|
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 Commercial |
$237.89
|
| Rate for Payer: Cofinity Commercial |
$292.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$237.89
|
| 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: PHP Commercial |
$288.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.90
|
| Rate for Payer: Priority Health SBD |
$214.10
|
| Rate for Payer: UMR Bronson Commercial |
$125.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$254.88
|
|
|
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 Commercial |
$216.38
|
| Rate for Payer: Cofinity Commercial |
$265.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$216.38
|
| 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: PHP Commercial |
$262.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.93
|
| Rate for Payer: Priority Health SBD |
$194.75
|
| 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
|
$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 Commercial |
$216.38
|
| Rate for Payer: Cofinity Commercial |
$265.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$216.38
|
| 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: PHP Commercial |
$262.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.93
|
| 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
|
|
|
DOXEPIN 5 % TOPICAL CREAM
|
Facility
|
OP
|
$1,880.87
|
|
|
Service Code
|
NDC 00093960995
|
| Hospital Charge Code |
12666
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$695.92 |
| Max. Negotiated Rate |
$1,692.78 |
| Rate for Payer: Aetna American Axle |
$1,222.57
|
| Rate for Payer: Aetna Commercial |
$1,598.74
|
| Rate for Payer: Aetna Medicare |
$940.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,222.57
|
| Rate for Payer: BCBS Complete |
$752.35
|
| Rate for Payer: Cash Price |
$1,504.70
|
| Rate for Payer: Cofinity Commercial |
$1,316.61
|
| Rate for Payer: Cofinity Commercial |
$1,617.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,316.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,504.70
|
| Rate for Payer: Healthscope Commercial |
$1,692.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,316.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,410.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,598.74
|
| Rate for Payer: PHP Commercial |
$1,598.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,222.57
|
| Rate for Payer: Priority Health SBD |
$1,184.95
|
| Rate for Payer: UMR Bronson Commercial |
$695.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,410.65
|
|
|
DOXEPIN 5 % TOPICAL CREAM
|
Facility
|
IP
|
$1,880.87
|
|
|
Service Code
|
NDC 00093960995
|
| Hospital Charge Code |
12666
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$827.58 |
| Max. Negotiated Rate |
$1,692.78 |
| Rate for Payer: Aetna American Axle |
$1,222.57
|
| Rate for Payer: Aetna Commercial |
$1,598.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,222.57
|
| Rate for Payer: Cash Price |
$1,504.70
|
| Rate for Payer: Cofinity Commercial |
$1,316.61
|
| Rate for Payer: Cofinity Commercial |
$1,617.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,316.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,504.70
|
| Rate for Payer: Healthscope Commercial |
$1,692.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,316.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,410.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,598.74
|
| Rate for Payer: PHP Commercial |
$1,598.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,222.57
|
| Rate for Payer: Priority Health SBD |
$1,184.95
|
| Rate for Payer: UMR Bronson Commercial |
$827.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,410.65
|
|
|
DOXEPIN 5 % TOPICAL CREAM
|
Facility
|
IP
|
$1,959.30
|
|
|
Service Code
|
NDC 00378811745
|
| Hospital Charge Code |
12666
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$862.09 |
| Max. Negotiated Rate |
$1,763.37 |
| Rate for Payer: Aetna American Axle |
$1,273.54
|
| Rate for Payer: Aetna Commercial |
$1,665.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,273.54
|
| Rate for Payer: Cash Price |
$1,567.44
|
| Rate for Payer: Cofinity Commercial |
$1,371.51
|
| Rate for Payer: Cofinity Commercial |
$1,685.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,371.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,567.44
|
| Rate for Payer: Healthscope Commercial |
$1,763.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,371.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,469.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,665.40
|
| Rate for Payer: PHP Commercial |
$1,665.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,273.54
|
| Rate for Payer: Priority Health SBD |
$1,234.36
|
| Rate for Payer: UMR Bronson Commercial |
$862.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,469.48
|
|
|
DOXEPIN 5 % TOPICAL CREAM
|
Facility
|
OP
|
$1,959.30
|
|
|
Service Code
|
NDC 00378811745
|
| Hospital Charge Code |
12666
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$724.94 |
| Max. Negotiated Rate |
$1,763.37 |
| Rate for Payer: Aetna American Axle |
$1,273.54
|
| Rate for Payer: Aetna Commercial |
$1,665.40
|
| Rate for Payer: Aetna Medicare |
$979.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,273.54
|
| Rate for Payer: BCBS Complete |
$783.72
|
| Rate for Payer: Cash Price |
$1,567.44
|
| Rate for Payer: Cofinity Commercial |
$1,371.51
|
| Rate for Payer: Cofinity Commercial |
$1,685.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,371.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,567.44
|
| Rate for Payer: Healthscope Commercial |
$1,763.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,371.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,469.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,665.40
|
| Rate for Payer: PHP Commercial |
$1,665.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,273.54
|
| Rate for Payer: Priority Health SBD |
$1,234.36
|
| Rate for Payer: UMR Bronson Commercial |
$724.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,469.48
|
|
|
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 Commercial |
$20.16
|
| Rate for Payer: Cofinity Commercial |
$24.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.16
|
