|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
IP
|
$177.12
|
|
|
Service Code
|
NDC 43386-160-06
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.93 |
| Max. Negotiated Rate |
$159.41 |
| Rate for Payer: Aetna American Axle |
$115.13
|
| Rate for Payer: Aetna Commercial |
$150.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.13
|
| Rate for Payer: Cash Price |
$141.70
|
| Rate for Payer: Cofinity Commercial |
$123.98
|
| Rate for Payer: Cofinity Commercial |
$152.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.70
|
| Rate for Payer: Healthscope Commercial |
$159.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$150.55
|
| Rate for Payer: PHP Commercial |
$150.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.98
|
| Rate for Payer: Priority Health SBD |
$111.59
|
| Rate for Payer: UMR Bronson Commercial |
$77.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.84
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
IP
|
$744.96
|
|
|
Service Code
|
NDC 60687-735-01
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$327.78 |
| Max. Negotiated Rate |
$670.46 |
| Rate for Payer: Aetna American Axle |
$484.22
|
| Rate for Payer: Aetna Commercial |
$633.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$484.22
|
| Rate for Payer: Cash Price |
$595.97
|
| Rate for Payer: Cofinity Commercial |
$521.47
|
| Rate for Payer: Cofinity Commercial |
$640.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$595.97
|
| Rate for Payer: Healthscope Commercial |
$670.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$521.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$558.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$633.22
|
| Rate for Payer: PHP Commercial |
$633.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$521.47
|
| Rate for Payer: Priority Health SBD |
$469.32
|
| Rate for Payer: UMR Bronson Commercial |
$327.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$558.72
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
IP
|
$1,442.63
|
|
|
Service Code
|
NDC 0025-1451-34
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$634.76 |
| Max. Negotiated Rate |
$1,298.37 |
| Rate for Payer: Aetna American Axle |
$937.71
|
| Rate for Payer: Aetna Commercial |
$1,226.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$937.71
|
| Rate for Payer: Cash Price |
$1,154.10
|
| Rate for Payer: Cofinity Commercial |
$1,009.84
|
| Rate for Payer: Cofinity Commercial |
$1,240.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,154.10
|
| Rate for Payer: Healthscope Commercial |
$1,298.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,009.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,081.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,226.24
|
| Rate for Payer: PHP Commercial |
$1,226.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,009.84
|
| Rate for Payer: Priority Health SBD |
$908.86
|
| Rate for Payer: UMR Bronson Commercial |
$634.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,081.97
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
IP
|
$196.65
|
|
|
Service Code
|
NDC 70954-443-10
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.53 |
| Max. Negotiated Rate |
$176.98 |
| Rate for Payer: Aetna American Axle |
$127.82
|
| Rate for Payer: Aetna Commercial |
$167.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.82
|
| Rate for Payer: Cash Price |
$157.32
|
| Rate for Payer: Cofinity Commercial |
$137.66
|
| Rate for Payer: Cofinity Commercial |
$169.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.32
|
| Rate for Payer: Healthscope Commercial |
$176.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$167.15
|
| Rate for Payer: PHP Commercial |
$167.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.66
|
| Rate for Payer: Priority Health SBD |
$123.89
|
| Rate for Payer: UMR Bronson Commercial |
$86.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.49
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
IP
|
$699.84
|
|
|
Service Code
|
NDC 68084-040-01
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$307.93 |
| Max. Negotiated Rate |
$629.86 |
| Rate for Payer: Aetna American Axle |
$454.90
|
| Rate for Payer: Aetna Commercial |
$594.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$454.90
|
| Rate for Payer: Cash Price |
$559.87
|
| Rate for Payer: Cofinity Commercial |
$489.89
|
| Rate for Payer: Cofinity Commercial |
$601.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$559.87
|
| Rate for Payer: Healthscope Commercial |
$629.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$489.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$524.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$594.86
|
| Rate for Payer: PHP Commercial |
$594.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$489.89
|
| Rate for Payer: Priority Health SBD |
$440.90
|
| Rate for Payer: UMR Bronson Commercial |
$307.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$524.88
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
IP
|
$177.41
|
|
|
Service Code
|
NDC 59762-5007-1
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.06 |
| Max. Negotiated Rate |
$159.67 |
| Rate for Payer: Aetna American Axle |
$115.32
|
| Rate for Payer: Aetna Commercial |
$150.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.32
