|
DOXEPIN 10 MG CAPSULE
|
Facility
|
IP
|
$414.20
|
|
|
Service Code
|
NDC 00378104901
|
| Hospital Charge Code |
2608
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$182.25 |
| Max. Negotiated Rate |
$372.78 |
| Rate for Payer: Aetna American Axle |
$269.23
|
| Rate for Payer: Aetna Commercial |
$352.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.23
|
| Rate for Payer: Cash Price |
$331.36
|
| Rate for Payer: Cofinity Advantage |
$289.94
|
| Rate for Payer: Cofinity Commercial |
$356.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.36
|
| Rate for Payer: Healthscope Commercial |
$372.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$289.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$310.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$310.65
|
| Rate for Payer: PHP Commercial |
$352.07
|
| Rate for Payer: Priority Health SBD |
$260.95
|
| Rate for Payer: UMR Bronson Commercial |
$182.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$310.65
|
|
|
DOXEPIN 10 MG CAPSULE
|
Facility
|
IP
|
$265.44
|
|
|
Service Code
|
NDC 51079043620
|
| Hospital Charge Code |
2608
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.79 |
| Max. Negotiated Rate |
$238.90 |
| Rate for Payer: Aetna American Axle |
$172.54
|
| Rate for Payer: Aetna Commercial |
$225.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.54
|
| Rate for Payer: Cash Price |
$212.35
|
| Rate for Payer: Cofinity Advantage |
$185.81
|
| Rate for Payer: Cofinity Commercial |
$228.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.35
|
| Rate for Payer: Healthscope Commercial |
$238.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.08
|
| Rate for Payer: PHP Commercial |
$225.62
|
| Rate for Payer: Priority Health SBD |
$167.23
|
| Rate for Payer: UMR Bronson Commercial |
$116.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.08
|
|
|
DOXEPIN 10 MG CAPSULE
|
Facility
|
OP
|
$2.66
|
|
|
Service Code
|
NDC 51079043601
|
| Hospital Charge Code |
2608
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$2.39 |
| Rate for Payer: Aetna American Axle |
$1.73
|
| Rate for Payer: Aetna Commercial |
$2.26
|
| Rate for Payer: Aetna Medicare |
$1.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.73
|
| Rate for Payer: BCBS Complete |
$1.06
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cofinity Advantage |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$2.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.13
|
| Rate for Payer: Healthscope Commercial |
$2.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.00
|
| Rate for Payer: PHP Commercial |
$2.26
|
| Rate for Payer: Priority Health SBD |
$1.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.73
|
| Rate for Payer: UHC Core |
$1.39
|
| Rate for Payer: UHC Exchange |
$1.05
|
| Rate for Payer: UMR Bronson Commercial |
$0.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.00
|
|
|
DOXEPIN 25 MG CAPSULE
|
Facility
|
OP
|
$309.12
|
|
|
Service Code
|
NDC 00904705361
|
| Hospital Charge Code |
2611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.37 |
| Max. Negotiated Rate |
$278.21 |
| Rate for Payer: Aetna American Axle |
$200.93
|
| Rate for Payer: Aetna Commercial |
$262.75
|
| Rate for Payer: Aetna Medicare |
$154.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.93
|
| Rate for Payer: BCBS Complete |
$123.65
|
| Rate for Payer: Cash Price |
$247.30
|
| Rate for Payer: Cofinity Advantage |
$216.38
|
| Rate for Payer: Cofinity Commercial |
$265.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.30
|
| Rate for Payer: Healthscope Commercial |
$278.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$231.84
|
| Rate for Payer: PHP Commercial |
$262.75
|
| Rate for Payer: Priority Health SBD |
$194.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.93
|
| Rate for Payer: UHC Core |
$161.05
|
| Rate for Payer: UHC Exchange |
$121.48
|
| Rate for Payer: UMR Bronson Commercial |
$114.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.84
|
|
|
DOXEPIN 25 MG CAPSULE
|
Facility
|
IP
|
$3.40
|
|
|
Service Code
|
NDC 51079043701
|
| Hospital Charge Code |
2611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Aetna American Axle |
$2.21
|
| Rate for Payer: Aetna Commercial |
$2.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.21
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cofinity Advantage |
$2.38
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.72
|
| Rate for Payer: Healthscope Commercial |
$3.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.55
|
| Rate for Payer: PHP Commercial |
$2.89
|
| Rate for Payer: Priority Health SBD |
$2.14
|
| Rate for Payer: UMR Bronson Commercial |
$1.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.55
|
|
|
DOXEPIN 25 MG CAPSULE
|
Facility
|
OP
|
$339.84
|
|
|
Service Code
|
NDC 51079043720
|
| Hospital Charge Code |
2611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.74 |
| Max. Negotiated Rate |
$305.86 |
| Rate for Payer: Aetna American Axle |
$220.90
|
| Rate for Payer: Aetna Commercial |
$288.86
|
| Rate for Payer: Aetna Medicare |
$169.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.90
|
| Rate for Payer: BCBS Complete |
$135.94
|
| Rate for Payer: Cash Price |
$271.87
|
| Rate for Payer: Cofinity Advantage |
$237.89
|
| Rate for Payer: Cofinity Commercial |
$292.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.87
|
| Rate for Payer: Healthscope Commercial |
$305.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$237.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$254.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$254.88
|
| Rate for Payer: PHP Commercial |
$288.86
|
| Rate for Payer: Priority Health SBD |
$214.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.90
|
| Rate for Payer: UHC Core |
$177.06
|
