|
DACARBAZINE 200 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$66.86
|
|
|
Service Code
|
HCPCS J9130
|
| Hospital Charge Code |
2091
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.42 |
| Max. Negotiated Rate |
$60.17 |
| Rate for Payer: Aetna American Axle |
$43.46
|
| Rate for Payer: Aetna American Axle |
$123.99
|
| Rate for Payer: Aetna Commercial |
$162.14
|
| Rate for Payer: Aetna Commercial |
$56.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.46
|
| Rate for Payer: Cash Price |
$53.49
|
| Rate for Payer: Cash Price |
$152.60
|
| Rate for Payer: Cofinity Commercial |
$133.52
|
| Rate for Payer: Cofinity Commercial |
$57.50
|
| Rate for Payer: Cofinity Commercial |
$46.80
|
| Rate for Payer: Cofinity Commercial |
$164.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$133.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.60
|
| Rate for Payer: Healthscope Commercial |
$171.68
|
| Rate for Payer: Healthscope Commercial |
$60.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.83
|
| Rate for Payer: PHP Commercial |
$56.83
|
| Rate for Payer: PHP Commercial |
$162.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.46
|
| Rate for Payer: Priority Health SBD |
$120.17
|
| Rate for Payer: Priority Health SBD |
$42.12
|
| Rate for Payer: UMR Bronson Commercial |
$83.93
|
| Rate for Payer: UMR Bronson Commercial |
$29.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.14
|
|
|
DACTINOMYCIN 0.5 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,098.32
|
|
|
Service Code
|
HCPCS J9120
|
| Hospital Charge Code |
28912
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$174.09 |
| Max. Negotiated Rate |
$1,888.49 |
| Rate for Payer: BCBS Complete |
$182.80
|
| Rate for Payer: BCBS Complete |
$182.80
|
| Rate for Payer: BCBS Complete |
$182.80
|
| Rate for Payer: BCBS Complete |
$182.80
|
| Rate for Payer: BCBS MAPPO |
$324.80
|
| Rate for Payer: BCBS MAPPO |
$324.80
|
| Rate for Payer: BCBS MAPPO |
$324.80
|
| Rate for Payer: BCBS MAPPO |
$324.80
|
| Rate for Payer: BCBS MAPPO |
$324.80
|
| Rate for Payer: BCBS Trust/PPO |
$760.71
|
| Rate for Payer: BCBS Trust/PPO |
$760.71
|
| Rate for Payer: BCBS Trust/PPO |
$760.71
|
| Rate for Payer: BCBS Trust/PPO |
$760.71
|
| Rate for Payer: BCBS Trust/PPO |
$760.71
|
| Rate for Payer: BCN Commercial |
$760.71
|
| Rate for Payer: BCN Commercial |
$760.71
|
| Rate for Payer: BCN Commercial |
$760.71
|
| Rate for Payer: BCN Commercial |
$760.71
|
| Rate for Payer: BCN Commercial |
$760.71
|
| Rate for Payer: BCN Medicare Advantage |
$324.80
|
| Rate for Payer: BCN Medicare Advantage |
$324.80
|
| Rate for Payer: BCN Medicare Advantage |
$324.80
|
| Rate for Payer: BCN Medicare Advantage |
$324.80
|
| Rate for Payer: BCN Medicare Advantage |
$324.80
|
| Rate for Payer: Cash Price |
$2,371.62
|
| Rate for Payer: Cash Price |
$1,236.90
|
| Rate for Payer: Cash Price |
$9,729.08
|
| Rate for Payer: Cash Price |
$9,729.08
|
| Rate for Payer: Cash Price |
$2,371.62
|
| Rate for Payer: Cash Price |
$1,678.66
|
| Rate for Payer: Cash Price |
$1,236.90
|
| Rate for Payer: Cash Price |
$1,335.86
|
| Rate for Payer: Cash Price |
$1,678.66
|
| Rate for Payer: Cash Price |
$1,335.86
|
| Rate for Payer: Cofinity Commercial |
$8,512.94
|
| Rate for Payer: Cofinity Commercial |
$2,549.50
|
| Rate for Payer: Cofinity Commercial |
$1,329.67
|
| Rate for Payer: Cofinity Commercial |
$2,075.17
|
| Rate for Payer: Cofinity Commercial |
$1,436.05
|
| Rate for Payer: Cofinity Commercial |
$1,168.87
|
| Rate for Payer: Cofinity Commercial |
$10,458.76
|
| Rate for Payer: Cofinity Commercial |
$1,082.29
|
| Rate for Payer: Cofinity Commercial |
$1,804.56
|
| Rate for Payer: Cofinity Commercial |
$1,468.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,468.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,082.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,168.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,512.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,075.17
|
| Rate for Payer: Aetna American Axle |
$1,363.91
|
| Rate for Payer: Aetna American Axle |
$1,926.94
|
| Rate for Payer: Aetna American Axle |
$1,004.98
|
| Rate for Payer: Aetna American Axle |
$7,904.88
|
| Rate for Payer: Aetna American Axle |
$1,085.38
|
| Rate for Payer: Aetna Commercial |
$1,314.21
|
| Rate for Payer: Aetna Commercial |
$2,519.85
|
| Rate for Payer: Aetna Commercial |
$10,337.15
|
| Rate for Payer: Aetna Commercial |
$1,419.35
|
| Rate for Payer: Aetna Commercial |
$1,783.57
|
| Rate for Payer: Aetna Medicare |
$337.79
|
| Rate for Payer: Aetna Medicare |
$337.79
|
| Rate for Payer: Aetna Medicare |
$337.79
|
| Rate for Payer: Aetna Medicare |
$337.79
|
| Rate for Payer: Aetna Medicare |
$337.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,904.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,926.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,363.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,004.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,085.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$406.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$406.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$406.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$406.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$406.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$406.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$406.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$406.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$406.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$406.00