| 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: PHP Commercial |
$24.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.72
|
| 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
|
|
|
DOXERCALCIFEROL 4 MCG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$20.62
|
|
|
Service Code
|
HCPCS J1270
|
| Hospital Charge Code |
28277
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$18.56 |
| Rate for Payer: Aetna American Axle |
$13.40
|
| Rate for Payer: Aetna American Axle |
$18.72
|
| Rate for Payer: Aetna American Axle |
$13.16
|
| Rate for Payer: Aetna Commercial |
$24.48
|
| Rate for Payer: Aetna Commercial |
$17.21
|
| Rate for Payer: Aetna Commercial |
$17.53
|
| Rate for Payer: Aetna Medicare |
$10.12
|
| Rate for Payer: Aetna Medicare |
$10.31
|
| Rate for Payer: Aetna Medicare |
$14.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.16
|
| Rate for Payer: BCBS Complete |
$11.52
|
| Rate for Payer: BCBS Complete |
$8.25
|
| Rate for Payer: BCBS Complete |
$8.10
|
| Rate for Payer: BCBS Trust/PPO |
$1.01
|
| Rate for Payer: BCBS Trust/PPO |
$1.01
|
| Rate for Payer: BCBS Trust/PPO |
$1.01
|
| Rate for Payer: BCN Commercial |
$1.01
|
| Rate for Payer: BCN Commercial |
$1.01
|
| Rate for Payer: BCN Commercial |
$1.01
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$23.04
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$23.04
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cofinity Commercial |
$14.43
|
| Rate for Payer: Cofinity Commercial |
$14.18
|
| Rate for Payer: Cofinity Commercial |
$17.73
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$24.77
|
| Rate for Payer: Cofinity Commercial |
$20.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.04
|
| Rate for Payer: Healthscope Commercial |
$25.92
|
| Rate for Payer: Healthscope Commercial |
$18.56
|
| Rate for Payer: Healthscope Commercial |
$18.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.48
|
| Rate for Payer: PHP Commercial |
$24.48
|
| Rate for Payer: PHP Commercial |
$17.21
|
| Rate for Payer: PHP Commercial |
$17.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.72
|
| Rate for Payer: Priority Health SBD |
$12.76
|
| Rate for Payer: Priority Health SBD |
$12.99
|
| Rate for Payer: Priority Health SBD |
$18.14
|
| Rate for Payer: UMR Bronson Commercial |
$7.63
|
| Rate for Payer: UMR Bronson Commercial |
$7.49
|
| Rate for Payer: UMR Bronson Commercial |
$10.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.46
|
|
|
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 Commercial |
$118.96
|
| Rate for Payer: Cofinity Commercial |
$146.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$118.96
|
| 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 |
$118.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.46
|
| Rate for Payer: PHP Commercial |
$144.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.47
|
| 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 |
$8.73 |
| 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 |
$84.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.47
|
| Rate for Payer: BCBS Complete |
$67.98
|
| Rate for Payer: BCBS Trust/PPO |
$8.73
|
| Rate for Payer: BCN Commercial |
$8.73
|
| Rate for Payer: Cash Price |
$135.96
|
| Rate for Payer: Cash Price |
$135.96
|
| Rate for Payer: Cofinity Commercial |
$118.96
|
| Rate for Payer: Cofinity Commercial |
$146.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$118.96
|
| 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 |
$118.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.46
|
| Rate for Payer: PHP Commercial |
$144.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.47
|
| Rate for Payer: Priority Health SBD |
$107.07
|
| 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
|
$682.25
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
2616
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.73 |
| Max. Negotiated Rate |
$614.02 |
| Rate for Payer: Aetna American Axle |
$443.46
|
| Rate for Payer: Aetna American Axle |
$189.31
|
| Rate for Payer: Aetna American Axle |
$745.55
|
| Rate for Payer: Aetna American Axle |
$237.35
|
| Rate for Payer: Aetna American Axle |
$328.89
|
| Rate for Payer: Aetna American Axle |
$366.76
|
| Rate for Payer: Aetna Commercial |
$310.39
|
| Rate for Payer: Aetna Commercial |
$479.61
|
| Rate for Payer: Aetna Commercial |
$247.56
|
| Rate for Payer: Aetna Commercial |
$974.95
|
| Rate for Payer: Aetna Commercial |
$579.91
|
| Rate for Payer: Aetna Commercial |
$430.08
|
| Rate for Payer: Aetna Medicare |
$341.12
|
| Rate for Payer: Aetna Medicare |
$252.99
|
| Rate for Payer: Aetna Medicare |
$145.62
|
| Rate for Payer: Aetna Medicare |
$282.12
|
| Rate for Payer: Aetna Medicare |
$182.58
|
| Rate for Payer: Aetna Medicare |
$573.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$443.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$745.55
|
| 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) |
$328.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$366.76
|
| Rate for Payer: BCBS Complete |
$225.70
|
| Rate for Payer: BCBS Complete |
$202.39
|
| Rate for Payer: BCBS Complete |
$458.80
|
| Rate for Payer: BCBS Complete |
$146.06
|
| Rate for Payer: BCBS Complete |
$116.50
|
| Rate for Payer: BCBS Complete |
$272.90
|
| Rate for Payer: BCBS Trust/PPO |
$8.73
|
| Rate for Payer: BCBS Trust/PPO |
$8.73
|
| Rate for Payer: BCBS Trust/PPO |
$8.73
|
| Rate for Payer: BCBS Trust/PPO |
$8.73
|
| Rate for Payer: BCBS Trust/PPO |
$8.73
|
| Rate for Payer: BCBS Trust/PPO |
$8.73
|
| Rate for Payer: BCN Commercial |
$8.73
|
| Rate for Payer: BCN Commercial |
$8.73
|
| Rate for Payer: BCN Commercial |
$8.73
|
| Rate for Payer: BCN Commercial |
$8.73
|
| Rate for Payer: BCN Commercial |
$8.73
|
| Rate for Payer: BCN Commercial |
$8.73
|
| Rate for Payer: Cash Price |
$545.80
|
| 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 |
$917.60
|
| Rate for Payer: Cash Price |
$233.00
|
| Rate for Payer: Cash Price |
$292.13
|
| Rate for Payer: Cash Price |
$451.40
|
| Rate for Payer: Cash Price |
$545.80
|
| Rate for Payer: Cash Price |
$404.78
|
| Rate for Payer: Cash Price |
$404.78
|
| Rate for Payer: Cash Price |
$917.60
|
| Rate for Payer: Cofinity Commercial |
$255.61
|
