|
MEPIVACAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$25.10
|
|
|
Service Code
|
HCPCS J0670
|
| Hospital Charge Code |
105637
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.04 |
| Max. Negotiated Rate |
$22.59 |
| Rate for Payer: Aetna American Axle |
$16.32
|
| Rate for Payer: Aetna American Axle |
$11.72
|
| Rate for Payer: Aetna Commercial |
$21.34
|
| Rate for Payer: Aetna Commercial |
$15.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.32
|
| Rate for Payer: Cash Price |
$14.42
|
| Rate for Payer: Cash Price |
$20.08
|
| Rate for Payer: Cofinity Commercial |
$12.62
|
| Rate for Payer: Cofinity Commercial |
$15.51
|
| Rate for Payer: Cofinity Commercial |
$21.59
|
| Rate for Payer: Cofinity Commercial |
$17.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.08
|
| Rate for Payer: Healthscope Commercial |
$22.59
|
| Rate for Payer: Healthscope Commercial |
$16.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.34
|
| Rate for Payer: PHP Commercial |
$21.34
|
| Rate for Payer: PHP Commercial |
$15.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.57
|
| Rate for Payer: Priority Health SBD |
$15.81
|
| Rate for Payer: Priority Health SBD |
$11.36
|
| Rate for Payer: UMR Bronson Commercial |
$7.93
|
| Rate for Payer: UMR Bronson Commercial |
$11.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.52
|
|
|
MEPIVACAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
IP
|
$27.86
|
|
|
Service Code
|
HCPCS J0670
|
| Hospital Charge Code |
105638
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.26 |
| Max. Negotiated Rate |
$25.07 |
| Rate for Payer: Aetna American Axle |
$18.11
|
| Rate for Payer: Aetna American Axle |
$16.84
|
| Rate for Payer: Aetna Commercial |
$23.68
|
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$22.29
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$23.96
|
| Rate for Payer: Cofinity Commercial |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Cofinity Commercial |
$19.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.29
|
| Rate for Payer: Healthscope Commercial |
$25.07
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.02
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Commercial |
$23.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.13
|
| Rate for Payer: Priority Health SBD |
$17.55
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: UMR Bronson Commercial |
$11.40
|
| Rate for Payer: UMR Bronson Commercial |
$12.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.42
|
|
|
MEPOLIZUMAB 100 MG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$7,673.02
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
176478
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.69 |
| Max. Negotiated Rate |
$6,905.72 |
| Rate for Payer: Aetna American Axle |
$4,987.46
|
| Rate for Payer: Aetna Commercial |
$6,522.07
|
| Rate for Payer: Aetna Medicare |
$31.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,987.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.13
|
| Rate for Payer: BCBS Complete |
$17.52
|
| Rate for Payer: BCBS MAPPO |
$30.50
|
| Rate for Payer: BCBS Trust/PPO |
$98.58
|
| Rate for Payer: BCN Medicare Advantage |
$30.50
|
| Rate for Payer: Cash Price |
$6,138.42
|
| Rate for Payer: Cash Price |
$6,138.42
|
| Rate for Payer: Cofinity Commercial |
$5,371.11
|
| Rate for Payer: Cofinity Commercial |
$6,598.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,138.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.50
|
| Rate for Payer: Healthscope Commercial |
$6,905.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,371.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,754.76
|
| Rate for Payer: Mclaren Medicaid |
$16.69
|
| Rate for Payer: Mclaren Medicare |
$30.50
|
| Rate for Payer: Meridian Medicaid |
$17.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$32.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,522.07
|
| Rate for Payer: PACE Medicare |
$28.98
|
| Rate for Payer: PACE SWMI |
$30.50
|
| Rate for Payer: PHP Commercial |
$6,522.07
|
| Rate for Payer: PHP Medicare Advantage |
$30.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,371.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$88.59
|
| Rate for Payer: Priority Health Medicare |
$30.50
|
| Rate for Payer: Priority Health Narrow Network |
$70.87