|
| Rate for Payer: BCBS Complete |
$182.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,729.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,678.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,371.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,335.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,236.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$324.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$324.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$324.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$324.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$324.80
|
| Rate for Payer: Healthscope Commercial |
$1,391.52
|
| Rate for Payer: Healthscope Commercial |
$1,888.49
|
| Rate for Payer: Healthscope Commercial |
$2,668.08
|
| Rate for Payer: Healthscope Commercial |
$1,502.84
|
| Rate for Payer: Healthscope Commercial |
$10,945.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,168.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,075.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,512.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,082.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,468.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,121.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,223.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,252.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,159.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,573.74
|
| Rate for Payer: Mclaren Medicaid |
$174.09
|
| Rate for Payer: Mclaren Medicaid |
$174.09
|
| Rate for Payer: Mclaren Medicaid |
$174.09
|
| Rate for Payer: Mclaren Medicaid |
$174.09
|
| Rate for Payer: Mclaren Medicaid |
$174.09
|
| Rate for Payer: Mclaren Medicare |
$324.80
|
| Rate for Payer: Mclaren Medicare |
$324.80
|
| Rate for Payer: Mclaren Medicare |
$324.80
|
| Rate for Payer: Mclaren Medicare |
$324.80
|
| Rate for Payer: Mclaren Medicare |
$324.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$341.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$341.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$341.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$341.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$341.04
|
| Rate for Payer: Meridian Medicaid |
$182.80
|
| Rate for Payer: Meridian Medicaid |
$182.80
|
| Rate for Payer: Meridian Medicaid |
$182.80
|
| Rate for Payer: Meridian Medicaid |
$182.80
|
| Rate for Payer: Meridian Medicaid |
$182.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$373.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$373.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$373.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$373.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$373.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,314.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,337.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,419.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,783.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,519.85
|
| Rate for Payer: Nomi Health Commercial |
$974.40
|
| Rate for Payer: Nomi Health Commercial |
$974.40
|
| Rate for Payer: Nomi Health Commercial |
$974.40
|
| Rate for Payer: Nomi Health Commercial |
$974.40
|
| Rate for Payer: Nomi Health Commercial |
$974.40
|
| Rate for Payer: PACE Medicare |
$308.56
|
| Rate for Payer: PACE Medicare |
$308.56
|
| Rate for Payer: PACE Medicare |
$308.56
|
| Rate for Payer: PACE Medicare |
$308.56
|
| Rate for Payer: PACE Medicare |
$308.56
|
| Rate for Payer: PACE SWMI |
$324.80
|
| Rate for Payer: PACE SWMI |
$324.80
|
| Rate for Payer: PACE SWMI |
$324.80
|
| Rate for Payer: PACE SWMI |
$324.80
|
| Rate for Payer: PACE SWMI |
$324.80
|
| Rate for Payer: PHP Commercial |
$1,419.35
|
| Rate for Payer: PHP Commercial |
$1,783.57
|
| Rate for Payer: PHP Commercial |
$2,519.85
|
| Rate for Payer: PHP Commercial |
$10,337.15
|
| Rate for Payer: PHP Commercial |
$1,314.21
|
| Rate for Payer: PHP Medicare Advantage |
$324.80
|
| Rate for Payer: PHP Medicare Advantage |
$324.80
|
| Rate for Payer: PHP Medicare Advantage |
$324.80
|
| Rate for Payer: PHP Medicare Advantage |
$324.80
|
| Rate for Payer: PHP Medicare Advantage |
$324.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,363.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,004.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,904.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,926.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,085.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$811.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$811.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$811.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$811.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$811.98
|
| Rate for Payer: Priority Health Medicare |
$324.80
|
| Rate for Payer: Priority Health Medicare |
$324.80
|
| Rate for Payer: Priority Health Medicare |
$324.80
|
| Rate for Payer: Priority Health Medicare |
$324.80
|
| Rate for Payer: Priority Health Medicare |
$324.80
|
| Rate for Payer: Priority Health Narrow Network |
$649.58
|
| Rate for Payer: Priority Health Narrow Network |
$649.58
|
| Rate for Payer: Priority Health Narrow Network |
$649.58
|
| Rate for Payer: Priority Health Narrow Network |
$649.58
|
| Rate for Payer: Priority Health Narrow Network |
$649.58
|
| Rate for Payer: Priority Health SBD |
$1,321.94
|
| Rate for Payer: Priority Health SBD |
$7,661.65
|