|
| Rate for Payer: Cash Price |
$141.93
|
| Rate for Payer: Cofinity Commercial |
$124.19
|
| Rate for Payer: Cofinity Commercial |
$152.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.93
|
| Rate for Payer: Healthscope Commercial |
$159.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$150.80
|
| Rate for Payer: PHP Commercial |
$150.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.19
|
| Rate for Payer: Priority Health SBD |
$111.77
|
| Rate for Payer: UMR Bronson Commercial |
$78.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.06
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
IP
|
$7.45
|
|
|
Service Code
|
NDC 60687-735-11
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna American Axle |
$4.84
|
| Rate for Payer: Aetna Commercial |
$6.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.84
|
| Rate for Payer: Cash Price |
$5.96
|
| Rate for Payer: Cofinity Commercial |
$5.22
|
| Rate for Payer: Cofinity Commercial |
$6.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.96
|
| Rate for Payer: Healthscope Commercial |
$6.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.33
|
| Rate for Payer: PHP Commercial |
$6.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.22
|
| Rate for Payer: Priority Health SBD |
$4.69
|
| Rate for Payer: UMR Bronson Commercial |
$3.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.59
|
|
|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
IP
|
$431.04
|
|
|
Service Code
|
NDC 59762-5008-2
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$189.66 |
| Max. Negotiated Rate |
$387.94 |
| Rate for Payer: Aetna American Axle |
$280.18
|
| Rate for Payer: Aetna Commercial |
$366.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.18
|
| Rate for Payer: Cash Price |
$344.83
|
| Rate for Payer: Cofinity Commercial |
$301.73
|
| Rate for Payer: Cofinity Commercial |
$370.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.83
|
| Rate for Payer: Healthscope Commercial |
$387.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$301.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$366.38
|
| Rate for Payer: PHP Commercial |
$366.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.73
|
| Rate for Payer: Priority Health SBD |
$271.56
|
| Rate for Payer: UMR Bronson Commercial |
$189.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.28
|
|
|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
IP
|
$431.04
|
|
|
Service Code
|
NDC 43386-161-01
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$189.66 |
| Max. Negotiated Rate |
$387.94 |
| Rate for Payer: Aetna American Axle |
$280.18
|
| Rate for Payer: Aetna Commercial |
$366.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.18
|
| Rate for Payer: Cash Price |
$344.83
|
| Rate for Payer: Cofinity Commercial |
$301.73
|
| Rate for Payer: Cofinity Commercial |
$370.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.83
|
| Rate for Payer: Healthscope Commercial |
$387.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$301.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$366.38
|
| Rate for Payer: PHP Commercial |
$366.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.73
|
| Rate for Payer: Priority Health SBD |
$271.56
|
| Rate for Payer: UMR Bronson Commercial |
$189.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.28
|
|
|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
IP
|
$794.88
|
|
|
Service Code
|
NDC 68084-041-01
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$349.75 |
| Max. Negotiated Rate |
$715.39 |
| Rate for Payer: Aetna American Axle |
$516.67
|
| Rate for Payer: Aetna Commercial |
$675.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$516.67
|
| Rate for Payer: Cash Price |
$635.90
|
| Rate for Payer: Cofinity Commercial |
$556.42
|
| Rate for Payer: Cofinity Commercial |
$683.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$635.90
|
| Rate for Payer: Healthscope Commercial |
$715.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$556.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$596.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$675.65
|
| Rate for Payer: PHP Commercial |
$675.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$556.42
|
| Rate for Payer: Priority Health SBD |
$500.77
|
| Rate for Payer: UMR Bronson Commercial |
$349.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$596.16
|
|
|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
IP
|
$327.84
|
|
|
Service Code
|
NDC 70954-444-20
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.25 |
| Max. Negotiated Rate |
$295.06 |
| Rate for Payer: Aetna American Axle |
$213.10
|
| Rate for Payer: Aetna Commercial |
$278.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.10
|
| Rate for Payer: Cash Price |
$262.27
|
| Rate for Payer: Cofinity Commercial |
$229.49
|
| Rate for Payer: Cofinity Commercial |
$281.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.27
|
| Rate for Payer: Healthscope Commercial |
$295.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$229.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$278.66
|
| Rate for Payer: PHP Commercial |
$278.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.49
|
| Rate for Payer: Priority Health SBD |
$206.54
|