|
| Rate for Payer: Priority Health SBD |
$4,834.00
|
| Rate for Payer: Railroad Medicare Medicare |
$30.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.50
|
| Rate for Payer: UHC Medicare Advantage |
$31.42
|
| Rate for Payer: UMR Bronson Commercial |
$2,839.02
|
| Rate for Payer: VA VA |
$30.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,754.76
|
|
|
MEPOLIZUMAB 100 MG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$7,673.02
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
176478
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,376.13 |
| Max. Negotiated Rate |
$6,905.72 |
| Rate for Payer: Aetna American Axle |
$4,987.46
|
| Rate for Payer: Aetna Commercial |
$6,522.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,987.46
|
| Rate for Payer: Cash Price |
$6,138.42
|
| Rate for Payer: Cofinity Commercial |
$5,371.11
|
| Rate for Payer: Cofinity Commercial |
$6,598.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,138.42
|
| Rate for Payer: Healthscope Commercial |
$6,905.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,371.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,754.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,522.07
|
| Rate for Payer: PHP Commercial |
$6,522.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,371.11
|
| Rate for Payer: Priority Health SBD |
$4,834.00
|
| Rate for Payer: UMR Bronson Commercial |
$3,376.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,754.76
|
|
|
MERCAPTOPURINE 50 MG TABLET
|
Facility
|
IP
|
$96.96
|
|
|
Service Code
|
NDC 0054-4581-11
|
| Hospital Charge Code |
10531
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.66 |
| Max. Negotiated Rate |
$87.26 |
| Rate for Payer: Aetna American Axle |
$63.02
|
| Rate for Payer: Aetna Commercial |
$82.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.02
|
| Rate for Payer: Cash Price |
$77.57
|
| Rate for Payer: Cofinity Commercial |
$67.87
|
| Rate for Payer: Cofinity Commercial |
$83.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.57
|
| Rate for Payer: Healthscope Commercial |
$87.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$82.42
|
| Rate for Payer: PHP Commercial |
$82.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.87
|
| Rate for Payer: Priority Health SBD |
$61.08
|
| Rate for Payer: UMR Bronson Commercial |
$42.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.72
|
|
|
MEROPENEM 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$23.97
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
17380
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$21.57 |
| Rate for Payer: Aetna American Axle |
$15.58
|
| Rate for Payer: Aetna Commercial |
$20.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.58
|
| Rate for Payer: BCBS Complete |
$9.59
|
| Rate for Payer: BCBS Trust/PPO |
$1.46
|
| Rate for Payer: Cash Price |
$19.18
|
| Rate for Payer: Cash Price |
$19.18
|
| Rate for Payer: Cofinity Commercial |
$20.61
|
| Rate for Payer: Cofinity Commercial |
$16.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.18
|
| Rate for Payer: Healthscope Commercial |
$21.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.37
|
| Rate for Payer: PHP Commercial |
$20.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.78
|
| Rate for Payer: Priority Health SBD |
$15.10
|
| Rate for Payer: UMR Bronson Commercial |
$8.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.98
|
|
|
MEROPENEM 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$22.72
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
17380
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$20.45 |
| Rate for Payer: Aetna American Axle |
$14.77
|
| Rate for Payer: Aetna American Axle |
$15.58
|
| Rate for Payer: Aetna American Axle |
$18.53
|
| Rate for Payer: Aetna Commercial |
$19.31
|
| Rate for Payer: Aetna Commercial |
$24.23
|
| Rate for Payer: Aetna Commercial |
$20.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.53
|
| Rate for Payer: Cash Price |
$19.18
|
| Rate for Payer: Cash Price |
$18.18
|
| Rate for Payer: Cash Price |
$22.81
|
| Rate for Payer: Cofinity Commercial |
$15.90
|
| Rate for Payer: Cofinity Commercial |
$20.61
|
| Rate for Payer: Cofinity Commercial |
$16.78
|
| Rate for Payer: Cofinity Commercial |
$19.96
|
| Rate for Payer: Cofinity Commercial |
$24.52
|