| Rate for Payer: UHC Exchange |
$133.56
|
| Rate for Payer: UMR Bronson Commercial |
$125.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$254.88
|
|
|
DOXEPIN 25 MG CAPSULE
|
Facility
|
IP
|
$339.84
|
|
|
Service Code
|
NDC 51079043720
|
| Hospital Charge Code |
2611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.53 |
| Max. Negotiated Rate |
$305.86 |
| Rate for Payer: Aetna American Axle |
$220.90
|
| Rate for Payer: Aetna Commercial |
$288.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.90
|
| Rate for Payer: Cash Price |
$271.87
|
| Rate for Payer: Cofinity Advantage |
$237.89
|
| Rate for Payer: Cofinity Commercial |
$292.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.87
|
| Rate for Payer: Healthscope Commercial |
$305.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$237.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$254.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$254.88
|
| Rate for Payer: PHP Commercial |
$288.86
|
| Rate for Payer: Priority Health SBD |
$214.10
|
| Rate for Payer: UMR Bronson Commercial |
$149.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$254.88
|
|
|
DOXEPIN 25 MG CAPSULE
|
Facility
|
OP
|
$3.40
|
|
|
Service Code
|
NDC 51079043701
|
| Hospital Charge Code |
2611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Aetna American Axle |
$2.21
|
| Rate for Payer: Aetna Commercial |
$2.89
|
| Rate for Payer: Aetna Medicare |
$1.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.21
|
| Rate for Payer: BCBS Complete |
$1.36
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cofinity Advantage |
$2.38
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.72
|
| Rate for Payer: Healthscope Commercial |
$3.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.55
|
| Rate for Payer: PHP Commercial |
$2.89
|
| Rate for Payer: Priority Health SBD |
$2.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.21
|
| Rate for Payer: UHC Core |
$1.77
|
| Rate for Payer: UHC Exchange |
$1.34
|
| Rate for Payer: UMR Bronson Commercial |
$1.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.55
|
|
|
DOXEPIN 25 MG CAPSULE
|
Facility
|
IP
|
$309.12
|
|
|
Service Code
|
NDC 00904705361
|
| Hospital Charge Code |
2611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.01 |
| Max. Negotiated Rate |
$278.21 |
| Rate for Payer: Aetna American Axle |
$200.93
|
| Rate for Payer: Aetna Commercial |
$262.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.93
|
| Rate for Payer: Cash Price |
$247.30
|
| Rate for Payer: Cofinity Advantage |
$216.38
|
| Rate for Payer: Cofinity Commercial |
$265.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.30
|
| Rate for Payer: Healthscope Commercial |
$278.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$231.84
|
| Rate for Payer: PHP Commercial |
$262.75
|
| Rate for Payer: Priority Health SBD |
$194.75
|
| Rate for Payer: UMR Bronson Commercial |
$136.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.84
|
|
|
DOXERCALCIFEROL 4 MCG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$28.80
|
|
|
Service Code
|
HCPCS J1270
|
| Hospital Charge Code |
28277
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$25.92 |
| Rate for Payer: Aetna American Axle |
$18.72
|
| Rate for Payer: Aetna Commercial |
$24.48
|
| Rate for Payer: Aetna Medicare |
$14.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.72
|
| Rate for Payer: BCBS Complete |
$11.52
|
| Rate for Payer: BCBS Trust/PPO |
$0.99
|
| Rate for Payer: BCN Commercial |
$0.99
|
| Rate for Payer: Cash Price |
$23.04
|
| Rate for Payer: Cash Price |
$23.04
|
| Rate for Payer: Cofinity Advantage |
$20.16
|
| Rate for Payer: Cofinity Commercial |
$24.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.04
|
| Rate for Payer: Healthscope Commercial |
$25.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.60
|
| Rate for Payer: PHP Commercial |
$24.48
|
| Rate for Payer: Priority Health SBD |
$18.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.51
|
| Rate for Payer: UHC Core |
$0.51
|
| Rate for Payer: UHC Exchange |
$0.51
|
| Rate for Payer: UMR Bronson Commercial |
$10.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.60
|
|
|
DOXERCALCIFEROL 4 MCG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$28.80
|
|
|
Service Code
|
HCPCS J1270
|
| Hospital Charge Code |
28277
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$25.92 |
| Rate for Payer: Aetna American Axle |
$18.72
|
| Rate for Payer: Aetna Commercial |
$24.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.72
|
| Rate for Payer: Cash Price |
$23.04
|
| Rate for Payer: Cofinity Advantage |
$20.16
|
| Rate for Payer: Cofinity Commercial |
$24.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.04
|
| Rate for Payer: Healthscope Commercial |
$25.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.60
|
| Rate for Payer: PHP Commercial |
$24.48
|
| Rate for Payer: Priority Health SBD |
$18.14
|
| Rate for Payer: UMR Bronson Commercial |
$12.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.60
|
|
|
DOXORUBICIN 10 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$169.95
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
118502
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.78 |
| Max. Negotiated Rate |
$152.96 |
| Rate for Payer: Aetna American Axle |
$110.47
|
| Rate for Payer: Aetna Commercial |
$144.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.47
|
| Rate for Payer: Cash Price |
$135.96
|
| Rate for Payer: Cofinity Advantage |
$118.97
|
| Rate for Payer: Cofinity Commercial |
$146.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.96
|
| Rate for Payer: Healthscope Commercial |
$152.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.46
|
| Rate for Payer: PHP Commercial |
$144.46
|
| Rate for Payer: Priority Health SBD |
$107.07
|