| Rate for Payer: UMR Bronson Commercial |
$144.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.88
|
|
|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
IP
|
$7.95
|
|
|
Service Code
|
NDC 68084-041-11
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$7.16 |
| Rate for Payer: Aetna American Axle |
$5.17
|
| Rate for Payer: Aetna Commercial |
$6.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.17
|
| Rate for Payer: Cash Price |
$6.36
|
| Rate for Payer: Cofinity Commercial |
$5.56
|
| Rate for Payer: Cofinity Commercial |
$6.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.36
|
| Rate for Payer: Healthscope Commercial |
$7.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.76
|
| Rate for Payer: PHP Commercial |
$6.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.56
|
| Rate for Payer: Priority Health SBD |
$5.01
|
| Rate for Payer: UMR Bronson Commercial |
$3.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.96
|
|
|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
IP
|
$258.63
|
|
|
Service Code
|
NDC 59762-5008-1
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.80 |
| Max. Negotiated Rate |
$232.77 |
| Rate for Payer: Aetna American Axle |
$168.11
|
| Rate for Payer: Aetna Commercial |
$219.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.11
|
| Rate for Payer: Cash Price |
$206.90
|
| Rate for Payer: Cofinity Commercial |
$181.04
|
| Rate for Payer: Cofinity Commercial |
$222.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.90
|
| Rate for Payer: Healthscope Commercial |
$232.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$181.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$219.84
|
| Rate for Payer: PHP Commercial |
$219.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.04
|
| Rate for Payer: Priority Health SBD |
$162.94
|
| Rate for Payer: UMR Bronson Commercial |
$113.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.97
|
|
|
MISOPROSTOL 25 MCG CUSTOM TAB
|
Facility
|
IP
|
$1,442.63
|
|
|
Service Code
|
NDC 9900-0000-16
|
| Hospital Charge Code |
150707
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$634.76 |
| Max. Negotiated Rate |
$1,298.37 |
| Rate for Payer: Aetna American Axle |
$937.71
|
| Rate for Payer: Aetna Commercial |
$1,226.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$937.71
|
| Rate for Payer: Cash Price |
$1,154.10
|
| Rate for Payer: Cofinity Commercial |
$1,009.84
|
| Rate for Payer: Cofinity Commercial |
$1,240.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,154.10
|
| Rate for Payer: Healthscope Commercial |
$1,298.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,009.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,081.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,226.24
|
| Rate for Payer: PHP Commercial |
$1,226.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,009.84
|
| Rate for Payer: Priority Health SBD |
$908.86
|
| Rate for Payer: UMR Bronson Commercial |
$634.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,081.97
|
|
|
MITOMYCIN 0.2 MG/ML OCULAR SOLUTION
|
Facility
|
IP
|
$254.52
|
|
|
Service Code
|
HCPCS J7315
|
| Hospital Charge Code |
151070
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$111.99 |
| Max. Negotiated Rate |
$229.07 |
| Rate for Payer: Aetna American Axle |
$165.44
|
| Rate for Payer: Aetna Commercial |
$216.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.44
|
| Rate for Payer: Cash Price |
$203.62
|
| Rate for Payer: Cofinity Commercial |
$178.16
|
| Rate for Payer: Cofinity Commercial |
$218.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.62
|
| Rate for Payer: Healthscope Commercial |
$229.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$216.34
|
| Rate for Payer: PHP Commercial |
$216.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.16
|
| Rate for Payer: Priority Health SBD |
$160.35
|
| Rate for Payer: UMR Bronson Commercial |
$111.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.89
|
|
|
MITOMYCIN 20 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,416.79
|
|
|
Service Code
|
HCPCS J9280
|
| Hospital Charge Code |
10630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.65 |
| Max. Negotiated Rate |
$2,175.11 |
| Rate for Payer: Aetna American Axle |
$1,570.91
|
| Rate for Payer: Aetna American Axle |
$301.41
|
| Rate for Payer: Aetna American Axle |
$501.12
|
| Rate for Payer: Aetna Commercial |
$655.31
|
| Rate for Payer: Aetna Commercial |
$394.15
|
| Rate for Payer: Aetna Commercial |
$2,054.27
|
| Rate for Payer: Aetna Medicare |
$65.88
|
| Rate for Payer: Aetna Medicare |
$65.88
|
| Rate for Payer: Aetna Medicare |
$65.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,570.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$501.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.18
|
| Rate for Payer: BCBS Complete |
$36.39
|
| Rate for Payer: BCBS Complete |
$36.39
|
| Rate for Payer: BCBS Complete |
$36.39
|
| Rate for Payer: BCBS MAPPO |
$63.35
|
| Rate for Payer: BCBS MAPPO |
$63.35
|
| Rate for Payer: BCBS MAPPO |
$63.35
|
| Rate for Payer: BCBS Trust/PPO |
$204.70
|
| Rate for Payer: BCBS Trust/PPO |
$204.70
|
| Rate for Payer: BCBS Trust/PPO |
$204.70
|
| Rate for Payer: BCN Medicare Advantage |
$63.35
|
| Rate for Payer: BCN Medicare Advantage |
$63.35
|