| Rate for Payer: Priority Health SBD |
$1,867.65
|
| Rate for Payer: Priority Health SBD |
$974.06
|
| Rate for Payer: Priority Health SBD |
$1,051.99
|
| Rate for Payer: Railroad Medicare Medicare |
$324.80
|
| Rate for Payer: Railroad Medicare Medicare |
$324.80
|
| Rate for Payer: Railroad Medicare Medicare |
$324.80
|
| Rate for Payer: Railroad Medicare Medicare |
$324.80
|
| Rate for Payer: Railroad Medicare Medicare |
$324.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$914.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$914.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$914.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$914.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$914.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$324.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$324.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$324.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$324.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$324.80
|
| Rate for Payer: UHC Exchange |
$620.73
|
| Rate for Payer: UHC Exchange |
$620.73
|
| Rate for Payer: UHC Exchange |
$620.73
|
| Rate for Payer: UHC Exchange |
$620.73
|
| Rate for Payer: UHC Exchange |
$620.73
|
| Rate for Payer: UHC Medicare Advantage |
$324.80
|
| Rate for Payer: UHC Medicare Advantage |
$324.80
|
| Rate for Payer: UHC Medicare Advantage |
$324.80
|
| Rate for Payer: UHC Medicare Advantage |
$324.80
|
| Rate for Payer: UHC Medicare Advantage |
$324.80
|
| Rate for Payer: UHCCP Medicaid |
$174.09
|
| Rate for Payer: UHCCP Medicaid |
$174.09
|
| Rate for Payer: UHCCP Medicaid |
$174.09
|
| Rate for Payer: UHCCP Medicaid |
$174.09
|
| Rate for Payer: UHCCP Medicaid |
$174.09
|
| Rate for Payer: UMR Bronson Commercial |
$572.07
|
| Rate for Payer: UMR Bronson Commercial |
$776.38
|
| Rate for Payer: UMR Bronson Commercial |
$617.83
|
| Rate for Payer: UMR Bronson Commercial |
$1,096.88
|
| Rate for Payer: UMR Bronson Commercial |
$4,499.70
|
| Rate for Payer: VA VA |
$324.80
|
| Rate for Payer: VA VA |
$324.80
|
| Rate for Payer: VA VA |
$324.80
|
| Rate for Payer: VA VA |
$324.80
|
| Rate for Payer: VA VA |
$324.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,573.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,121.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,159.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,252.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,223.40
|
|
|
DACTINOMYCIN 0.5 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,098.32
|
|
|
Service Code
|
HCPCS J9120
|
| Hospital Charge Code |
28912
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$923.26 |
| Max. Negotiated Rate |
$1,888.49 |
| Rate for Payer: Aetna American Axle |
$1,363.91
|
| Rate for Payer: Aetna American Axle |
$7,904.88
|
| Rate for Payer: Aetna American Axle |
$1,004.98
|
| Rate for Payer: Aetna American Axle |
$1,926.94
|
| Rate for Payer: Aetna American Axle |
$1,085.38
|
| Rate for Payer: Aetna Commercial |
$1,783.57
|
| Rate for Payer: Aetna Commercial |
$1,314.21
|
| Rate for Payer: Aetna Commercial |
$10,337.15
|
| Rate for Payer: Aetna Commercial |
$2,519.85
|
| Rate for Payer: Aetna Commercial |
$1,419.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,363.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,085.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,926.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,904.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,004.98
|
| Rate for Payer: Cash Price |
$1,678.66
|
| Rate for Payer: Cash Price |
$2,371.62
|
| Rate for Payer: Cash Price |
$1,236.90
|
| Rate for Payer: Cash Price |
$1,335.86
|
| Rate for Payer: Cash Price |
$9,729.08
|
| Rate for Payer: Cofinity Commercial |
$2,075.17
|
| Rate for Payer: Cofinity Commercial |
$10,458.76
|
| Rate for Payer: Cofinity Commercial |
$1,804.56
|
| Rate for Payer: Cofinity Commercial |
$1,468.82
|
| Rate for Payer: Cofinity Commercial |
$1,168.87
|
| Rate for Payer: Cofinity Commercial |
$1,082.29
|
| Rate for Payer: Cofinity Commercial |
$1,329.67
|
| Rate for Payer: Cofinity Commercial |
$1,436.05
|
| Rate for Payer: Cofinity Commercial |
$8,512.94
|
| Rate for Payer: Cofinity Commercial |
$2,549.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,468.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,512.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,082.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,075.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,168.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,678.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,236.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,729.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,371.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,335.86
|
| Rate for Payer: Healthscope Commercial |
$1,391.52
|
| Rate for Payer: Healthscope Commercial |
$1,888.49
|
| Rate for Payer: Healthscope Commercial |
$1,502.84
|
| Rate for Payer: Healthscope Commercial |
$2,668.08
|
| Rate for Payer: Healthscope Commercial |
$10,945.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,468.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,512.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,168.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,082.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,075.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,252.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,159.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,121.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,573.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,223.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,314.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,419.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,519.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,783.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,337.15