| Rate for Payer: Cofinity Commercial |
$477.58
|
| Rate for Payer: Cofinity Commercial |
$203.88
|
| Rate for Payer: Cofinity Commercial |
$986.42
|
| Rate for Payer: Cofinity Commercial |
$802.90
|
| Rate for Payer: Cofinity Commercial |
$250.48
|
| Rate for Payer: Cofinity Commercial |
$485.26
|
| Rate for Payer: Cofinity Commercial |
$394.98
|
| Rate for Payer: Cofinity Commercial |
$435.14
|
| Rate for Payer: Cofinity Commercial |
$354.19
|
| Rate for Payer: Cofinity Commercial |
$314.04
|
| Rate for Payer: Cofinity Commercial |
$586.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$394.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$255.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$802.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$203.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$354.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$477.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$404.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$917.60
|
| 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 |
$545.80
|
| Rate for Payer: Healthscope Commercial |
$507.82
|
| Rate for Payer: Healthscope Commercial |
$614.02
|
| Rate for Payer: Healthscope Commercial |
$455.38
|
| Rate for Payer: Healthscope Commercial |
$328.64
|
| Rate for Payer: Healthscope Commercial |
$262.12
|
| Rate for Payer: Healthscope Commercial |
$1,032.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$802.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$255.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$354.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$477.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$394.98
|
| 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 |
$218.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$423.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$860.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$379.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.39
|
| 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 |
$579.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$479.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$430.08
|
| Rate for Payer: PHP Commercial |
$310.39
|
| Rate for Payer: PHP Commercial |
$430.08
|
| Rate for Payer: PHP Commercial |
$247.56
|
| Rate for Payer: PHP Commercial |
$974.95
|
| Rate for Payer: PHP Commercial |
$479.61
|
| Rate for Payer: PHP Commercial |
$579.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$443.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$366.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$328.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$745.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.31
|
| Rate for Payer: Priority Health SBD |
$355.48
|
| Rate for Payer: Priority Health SBD |
$183.49
|
| Rate for Payer: Priority Health SBD |
$230.05
|
| Rate for Payer: Priority Health SBD |
$318.77
|
| Rate for Payer: Priority Health SBD |
$722.61
|
| Rate for Payer: Priority Health SBD |
$429.82
|
| Rate for Payer: UMR Bronson Commercial |
$208.77
|
| Rate for Payer: UMR Bronson Commercial |
$252.43
|
| Rate for Payer: UMR Bronson Commercial |
$135.11
|
| Rate for Payer: UMR Bronson Commercial |
$424.39
|
| Rate for Payer: UMR Bronson Commercial |
$107.76
|
| Rate for Payer: UMR Bronson Commercial |
$187.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$860.25
|
| 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 |
$273.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$423.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$379.48
|
|
|
DOXORUBICIN 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$564.25
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
2616
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$248.27 |
| Max. Negotiated Rate |
$507.82 |
| Rate for Payer: PHP Commercial |
$247.56
|
| Rate for Payer: PHP Commercial |
$430.08
|
| Rate for Payer: Aetna American Axle |
$366.76
|
| Rate for Payer: Aetna American Axle |
$328.89
|
| Rate for Payer: Aetna American Axle |
$189.31
|
| Rate for Payer: Aetna American Axle |
$443.46
|
| Rate for Payer: Aetna Commercial |
$479.61
|
| Rate for Payer: Aetna Commercial |
$579.91
|
| Rate for Payer: Aetna Commercial |
$430.08
|
| Rate for Payer: Aetna Commercial |
$247.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$328.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$443.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$366.76
|
| Rate for Payer: Cash Price |
$404.78
|
| 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 Commercial |
$203.88
|
| Rate for Payer: Cofinity Commercial |
$586.74
|
| Rate for Payer: Cofinity Commercial |
$477.58
|
| Rate for Payer: Cofinity Commercial |
$394.98
|
| Rate for Payer: Cofinity Commercial |
$354.19
|
| Rate for Payer: Cofinity Commercial |
$435.14
|
| Rate for Payer: Cofinity Commercial |
$485.26
|
| Rate for Payer: Cofinity Commercial |
$250.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$354.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$394.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$477.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$203.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.00
|
| 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 |
$404.78
|
| Rate for Payer: Healthscope Commercial |
$507.82
|
| Rate for Payer: Healthscope Commercial |
$262.12
|
| Rate for Payer: Healthscope Commercial |
$455.38
|
| Rate for Payer: Healthscope Commercial |
$614.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$354.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$477.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$394.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$379.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$423.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$511.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$579.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$430.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$479.61
|
| Rate for Payer: PHP Commercial |
$479.61
|
| Rate for Payer: PHP Commercial |
$579.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$366.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$443.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$328.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.31