| Rate for Payer: BCN Medicare Advantage |
$63.35
|
| Rate for Payer: Cash Price |
$370.97
|
| Rate for Payer: Cash Price |
$1,933.43
|
| Rate for Payer: Cash Price |
$1,933.43
|
| Rate for Payer: Cash Price |
$370.97
|
| Rate for Payer: Cash Price |
$616.76
|
| Rate for Payer: Cash Price |
$616.76
|
| Rate for Payer: Cofinity Commercial |
$324.60
|
| Rate for Payer: Cofinity Commercial |
$2,078.44
|
| Rate for Payer: Cofinity Commercial |
$1,691.75
|
| Rate for Payer: Cofinity Commercial |
$663.02
|
| Rate for Payer: Cofinity Commercial |
$539.66
|
| Rate for Payer: Cofinity Commercial |
$398.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,933.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$616.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.35
|
| Rate for Payer: Healthscope Commercial |
$2,175.11
|
| Rate for Payer: Healthscope Commercial |
$693.86
|
| Rate for Payer: Healthscope Commercial |
$417.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,691.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$324.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$539.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,812.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$347.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$578.21
|
| Rate for Payer: Mclaren Medicaid |
$34.65
|
| Rate for Payer: Mclaren Medicaid |
$34.65
|
| Rate for Payer: Mclaren Medicaid |
$34.65
|
| Rate for Payer: Mclaren Medicare |
$63.35
|
| Rate for Payer: Mclaren Medicare |
$63.35
|
| Rate for Payer: Mclaren Medicare |
$63.35
|
| Rate for Payer: Meridian Medicaid |
$36.39
|
| Rate for Payer: Meridian Medicaid |
$36.39
|
| Rate for Payer: Meridian Medicaid |
$36.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$66.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$66.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$66.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$394.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,054.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$655.31
|
| Rate for Payer: PACE Medicare |
$60.18
|
| Rate for Payer: PACE Medicare |
$60.18
|
| Rate for Payer: PACE Medicare |
$60.18
|
| Rate for Payer: PACE SWMI |
$63.35
|
| Rate for Payer: PACE SWMI |
$63.35
|
| Rate for Payer: PACE SWMI |
$63.35
|
| Rate for Payer: PHP Commercial |
$394.15
|
| Rate for Payer: PHP Commercial |
$2,054.27
|
| Rate for Payer: PHP Commercial |
$655.31
|
| Rate for Payer: PHP Medicare Advantage |
$63.35
|
| Rate for Payer: PHP Medicare Advantage |
$63.35
|
| Rate for Payer: PHP Medicare Advantage |
$63.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$539.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,691.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$280.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$280.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$280.80
|
| Rate for Payer: Priority Health Medicare |
$63.35
|
| Rate for Payer: Priority Health Medicare |
$63.35
|
| Rate for Payer: Priority Health Medicare |
$63.35
|
| Rate for Payer: Priority Health Narrow Network |
$224.64
|
| Rate for Payer: Priority Health Narrow Network |
$224.64
|
| Rate for Payer: Priority Health Narrow Network |
$224.64
|
| Rate for Payer: Priority Health SBD |
$292.14
|
| Rate for Payer: Priority Health SBD |
$1,522.58
|
| Rate for Payer: Priority Health SBD |
$485.70
|
| Rate for Payer: Railroad Medicare Medicare |
$63.35
|
| Rate for Payer: Railroad Medicare Medicare |
$63.35
|
| Rate for Payer: Railroad Medicare Medicare |
$63.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.35
|
| Rate for Payer: UHC Medicare Advantage |
$65.25
|
| Rate for Payer: UHC Medicare Advantage |
$65.25
|
| Rate for Payer: UHC Medicare Advantage |
$65.25
|
| Rate for Payer: UMR Bronson Commercial |
$285.25
|
| Rate for Payer: UMR Bronson Commercial |
$171.57
|
| Rate for Payer: UMR Bronson Commercial |
$894.21
|
| Rate for Payer: VA VA |
$63.35
|
| Rate for Payer: VA VA |
$63.35
|
| Rate for Payer: VA VA |
$63.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$347.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$578.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,812.59
|
|
|
MITOMYCIN 20 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$770.95
|
|
|
Service Code
|
HCPCS J9280
|
| Hospital Charge Code |
10630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$339.22 |
| Max. Negotiated Rate |
$693.86 |
| Rate for Payer: Aetna American Axle |
$501.12
|
| Rate for Payer: Aetna American Axle |
$301.41
|
| Rate for Payer: Aetna Commercial |
$394.15
|
| Rate for Payer: Aetna Commercial |
$655.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$501.12
|
| Rate for Payer: Cash Price |
$370.97
|
| Rate for Payer: Cash Price |
$616.76
|
| Rate for Payer: Cofinity Commercial |
$398.79
|
| Rate for Payer: Cofinity Commercial |
$324.60
|
| Rate for Payer: Cofinity Commercial |
$663.02
|
| Rate for Payer: Cofinity Commercial |
$539.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$616.76
|
| Rate for Payer: Healthscope Commercial |
$693.86
|
| Rate for Payer: Healthscope Commercial |
$417.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$539.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$324.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$347.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$578.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$394.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$655.31