|
| Rate for Payer: PHP Commercial |
$10,337.15
|
| Rate for Payer: PHP Commercial |
$2,519.85
|
| Rate for Payer: PHP Commercial |
$1,419.35
|
| Rate for Payer: PHP Commercial |
$1,783.57
|
| Rate for Payer: PHP Commercial |
$1,314.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,004.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,363.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,085.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,926.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,904.88
|
| Rate for Payer: Priority Health SBD |
$1,867.65
|
| Rate for Payer: Priority Health SBD |
$1,051.99
|
| Rate for Payer: Priority Health SBD |
$974.06
|
| Rate for Payer: Priority Health SBD |
$7,661.65
|
| Rate for Payer: Priority Health SBD |
$1,321.94
|
| Rate for Payer: UMR Bronson Commercial |
$5,350.99
|
| Rate for Payer: UMR Bronson Commercial |
$680.30
|
| Rate for Payer: UMR Bronson Commercial |
$923.26
|
| Rate for Payer: UMR Bronson Commercial |
$1,304.39
|
| Rate for Payer: UMR Bronson Commercial |
$734.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,121.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,252.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,159.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,223.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,573.74
|
|
|
DALBAVANCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,976.00
|
|
|
Service Code
|
HCPCS J0875
|
| Hospital Charge Code |
171111
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$2,678.40 |
| Rate for Payer: Aetna American Axle |
$1,934.40
|
| Rate for Payer: Aetna Commercial |
$2,529.60
|
| Rate for Payer: Aetna Medicare |
$16.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,934.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.50
|
| Rate for Payer: BCBS Complete |
$8.78
|
| Rate for Payer: BCBS MAPPO |
$15.60
|
| Rate for Payer: BCBS Trust/PPO |
$42.08
|
| Rate for Payer: BCN Commercial |
$42.08
|
| Rate for Payer: BCN Medicare Advantage |
$15.60
|
| Rate for Payer: Cash Price |
$2,380.80
|
| Rate for Payer: Cash Price |
$2,380.80
|
| Rate for Payer: Cofinity Commercial |
$2,559.36
|
| Rate for Payer: Cofinity Commercial |
$2,083.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,083.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,380.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.60
|
| Rate for Payer: Healthscope Commercial |
$2,678.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,083.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,232.00
|
| Rate for Payer: Mclaren Medicaid |
$8.36
|
| Rate for Payer: Mclaren Medicare |
$15.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.38
|
| Rate for Payer: Meridian Medicaid |
$8.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,529.60
|
| Rate for Payer: Nomi Health Commercial |
$46.80
|
| Rate for Payer: PACE Medicare |
$14.82
|
| Rate for Payer: PACE SWMI |
$15.60
|
| Rate for Payer: PHP Commercial |
$2,529.60
|
| Rate for Payer: PHP Medicare Advantage |
$15.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,934.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.94
|
| Rate for Payer: Priority Health Medicare |
$15.60
|
| Rate for Payer: Priority Health Narrow Network |
$35.95
|
| Rate for Payer: Priority Health SBD |
$1,874.88
|
| Rate for Payer: Railroad Medicare Medicare |
$15.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.60
|
| Rate for Payer: UHC Exchange |
$29.81
|
| Rate for Payer: UHC Medicare Advantage |
$15.60
|
| Rate for Payer: UHCCP Medicaid |
$8.36
|
| Rate for Payer: UMR Bronson Commercial |
$1,101.12
|
| Rate for Payer: VA VA |
$15.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,232.00
|
|
|
DALBAVANCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,976.00
|
|
|
Service Code
|
HCPCS J0875
|
| Hospital Charge Code |
171111
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,309.44 |
| Max. Negotiated Rate |
$2,678.40 |
| Rate for Payer: Aetna American Axle |
$1,934.40
|
| Rate for Payer: Aetna Commercial |
$2,529.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,934.40
|
| Rate for Payer: Cash Price |
$2,380.80
|
| Rate for Payer: Cofinity Commercial |
$2,083.20
|
| Rate for Payer: Cofinity Commercial |
$2,559.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,083.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,380.80
|
| Rate for Payer: Healthscope Commercial |
$2,678.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,083.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,232.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,529.60
|
| Rate for Payer: PHP Commercial |
$2,529.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,934.40
|
| Rate for Payer: Priority Health SBD |
$1,874.88
|
| Rate for Payer: UMR Bronson Commercial |
$1,309.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,232.00
|
|
|
DANAZOL 100 MG CAPSULE
|
Facility
|
IP
|
$1,338.66
|
|
|
Service Code
|
NDC 00555063402
|
| Hospital Charge Code |
9714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$589.01 |
| Max. Negotiated Rate |
$1,204.79 |
| Rate for Payer: Aetna American Axle |
$870.13
|
| Rate for Payer: Aetna Commercial |