| Rate for Payer: Cofinity Commercial |
$19.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.81
|
| Rate for Payer: Healthscope Commercial |
$20.45
|
| Rate for Payer: Healthscope Commercial |
$25.66
|
| Rate for Payer: Healthscope Commercial |
$21.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.31
|
| Rate for Payer: PHP Commercial |
$20.37
|
| Rate for Payer: PHP Commercial |
$24.23
|
| Rate for Payer: PHP Commercial |
$19.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.78
|
| Rate for Payer: Priority Health SBD |
$17.96
|
| Rate for Payer: Priority Health SBD |
$15.10
|
| Rate for Payer: Priority Health SBD |
$14.31
|
| Rate for Payer: UMR Bronson Commercial |
$10.00
|
| Rate for Payer: UMR Bronson Commercial |
$10.55
|
| Rate for Payer: UMR Bronson Commercial |
$12.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.04
|
|
|
MEROPENEM 500 MG CUSTOM INTRAVENOUS SOLUTION (CHARGE IN INCREMENTS)
|
Facility
|
IP
|
$44.50
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
180571
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.58 |
| Max. Negotiated Rate |
$40.05 |
| Rate for Payer: Aetna American Axle |
$28.92
|
| Rate for Payer: Aetna Commercial |
$37.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.92
|
| Rate for Payer: Cash Price |
$35.60
|
| Rate for Payer: Cofinity Commercial |
$31.15
|
| Rate for Payer: Cofinity Commercial |
$38.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.60
|
| Rate for Payer: Healthscope Commercial |
$40.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.82
|
| Rate for Payer: PHP Commercial |
$37.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.15
|
| Rate for Payer: Priority Health SBD |
$28.04
|
| Rate for Payer: UMR Bronson Commercial |
$19.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.38
|
|
|
MEROPENEM 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.89
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
17379
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.31 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Aetna American Axle |
$12.28
|
| Rate for Payer: Aetna American Axle |
$12.94
|
| Rate for Payer: Aetna American Axle |
$12.73
|
| Rate for Payer: Aetna American Axle |
$15.55
|
| Rate for Payer: Aetna Commercial |
$16.06
|
| Rate for Payer: Aetna Commercial |
$20.33
|
| Rate for Payer: Aetna Commercial |
$16.92
|
| Rate for Payer: Aetna Commercial |
$16.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.94
|
| Rate for Payer: Cash Price |
$15.67
|
| Rate for Payer: Cash Price |
$15.11
|
| Rate for Payer: Cash Price |
$15.92
|
| Rate for Payer: Cash Price |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$13.93
|
| Rate for Payer: Cofinity Commercial |
$17.11
|
| Rate for Payer: Cofinity Commercial |
$13.71
|
| Rate for Payer: Cofinity Commercial |
$16.85
|
| Rate for Payer: Cofinity Commercial |
$20.57
|
| Rate for Payer: Cofinity Commercial |
$16.74
|
| Rate for Payer: Cofinity Commercial |
$13.22
|
| Rate for Payer: Cofinity Commercial |
$16.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.14
|
| Rate for Payer: Healthscope Commercial |
$17.63
|
| Rate for Payer: Healthscope Commercial |
$17.91
|
| Rate for Payer: Healthscope Commercial |
$17.00
|
| Rate for Payer: Healthscope Commercial |
$21.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.06
|
| Rate for Payer: PHP Commercial |
$20.33
|
| Rate for Payer: PHP Commercial |
$16.65
|
| Rate for Payer: PHP Commercial |
$16.06
|
| Rate for Payer: PHP Commercial |
$16.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.74
|
| Rate for Payer: Priority Health SBD |
$12.34
|
| Rate for Payer: Priority Health SBD |
$12.54
|
| Rate for Payer: Priority Health SBD |
$15.07
|
| Rate for Payer: Priority Health SBD |
$11.90
|
| Rate for Payer: UMR Bronson Commercial |
$10.52
|
| Rate for Payer: UMR Bronson Commercial |
$8.31
|
| Rate for Payer: UMR Bronson Commercial |
$8.76
|
| Rate for Payer: UMR Bronson Commercial |
$8.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.92
|
|
|
MEROPENEM IV 0.00001 MG/ML IVPB FOR DESENSITIZATION 50 ML
|
Facility
|
IP
|
$1.25
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
180552
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$1.12 |
| Rate for Payer: Aetna American Axle |
$0.81
|
| Rate for Payer: Aetna Commercial |