|
| Rate for Payer: PHP Commercial |
$655.31
|
| Rate for Payer: PHP Commercial |
$394.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$539.66
|
| Rate for Payer: Priority Health SBD |
$292.14
|
| Rate for Payer: Priority Health SBD |
$485.70
|
| Rate for Payer: UMR Bronson Commercial |
$339.22
|
| Rate for Payer: UMR Bronson Commercial |
$204.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$347.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$578.21
|
|
|
MITOMYCIN 20 MG SOLUTION FOR BLADDER IRRIGATION (CUSTOM)
|
Facility
|
OP
|
$770.95
|
|
|
Service Code
|
HCPCS J9280
|
| Hospital Charge Code |
300956
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.65 |
| Max. Negotiated Rate |
$693.86 |
| Rate for Payer: Aetna American Axle |
$501.12
|
| Rate for Payer: Aetna Commercial |
$655.31
|
| Rate for Payer: Aetna Medicare |
$65.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$501.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.18
|
| Rate for Payer: BCBS Complete |
$36.39
|
| Rate for Payer: BCBS MAPPO |
$63.35
|
| Rate for Payer: BCBS Trust/PPO |
$204.70
|
| Rate for Payer: BCN Medicare Advantage |
$63.35
|
| Rate for Payer: Cash Price |
$616.76
|
| Rate for Payer: Cash Price |
$616.76
|
| Rate for Payer: Cofinity Commercial |
$663.02
|
| Rate for Payer: Cofinity Commercial |
$539.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$616.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.35
|
| Rate for Payer: Healthscope Commercial |
$693.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$539.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$578.21
|
| Rate for Payer: Mclaren Medicaid |
$34.65
|
| Rate for Payer: Mclaren Medicare |
$63.35
|
| Rate for Payer: Meridian Medicaid |
$36.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$66.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$655.31
|
| Rate for Payer: PACE Medicare |
$60.18
|
| Rate for Payer: PACE SWMI |
$63.35
|
| Rate for Payer: PHP Commercial |
$655.31
|
| Rate for Payer: PHP Medicare Advantage |
$63.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$539.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$280.80
|
| Rate for Payer: Priority Health Medicare |
$63.35
|
| Rate for Payer: Priority Health Narrow Network |
$224.64
|
| Rate for Payer: Priority Health SBD |
$485.70
|
| Rate for Payer: Railroad Medicare Medicare |
$63.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.35
|
| Rate for Payer: UHC Medicare Advantage |
$65.25
|
| Rate for Payer: UMR Bronson Commercial |
$285.25
|
| Rate for Payer: VA VA |
$63.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$578.21
|
|
|
MITOMYCIN 40 MG/20 ML BLADDER FOR IRRIGATION SOLUTION CUSTOM
|
Facility
|
IP
|
$5,675.14
|
|
|
Service Code
|
HCPCS J9280
|
| Hospital Charge Code |
301471
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,497.06 |
| Max. Negotiated Rate |
$5,107.63 |
| Rate for Payer: Aetna American Axle |
$3,688.84
|
| Rate for Payer: Aetna American Axle |
$602.76
|
| Rate for Payer: Aetna Commercial |
$4,823.87
|
| Rate for Payer: Aetna Commercial |
$788.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,688.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$602.76
|
| Rate for Payer: Cash Price |
$4,540.11
|
| Rate for Payer: Cash Price |
$741.86
|
| Rate for Payer: Cofinity Commercial |
$4,880.62
|
| Rate for Payer: Cofinity Commercial |
$3,972.60
|
| Rate for Payer: Cofinity Commercial |
$649.12
|
| Rate for Payer: Cofinity Commercial |
$797.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$741.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,540.11
|
| Rate for Payer: Healthscope Commercial |
$5,107.63
|
| Rate for Payer: Healthscope Commercial |
$834.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$649.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,972.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,256.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$695.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$788.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,823.87
|
| Rate for Payer: PHP Commercial |
$4,823.87
|
| Rate for Payer: PHP Commercial |
$788.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,972.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$649.12
|
| Rate for Payer: Priority Health SBD |
$3,575.34
|
| Rate for Payer: Priority Health SBD |
$584.21
|
| Rate for Payer: UMR Bronson Commercial |
$2,497.06
|
| Rate for Payer: UMR Bronson Commercial |
$408.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$695.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,256.36
|
|
|
MITOMYCIN 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,196.90
|
|
|
Service Code
|
HCPCS J9280
|
| Hospital Charge Code |
10631
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$526.64 |
| Max. Negotiated Rate |
$1,077.21 |
| Rate for Payer: Aetna American Axle |
$777.98
|
| Rate for Payer: Aetna American Axle |
$3,430.64
|
| Rate for Payer: Aetna American Axle |
$3,688.84
|
| Rate for Payer: Aetna American Axle |
$1,148.55
|
| Rate for Payer: Aetna American Axle |
$602.76
|
| Rate for Payer: Aetna Commercial |