|
| Rate for Payer: Priority Health SBD |
$429.82
|
| Rate for Payer: Priority Health SBD |
$183.49
|
| Rate for Payer: Priority Health SBD |
$318.77
|
| Rate for Payer: Priority Health SBD |
$355.48
|
| Rate for Payer: UMR Bronson Commercial |
$248.27
|
| Rate for Payer: UMR Bronson Commercial |
$300.19
|
| Rate for Payer: UMR Bronson Commercial |
$222.63
|
| Rate for Payer: UMR Bronson Commercial |
$128.15
|
| 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 |
$379.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$423.19
|
|
|
DOXORUBICIN 50 MG/25 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$333.64
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
118501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.73 |
| Max. Negotiated Rate |
$300.28 |
| Rate for Payer: Aetna American Axle |
$216.87
|
| Rate for Payer: Aetna American Axle |
$179.97
|
| Rate for Payer: Aetna American Axle |
$161.23
|
| Rate for Payer: Aetna American Axle |
$169.61
|
| Rate for Payer: Aetna Commercial |
$283.59
|
| Rate for Payer: Aetna Commercial |
$221.80
|
| Rate for Payer: Aetna Commercial |
$210.84
|
| Rate for Payer: Aetna Commercial |
$235.35
|
| Rate for Payer: Aetna Medicare |
$138.44
|
| Rate for Payer: Aetna Medicare |
$130.47
|
| Rate for Payer: Aetna Medicare |
$124.02
|
| Rate for Payer: Aetna Medicare |
$166.82
|
| 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: Aetna New Business (MI Preferred) |
$169.61
|
| Rate for Payer: BCBS Complete |
$110.75
|
| Rate for Payer: BCBS Complete |
$99.22
|
| Rate for Payer: BCBS Complete |
$133.46
|
| Rate for Payer: BCBS Complete |
$104.38
|
| Rate for Payer: BCBS Trust/PPO |
$8.73
|
| Rate for Payer: BCBS Trust/PPO |
$8.73
|
| Rate for Payer: BCBS Trust/PPO |
$8.73
|
| Rate for Payer: BCBS Trust/PPO |
$8.73
|
| Rate for Payer: BCN Commercial |
$8.73
|
| Rate for Payer: BCN Commercial |
$8.73
|
| Rate for Payer: BCN Commercial |
$8.73
|
| Rate for Payer: BCN Commercial |
$8.73
|
| Rate for Payer: Cash Price |
$208.75
|
| Rate for Payer: Cash Price |
$266.91
|
| Rate for Payer: Cash Price |
$221.50
|
| Rate for Payer: Cash Price |
$208.75
|
| Rate for Payer: Cash Price |
$198.44
|
| Rate for Payer: Cash Price |
$198.44
|
| Rate for Payer: Cash Price |
$221.50
|
| Rate for Payer: Cash Price |
$266.91
|
| Rate for Payer: Cofinity Commercial |
$286.93
|
| Rate for Payer: Cofinity Commercial |
$224.41
|
| Rate for Payer: Cofinity Commercial |
$173.64
|
| Rate for Payer: Cofinity Commercial |
$213.32
|
| Rate for Payer: Cofinity Commercial |
$182.66
|
| Rate for Payer: Cofinity Commercial |
$193.82
|
| Rate for Payer: Cofinity Commercial |
$238.12
|
| Rate for Payer: Cofinity Commercial |
$233.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$182.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$193.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$173.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$233.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.44
|
| Rate for Payer: Healthscope Commercial |
$223.24
|
| Rate for Payer: Healthscope Commercial |
$300.28
|
| Rate for Payer: Healthscope Commercial |
$249.19
|
| Rate for Payer: Healthscope Commercial |
$234.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$193.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.66
|
| 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: Lakeland Regional Health Systems Commercial |
$195.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.84
|
| Rate for Payer: PHP Commercial |
$283.59
|
| Rate for Payer: PHP Commercial |
$221.80
|
| Rate for Payer: PHP Commercial |
$210.84
|
| Rate for Payer: PHP Commercial |
$235.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.97
|
| Rate for Payer: Priority Health SBD |
$156.27
|
| Rate for Payer: Priority Health SBD |
$174.43
|
| Rate for Payer: Priority Health SBD |
$164.39
|
| Rate for Payer: Priority Health SBD |
$210.19
|
| Rate for Payer: UMR Bronson Commercial |
$91.78
|
| Rate for Payer: UMR Bronson Commercial |
$102.45
|
| Rate for Payer: UMR Bronson Commercial |
$123.45
|
| Rate for Payer: UMR Bronson Commercial |
$96.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.70
|
| 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
|
IP
|
$248.05
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
118501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$109.14 |
| Max. Negotiated Rate |
$223.24 |
| Rate for Payer: Aetna American Axle |
$161.23
|
| Rate for Payer: Aetna American Axle |
$179.97
|
| Rate for Payer: Aetna Commercial |
$210.84
|
| Rate for Payer: Aetna Commercial |
$235.35
|
| 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 |
$198.44
|
| Rate for Payer: Cash Price |
$221.50
|
| Rate for Payer: Cofinity Commercial |
$238.12
|
| Rate for Payer: Cofinity Commercial |
$193.82
|
| Rate for Payer: Cofinity Commercial |
$173.64
|
| Rate for Payer: Cofinity Commercial |
$213.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$173.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$193.82
|
| 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 |
$223.24
|
| Rate for Payer: Healthscope Commercial |
$249.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.64
|
| 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 |
$207.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.84
|
| Rate for Payer: PHP Commercial |
$235.35
|
| Rate for Payer: PHP Commercial |
$210.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.97
|
| Rate for Payer: Priority Health SBD |
$156.27
|
| Rate for Payer: Priority Health SBD |
$174.43
|
| Rate for Payer: UMR Bronson Commercial |
$109.14
|
| Rate for Payer: UMR Bronson Commercial |
$121.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.66
|
|
|
DOXORUBICIN, PEGYLATED LIPOSOMAL 2 MG/ML INTRAVENOUS SUSPENSION
|
Facility
|
OP
|
$3,284.66
|
|
|
Service Code
|
HCPCS Q2050
|
| Hospital Charge Code |
27431
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$72.92 |
| Max. Negotiated Rate |
$2,956.19 |
| Rate for Payer: Cash Price |
$809.34
|
| Rate for Payer: Cash Price |
$2,416.34
|
| Rate for Payer: Cash Price |
$2,627.73
|
| Rate for Payer: Cash Price |
$1,157.04
|