$1.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.81
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Cofinity Commercial |
$0.88
|
| Rate for Payer: Cofinity Commercial |
$1.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.00
|
| Rate for Payer: Healthscope Commercial |
$1.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.06
|
| Rate for Payer: PHP Commercial |
$1.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.88
|
| Rate for Payer: Priority Health SBD |
$0.79
|
| Rate for Payer: UMR Bronson Commercial |
$0.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.94
|
|
|
MEROPENEM IV 0.0001 MG/ML IVPB FOR DESENSITIZATION 50 ML
|
Facility
|
IP
|
$1.25
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
180553
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$1.12 |
| Rate for Payer: Aetna American Axle |
$0.81
|
| Rate for Payer: Aetna Commercial |
$1.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.81
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Cofinity Commercial |
$0.88
|
| Rate for Payer: Cofinity Commercial |
$1.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.00
|
| Rate for Payer: Healthscope Commercial |
$1.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.06
|
| Rate for Payer: PHP Commercial |
$1.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.88
|
| Rate for Payer: Priority Health SBD |
$0.79
|
| Rate for Payer: UMR Bronson Commercial |
$0.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.94
|
|
|
MEROPENEM IV 0.001 MG/ML IVPB FOR DESENSITIZATION 50 ML
|
Facility
|
IP
|
$1.25
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
180554
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$1.12 |
| Rate for Payer: Aetna American Axle |
$0.81
|
| Rate for Payer: Aetna Commercial |
$1.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.81
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Cofinity Commercial |
$1.08
|
| Rate for Payer: Cofinity Commercial |
$0.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.00
|
| Rate for Payer: Healthscope Commercial |
$1.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.06
|
| Rate for Payer: PHP Commercial |
$1.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.88
|
| Rate for Payer: Priority Health SBD |
$0.79
|
| Rate for Payer: UMR Bronson Commercial |
$0.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.94
|
|
|
MEROPENEM IV 0.01 MG/ML IVPB FOR DESENSITIZATION 50 ML
|
Facility
|
IP
|
$1.25
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
180555
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$1.12 |
| Rate for Payer: Aetna American Axle |
$0.81
|
| Rate for Payer: Aetna Commercial |
$1.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.81
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Cofinity Commercial |
$0.88
|
| Rate for Payer: Cofinity Commercial |
$1.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.00
|
| Rate for Payer: Healthscope Commercial |
$1.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.06
|
| Rate for Payer: PHP Commercial |
$1.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.88
|
| Rate for Payer: Priority Health SBD |
$0.79
|
| Rate for Payer: UMR Bronson Commercial |
$0.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.94
|
|
|
MESALAMINE 1,000 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$3,997.67
|
|
|
Service Code
|
NDC 58914-501-56
|
| Hospital Charge Code |
40369
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,758.97 |
| Max. Negotiated Rate |
$3,597.90 |
| Rate for Payer: Aetna American Axle |
$2,598.49
|
| Rate for Payer: Aetna Commercial |
$3,398.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,598.49
|
| Rate for Payer: Cash Price |
$3,198.14
|
| Rate for Payer: Cofinity Commercial |
$2,798.37
|
| Rate for Payer: Cofinity Commercial |
$3,438.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,198.14
|
| Rate for Payer: Healthscope Commercial |
$3,597.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,798.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,998.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,398.02
|
| Rate for Payer: PHP Commercial |
$3,398.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,798.37
|
| Rate for Payer: Priority Health SBD |
$2,518.53
|
| Rate for Payer: UMR Bronson Commercial |
$1,758.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,998.25
