCPCS J7515
|
| Hospital Charge Code |
28842
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$121.61 |
| Max. Negotiated Rate |
$248.75 |
| Rate for Payer: Cash Price |
$117.86
|
| Rate for Payer: Cash Price |
$221.11
|
| Rate for Payer: Cash Price |
$100.46
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cofinity Commercial |
$107.99
|
| Rate for Payer: Cofinity Commercial |
$4.23
|
| Rate for Payer: Cofinity Commercial |
$3.44
|
| Rate for Payer: Cofinity Commercial |
$193.47
|
| Rate for Payer: Cofinity Commercial |
$103.12
|
| Rate for Payer: Cofinity Commercial |
$126.70
|
| Rate for Payer: Cofinity Commercial |
$237.70
|
| Rate for Payer: Cofinity Commercial |
$87.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$193.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.90
|
| Rate for Payer: Aetna American Axle |
$179.65
|
| Rate for Payer: Aetna American Axle |
$95.76
|
| Rate for Payer: Aetna American Axle |
$81.62
|
| Rate for Payer: Aetna American Axle |
$3.20
|
| Rate for Payer: Aetna Commercial |
$234.93
|
| Rate for Payer: Aetna Commercial |
$4.18
|
| Rate for Payer: Aetna Commercial |
$125.22
|
| Rate for Payer: Aetna Commercial |
$106.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.86
|
| Rate for Payer: Healthscope Commercial |
$248.75
|
| Rate for Payer: Healthscope Commercial |
$113.01
|
| Rate for Payer: Healthscope Commercial |
$132.59
|
| Rate for Payer: Healthscope Commercial |
$4.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.90
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$193.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.93
|
| Rate for Payer: PHP Commercial |
$234.93
|
| Rate for Payer: PHP Commercial |
$4.18
|
| Rate for Payer: PHP Commercial |
$106.73
|
| Rate for Payer: PHP Commercial |
$125.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.62
|
| Rate for Payer: Priority Health SBD |
$3.10
|
| Rate for Payer: Priority Health SBD |
$79.11
|
| Rate for Payer: Priority Health SBD |
$92.81
|
| Rate for Payer: Priority Health SBD |
$174.13
|
| Rate for Payer: UMR Bronson Commercial |
$121.61
|
| Rate for Payer: UMR Bronson Commercial |
$2.16
|
| Rate for Payer: UMR Bronson Commercial |
$64.82
|
| Rate for Payer: UMR Bronson Commercial |
$55.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.29
|
|
|
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 |
$1,000.40 |
| 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 Commercial |
$778.08
|
| Rate for Payer: Cofinity Commercial |
$955.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$778.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$889.24
|
| Rate for Payer: Healthscope Commercial |
$1,000.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$778.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$833.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$944.82
|
| Rate for Payer: PHP Commercial |
$944.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$722.51
|
| 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 |
$1,000.40 |
| Rate for Payer: Aetna American Axle |
$722.51
|
| Rate for Payer: Aetna Commercial |
$944.82
|
| Rate for Payer: Aetna Medicare |
$555.78
|
| 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 Commercial |
$778.08
|
| Rate for Payer: Cofinity Commercial |
$955.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$778.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$889.24
|
| Rate for Payer: Healthscope Commercial |
$1,000.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$778.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$833.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$944.82
|
| Rate for Payer: PHP Commercial |
$944.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$722.51
|
| Rate for Payer: Priority Health SBD |
$700.28
|
| Rate for Payer: UMR Bronson Commercial |
$411.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$833.66
|
|
|
CYPROHEPTADINE 4 MG TABLET
|
Facility
|
IP
|
$202.10
|
|
|
Service Code
|
NDC 70752010710
|
| Hospital Charge Code |
2033
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.92 |
| Max. Negotiated Rate |
$181.89 |
| Rate for Payer: Aetna American Axle |
$131.36
|
| Rate for Payer: Aetna Commercial |
$171.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.36
|
| Rate for Payer: Cash Price |
$161.68
|
| Rate for Payer: Cofinity Commercial |
$141.47
|
| Rate for Payer: Cofinity Commercial |
$173.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$141.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.68
|
| Rate for Payer: Healthscope Commercial |
$181.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$141.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.78