$4,486.22
|
| Rate for Payer: Aetna Commercial |
$1,017.36
|
| Rate for Payer: Aetna Commercial |
$1,501.95
|
| Rate for Payer: Aetna Commercial |
$788.22
|
| Rate for Payer: Aetna Commercial |
$4,823.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,688.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$777.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$602.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,148.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,430.64
|
| Rate for Payer: Cash Price |
$957.52
|
| Rate for Payer: Cash Price |
$4,540.11
|
| Rate for Payer: Cash Price |
$1,413.60
|
| Rate for Payer: Cash Price |
$741.86
|
| Rate for Payer: Cash Price |
$4,222.33
|
| Rate for Payer: Cofinity Commercial |
$1,236.90
|
| Rate for Payer: Cofinity Commercial |
$1,519.62
|
| Rate for Payer: Cofinity Commercial |
$4,880.62
|
| Rate for Payer: Cofinity Commercial |
$649.12
|
| Rate for Payer: Cofinity Commercial |
$797.50
|
| Rate for Payer: Cofinity Commercial |
$1,029.33
|
| Rate for Payer: Cofinity Commercial |
$4,539.00
|
| Rate for Payer: Cofinity Commercial |
$837.83
|
| Rate for Payer: Cofinity Commercial |
$3,972.60
|
| Rate for Payer: Cofinity Commercial |
$3,694.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,413.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$957.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$741.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,222.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,540.11
|
| Rate for Payer: Healthscope Commercial |
$4,750.12
|
| Rate for Payer: Healthscope Commercial |
$1,590.30
|
| Rate for Payer: Healthscope Commercial |
$5,107.63
|
| Rate for Payer: Healthscope Commercial |
$834.59
|
| Rate for Payer: Healthscope Commercial |
$1,077.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$837.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,972.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,694.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$649.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,236.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$695.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,958.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$897.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,256.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,325.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,017.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,501.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,486.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,823.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$788.22
|
| Rate for Payer: PHP Commercial |
$1,017.36
|
| Rate for Payer: PHP Commercial |
$788.22
|
| Rate for Payer: PHP Commercial |
$4,823.87
|
| Rate for Payer: PHP Commercial |
$4,486.22
|
| Rate for Payer: PHP Commercial |
$1,501.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$837.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,236.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,694.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,972.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$649.12
|
| Rate for Payer: Priority Health SBD |
$3,575.34
|
| Rate for Payer: Priority Health SBD |
$3,325.08
|
| Rate for Payer: Priority Health SBD |
$1,113.21
|
| Rate for Payer: Priority Health SBD |
$754.05
|
| Rate for Payer: Priority Health SBD |
$584.21
|
| Rate for Payer: UMR Bronson Commercial |
$2,497.06
|
| Rate for Payer: UMR Bronson Commercial |
$2,322.28
|
| Rate for Payer: UMR Bronson Commercial |
$408.02
|
| Rate for Payer: UMR Bronson Commercial |
$777.48
|
| Rate for Payer: UMR Bronson Commercial |
$526.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,325.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$897.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,256.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$695.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,958.43
|
|
|
MITOMYCIN 5 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,018.05
|
|
|
Service Code
|
HCPCS J9280
|
| Hospital Charge Code |
10632
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$447.94 |
| Max. Negotiated Rate |
$916.24 |
| Rate for Payer: Aetna American Axle |
$661.73
|
| Rate for Payer: Aetna Commercial |
$865.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$661.73
|
| Rate for Payer: Cash Price |
$814.44
|
| Rate for Payer: Cofinity Commercial |
$712.64
|
| Rate for Payer: Cofinity Commercial |
$875.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$814.44
|
| Rate for Payer: Healthscope Commercial |
$916.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$712.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$763.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$865.34
|
| Rate for Payer: PHP Commercial |
$865.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$712.64
|
| Rate for Payer: Priority Health SBD |
$641.37
|
| Rate for Payer: UMR Bronson Commercial |
$447.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$763.54
|
|
|
MITOMYCIN 5 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,018.05
|
|
|
Service Code
|
HCPCS J9280
|
| Hospital Charge Code |
10632
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.65 |