|
|
|
MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$3,865.02
|
|
|
Service Code
|
NDC 54092-476-12
|
| Hospital Charge Code |
78310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,700.61 |
| Max. Negotiated Rate |
$3,478.52 |
| Rate for Payer: Aetna American Axle |
$2,512.26
|
| Rate for Payer: Aetna Commercial |
$3,285.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,512.26
|
| Rate for Payer: Cash Price |
$3,092.02
|
| Rate for Payer: Cofinity Commercial |
$2,705.51
|
| Rate for Payer: Cofinity Commercial |
$3,323.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,092.02
|
| Rate for Payer: Healthscope Commercial |
$3,478.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,705.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,898.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,285.27
|
| Rate for Payer: PHP Commercial |
$3,285.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,705.51
|
| Rate for Payer: Priority Health SBD |
$2,434.96
|
| Rate for Payer: UMR Bronson Commercial |
$1,700.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,898.76
|
|
|
MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$1,419.47
|
|
|
Service Code
|
NDC 68382-711-19
|
| Hospital Charge Code |
78310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$624.57 |
| Max. Negotiated Rate |
$1,277.52 |
| Rate for Payer: Aetna American Axle |
$922.66
|
| Rate for Payer: Aetna Commercial |
$1,206.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$922.66
|
| Rate for Payer: Cash Price |
$1,135.58
|
| Rate for Payer: Cofinity Commercial |
$1,220.74
|
| Rate for Payer: Cofinity Commercial |
$993.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,135.58
|
| Rate for Payer: Healthscope Commercial |
$1,277.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$993.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,064.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,206.55
|
| Rate for Payer: PHP Commercial |
$1,206.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$993.63
|
| Rate for Payer: Priority Health SBD |
$894.27
|
| Rate for Payer: UMR Bronson Commercial |
$624.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,064.60
|
|
|
MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)
|
Facility
|
IP
|
$1,441.89
|
|
|
Service Code
|
NDC 59762-0117-1
|
| Hospital Charge Code |
179241
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$634.43 |
| Max. Negotiated Rate |
$1,297.70 |
| Rate for Payer: Aetna American Axle |
$937.23
|
| Rate for Payer: Aetna Commercial |
$1,225.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$937.23
|
| Rate for Payer: Cash Price |
$1,153.51
|
| Rate for Payer: Cofinity Commercial |
$1,009.32
|
| Rate for Payer: Cofinity Commercial |
$1,240.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,153.51
|
| Rate for Payer: Healthscope Commercial |
$1,297.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,009.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,081.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,225.61
|
| Rate for Payer: PHP Commercial |
$1,225.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,009.32
|
| Rate for Payer: Priority Health SBD |
$908.39
|
| Rate for Payer: UMR Bronson Commercial |
$634.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,081.42
|
|
|
MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)
|
Facility
|
IP
|
$2,402.93
|
|
|
Service Code
|
NDC 0023-5853-18
|
| Hospital Charge Code |
179241
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,057.29 |
| Max. Negotiated Rate |
$2,162.64 |
| Rate for Payer: Aetna American Axle |
$1,561.90
|
| Rate for Payer: Aetna Commercial |
$2,042.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,561.90
|
| Rate for Payer: Cash Price |
$1,922.34
|
| Rate for Payer: Cofinity Commercial |
$1,682.05
|
| Rate for Payer: Cofinity Commercial |
$2,066.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,922.34
|
| Rate for Payer: Healthscope Commercial |
$2,162.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,682.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,802.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,042.49
|
| Rate for Payer: PHP Commercial |
$2,042.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,682.05
|
| Rate for Payer: Priority Health SBD |