$1,137.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$870.13
|
| Rate for Payer: Cash Price |
$1,070.93
|
| Rate for Payer: Cofinity Commercial |
$1,151.25
|
| Rate for Payer: Cofinity Commercial |
$937.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$937.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,070.93
|
| Rate for Payer: Healthscope Commercial |
$1,204.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$937.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,004.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,137.86
|
| Rate for Payer: PHP Commercial |
$1,137.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$870.13
|
| Rate for Payer: Priority Health SBD |
$843.36
|
| Rate for Payer: UMR Bronson Commercial |
$589.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,004.00
|
|
|
DANAZOL 100 MG CAPSULE
|
Facility
|
OP
|
$1,338.66
|
|
|
Service Code
|
NDC 00555063402
|
| Hospital Charge Code |
9714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$495.30 |
| Max. Negotiated Rate |
$1,204.79 |
| Rate for Payer: Aetna American Axle |
$870.13
|
| Rate for Payer: Aetna Commercial |
$1,137.86
|
| Rate for Payer: Aetna Medicare |
$669.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$870.13
|
| Rate for Payer: BCBS Complete |
$535.46
|
| Rate for Payer: Cash Price |
$1,070.93
|
| Rate for Payer: Cofinity Commercial |
$1,151.25
|
| Rate for Payer: Cofinity Commercial |
$937.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$937.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,070.93
|
| Rate for Payer: Healthscope Commercial |
$1,204.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$937.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,004.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,137.86
|
| Rate for Payer: PHP Commercial |
$1,137.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$870.13
|
| Rate for Payer: Priority Health SBD |
$843.36
|
| Rate for Payer: UMR Bronson Commercial |
$495.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,004.00
|
|
|
DANTROLENE 20 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$187.30
|
|
|
Service Code
|
NDC 00143929701
|
| Hospital Charge Code |
9716
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$168.57 |
| Rate for Payer: Aetna American Axle |
$121.74
|
| Rate for Payer: Aetna Commercial |
$159.20
|
| Rate for Payer: Aetna Medicare |
$93.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.74
|
| Rate for Payer: BCBS Complete |
$74.92
|
| Rate for Payer: Cash Price |
$149.84
|
| Rate for Payer: Cofinity Commercial |
$131.11
|
| Rate for Payer: Cofinity Commercial |
$161.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$131.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.84
|
| Rate for Payer: Healthscope Commercial |
$168.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$131.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.20
|
| Rate for Payer: PHP Commercial |
$159.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.74
|
| Rate for Payer: Priority Health SBD |
$118.00
|
| Rate for Payer: UMR Bronson Commercial |
$69.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.48
|
|
|
DANTROLENE 20 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$292.65
|
|
|
Service Code
|
NDC 42023012306
|
| Hospital Charge Code |
9716
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$128.77 |
| Max. Negotiated Rate |
$263.38 |
| Rate for Payer: Aetna American Axle |
$190.22
|
| Rate for Payer: Aetna Commercial |
$248.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.22
|
| Rate for Payer: Cash Price |
$234.12
|
| Rate for Payer: Cofinity Commercial |
$204.86
|
| Rate for Payer: Cofinity Commercial |
$251.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$204.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.12
|
| Rate for Payer: Healthscope Commercial |
$263.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$204.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$219.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.75
|
| Rate for Payer: PHP Commercial |
$248.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.22
|
| Rate for Payer: Priority Health SBD |
$184.37
|
| Rate for Payer: UMR Bronson Commercial |
$128.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$219.49
|
|
|
DANTROLENE 20 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$292.65
|
|
|
Service Code
|
NDC 42023012306
|
| Hospital Charge Code |
9716
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$108.28 |
| Max. Negotiated Rate |
$263.38 |
| Rate for Payer: Aetna American Axle |
$190.22
|
| Rate for Payer: Aetna Commercial |
$248.75
|
| Rate for Payer: Aetna Medicare |
$146.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.22
|
| Rate for Payer: BCBS Complete |
$117.06
|
| Rate for Payer: Cash Price |
$234.12
|
| Rate for Payer: Cofinity Commercial |
$204.86
|
| Rate for Payer: Cofinity Commercial |
$251.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$204.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.12
|
| Rate for Payer: Healthscope Commercial |
$263.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$204.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$219.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.75
|
| Rate for Payer: PHP Commercial |
$248.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.22
|
| Rate for Payer: Priority Health SBD |
$184.37
|
| Rate for Payer: UMR Bronson Commercial |
$108.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$219.49
|
|
|
DANTROLENE 20 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$187.30