| Rate for Payer: Cash Price |
$1,157.04
|
| Rate for Payer: Cash Price |
$809.34
|
| Rate for Payer: Cofinity Commercial |
$1,424.65
|
| Rate for Payer: Cofinity Commercial |
$870.04
|
| Rate for Payer: Cofinity Commercial |
$708.18
|
| Rate for Payer: Cofinity Commercial |
$844.69
|
| Rate for Payer: Cofinity Commercial |
$687.54
|
| Rate for Payer: Cofinity Commercial |
$2,824.81
|
| Rate for Payer: Cofinity Commercial |
$2,299.26
|
| Rate for Payer: Cofinity Commercial |
$1,012.41
|
| Rate for Payer: Cofinity Commercial |
$1,243.82
|
| Rate for Payer: Cofinity Commercial |
$2,597.57
|
| Rate for Payer: Cofinity Commercial |
$2,114.30
|
| Rate for Payer: Cofinity Commercial |
$1,045.63
|
| Rate for Payer: Cofinity Commercial |
$1,284.63
|
| Rate for Payer: Cofinity Commercial |
$1,750.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,424.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,012.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,114.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,045.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$708.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$687.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,299.26
|
| Rate for Payer: Railroad Medicare Medicare |
$136.05
|
| Rate for Payer: Railroad Medicare Medicare |
$136.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$382.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$382.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$382.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$382.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$382.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$382.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$382.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$136.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$136.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$136.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$136.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$136.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$136.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$136.05
|
| Rate for Payer: UHC Exchange |
$260.01
|
| Rate for Payer: UHC Exchange |
$260.01
|
| Rate for Payer: UHC Exchange |
$260.01
|
| Rate for Payer: UHC Exchange |
$260.01
|
| Rate for Payer: UHC Exchange |
$260.01
|
| Rate for Payer: UHC Exchange |
$260.01
|
| Rate for Payer: UHC Exchange |
$260.01
|
| Rate for Payer: UHC Medicare Advantage |
$136.05
|
| Rate for Payer: UHC Medicare Advantage |
$136.05
|
| Rate for Payer: UHC Medicare Advantage |
$136.05
|
| Rate for Payer: UHC Medicare Advantage |
$136.05
|
| Rate for Payer: UHC Medicare Advantage |
$136.05
|
| Rate for Payer: UHC Medicare Advantage |
$136.05
|
| Rate for Payer: UHC Medicare Advantage |
$136.05
|
| Rate for Payer: UHCCP Medicaid |
$72.92
|
| Rate for Payer: UHCCP Medicaid |
$72.92
|
| Rate for Payer: UHCCP Medicaid |
$72.92
|
| Rate for Payer: UHCCP Medicaid |
$72.92
|
| Rate for Payer: UHCCP Medicaid |
$72.92
|
| Rate for Payer: UHCCP Medicaid |
$72.92
|
| Rate for Payer: UHCCP Medicaid |
$72.92
|
| Rate for Payer: UMR Bronson Commercial |
$1,215.32
|
| Rate for Payer: UMR Bronson Commercial |
$1,117.56
|
| Rate for Payer: UMR Bronson Commercial |
$363.41
|
| Rate for Payer: UMR Bronson Commercial |
$374.32
|
| Rate for Payer: UMR Bronson Commercial |
$753.03
|
| Rate for Payer: UMR Bronson Commercial |
$552.69
|
| Rate for Payer: UMR Bronson Commercial |
$535.13
|
| Rate for Payer: VA VA |
$136.05
|
| Rate for Payer: VA VA |
$136.05
|
| Rate for Payer: VA VA |
$136.05
|
| Rate for Payer: VA VA |
$136.05
|
| Rate for Payer: VA VA |
$136.05
|
| Rate for Payer: VA VA |
$136.05
|
| Rate for Payer: VA VA |
$136.05
|
| Rate for Payer: Aetna American Axle |
$2,135.03
|
| Rate for Payer: Aetna American Axle |
$1,963.28
|
| Rate for Payer: Aetna American Axle |
$970.94
|
| Rate for Payer: Aetna American Axle |
$638.43
|
| Rate for Payer: Aetna American Axle |
$940.10
|
| Rate for Payer: Aetna American Axle |
$1,322.89
|
| Rate for Payer: Aetna American Axle |
$657.59
|
| Rate for Payer: Aetna Commercial |
$1,729.93
|
| Rate for Payer: Aetna Commercial |
$859.93
|
| Rate for Payer: Aetna Commercial |
$2,567.37
|
| Rate for Payer: Aetna Commercial |
$1,229.36
|
| Rate for Payer: Aetna Commercial |
$2,791.96
|
| Rate for Payer: Aetna Commercial |
$834.87
|
| Rate for Payer: Aetna Commercial |
$1,269.70
|
| Rate for Payer: Aetna Medicare |
$141.49
|
| Rate for Payer: Aetna Medicare |
$141.49
|
| Rate for Payer: Aetna Medicare |
$141.49
|
| Rate for Payer: Aetna Medicare |
$141.49
|
| Rate for Payer: Aetna Medicare |
$141.49
|
| Rate for Payer: Aetna Medicare |
$141.49
|
| Rate for Payer: Aetna Medicare |
$141.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$657.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,963.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,135.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$940.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$638.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$970.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,322.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$170.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$170.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$170.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$170.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$170.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$170.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$170.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$170.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$170.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$170.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$170.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$170.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$170.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$170.06
|
| Rate for Payer: BCBS Complete |
$76.57
|
| Rate for Payer: BCBS Complete |
$76.57
|
| Rate for Payer: BCBS Complete |
$76.57
|
| Rate for Payer: BCBS Complete |
$76.57
|
| Rate for Payer: BCBS Complete |
$76.57
|
| Rate for Payer: BCBS Complete |
$76.57
|
| Rate for Payer: BCBS Complete |