| Max. Negotiated Rate |
$916.24 |
| Rate for Payer: Aetna American Axle |
$661.73
|
| Rate for Payer: Aetna Commercial |
$865.34
|
| Rate for Payer: Aetna Medicare |
$65.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$661.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.18
|
| Rate for Payer: BCBS Complete |
$36.39
|
| Rate for Payer: BCBS MAPPO |
$63.35
|
| Rate for Payer: BCBS Trust/PPO |
$204.70
|
| Rate for Payer: BCN Medicare Advantage |
$63.35
|
| Rate for Payer: Cash Price |
$814.44
|
| Rate for Payer: Cash Price |
$814.44
|
| Rate for Payer: Cofinity Commercial |
$712.64
|
| Rate for Payer: Cofinity Commercial |
$875.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$814.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.35
|
| Rate for Payer: Healthscope Commercial |
$916.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$712.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$763.54
|
| Rate for Payer: Mclaren Medicaid |
$34.65
|
| Rate for Payer: Mclaren Medicare |
$63.35
|
| Rate for Payer: Meridian Medicaid |
$36.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$66.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$865.34
|
| Rate for Payer: PACE Medicare |
$60.18
|
| Rate for Payer: PACE SWMI |
$63.35
|
| Rate for Payer: PHP Commercial |
$865.34
|
| Rate for Payer: PHP Medicare Advantage |
$63.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$712.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$280.80
|
| Rate for Payer: Priority Health Medicare |
$63.35
|
| Rate for Payer: Priority Health Narrow Network |
$224.64
|
| Rate for Payer: Priority Health SBD |
$641.37
|
| Rate for Payer: Railroad Medicare Medicare |
$63.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.35
|
| Rate for Payer: UHC Medicare Advantage |
$65.25
|
| Rate for Payer: UMR Bronson Commercial |
$376.68
|
| Rate for Payer: VA VA |
$63.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$763.54
|
|
|
MITOXANTRONE 2 MG/ML CONCENTRATE,INTRAVENOUS
|
Facility
|
IP
|
$776.65
|
|
|
Service Code
|
HCPCS J9293
|
| Hospital Charge Code |
10634
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$341.73 |
| Max. Negotiated Rate |
$698.98 |
| Rate for Payer: Aetna American Axle |
$504.82
|
| Rate for Payer: Aetna American Axle |
$543.77
|
| Rate for Payer: Aetna American Axle |
$729.26
|
| Rate for Payer: Aetna American Axle |
$630.99
|
| Rate for Payer: Aetna Commercial |
$825.14
|
| Rate for Payer: Aetna Commercial |
$711.08
|
| Rate for Payer: Aetna Commercial |
$660.15
|
| Rate for Payer: Aetna Commercial |
$953.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$543.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$729.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$630.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$504.82
|
| Rate for Payer: Cash Price |
$897.55
|
| Rate for Payer: Cash Price |
$776.60
|
| Rate for Payer: Cash Price |
$669.26
|
| Rate for Payer: Cash Price |
$621.32
|
| Rate for Payer: Cofinity Commercial |
$679.52
|
| Rate for Payer: Cofinity Commercial |
$543.66
|
| Rate for Payer: Cofinity Commercial |
$667.92
|
| Rate for Payer: Cofinity Commercial |
$964.87
|
| Rate for Payer: Cofinity Commercial |
$785.36
|
| Rate for Payer: Cofinity Commercial |
$719.45
|
| Rate for Payer: Cofinity Commercial |
$585.60
|
| Rate for Payer: Cofinity Commercial |
$834.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$669.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$897.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$776.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$621.32
|
| Rate for Payer: Healthscope Commercial |
$698.98
|
| Rate for Payer: Healthscope Commercial |
$752.91
|
| Rate for Payer: Healthscope Commercial |
$1,009.75
|
| Rate for Payer: Healthscope Commercial |
$873.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$543.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$785.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$585.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$679.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$728.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$582.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$841.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$627.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$711.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$953.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$825.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$660.15
|
| Rate for Payer: PHP Commercial |
$825.14
|
| Rate for Payer: PHP Commercial |
$711.08
|
| Rate for Payer: PHP Commercial |
$660.15
|
| Rate for Payer: PHP Commercial |
$953.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$785.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$585.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$543.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$679.52
|
| Rate for Payer: Priority Health SBD |
$611.57
|
| Rate for Payer: Priority Health SBD |
$706.82
|
| Rate for Payer: Priority Health SBD |
$489.29
|
| Rate for Payer: Priority Health SBD |
$527.04
|
| Rate for Payer: UMR Bronson Commercial |
$368.09
|
| Rate for Payer: UMR Bronson Commercial |
$341.73
|
| Rate for Payer: UMR Bronson Commercial |
$493.65
|