|
| Rate for Payer: PHP Commercial |
$171.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.36
|
| Rate for Payer: Priority Health SBD |
$127.32
|
| Rate for Payer: UMR Bronson Commercial |
$88.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.58
|
|
|
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 |
$195.42
|
| 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 Commercial |
$160.93
|
| Rate for Payer: Cofinity Commercial |
$197.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$160.93
|
| 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 |
$172.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.42
|
| Rate for Payer: PHP Commercial |
$195.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.44
|
| Rate for Payer: Priority Health SBD |
$144.84
|
| Rate for Payer: UMR Bronson Commercial |
$85.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$172.42
|
|
|
CYPROHEPTADINE 4 MG TABLET
|
Facility
|
OP
|
$202.10
|
|
|
Service Code
|
NDC 70752010710
|
| Hospital Charge Code |
2033
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.78 |
| Max. Negotiated Rate |
$181.89 |
| Rate for Payer: Aetna American Axle |
$131.36
|
| Rate for Payer: Aetna Commercial |
$171.78
|
| Rate for Payer: Aetna Medicare |
$101.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.36
|
| Rate for Payer: BCBS Complete |
$80.84
|
| Rate for Payer: Cash Price |
$161.68
|
| Rate for Payer: Cofinity Commercial |
$141.47
|
| Rate for Payer: Cofinity Commercial |
$173.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$141.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.68
|
| Rate for Payer: Healthscope Commercial |
$181.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$141.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.78
|
| Rate for Payer: PHP Commercial |
$171.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.36
|
| Rate for Payer: Priority Health SBD |
$127.32
|
| Rate for Payer: UMR Bronson Commercial |
$74.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.58
|
|
|
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 |
$195.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.44
|
| Rate for Payer: Cash Price |
$183.92
|
| Rate for Payer: Cofinity Commercial |
$160.93
|
| Rate for Payer: Cofinity Commercial |
$197.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$160.93
|
| 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 |
$172.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.42
|
| Rate for Payer: PHP Commercial |
$195.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.44
|
| 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 |
$172.42
|
|
|
CYSTEINE (L-CYSTEINE) 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$123.30
|
|
|
Service Code
|
NDC 51754100703
|
| Hospital Charge Code |
4294
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.62 |
| Max. Negotiated Rate |
$110.97 |
| Rate for Payer: Aetna American Axle |
$80.14
|
| Rate for Payer: Aetna Commercial |
$104.80
|
| Rate for Payer: Aetna Medicare |
$61.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.14
|
| Rate for Payer: BCBS Complete |
$49.32
|
| Rate for Payer: Cash Price |
$98.64
|
| Rate for Payer: Cofinity Commercial |
$106.04
|
| Rate for Payer: Cofinity Commercial |
$86.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.64
|
| Rate for Payer: Healthscope Commercial |
$110.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.80
|
| Rate for Payer: PHP Commercial |
$104.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.14
|
| Rate for Payer: Priority Health SBD |
$77.68
|
| Rate for Payer: UMR Bronson Commercial |
$45.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.48
|
|
|
CYSTEINE (L-CYSTEINE) 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$123.30
|
|
|
Service Code
|
NDC 51754100701
|
| Hospital Charge Code |
4294
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$54.25 |
| Max. Negotiated Rate |
$110.97 |
| Rate for Payer: Aetna American Axle |
$80.14
|
| Rate for Payer: Aetna Commercial |
$104.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.14
|
| Rate for Payer: Cash Price |
$98.64
|
| Rate for Payer: Cofinity Commercial |
$106.04
|
| Rate for Payer: Cofinity Commercial |
$86.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.64
|
| Rate for Payer: Healthscope Commercial |
$110.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.80
|
| Rate for Payer: PHP Commercial |
$104.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.14
|
| Rate for Payer: Priority Health SBD |
$77.68
|
| Rate for Payer: UMR Bronson Commercial |
$54.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.48
|
|