$76.57
|
| Rate for Payer: BCBS MAPPO |
$136.05
|
| Rate for Payer: BCBS MAPPO |
$136.05
|
| Rate for Payer: BCBS MAPPO |
$136.05
|
| Rate for Payer: BCBS MAPPO |
$136.05
|
| Rate for Payer: BCBS MAPPO |
$136.05
|
| Rate for Payer: BCBS MAPPO |
$136.05
|
| Rate for Payer: BCBS MAPPO |
$136.05
|
| Rate for Payer: BCBS Trust/PPO |
$358.83
|
| Rate for Payer: BCBS Trust/PPO |
$358.83
|
| Rate for Payer: BCBS Trust/PPO |
$358.83
|
| Rate for Payer: BCBS Trust/PPO |
$358.83
|
| Rate for Payer: BCBS Trust/PPO |
$358.83
|
| Rate for Payer: BCBS Trust/PPO |
$358.83
|
| Rate for Payer: BCBS Trust/PPO |
$358.83
|
| Rate for Payer: BCN Commercial |
$358.83
|
| Rate for Payer: BCN Commercial |
$358.83
|
| Rate for Payer: BCN Commercial |
$358.83
|
| Rate for Payer: BCN Commercial |
$358.83
|
| Rate for Payer: BCN Commercial |
$358.83
|
| Rate for Payer: BCN Commercial |
$358.83
|
| Rate for Payer: BCN Commercial |
$358.83
|
| Rate for Payer: BCN Medicare Advantage |
$136.05
|
| Rate for Payer: BCN Medicare Advantage |
$136.05
|
| Rate for Payer: BCN Medicare Advantage |
$136.05
|
| Rate for Payer: BCN Medicare Advantage |
$136.05
|
| Rate for Payer: BCN Medicare Advantage |
$136.05
|
| Rate for Payer: BCN Medicare Advantage |
$136.05
|
| Rate for Payer: BCN Medicare Advantage |
$136.05
|
| Rate for Payer: Cash Price |
$2,627.73
|
| Rate for Payer: Cash Price |
$1,628.17
|
| Rate for Payer: Cash Price |
$1,628.17
|
| Rate for Payer: Cash Price |
$2,416.34
|
| Rate for Payer: Cash Price |
$1,195.01
|
| Rate for Payer: Cash Price |
$1,195.01
|
| Rate for Payer: Cash Price |
$785.76
|
| Rate for Payer: Cash Price |
$785.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,628.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,157.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,627.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,416.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$785.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,195.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$809.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.05
|
| Rate for Payer: Healthscope Commercial |
$1,344.38
|
| Rate for Payer: Healthscope Commercial |
$2,956.19
|
| Rate for Payer: Healthscope Commercial |
$1,301.67
|
| Rate for Payer: Healthscope Commercial |
$883.98
|
| Rate for Payer: Healthscope Commercial |
$910.51
|
| Rate for Payer: Healthscope Commercial |
$1,831.69
|
| Rate for Payer: Healthscope Commercial |
$2,718.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,012.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,299.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$708.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,424.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$687.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,045.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,114.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$736.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,463.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,120.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,526.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,084.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$758.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,265.32
|
| Rate for Payer: Mclaren Medicaid |
$72.92
|
| Rate for Payer: Mclaren Medicaid |
$72.92
|
| Rate for Payer: Mclaren Medicaid |
$72.92
|
| Rate for Payer: Mclaren Medicaid |
$72.92
|
| Rate for Payer: Mclaren Medicaid |
$72.92
|
| Rate for Payer: Mclaren Medicaid |
$72.92
|
| Rate for Payer: Mclaren Medicaid |
$72.92
|
| Rate for Payer: Mclaren Medicare |
$136.05
|
| Rate for Payer: Mclaren Medicare |
$136.05
|
| Rate for Payer: Mclaren Medicare |
$136.05
|
| Rate for Payer: Mclaren Medicare |
$136.05
|
| Rate for Payer: Mclaren Medicare |
$136.05
|
| Rate for Payer: Mclaren Medicare |
$136.05
|
| Rate for Payer: Mclaren Medicare |
$136.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$142.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$142.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$142.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$142.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$142.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$142.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$142.85
|
| Rate for Payer: Meridian Medicaid |
$76.57
|
| Rate for Payer: Meridian Medicaid |
$76.57
|
| Rate for Payer: Meridian Medicaid |
$76.57
|
| Rate for Payer: Meridian Medicaid |
$76.57
|
| Rate for Payer: Meridian Medicaid |
$76.57
|
| Rate for Payer: Meridian Medicaid |
$76.57
|
| Rate for Payer: Meridian Medicaid |
$76.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.46
|
| 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 |
$1,269.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$834.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,229.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$859.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,791.96
|
| Rate for Payer: Nomi Health Commercial |
$408.15
|
| Rate for Payer: Nomi Health Commercial |
$408.15
|
| Rate for Payer: Nomi Health Commercial |
$408.15
|
| Rate for Payer: Nomi Health Commercial |
$408.15
|
| Rate for Payer: Nomi Health Commercial |
$408.15
|
| Rate for Payer: Nomi Health Commercial |
$408.15
|
| Rate for Payer: Nomi Health Commercial |
$408.15
|
| Rate for Payer: PACE Medicare |
$129.25
|
| Rate for Payer: PACE Medicare |
$129.25
|
| Rate for Payer: PACE Medicare |
$129.25
|
| Rate for Payer: PACE Medicare |
$129.25
|
| Rate for Payer: PACE Medicare |
$129.25
|
| Rate for Payer: PACE Medicare |
$129.25
|
| Rate for Payer: PACE Medicare |
$129.25
|
| Rate for Payer: PACE SWMI |
$136.05
|
| Rate for Payer: PACE SWMI |
$136.05
|
| Rate for Payer: PACE SWMI |
$136.05
|
| Rate for Payer: PACE SWMI |
$136.05
|
| Rate for Payer: PACE SWMI |
$136.05
|
| Rate for Payer: PACE SWMI |
$136.05
|
| Rate for Payer: PACE SWMI |
$136.05
|
| Rate for Payer: PHP Commercial |
$2,567.37
|
| Rate for Payer: PHP Commercial |
$834.87
|
| Rate for Payer: PHP Commercial |
$2,791.96
|
| Rate for Payer: PHP Commercial |
$1,269.70
|
| Rate for Payer: PHP Commercial |
$859.93
|
| Rate for Payer: PHP Commercial |