| Rate for Payer: UMR Bronson Commercial |
$74.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.46
|
|
|
DOXORUBICIN 10 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$169.95
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
118502
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$152.96 |
| Rate for Payer: Aetna American Axle |
$110.47
|
| Rate for Payer: Aetna Commercial |
$144.46
|
| Rate for Payer: Aetna Medicare |
$84.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.47
|
| Rate for Payer: BCBS Complete |
$67.98
|
| Rate for Payer: BCBS Trust/PPO |
$8.85
|
| Rate for Payer: BCN Commercial |
$8.85
|
| Rate for Payer: Cash Price |
$135.96
|
| Rate for Payer: Cash Price |
$135.96
|
| Rate for Payer: Cofinity Advantage |
$118.97
|
| Rate for Payer: Cofinity Commercial |
$146.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.96
|
| Rate for Payer: Healthscope Commercial |
$152.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$135.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.46
|
| Rate for Payer: PHP Commercial |
$144.46
|
| Rate for Payer: Priority Health SBD |
$107.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.59
|
| Rate for Payer: UHC Core |
$4.59
|
| Rate for Payer: UHC Exchange |
$4.59
|
| Rate for Payer: UMR Bronson Commercial |
$62.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.46
|
|
|
DOXORUBICIN 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,147.00
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
2616
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$1,032.30 |
| Rate for Payer: Aetna American Axle |
$745.55
|
| Rate for Payer: Aetna American Axle |
$366.76
|
| Rate for Payer: Aetna American Axle |
$237.35
|
| Rate for Payer: Aetna American Axle |
$189.31
|
| Rate for Payer: Aetna American Axle |
$443.46
|
| Rate for Payer: Aetna Commercial |
$974.95
|
| Rate for Payer: Aetna Commercial |
$247.56
|
| Rate for Payer: Aetna Commercial |
$579.91
|
| Rate for Payer: Aetna Commercial |
$479.61
|
| Rate for Payer: Aetna Commercial |
$310.39
|
| Rate for Payer: Aetna Medicare |
$341.12
|
| Rate for Payer: Aetna Medicare |
$145.62
|
| Rate for Payer: Aetna Medicare |
$573.50
|
| Rate for Payer: Aetna Medicare |
$182.58
|
| Rate for Payer: Aetna Medicare |
$282.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$366.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$745.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$443.46
|
| Rate for Payer: BCBS Complete |
$225.70
|
| Rate for Payer: BCBS Complete |
$458.80
|
| Rate for Payer: BCBS Complete |
$116.50
|
| Rate for Payer: BCBS Complete |
$146.06
|
| Rate for Payer: BCBS Complete |
$272.90
|
| Rate for Payer: BCBS Trust/PPO |
$8.85
|
| Rate for Payer: BCBS Trust/PPO |
$8.85
|
| Rate for Payer: BCBS Trust/PPO |
$8.85
|
| Rate for Payer: BCBS Trust/PPO |
$8.85
|
| Rate for Payer: BCBS Trust/PPO |
$8.85
|
| Rate for Payer: BCN Commercial |
$8.85
|
| Rate for Payer: BCN Commercial |
$8.85
|
| Rate for Payer: BCN Commercial |
$8.85
|
| Rate for Payer: BCN Commercial |
$8.85
|
| Rate for Payer: BCN Commercial |
$8.85
|
| Rate for Payer: Cash Price |
$451.40
|
| Rate for Payer: Cash Price |
$545.80
|
| Rate for Payer: Cash Price |
$233.00
|
| Rate for Payer: Cash Price |
$917.60
|
| Rate for Payer: Cash Price |
$292.13
|
| Rate for Payer: Cash Price |
$917.60
|
| Rate for Payer: Cash Price |
$292.13
|
| Rate for Payer: Cash Price |
$451.40
|
| Rate for Payer: Cash Price |
$233.00
|
| Rate for Payer: Cash Price |
$545.80
|
| Rate for Payer: Cofinity Advantage |
$394.98
|
| Rate for Payer: Cofinity Advantage |
$203.88
|
| Rate for Payer: Cofinity Advantage |
$255.61
|
| Rate for Payer: Cofinity Advantage |
$477.57
|
| Rate for Payer: Cofinity Advantage |
$802.90
|
| Rate for Payer: Cofinity Commercial |
$485.25
|
| Rate for Payer: Cofinity Commercial |
$986.42
|
| Rate for Payer: Cofinity Commercial |
$250.47
|
| Rate for Payer: Cofinity Commercial |
$314.04
|
| Rate for Payer: Cofinity Commercial |
$586.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$545.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$451.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$917.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.13
|
| Rate for Payer: Healthscope Commercial |
$328.64
|
| Rate for Payer: Healthscope Commercial |
$614.02
|
| Rate for Payer: Healthscope Commercial |
$507.82
|
| Rate for Payer: Healthscope Commercial |
$1,032.30
|
| Rate for Payer: Healthscope Commercial |
$262.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$477.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$255.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$394.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$802.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$511.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$423.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$860.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$545.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$233.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$451.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$292.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$917.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$479.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$974.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$579.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$860.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$423.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$511.69
|
| Rate for Payer: PHP Commercial |
$247.56
|
| Rate for Payer: PHP Commercial |
$310.39
|
| Rate for Payer: PHP Commercial |
$579.91
|
| Rate for Payer: PHP Commercial |
$479.61
|
| Rate for Payer: PHP Commercial |
$974.95
|
| Rate for Payer: Priority Health SBD |
$230.05