|
|
|
Service Code
|
NDC 00143929701
|
| Hospital Charge Code |
9716
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$82.41 |
| Max. Negotiated Rate |
$168.57 |
| Rate for Payer: Aetna American Axle |
$121.74
|
| Rate for Payer: Aetna Commercial |
$159.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.74
|
| Rate for Payer: Cash Price |
$149.84
|
| Rate for Payer: Cofinity Commercial |
$131.11
|
| Rate for Payer: Cofinity Commercial |
$161.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$131.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.84
|
| Rate for Payer: Healthscope Commercial |
$168.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$131.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.20
|
| Rate for Payer: PHP Commercial |
$159.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.74
|
| Rate for Payer: Priority Health SBD |
$118.00
|
| Rate for Payer: UMR Bronson Commercial |
$82.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.48
|
|
|
DANTROLENE 25 MG CAPSULE
|
Facility
|
IP
|
$322.05
|
|
|
Service Code
|
NDC 00115441101
|
| Hospital Charge Code |
9718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.70 |
| Max. Negotiated Rate |
$289.84 |
| Rate for Payer: Aetna American Axle |
$209.33
|
| Rate for Payer: Aetna Commercial |
$273.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.33
|
| Rate for Payer: Cash Price |
$257.64
|
| Rate for Payer: Cofinity Commercial |
$225.44
|
| Rate for Payer: Cofinity Commercial |
$276.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$225.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.64
|
| Rate for Payer: Healthscope Commercial |
$289.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$225.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.74
|
| Rate for Payer: PHP Commercial |
$273.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.33
|
| Rate for Payer: Priority Health SBD |
$202.89
|
| Rate for Payer: UMR Bronson Commercial |
$141.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.54
|
|
|
DANTROLENE 25 MG CAPSULE
|
Facility
|
OP
|
$322.05
|
|
|
Service Code
|
NDC 00115441101
|
| Hospital Charge Code |
9718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.16 |
| Max. Negotiated Rate |
$289.84 |
| Rate for Payer: Aetna American Axle |
$209.33
|
| Rate for Payer: Aetna Commercial |
$273.74
|
| Rate for Payer: Aetna Medicare |
$161.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.33
|
| Rate for Payer: BCBS Complete |
$128.82
|
| Rate for Payer: Cash Price |
$257.64
|
| Rate for Payer: Cofinity Commercial |
$225.44
|
| Rate for Payer: Cofinity Commercial |
$276.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$225.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.64
|
| Rate for Payer: Healthscope Commercial |
$289.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$225.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.74
|
| Rate for Payer: PHP Commercial |
$273.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.33
|
| Rate for Payer: Priority Health SBD |
$202.89
|
| Rate for Payer: UMR Bronson Commercial |
$119.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.54
|
|
|
DAPAGLIFLOZIN PROPANEDIOL 10 MG TABLET
|
Facility
|
IP
|
$1,302.26
|
|
|
Service Code
|
NDC 66993045730
|
| Hospital Charge Code |
169524
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$572.99 |
| Max. Negotiated Rate |
$1,172.03 |
| Rate for Payer: Aetna American Axle |
$846.47
|
| Rate for Payer: Aetna Commercial |
$1,106.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$846.47
|
| Rate for Payer: Cash Price |
$1,041.81
|
| Rate for Payer: Cofinity Commercial |
$1,119.94
|
| Rate for Payer: Cofinity Commercial |
$911.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$911.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,041.81
|
| Rate for Payer: Healthscope Commercial |
$1,172.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$911.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$976.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,106.92
|
| Rate for Payer: PHP Commercial |
$1,106.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$846.47
|
| Rate for Payer: Priority Health SBD |
$820.42
|
| Rate for Payer: UMR Bronson Commercial |
$572.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$976.70
|
|
|
DAPAGLIFLOZIN PROPANEDIOL 10 MG TABLET
|
Facility
|
OP
|
$1,400.16
|
|
|
Service Code
|
NDC 00310621030
|
| Hospital Charge Code |
169524
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$518.06 |
| Max. Negotiated Rate |
$1,260.14 |
| Rate for Payer: Aetna American Axle |
$910.10
|
| Rate for Payer: Aetna Commercial |
$1,190.14
|
| Rate for Payer: Aetna Medicare |
$700.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$910.10
|
| Rate for Payer: BCBS Complete |
$560.06
|
| Rate for Payer: Cash Price |
$1,120.13
|
| Rate for Payer: Cofinity Commercial |
$1,204.14
|
| Rate for Payer: Cofinity Commercial |
$980.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$980.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,120.13
|
| Rate for Payer: Healthscope Commercial |
$1,260.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$980.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,050.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,190.14
|
| Rate for Payer: PHP Commercial |
$1,190.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$910.10
|
| Rate for Payer: Priority Health SBD |
$882.10
|
| Rate for Payer: UMR Bronson Commercial |
$518.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,050.12