$1,513.85
|
| Rate for Payer: UMR Bronson Commercial |
$1,057.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,802.20
|
|
|
MESALAMINE 4 GRAM/60 ML ENEMA
|
Facility
|
IP
|
$46.85
|
|
|
Service Code
|
NDC 62559-420-07
|
| Hospital Charge Code |
10535
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.61 |
| Max. Negotiated Rate |
$42.16 |
| Rate for Payer: Aetna American Axle |
$30.45
|
| Rate for Payer: Aetna Commercial |
$39.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.45
|
| Rate for Payer: Cash Price |
$37.48
|
| Rate for Payer: Cofinity Commercial |
$32.80
|
| Rate for Payer: Cofinity Commercial |
$40.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.48
|
| Rate for Payer: Healthscope Commercial |
$42.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.82
|
| Rate for Payer: PHP Commercial |
$39.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.80
|
| Rate for Payer: Priority Health SBD |
$29.52
|
| Rate for Payer: UMR Bronson Commercial |
$20.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.14
|
|
|
MESALAMINE 4 GRAM/60 ML ENEMA
|
Facility
|
IP
|
$38.19
|
|
|
Service Code
|
NDC 45802-098-46
|
| Hospital Charge Code |
10535
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$34.37 |
| Rate for Payer: Aetna American Axle |
$24.82
|
| Rate for Payer: Aetna Commercial |
$32.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.82
|
| Rate for Payer: Cash Price |
$30.55
|
| Rate for Payer: Cofinity Commercial |
$26.73
|
| Rate for Payer: Cofinity Commercial |
$32.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.55
|
| Rate for Payer: Healthscope Commercial |
$34.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.46
|
| Rate for Payer: PHP Commercial |
$32.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.73
|
| Rate for Payer: Priority Health SBD |
$24.06
|
| Rate for Payer: UMR Bronson Commercial |
$16.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.64
|
|
|
MESALAMINE 800 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$3,993.34
|
|
|
Service Code
|
NDC 68382-435-28
|
| Hospital Charge Code |
96949
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,757.07 |
| Max. Negotiated Rate |
$3,594.01 |
| Rate for Payer: Aetna American Axle |
$2,595.67
|
| Rate for Payer: Aetna Commercial |
$3,394.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,595.67
|
| Rate for Payer: Cash Price |
$3,194.67
|
| Rate for Payer: Cofinity Commercial |
$2,795.34
|
| Rate for Payer: Cofinity Commercial |
$3,434.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,194.67
|
| Rate for Payer: Healthscope Commercial |
$3,594.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,795.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,995.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,394.34
|
| Rate for Payer: PHP Commercial |
$3,394.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,795.34
|
| Rate for Payer: Priority Health SBD |
$2,515.80
|
| Rate for Payer: UMR Bronson Commercial |
$1,757.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,995.00
|
|
|
MESALAMINE ER 0.375 GRAM CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$1,756.02
|
|
|
Service Code
|
NDC 65649-103-02
|
| Hospital Charge Code |
95687
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$772.65 |
| Max. Negotiated Rate |
$1,580.42 |
| Rate for Payer: Aetna American Axle |
$1,141.41
|
| Rate for Payer: Aetna Commercial |
$1,492.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,141.41
|
| Rate for Payer: Cash Price |
$1,404.82
|
| Rate for Payer: Cofinity Commercial |
$1,229.21
|
| Rate for Payer: Cofinity Commercial |
$1,510.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,404.82
|
| Rate for Payer: Healthscope Commercial |
$1,580.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,229.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,317.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,492.62
|
| Rate for Payer: PHP Commercial |
$1,492.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,229.21
|
| Rate for Payer: Priority Health SBD |
$1,106.29
|
| Rate for Payer: UMR Bronson Commercial |
$772.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,317.02
|
|
|
MESALAMINE ER 250 MG CAPSULE,EXTENDED RELEASE
|
Facility
|
IP
|
$2,507.72
|
|
|
Service Code
|
NDC 54092-189-81
|
| Hospital Charge Code |