|
| Rate for Payer: Priority Health SBD |
$722.61
|
| Rate for Payer: Priority Health SBD |
$355.48
|
| Rate for Payer: Priority Health SBD |
$429.82
|
| Rate for Payer: Priority Health SBD |
$183.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.59
|
| Rate for Payer: UHC Core |
$4.59
|
| Rate for Payer: UHC Core |
$4.59
|
| Rate for Payer: UHC Core |
$4.59
|
| Rate for Payer: UHC Core |
$4.59
|
| Rate for Payer: UHC Core |
$4.59
|
| Rate for Payer: UHC Exchange |
$4.59
|
| Rate for Payer: UHC Exchange |
$4.59
|
| Rate for Payer: UHC Exchange |
$4.59
|
| Rate for Payer: UHC Exchange |
$4.59
|
| Rate for Payer: UHC Exchange |
$4.59
|
| Rate for Payer: UMR Bronson Commercial |
$424.39
|
| Rate for Payer: UMR Bronson Commercial |
$208.77
|
| Rate for Payer: UMR Bronson Commercial |
$135.11
|
| Rate for Payer: UMR Bronson Commercial |
$252.43
|
| Rate for Payer: UMR Bronson Commercial |
$107.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$423.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$511.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$860.25
|
|
|
DOXORUBICIN 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$291.25
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
2616
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$128.15 |
| Max. Negotiated Rate |
$262.12 |
| Rate for Payer: Aetna American Axle |
$189.31
|
| Rate for Payer: Aetna American Axle |
$443.46
|
| Rate for Payer: Aetna American Axle |
$366.76
|
| Rate for Payer: Aetna Commercial |
$479.61
|
| Rate for Payer: Aetna Commercial |
$247.56
|
| Rate for Payer: Aetna Commercial |
$579.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$443.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$366.76
|
| Rate for Payer: Cash Price |
$451.40
|
| Rate for Payer: Cash Price |
$233.00
|
| Rate for Payer: Cash Price |
$545.80
|
| Rate for Payer: Cofinity Advantage |
$477.57
|
| Rate for Payer: Cofinity Advantage |
$203.88
|
| Rate for Payer: Cofinity Advantage |
$394.98
|
| Rate for Payer: Cofinity Commercial |
$586.74
|
| Rate for Payer: Cofinity Commercial |
$250.47
|
| Rate for Payer: Cofinity Commercial |
$485.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$451.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$545.80
|
| Rate for Payer: Healthscope Commercial |
$507.82
|
| Rate for Payer: Healthscope Commercial |
$614.02
|
| Rate for Payer: Healthscope Commercial |
$262.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$394.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$477.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$511.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$423.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$479.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$579.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$423.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$511.69
|
| Rate for Payer: PHP Commercial |
$479.61
|
| Rate for Payer: PHP Commercial |
$247.56
|
| Rate for Payer: PHP Commercial |
$579.91
|
| Rate for Payer: Priority Health SBD |
$183.49
|
| Rate for Payer: Priority Health SBD |
$355.48
|
| Rate for Payer: Priority Health SBD |
$429.82
|
| Rate for Payer: UMR Bronson Commercial |
$128.15
|
| Rate for Payer: UMR Bronson Commercial |
$300.19
|
| Rate for Payer: UMR Bronson Commercial |
$248.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$423.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$511.69
|
|
|
DOXORUBICIN 50 MG/25 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$248.05
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
118501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$109.14 |
| Max. Negotiated Rate |
$223.25 |
| Rate for Payer: Aetna American Axle |
$161.23
|
| Rate for Payer: Aetna American Axle |
$216.87
|
| Rate for Payer: Aetna American Axle |
$179.97
|
| Rate for Payer: Aetna Commercial |
$235.35
|
| Rate for Payer: Aetna Commercial |
$210.84
|
| Rate for Payer: Aetna Commercial |
$283.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.97
|
| Rate for Payer: Cash Price |
$221.50
|
| Rate for Payer: Cash Price |
$198.44
|
| Rate for Payer: Cash Price |
$266.91
|
| Rate for Payer: Cofinity Advantage |
$233.55
|
| Rate for Payer: Cofinity Advantage |
$173.63
|
| Rate for Payer: Cofinity Advantage |
$193.82
|
| Rate for Payer: Cofinity Commercial |
$286.93
|
| Rate for Payer: Cofinity Commercial |
$213.32
|
| Rate for Payer: Cofinity Commercial |
$238.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.91
|
| Rate for Payer: Healthscope Commercial |
$249.19
|
| Rate for Payer: Healthscope Commercial |
$300.28
|
| Rate for Payer: Healthscope Commercial |
$223.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$193.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$186.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$250.23
|
| Rate for Payer: PHP Commercial |
$235.35
|
| Rate for Payer: PHP Commercial |
$210.84
|
| Rate for Payer: PHP Commercial |
$283.59
|
| Rate for Payer: Priority Health SBD |
$156.27
|
| Rate for Payer: Priority Health SBD |
$174.43
|
| Rate for Payer: Priority Health SBD |
$210.19
|
| Rate for Payer: UMR Bronson Commercial |
$109.14
|
| Rate for Payer: UMR Bronson Commercial |
$146.80
|
| Rate for Payer: UMR Bronson Commercial |
$121.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.23
|
|
|
DOXORUBICIN 50 MG/25 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$276.88
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
118501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$249.19 |
| Rate for Payer: Aetna American Axle |
$179.97
|
| Rate for Payer: Aetna American Axle |
$161.23
|
| Rate for Payer: Aetna American Axle |
$216.87
|
| Rate for Payer: Aetna Commercial |
$235.35
|
| Rate for Payer: Aetna Commercial |
$283.59
|