|
|
|
DAPAGLIFLOZIN PROPANEDIOL 10 MG TABLET
|
Facility
|
IP
|
$300.70
|
|
|
Service Code
|
NDC 00310621095
|
| Hospital Charge Code |
169524
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.31 |
| Max. Negotiated Rate |
$270.63 |
| Rate for Payer: Aetna American Axle |
$195.46
|
| Rate for Payer: Aetna Commercial |
$255.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.46
|
| Rate for Payer: Cash Price |
$240.56
|
| Rate for Payer: Cofinity Commercial |
$210.49
|
| Rate for Payer: Cofinity Commercial |
$258.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$210.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.56
|
| Rate for Payer: Healthscope Commercial |
$270.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.60
|
| Rate for Payer: PHP Commercial |
$255.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.46
|
| Rate for Payer: Priority Health SBD |
$189.44
|
| Rate for Payer: UMR Bronson Commercial |
$132.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.52
|
|
|
DAPAGLIFLOZIN PROPANEDIOL 10 MG TABLET
|
Facility
|
IP
|
$1,400.16
|
|
|
Service Code
|
NDC 00310621030
|
| Hospital Charge Code |
169524
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$616.07 |
| Max. Negotiated Rate |
$1,260.14 |
| Rate for Payer: Aetna American Axle |
$910.10
|
| Rate for Payer: Aetna Commercial |
$1,190.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$910.10
|
| Rate for Payer: Cash Price |
$1,120.13
|
| Rate for Payer: Cofinity Commercial |
$1,204.14
|
| Rate for Payer: Cofinity Commercial |
$980.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$980.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,120.13
|
| Rate for Payer: Healthscope Commercial |
$1,260.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$980.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,050.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,190.14
|
| Rate for Payer: PHP Commercial |
$1,190.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$910.10
|
| Rate for Payer: Priority Health SBD |
$882.10
|
| Rate for Payer: UMR Bronson Commercial |
$616.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,050.12
|
|
|
DAPAGLIFLOZIN PROPANEDIOL 10 MG TABLET
|
Facility
|
OP
|
$300.70
|
|
|
Service Code
|
NDC 00310621095
|
| Hospital Charge Code |
169524
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.26 |
| Max. Negotiated Rate |
$270.63 |
| Rate for Payer: Aetna American Axle |
$195.46
|
| Rate for Payer: Aetna Commercial |
$255.60
|
| Rate for Payer: Aetna Medicare |
$150.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.46
|
| Rate for Payer: BCBS Complete |
$120.28
|
| Rate for Payer: Cash Price |
$240.56
|
| Rate for Payer: Cofinity Commercial |
$210.49
|
| Rate for Payer: Cofinity Commercial |
$258.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$210.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.56
|
| Rate for Payer: Healthscope Commercial |
$270.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.60
|
| Rate for Payer: PHP Commercial |
$255.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.46
|
| Rate for Payer: Priority Health SBD |
$189.44
|
| Rate for Payer: UMR Bronson Commercial |
$111.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.52
|
|
|
DAPAGLIFLOZIN PROPANEDIOL 10 MG TABLET
|
Facility
|
OP
|
$1,302.26
|
|
|
Service Code
|
NDC 66993045730
|
| Hospital Charge Code |
169524
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$481.84 |
| Max. Negotiated Rate |
$1,172.03 |
| Rate for Payer: Aetna American Axle |
$846.47
|
| Rate for Payer: Aetna Commercial |
$1,106.92
|
| Rate for Payer: Aetna Medicare |
$651.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$846.47
|
| Rate for Payer: BCBS Complete |
$520.90
|
| Rate for Payer: Cash Price |
$1,041.81
|
| Rate for Payer: Cofinity Commercial |
$1,119.94
|
| Rate for Payer: Cofinity Commercial |
$911.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$911.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,041.81
|
| Rate for Payer: Healthscope Commercial |
$1,172.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$911.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$976.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,106.92
|
| Rate for Payer: PHP Commercial |
$1,106.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$846.47
|
| Rate for Payer: Priority Health SBD |
$820.42
|
| Rate for Payer: UMR Bronson Commercial |
$481.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$976.70
|
|
|
DAPAGLIFLOZIN PROPANEDIOL 5 MG TABLET
|
Facility
|
OP
|
$1,302.26
|
|
|
Service Code
|
NDC 66993045630
|
| Hospital Charge Code |
169523
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$481.84 |
| Max. Negotiated Rate |
$1,172.03 |
| Rate for Payer: Aetna American Axle |
$846.47
|
| Rate for Payer: Aetna Commercial |
$1,106.92
|
| Rate for Payer: Aetna Medicare |
$651.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$846.47
|
| Rate for Payer: BCBS Complete |
$520.90
|
| Rate for Payer: Cash Price |
$1,041.81
|
| Rate for Payer: Cofinity Commercial |
$1,119.94
|
| Rate for Payer: Cofinity Commercial |
$911.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$911.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,041.81
|
| Rate for Payer: Healthscope Commercial |
$1,172.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$911.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$976.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,106.92
|
| Rate for Payer: PHP Commercial |
$1,106.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$846.47