| Rate for Payer: UMR Bronson Commercial |
$427.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$841.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$627.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$728.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$582.49
|
|
|
MITOXANTRONE 2 MG/ML CONCENTRATE,INTRAVENOUS
|
Facility
|
OP
|
$1,121.94
|
|
|
Service Code
|
HCPCS J9293
|
| Hospital Charge Code |
10634
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.84 |
| Max. Negotiated Rate |
$1,009.75 |
| Rate for Payer: Aetna American Axle |
$729.26
|
| Rate for Payer: Aetna American Axle |
$543.77
|
| Rate for Payer: Aetna Commercial |
$953.65
|
| Rate for Payer: Aetna Commercial |
$711.08
|
| Rate for Payer: Aetna Medicare |
$45.32
|
| Rate for Payer: Aetna Medicare |
$45.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$729.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$543.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$54.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$54.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$54.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$54.47
|
| Rate for Payer: BCBS Complete |
$25.03
|
| Rate for Payer: BCBS Complete |
$25.03
|
| Rate for Payer: BCBS MAPPO |
$43.58
|
| Rate for Payer: BCBS MAPPO |
$43.58
|
| Rate for Payer: BCBS Trust/PPO |
$140.82
|
| Rate for Payer: BCBS Trust/PPO |
$140.82
|
| Rate for Payer: BCN Medicare Advantage |
$43.58
|
| Rate for Payer: BCN Medicare Advantage |
$43.58
|
| Rate for Payer: Cash Price |
$897.55
|
| Rate for Payer: Cash Price |
$669.26
|
| Rate for Payer: Cash Price |
$897.55
|
| Rate for Payer: Cash Price |
$669.26
|
| Rate for Payer: Cofinity Commercial |
$585.60
|
| Rate for Payer: Cofinity Commercial |
$785.36
|
| Rate for Payer: Cofinity Commercial |
$964.87
|
| Rate for Payer: Cofinity Commercial |
$719.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$669.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$897.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.58
|
| Rate for Payer: Healthscope Commercial |
$1,009.75
|
| Rate for Payer: Healthscope Commercial |
$752.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$785.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$585.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$627.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$841.46
|
| Rate for Payer: Mclaren Medicaid |
$23.84
|
| Rate for Payer: Mclaren Medicaid |
$23.84
|
| Rate for Payer: Mclaren Medicare |
$43.58
|
| Rate for Payer: Mclaren Medicare |
$43.58
|
| Rate for Payer: Meridian Medicaid |
$25.03
|
| Rate for Payer: Meridian Medicaid |
$25.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$45.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$45.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$711.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$953.65
|
| Rate for Payer: PACE Medicare |
$41.40
|
| Rate for Payer: PACE Medicare |
$41.40
|
| Rate for Payer: PACE SWMI |
$43.58
|
| Rate for Payer: PACE SWMI |
$43.58
|
| Rate for Payer: PHP Commercial |
$953.65
|
| Rate for Payer: PHP Commercial |
$711.08
|
| Rate for Payer: PHP Medicare Advantage |
$43.58
|
| Rate for Payer: PHP Medicare Advantage |
$43.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$785.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$585.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$121.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$121.57
|
| Rate for Payer: Priority Health Medicare |
$43.58
|
| Rate for Payer: Priority Health Medicare |
$43.58
|
| Rate for Payer: Priority Health Narrow Network |
$97.26
|
| Rate for Payer: Priority Health Narrow Network |
$97.26
|
| Rate for Payer: Priority Health SBD |
$706.82
|
| Rate for Payer: Priority Health SBD |
$527.04
|
| Rate for Payer: Railroad Medicare Medicare |
$43.58
|
| Rate for Payer: Railroad Medicare Medicare |
$43.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.58
|
| Rate for Payer: UHC Medicare Advantage |
$44.89
|
| Rate for Payer: UHC Medicare Advantage |
$44.89
|
| Rate for Payer: UMR Bronson Commercial |
$309.53
|
| Rate for Payer: UMR Bronson Commercial |
$415.12
|
| Rate for Payer: VA VA |
$43.58
|
| Rate for Payer: VA VA |
$43.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$841.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$627.43
|
|
|
MODAFINIL 200 MG TABLET
|
Facility
|
IP
|
$135.38
|
|
|
Service Code
|
NDC 62332-386-30
|
| Hospital Charge Code |
24703
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.57 |
| Max. Negotiated Rate |
$121.84 |
| Rate for Payer: Aetna American Axle |
$88.00
|
| Rate for Payer: Aetna Commercial |
$115.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.00
|
| Rate for Payer: Cash Price |
$108.30
|
| Rate for Payer: Cofinity Commercial |
$116.43
|
| Rate for Payer: Cofinity Commercial |
$94.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.30
|
| Rate for Payer: Healthscope Commercial |
$121.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$115.07
|
| Rate for Payer: PHP Commercial |
$115.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.77
|
| Rate for Payer: Priority Health SBD |
$85.29
|
| Rate for Payer: UMR Bronson Commercial |
$59.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.54
|
|