| Rate for Payer: Aetna Commercial |
$210.84
|
| Rate for Payer: Aetna Medicare |
$138.44
|
| Rate for Payer: Aetna Medicare |
$124.03
|
| Rate for Payer: Aetna Medicare |
$166.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.87
|
| Rate for Payer: BCBS Complete |
$99.22
|
| Rate for Payer: BCBS Complete |
$110.75
|
| Rate for Payer: BCBS Complete |
$133.46
|
| Rate for Payer: BCBS Trust/PPO |
$8.85
|
| Rate for Payer: BCBS Trust/PPO |
$8.85
|
| Rate for Payer: BCBS Trust/PPO |
$8.85
|
| Rate for Payer: BCN Commercial |
$8.85
|
| Rate for Payer: BCN Commercial |
$8.85
|
| Rate for Payer: BCN Commercial |
$8.85
|
| Rate for Payer: Cash Price |
$198.44
|
| Rate for Payer: Cash Price |
$198.44
|
| Rate for Payer: Cash Price |
$266.91
|
| Rate for Payer: Cash Price |
$266.91
|
| Rate for Payer: Cash Price |
$221.50
|
| Rate for Payer: Cash Price |
$221.50
|
| Rate for Payer: Cofinity Advantage |
$233.55
|
| Rate for Payer: Cofinity Advantage |
$193.82
|
| Rate for Payer: Cofinity Advantage |
$173.63
|
| Rate for Payer: Cofinity Commercial |
$213.32
|
| Rate for Payer: Cofinity Commercial |
$238.12
|
| Rate for Payer: Cofinity Commercial |
$286.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.50
|
| Rate for Payer: Healthscope Commercial |
$223.25
|
| Rate for Payer: Healthscope Commercial |
$249.19
|
| Rate for Payer: Healthscope Commercial |
$300.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$193.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$221.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$266.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$186.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$250.23
|
| Rate for Payer: PHP Commercial |
$235.35
|
| Rate for Payer: PHP Commercial |
$210.84
|
| Rate for Payer: PHP Commercial |
$283.59
|
| Rate for Payer: Priority Health SBD |
$156.27
|
| Rate for Payer: Priority Health SBD |
$210.19
|
| Rate for Payer: Priority Health SBD |
$174.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.59
|
| Rate for Payer: UHC Core |
$4.59
|
| Rate for Payer: UHC Core |
$4.59
|
| Rate for Payer: UHC Core |
$4.59
|
| Rate for Payer: UHC Exchange |
$4.59
|
| Rate for Payer: UHC Exchange |
$4.59
|
| Rate for Payer: UHC Exchange |
$4.59
|
| Rate for Payer: UMR Bronson Commercial |
$123.45
|
| Rate for Payer: UMR Bronson Commercial |
$91.78
|
| Rate for Payer: UMR Bronson Commercial |
$102.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.23
|
|
|
DOXORUBICIN, PEGYLATED LIPOSOMAL 2 MG/ML INTRAVENOUS SUSPENSION
|
Facility
|
OP
|
$1,011.68
|
|
|
Service Code
|
HCPCS Q2050
|
| Hospital Charge Code |
27431
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.58 |
| Max. Negotiated Rate |
$910.51 |
| Rate for Payer: Aetna American Axle |
$657.59
|
| Rate for Payer: Aetna American Axle |
$1,322.89
|
| Rate for Payer: Aetna American Axle |
$638.43
|
| Rate for Payer: Aetna American Axle |
$1,963.28
|
| Rate for Payer: Aetna American Axle |
$970.94
|
| Rate for Payer: Aetna Commercial |
$834.87
|
| Rate for Payer: Aetna Commercial |
$859.93
|
| Rate for Payer: Aetna Commercial |
$1,729.93
|
| Rate for Payer: Aetna Commercial |
$1,269.70
|
| Rate for Payer: Aetna Commercial |
$2,567.37
|
| Rate for Payer: Aetna Medicare |
$74.73
|
| Rate for Payer: Aetna Medicare |
$74.73
|
| Rate for Payer: Aetna Medicare |
$74.73
|
| Rate for Payer: Aetna Medicare |
$74.73
|
| Rate for Payer: Aetna Medicare |
$74.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,322.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$970.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$657.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$638.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,963.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.83
|
| Rate for Payer: BCBS Complete |
$39.47
|
| Rate for Payer: BCBS Complete |
$39.47
|
| Rate for Payer: BCBS Complete |
$39.47
|
| Rate for Payer: BCBS Complete |
$39.47
|
| Rate for Payer: BCBS Complete |
$39.47
|
| Rate for Payer: BCBS MAPPO |
$71.86
|
| Rate for Payer: BCBS MAPPO |
$71.86
|
| Rate for Payer: BCBS MAPPO |
$71.86
|
| Rate for Payer: BCBS MAPPO |
$71.86
|
| Rate for Payer: BCBS MAPPO |
$71.86
|
| Rate for Payer: BCBS Trust/PPO |
$337.26
|
| Rate for Payer: BCBS Trust/PPO |
$337.26
|
| Rate for Payer: BCBS Trust/PPO |
$337.26
|
| Rate for Payer: BCBS Trust/PPO |
$337.26
|
| Rate for Payer: BCBS Trust/PPO |
$337.26
|
| Rate for Payer: BCN Commercial |
$337.26
|
| Rate for Payer: BCN Commercial |
$337.26
|
| Rate for Payer: BCN Commercial |
$337.26
|
| Rate for Payer: BCN Commercial |
$337.26
|
| Rate for Payer: BCN Commercial |
$337.26
|
| Rate for Payer: BCN Medicare Advantage |
$71.86
|
| Rate for Payer: BCN Medicare Advantage |
$71.86
|
| Rate for Payer: BCN Medicare Advantage |
$71.86
|
| Rate for Payer: BCN Medicare Advantage |
$71.86
|
| Rate for Payer: BCN Medicare Advantage |
$71.86
|
| Rate for Payer: Cash Price |
$809.34
|
| Rate for Payer: Cash Price |
$809.34
|
| Rate for Payer: Cash Price |
$785.76
|
| Rate for Payer: Cash Price |
$2,416.34
|
| Rate for Payer: Cash Price |
$1,195.01
|
| Rate for Payer: Cash Price |
$785.76
|
| Rate for Payer: Cash Price |
$2,416.34
|
| Rate for Payer: Cash Price |
$1,628.17
|
| Rate for Payer: Cash Price |
$1,628.17
|
| Rate for Payer: Cash Price |
$1,195.01
|
| Rate for Payer: Cofinity Advantage |
$708.18
|
| Rate for Payer: Cofinity Advantage |
$1,424.65
|
| Rate for Payer: Cofinity Advantage |
$687.54
|
| Rate for Payer: Cofinity Advantage |
$2,114.30
|
| Rate for Payer: Cofinity Advantage |
$1,045.63
|
| Rate for Payer: Cofinity Commercial |
$2,597.57
|
| Rate for Payer: Cofinity Commercial |
$870.04
|
| Rate for Payer: Cofinity Commercial |
$844.69
|
| Rate for Payer: Cofinity Commercial |
$1,750.28
|
| Rate for Payer: Cofinity Commercial |