$1,729.93
|
| Rate for Payer: PHP Commercial |
$1,229.36
|
| Rate for Payer: PHP Medicare Advantage |
$136.05
|
| Rate for Payer: PHP Medicare Advantage |
$136.05
|
| Rate for Payer: PHP Medicare Advantage |
$136.05
|
| Rate for Payer: PHP Medicare Advantage |
$136.05
|
| Rate for Payer: PHP Medicare Advantage |
$136.05
|
| Rate for Payer: PHP Medicare Advantage |
$136.05
|
| Rate for Payer: PHP Medicare Advantage |
$136.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,322.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$638.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$657.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,963.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,135.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$940.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$970.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$382.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$382.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$382.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$382.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$382.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$382.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$382.99
|
| Rate for Payer: Priority Health Medicare |
$136.05
|
| Rate for Payer: Priority Health Medicare |
$136.05
|
| Rate for Payer: Priority Health Medicare |
$136.05
|
| Rate for Payer: Priority Health Medicare |
$136.05
|
| Rate for Payer: Priority Health Medicare |
$136.05
|
| Rate for Payer: Priority Health Medicare |
$136.05
|
| Rate for Payer: Priority Health Medicare |
$136.05
|
| Rate for Payer: Priority Health Narrow Network |
$306.39
|
| Rate for Payer: Priority Health Narrow Network |
$306.39
|
| Rate for Payer: Priority Health Narrow Network |
$306.39
|
| Rate for Payer: Priority Health Narrow Network |
$306.39
|
| Rate for Payer: Priority Health Narrow Network |
$306.39
|
| Rate for Payer: Priority Health Narrow Network |
$306.39
|
| Rate for Payer: Priority Health Narrow Network |
$306.39
|
| Rate for Payer: Priority Health SBD |
$2,069.34
|
| Rate for Payer: Priority Health SBD |
$637.36
|
| Rate for Payer: Priority Health SBD |
$1,282.18
|
| Rate for Payer: Priority Health SBD |
$941.07
|
| Rate for Payer: Priority Health SBD |
$1,902.87
|
| Rate for Payer: Priority Health SBD |
$911.17
|
| Rate for Payer: Priority Health SBD |
$618.79
|
| Rate for Payer: Railroad Medicare Medicare |
$136.05
|
| Rate for Payer: Railroad Medicare Medicare |
$136.05
|
| Rate for Payer: Railroad Medicare Medicare |
$136.05
|
| Rate for Payer: Railroad Medicare Medicare |
$136.05
|
| Rate for Payer: Railroad Medicare Medicare |
$136.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,526.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,120.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$736.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,463.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$758.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,265.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,084.72
|
|
|
DOXORUBICIN, PEGYLATED LIPOSOMAL 2 MG/ML INTRAVENOUS SUSPENSION
|
Facility
|
IP
|
$982.20
|
|
|
Service Code
|
HCPCS Q2050
|
| Hospital Charge Code |
27431
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$432.17 |
| Max. Negotiated Rate |
$883.98 |
| Rate for Payer: UMR Bronson Commercial |
$1,328.99
|
| Rate for Payer: UMR Bronson Commercial |
$432.17
|
| Rate for Payer: Aetna American Axle |
$638.43
|
| Rate for Payer: Aetna American Axle |
$1,963.28
|
| 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 Commercial |
$844.69
|
| Rate for Payer: Cofinity Commercial |
$687.54
|
| Rate for Payer: Cofinity Commercial |
$2,597.57
|
| Rate for Payer: Cofinity Commercial |
$2,114.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$687.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,114.30
|
| 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: PHP Commercial |
$834.87
|
| Rate for Payer: PHP Commercial |
$2,567.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,963.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$638.43
|
| Rate for Payer: Priority Health SBD |
$618.79
|
| Rate for Payer: Priority Health SBD |
$1,902.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,265.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$736.65
|
|
|
DOXYCYCLINE 50 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$2,288.57
|
|
|
Service Code
|
NDC 00069097195
|
| Hospital Charge Code |
2621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,006.97 |
| Max. Negotiated Rate |
$2,059.71 |
| Rate for Payer: Healthscope Commercial |
$2,059.71
|
| Rate for Payer: Aetna American Axle |
$1,487.57
|
| Rate for Payer: Aetna Commercial |
$1,945.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,487.57
|
| Rate for Payer: Cash Price |
$1,830.86
|
| Rate for Payer: Cofinity Commercial |
$1,602.00
|
| Rate for Payer: Cofinity Commercial |
$1,968.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,602.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,830.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,602.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,716.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,945.28
|
| Rate for Payer: PHP Commercial |
$1,945.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,487.57
|
| Rate for Payer: Priority Health SBD |
$1,441.80
|
| Rate for Payer: UMR Bronson Commercial |
$1,006.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,716.43
|
|
|
DOXYCYCLINE 50 MG/5 ML ORAL SYRUP
|
Facility
|
OP
|
$2,288.57
|
|
|
Service Code
|
NDC 00069097195
|
| Hospital Charge Code |
2621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$846.77 |
| Max. Negotiated Rate |
$2,059.71 |
| Rate for Payer: Aetna American Axle |
$1,487.57
|
| Rate for Payer: Aetna Commercial |
$1,945.28
|
| Rate for Payer: Aetna Medicare |
$1,144.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,487.57
|
| Rate for Payer: BCBS Complete |
$915.43
|
| Rate for Payer: Cash Price |
$1,830.86
|
| Rate for Payer: Cofinity Commercial |
$1,602.00
|
| Rate for Payer: Cofinity Commercial |
$1,968.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,602.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,830.86