|
| Rate for Payer: Priority Health SBD |
$820.42
|
| Rate for Payer: UMR Bronson Commercial |
$481.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$976.70
|
|
|
DAPAGLIFLOZIN PROPANEDIOL 5 MG TABLET
|
Facility
|
IP
|
$1,302.26
|
|
|
Service Code
|
NDC 66993045630
|
| Hospital Charge Code |
169523
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$572.99 |
| Max. Negotiated Rate |
$1,172.03 |
| Rate for Payer: Aetna American Axle |
$846.47
|
| Rate for Payer: Aetna Commercial |
$1,106.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$846.47
|
| Rate for Payer: Cash Price |
$1,041.81
|
| Rate for Payer: Cofinity Commercial |
$1,119.94
|
| Rate for Payer: Cofinity Commercial |
$911.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$911.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,041.81
|
| Rate for Payer: Healthscope Commercial |
$1,172.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$911.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$976.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,106.92
|
| Rate for Payer: PHP Commercial |
$1,106.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$846.47
|
| Rate for Payer: Priority Health SBD |
$820.42
|
| Rate for Payer: UMR Bronson Commercial |
$572.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$976.70
|
|
|
DAPSONE 100 MG TABLET
|
Facility
|
OP
|
$250.98
|
|
|
Service Code
|
NDC 47781033431
|
| Hospital Charge Code |
2131
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.86 |
| Max. Negotiated Rate |
$225.88 |
| Rate for Payer: Aetna American Axle |
$163.14
|
| Rate for Payer: Aetna Commercial |
$213.33
|
| Rate for Payer: Aetna Medicare |
$125.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.14
|
| Rate for Payer: BCBS Complete |
$100.39
|
| Rate for Payer: Cash Price |
$200.78
|
| Rate for Payer: Cofinity Commercial |
$175.69
|
| Rate for Payer: Cofinity Commercial |
$215.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$175.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.78
|
| Rate for Payer: Healthscope Commercial |
$225.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.33
|
| Rate for Payer: PHP Commercial |
$213.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.14
|
| Rate for Payer: Priority Health SBD |
$158.12
|
| Rate for Payer: UMR Bronson Commercial |
$92.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.24
|
|
|
DAPSONE 100 MG TABLET
|
Facility
|
OP
|
$129.17
|
|
|
Service Code
|
NDC 70954013610
|
| Hospital Charge Code |
2131
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.79 |
| Max. Negotiated Rate |
$116.25 |
| Rate for Payer: Aetna American Axle |
$83.96
|
| Rate for Payer: Aetna Commercial |
$109.79
|
| Rate for Payer: Aetna Medicare |
$64.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.96
|
| Rate for Payer: BCBS Complete |
$51.67
|
| Rate for Payer: Cash Price |
$103.34
|
| Rate for Payer: Cofinity Commercial |
$111.09
|
| Rate for Payer: Cofinity Commercial |
$90.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$90.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.34
|
| Rate for Payer: Healthscope Commercial |
$116.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.79
|
| Rate for Payer: PHP Commercial |
$109.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.96
|
| Rate for Payer: Priority Health SBD |
$81.38
|
| Rate for Payer: UMR Bronson Commercial |
$47.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.88
|
|
|
DAPSONE 100 MG TABLET
|
Facility
|
OP
|
$289.05
|
|
|
Service Code
|
NDC 49938010130
|
| Hospital Charge Code |
2131
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.95 |
| Max. Negotiated Rate |
$260.14 |
| Rate for Payer: Aetna American Axle |
$187.88
|
| Rate for Payer: Aetna Commercial |
$245.69
|
| Rate for Payer: Aetna Medicare |
$144.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.88
|
| Rate for Payer: BCBS Complete |
$115.62
|
| Rate for Payer: Cash Price |
$231.24
|
| Rate for Payer: Cofinity Commercial |
$202.34
|
| Rate for Payer: Cofinity Commercial |
$248.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$202.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.24
|
| Rate for Payer: Healthscope Commercial |
$260.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$202.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.69
|
| Rate for Payer: PHP Commercial |
$245.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.88
|
| Rate for Payer: Priority Health SBD |
$182.10
|
| Rate for Payer: UMR Bronson Commercial |
$106.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.79
|
|
|
DAPSONE 100 MG TABLET
|
Facility
|
IP
|
$250.98
|
|
|
Service Code
|
NDC 47781033431
|
| Hospital Charge Code |
2131
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.43 |
| Max. Negotiated Rate |
$225.88 |
| Rate for Payer: Aetna American Axle |
$163.14
|
| Rate for Payer: Aetna Commercial |
$213.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.14
|
| Rate for Payer: Cash Price |
$200.78
|
| Rate for Payer: Cofinity Commercial |
$175.69
|
| Rate for Payer: Cofinity Commercial |
$215.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$175.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.78
|
| Rate for Payer: Healthscope Commercial |
$225.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.33
|
| Rate for Payer: PHP Commercial |
$213.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.14
|
| Rate for Payer: Priority Health SBD |
$158.12
|
| Rate for Payer: UMR Bronson Commercial |
$110.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.24
|
|