$1,284.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$809.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,195.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,628.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,416.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$785.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.86
|
| Rate for Payer: Healthscope Commercial |
$883.98
|
| Rate for Payer: Healthscope Commercial |
$910.51
|
| Rate for Payer: Healthscope Commercial |
$2,718.39
|
| Rate for Payer: Healthscope Commercial |
$1,831.69
|
| Rate for Payer: Healthscope Commercial |
$1,344.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,114.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$708.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,045.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$687.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,424.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,526.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,265.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,120.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$758.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$736.65
|
| Rate for Payer: Mclaren Medicaid |
$71.86
|
| Rate for Payer: Mclaren Medicaid |
$71.86
|
| Rate for Payer: Mclaren Medicaid |
$71.86
|
| Rate for Payer: Mclaren Medicaid |
$71.86
|
| Rate for Payer: Mclaren Medicaid |
$71.86
|
| Rate for Payer: Mclaren Medicare |
$71.86
|
| Rate for Payer: Mclaren Medicare |
$71.86
|
| Rate for Payer: Mclaren Medicare |
$71.86
|
| Rate for Payer: Mclaren Medicare |
$71.86
|
| Rate for Payer: Mclaren Medicare |
$71.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.45
|
| Rate for Payer: Meridian Medicaid |
$75.45
|
| Rate for Payer: Meridian Medicaid |
$75.45
|
| Rate for Payer: Meridian Medicaid |
$75.45
|
| Rate for Payer: Meridian Medicaid |
$75.45
|
| Rate for Payer: Meridian Medicaid |
$75.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$79.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$79.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$79.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$79.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$79.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,269.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$859.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,729.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,567.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$834.87
|
| Rate for Payer: Nomi Health Commercial |
$215.58
|
| Rate for Payer: Nomi Health Commercial |
$215.58
|
| Rate for Payer: Nomi Health Commercial |
$215.58
|
| Rate for Payer: Nomi Health Commercial |
$215.58
|
| Rate for Payer: Nomi Health Commercial |
$215.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$736.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,120.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,526.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,265.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$758.76
|
| Rate for Payer: PACE Medicare |
$68.27
|
| Rate for Payer: PACE Medicare |
$68.27
|
| Rate for Payer: PACE Medicare |
$68.27
|
| Rate for Payer: PACE Medicare |
$68.27
|
| Rate for Payer: PACE Medicare |
$68.27
|
| Rate for Payer: PACE SWMI |
$71.86
|
| Rate for Payer: PACE SWMI |
$71.86
|
| Rate for Payer: PACE SWMI |
$71.86
|
| Rate for Payer: PACE SWMI |
$71.86
|
| Rate for Payer: PACE SWMI |
$71.86
|
| Rate for Payer: PHP Commercial |
$2,567.37
|
| Rate for Payer: PHP Commercial |
$1,729.93
|
| Rate for Payer: PHP Commercial |
$859.93
|
| Rate for Payer: PHP Commercial |
$1,269.70
|
| Rate for Payer: PHP Commercial |
$834.87
|
| Rate for Payer: PHP Medicare Advantage |
$71.86
|
| Rate for Payer: PHP Medicare Advantage |
$71.86
|
| Rate for Payer: PHP Medicare Advantage |
$71.86
|
| Rate for Payer: PHP Medicare Advantage |
$71.86
|
| Rate for Payer: PHP Medicare Advantage |
$71.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$342.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$342.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$342.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$342.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$342.09
|
| Rate for Payer: Priority Health Medicare |
$71.86
|
| Rate for Payer: Priority Health Medicare |
$71.86
|
| Rate for Payer: Priority Health Medicare |
$71.86
|
| Rate for Payer: Priority Health Medicare |
$71.86
|
| Rate for Payer: Priority Health Medicare |
$71.86
|
| Rate for Payer: Priority Health SBD |
$1,902.87
|
| Rate for Payer: Priority Health SBD |
$1,282.18
|
| Rate for Payer: Priority Health SBD |
$941.07
|
| Rate for Payer: Priority Health SBD |
$618.79
|
| Rate for Payer: Priority Health SBD |
$637.36
|
| Rate for Payer: Priority Health Tiered Network |
$273.67
|
| Rate for Payer: Priority Health Tiered Network |
$273.67
|
| Rate for Payer: Priority Health Tiered Network |
$273.67
|
| Rate for Payer: Priority Health Tiered Network |
$273.67
|
| Rate for Payer: Priority Health Tiered Network |
$273.67
|
| Rate for Payer: Railroad Medicare Medicare |
$71.86
|
| Rate for Payer: Railroad Medicare Medicare |
$71.86
|
| Rate for Payer: Railroad Medicare Medicare |
$71.86
|
| Rate for Payer: Railroad Medicare Medicare |
$71.86
|
| Rate for Payer: Railroad Medicare Medicare |
$71.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.62
|
| Rate for Payer: UHC Core |
$171.62
|
| Rate for Payer: UHC Core |
$171.62
|
| Rate for Payer: UHC Core |
$171.62
|
| Rate for Payer: UHC Core |
$171.62
|
| Rate for Payer: UHC Core |
$171.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$71.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$71.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$71.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$71.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$71.86