|
| Rate for Payer: Healthscope Commercial |
$2,059.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,602.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,716.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,945.28
|
| Rate for Payer: PHP Commercial |
$1,945.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,487.57
|
| Rate for Payer: Priority Health SBD |
$1,441.80
|
| Rate for Payer: UMR Bronson Commercial |
$846.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,716.43
|
|
|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$50.08
|
|
|
Service Code
|
NDC 00143938101
|
| Hospital Charge Code |
2622
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.04 |
| Max. Negotiated Rate |
$45.07 |
| Rate for Payer: Aetna American Axle |
$32.55
|
| Rate for Payer: Aetna Commercial |
$42.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.55
|
| Rate for Payer: Cash Price |
$40.06
|
| Rate for Payer: Cofinity Commercial |
$35.06
|
| Rate for Payer: Cofinity Commercial |
$43.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.06
|
| Rate for Payer: Healthscope Commercial |
$45.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.57
|
| Rate for Payer: PHP Commercial |
$42.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.55
|
| Rate for Payer: Priority Health SBD |
$31.55
|
| Rate for Payer: UMR Bronson Commercial |
$22.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.56
|
|
|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$50.08
|
|
|
Service Code
|
NDC 00143938110
|
| Hospital Charge Code |
2622
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.53 |
| Max. Negotiated Rate |
$45.07 |
| Rate for Payer: Aetna Medicare |
$25.04
|
| Rate for Payer: Aetna American Axle |
$32.55
|
| Rate for Payer: Aetna Commercial |
$42.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.55
|
| Rate for Payer: BCBS Complete |
$20.03
|
| Rate for Payer: Cash Price |
$40.06
|
| Rate for Payer: Cofinity Commercial |
$35.06
|
| Rate for Payer: Cofinity Commercial |
$43.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.06
|
| Rate for Payer: Healthscope Commercial |
$45.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.57
|
| Rate for Payer: PHP Commercial |
$42.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.55
|
| Rate for Payer: Priority Health SBD |
$31.55
|
| Rate for Payer: UMR Bronson Commercial |
$18.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.56
|
|
|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$50.08
|
|
|
Service Code
|
NDC 00143938110
|
| Hospital Charge Code |
2622
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.04 |
| Max. Negotiated Rate |
$45.07 |
| Rate for Payer: Aetna American Axle |
$32.55
|
| Rate for Payer: Aetna Commercial |
$42.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.55
|
| Rate for Payer: Cash Price |
$40.06
|
| Rate for Payer: Cofinity Commercial |
$35.06
|
| Rate for Payer: Cofinity Commercial |
$43.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.06
|
| Rate for Payer: Healthscope Commercial |
$45.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.57
|
| Rate for Payer: PHP Commercial |
$42.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.55
|
| Rate for Payer: Priority Health SBD |
$31.55
|
| Rate for Payer: UMR Bronson Commercial |
$22.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.56
|
|
|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
NDC 68382091010
|
| Hospital Charge Code |
2622
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Aetna American Axle |
$27.95
|
| Rate for Payer: Aetna Commercial |
$36.55
|
| Rate for Payer: Aetna Medicare |
$21.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.95
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$30.10
|
| Rate for Payer: Cofinity Commercial |
$36.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.40
|
| Rate for Payer: Healthscope Commercial |
$38.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.55
|
| Rate for Payer: PHP Commercial |
$36.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health SBD |
$27.09
|
| Rate for Payer: UMR Bronson Commercial |
$15.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.25
|
|
|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$68.25
|
|
|
Service Code
|
NDC 63323013011
|
| Hospital Charge Code |
2622
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.25 |
| Max. Negotiated Rate |
$61.42 |
| Rate for Payer: Aetna American Axle |
$44.36
|
| Rate for Payer: Aetna Commercial |
$58.01
|
| Rate for Payer: Aetna Medicare |
$34.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.36
|
| Rate for Payer: BCBS Complete |
$27.30
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cofinity Commercial |
$47.78
|
| Rate for Payer: Cofinity Commercial |
$58.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.60
|
| Rate for Payer: Healthscope Commercial |
$61.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.01
|
| Rate for Payer: PHP Commercial |
$58.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.36
|
| Rate for Payer: Priority Health SBD |
$43.00
|
| Rate for Payer: UMR Bronson Commercial |
$25.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.19
|
|
|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$50.08
|
|
|
Service Code
|
NDC 00143938101
|
| Hospital Charge Code |
2622
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.53 |
| Max. Negotiated Rate |
$45.07 |
| Rate for Payer: Aetna American Axle |
$32.55
|
| Rate for Payer: Aetna Commercial |
$42.57
|
| Rate for Payer: Aetna Medicare |
$25.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.55
|
| Rate for Payer: BCBS Complete |
$20.03
|
| Rate for Payer: Cash Price |
$40.06
|
| Rate for Payer: Cofinity Commercial |
$35.06
|
| Rate for Payer: Cofinity Commercial |
$43.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.06
|
| Rate for Payer: Healthscope Commercial |
$45.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.57
|
| Rate for Payer: PHP Commercial |
$42.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.55
|
| Rate for Payer: Priority Health SBD |
$31.55
|
| Rate for Payer: UMR Bronson Commercial |
$18.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.56
|
|