10533
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,103.40 |
| Max. Negotiated Rate |
$2,256.95 |
| Rate for Payer: Aetna American Axle |
$1,630.02
|
| Rate for Payer: Aetna Commercial |
$2,131.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,630.02
|
| Rate for Payer: Cash Price |
$2,006.18
|
| Rate for Payer: Cofinity Commercial |
$1,755.40
|
| Rate for Payer: Cofinity Commercial |
$2,156.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,006.18
|
| Rate for Payer: Healthscope Commercial |
$2,256.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,755.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,880.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,131.56
|
| Rate for Payer: PHP Commercial |
$2,131.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,755.40
|
| Rate for Payer: Priority Health SBD |
$1,579.86
|
| Rate for Payer: UMR Bronson Commercial |
$1,103.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,880.79
|
|
|
MESNA 100 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$34.49
|
|
|
Service Code
|
HCPCS J9209
|
| Hospital Charge Code |
10537
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$31.04 |
| Rate for Payer: Aetna American Axle |
$22.42
|
| Rate for Payer: Aetna American Axle |
$21.61
|
| Rate for Payer: Aetna Commercial |
$29.32
|
| Rate for Payer: Aetna Commercial |
$28.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.61
|
| Rate for Payer: BCBS Complete |
$13.30
|
| Rate for Payer: BCBS Complete |
$13.80
|
| Rate for Payer: BCBS Trust/PPO |
$4.41
|
| Rate for Payer: BCBS Trust/PPO |
$4.41
|
| Rate for Payer: Cash Price |
$27.59
|
| Rate for Payer: Cash Price |
$26.60
|
| Rate for Payer: Cash Price |
$26.60
|
| Rate for Payer: Cash Price |
$27.59
|
| Rate for Payer: Cofinity Commercial |
$23.28
|
| Rate for Payer: Cofinity Commercial |
$24.14
|
| Rate for Payer: Cofinity Commercial |
$28.60
|
| Rate for Payer: Cofinity Commercial |
$29.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.59
|
| Rate for Payer: Healthscope Commercial |
$29.92
|
| Rate for Payer: Healthscope Commercial |
$31.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.32
|
| Rate for Payer: PHP Commercial |
$29.32
|
| Rate for Payer: PHP Commercial |
$28.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: Priority Health SBD |
$21.73
|
| Rate for Payer: Priority Health SBD |
$20.95
|
| Rate for Payer: UMR Bronson Commercial |
$12.30
|
| Rate for Payer: UMR Bronson Commercial |
$12.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.94
|
|
|
MESNA 100 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$33.25
|
|
|
Service Code
|
HCPCS J9209
|
| Hospital Charge Code |
10537
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.63 |
| Max. Negotiated Rate |
$29.92 |
| Rate for Payer: Aetna American Axle |
$21.61
|
| Rate for Payer: Aetna American Axle |
$21.90
|
| Rate for Payer: Aetna American Axle |
$22.42
|
| Rate for Payer: Aetna Commercial |
$28.64
|
| Rate for Payer: Aetna Commercial |
$28.26
|
| Rate for Payer: Aetna Commercial |
$29.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.90
|
| Rate for Payer: Cash Price |
$26.60
|
| Rate for Payer: Cash Price |
$27.59
|
| Rate for Payer: Cash Price |
$26.95
|
| Rate for Payer: Cofinity Commercial |
$28.60
|
| Rate for Payer: Cofinity Commercial |
$29.66
|
| Rate for Payer: Cofinity Commercial |
$24.14
|
| Rate for Payer: Cofinity Commercial |
$28.97
|
| Rate for Payer: Cofinity Commercial |
$23.58
|
| Rate for Payer: Cofinity Commercial |
$23.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.59
|
| Rate for Payer: Healthscope Commercial |
$29.92
|
| Rate for Payer: Healthscope Commercial |
$30.32
|
| Rate for Payer: Healthscope Commercial |
$31.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.64
|
| Rate for Payer: PHP Commercial |
$29.32
|
| Rate for Payer: PHP Commercial |
$28.26
|
| Rate for Payer: PHP Commercial |
$28.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.28
|
| Rate for Payer: Priority Health SBD |
$20.95
|
| Rate for Payer: Priority Health SBD |
$21.22
|
| Rate for Payer: Priority Health SBD |
$21.73
|
| Rate for Payer: UMR Bronson Commercial |
$15.18
|
| Rate for Payer: UMR Bronson Commercial |
$14.82
|
| Rate for Payer: UMR Bronson Commercial |
$14.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.27
|
|