|
| Rate for Payer: UHC Exchange |
$171.62
|
| Rate for Payer: UHC Exchange |
$171.62
|
| Rate for Payer: UHC Exchange |
$171.62
|
| Rate for Payer: UHC Exchange |
$171.62
|
| Rate for Payer: UHC Exchange |
$171.62
|
| Rate for Payer: UHC Medicaid |
$37.58
|
| Rate for Payer: UHC Medicaid |
$37.58
|
| Rate for Payer: UHC Medicaid |
$37.58
|
| Rate for Payer: UHC Medicaid |
$37.58
|
| Rate for Payer: UHC Medicaid |
$37.58
|
| Rate for Payer: UHCCP Medicaid |
$37.58
|
| Rate for Payer: UHCCP Medicaid |
$37.58
|
| Rate for Payer: UHCCP Medicaid |
$37.58
|
| Rate for Payer: UHCCP Medicaid |
$37.58
|
| Rate for Payer: UHCCP Medicaid |
$37.58
|
| Rate for Payer: UMR Bronson Commercial |
$753.03
|
| Rate for Payer: UMR Bronson Commercial |
$363.41
|
| Rate for Payer: UMR Bronson Commercial |
$1,117.56
|
| Rate for Payer: UMR Bronson Commercial |
$374.32
|
| Rate for Payer: UMR Bronson Commercial |
$552.69
|
| Rate for Payer: VA VA |
$71.86
|
| Rate for Payer: VA VA |
$71.86
|
| Rate for Payer: VA VA |
$71.86
|
| Rate for Payer: VA VA |
$71.86
|
| Rate for Payer: VA VA |
$71.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,265.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,526.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$758.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,120.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$736.65
|
|
|
DOXORUBICIN, PEGYLATED LIPOSOMAL 2 MG/ML INTRAVENOUS SUSPENSION
|
Facility
|
IP
|
$3,020.43
|
|
|
Service Code
|
HCPCS Q2050
|
| Hospital Charge Code |
27431
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,328.99 |
| Max. Negotiated Rate |
$2,718.39 |
| Rate for Payer: Aetna American Axle |
$1,963.28
|
| Rate for Payer: Aetna American Axle |
$638.43
|
| Rate for Payer: Aetna Commercial |
$2,567.37
|
| Rate for Payer: Aetna Commercial |
$834.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,963.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$638.43
|
| Rate for Payer: Cash Price |
$2,416.34
|
| Rate for Payer: Cash Price |
$785.76
|
| Rate for Payer: Cofinity Advantage |
$687.54
|
| Rate for Payer: Cofinity Advantage |
$2,114.30
|
| Rate for Payer: Cofinity Commercial |
$844.69
|
| Rate for Payer: Cofinity Commercial |
$2,597.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,416.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$785.76
|
| Rate for Payer: Healthscope Commercial |
$2,718.39
|
| Rate for Payer: Healthscope Commercial |
$883.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$687.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,114.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,265.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$736.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,567.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$834.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,265.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$736.65
|
| Rate for Payer: PHP Commercial |
$2,567.37
|
| Rate for Payer: PHP Commercial |
$834.87
|
| Rate for Payer: Priority Health SBD |
$618.79
|
| Rate for Payer: Priority Health SBD |
$1,902.87
|
| Rate for Payer: UMR Bronson Commercial |
$1,328.99
|
| Rate for Payer: UMR Bronson Commercial |
$432.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,265.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$736.65
|
|
|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$37.32
|
|
|
Service Code
|
HCPCS J1271
|
| Hospital Charge Code |
2622
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$33.59 |
| Rate for Payer: Aetna American Axle |
$24.26
|
| Rate for Payer: Aetna American Axle |
$15.61
|
| Rate for Payer: Aetna American Axle |
$29.84
|
| Rate for Payer: Aetna Commercial |
$31.72
|
| Rate for Payer: Aetna Commercial |
$39.02
|
| Rate for Payer: Aetna Commercial |
$20.41
|
| Rate for Payer: Aetna Medicare |
$18.66
|
| Rate for Payer: Aetna Medicare |
$12.01
|
| Rate for Payer: Aetna Medicare |
$22.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.84
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: BCBS Complete |
$14.93
|
| Rate for Payer: BCBS Complete |
$18.36
|
| Rate for Payer: BCBS Trust/PPO |
$0.32
|
| Rate for Payer: BCBS Trust/PPO |
$0.32
|
| Rate for Payer: BCBS Trust/PPO |
$0.32
|
| Rate for Payer: BCN Commercial |
$0.32
|
| Rate for Payer: BCN Commercial |
$0.32
|
| Rate for Payer: BCN Commercial |
$0.32
|
| Rate for Payer: Cash Price |
$19.21
|
| Rate for Payer: Cash Price |
$19.21
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cash Price |
$29.86
|
| Rate for Payer: Cash Price |
$29.86
|
| Rate for Payer: Cofinity Advantage |
$32.13
|
| Rate for Payer: Cofinity Advantage |
$26.12
|
| Rate for Payer: Cofinity Advantage |
$16.81
|
| Rate for Payer: Cofinity Commercial |
$20.65
|
| Rate for Payer: Cofinity Commercial |
$32.10
|
| Rate for Payer: Cofinity Commercial |
$39.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.86
|
| Rate for Payer: Healthscope Commercial |
$21.61
|
| Rate for Payer: Healthscope Commercial |
$33.59
|
| Rate for Payer: Healthscope Commercial |
$41.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.42
|
| Rate for Payer: PHP Commercial |
$31.72
|
| Rate for Payer: PHP Commercial |
$20.41
|
| Rate for Payer: PHP Commercial |
$39.02
|
| Rate for Payer: Priority Health SBD |
$15.13
|
| Rate for Payer: Priority Health SBD |
$28.92
|
| Rate for Payer: Priority Health SBD |
$23.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.17
|
| Rate for Payer: UHC Core |
$0.17
|
| Rate for Payer: UHC Core |
$0.17
|
| Rate for Payer: UHC Core |
$0.17
|
| Rate for Payer: UHC Exchange |
$0.17
|
| Rate for Payer: UHC Exchange |
$0.17
|
| Rate for Payer: UHC Exchange |
$0.17
|
| Rate for Payer: UMR Bronson Commercial |
$16.98
|
| Rate for Payer: UMR Bronson Commercial |
$8.88
|
| Rate for Payer: UMR Bronson Commercial |
$13.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.42
|
|
|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$24.01
|
|
|
Service Code
|
HCPCS J1271
|
| Hospital Charge Code |
2622
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$21.61 |
| Rate for Payer: Aetna American Axle |
$15.61
|
| Rate for Payer: Aetna American Axle |
$29.84
|
| Rate for Payer: Aetna American Axle |
$24.26
|
| Rate for Payer: Aetna Commercial |
$31.72
|
| Rate for Payer: Aetna Commercial |
$20.41
|
| Rate for Payer: Aetna Commercial |
$39.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.26
|
| Rate for Payer: Cash Price |
$29.86
|
| Rate for Payer: Cash Price |
$19.21
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Advantage |
$32.13
|
| Rate for Payer: Cofinity Advantage |
$16.81
|
| Rate for Payer: Cofinity Advantage |
$26.12
|
| Rate for Payer: Cofinity Commercial |
$39.47
|
| Rate for Payer: Cofinity Commercial |
$20.65
|
| Rate for Payer: Cofinity Commercial |
$32.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.72
|
| Rate for Payer: Healthscope Commercial |
$33.59
|
| Rate for Payer: Healthscope Commercial |
$41.31
|
| Rate for Payer: Healthscope Commercial |
$21.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.42
|
| Rate for Payer: PHP Commercial |
$31.72
|
| Rate for Payer: PHP Commercial |
$20.41
|
| Rate for Payer: PHP Commercial |
$39.02
|
| Rate for Payer: Priority Health SBD |
$15.13
|
| Rate for Payer: Priority Health SBD |
$23.51
|
| Rate for Payer: Priority Health SBD |
$28.92
|
| Rate for Payer: UMR Bronson Commercial |
$10.56
|
| Rate for Payer: UMR Bronson Commercial |
$20.20
|
| Rate for Payer: UMR Bronson Commercial |
$16.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.42
|
|
|
DOXYCYCLINE HYCLATE 100 MG IV MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$37.32
|
|
|
Service Code
|
HCPCS J1271
|
| Hospital Charge Code |
301731
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$33.59 |
| Rate for Payer: Aetna American Axle |
$24.26
|
| Rate for Payer: Aetna Commercial |
$31.72
|
| Rate for Payer: Aetna Medicare |
$18.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.26
|
| Rate for Payer: BCBS Complete |
$14.93
|
| Rate for Payer: BCBS Trust/PPO |
$0.32
|
| Rate for Payer: BCN Commercial |
$0.32
|
| Rate for Payer: Cash Price |
$29.86
|
| Rate for Payer: Cash Price |
$29.86
|
| Rate for Payer: Cofinity Advantage |
$26.12
|
| Rate for Payer: Cofinity Commercial |
$32.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.86
|
| Rate for Payer: Healthscope Commercial |
$33.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.99
|
| Rate for Payer: PHP Commercial |
$31.72
|
| Rate for Payer: Priority Health SBD |
$23.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.17
|
| Rate for Payer: UHC Core |
$0.17
|
| Rate for Payer: UHC Exchange |
$0.17
|
| Rate for Payer: UMR Bronson Commercial |
$13.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.99
|
|
|
DOXYCYCLINE HYCLATE 100 MG IV MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$37.32
|
|
|
Service Code
|
HCPCS J1271
|
| Hospital Charge Code |
301731
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.42 |
| Max. Negotiated Rate |
$33.59 |
| Rate for Payer: Aetna American Axle |
$24.26
|
| Rate for Payer: Aetna Commercial |
$31.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.26
|
| Rate for Payer: Cash Price |
$29.86
|
| Rate for Payer: Cofinity Advantage |
$26.12
|
| Rate for Payer: Cofinity Commercial |
$32.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.86
|
| Rate for Payer: Healthscope Commercial |
$33.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.99
|
| Rate for Payer: PHP Commercial |
$31.72
|
| Rate for Payer: Priority Health SBD |
$23.51
|
| Rate for Payer: UMR Bronson Commercial |
$16.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.99
|
|
|
DOXYCYCLINE HYCLATE 100 MG TABLET
|
Facility
|
IP
|
$276.24
|
|
|
Service Code
|
NDC 67405055055
|
| Hospital Charge Code |
2625
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.55 |
| Max. Negotiated Rate |
$248.62 |
| Rate for Payer: Aetna American Axle |
$179.56
|
| Rate for Payer: Aetna Commercial |
$234.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.56
|
| Rate for Payer: Cash Price |
$220.99
|
| Rate for Payer: Cofinity Advantage |
$193.37
|
| Rate for Payer: Cofinity Commercial |
$237.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.99
|
| Rate for Payer: Healthscope Commercial |
$248.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$193.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.18
|
| Rate for Payer: PHP Commercial |
$234.80
|
| Rate for Payer: Priority Health SBD |
$174.03
|
| Rate for Payer: UMR Bronson Commercial |
$121.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.18
|
|
|
DOXYCYCLINE HYCLATE 100 MG TABLET
|
Facility
|
IP
|
$132.53
|
|
|
Service Code
|
NDC 72578000118
|
| Hospital Charge Code |
2625
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.31 |
| Max. Negotiated Rate |
$119.28 |
| Rate for Payer: Aetna American Axle |
$86.14
|
| Rate for Payer: Aetna Commercial |
$112.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.14
|
| Rate for Payer: Cash Price |
$106.02
|
| Rate for Payer: Cofinity Advantage |
$92.77
|
| Rate for Payer: Cofinity Commercial |
$113.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.02
|
| Rate for Payer: Healthscope Commercial |
$119.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.40
|
| Rate for Payer: PHP Commercial |
$112.65
|
| Rate for Payer: Priority Health SBD |
$83.49
|
| Rate for Payer: UMR Bronson Commercial |
$58.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.40
|
|
