|
MEXILETINE 200 MG CAPSULE
|
Facility
|
IP
|
$259.20
|
|
|
Service Code
|
NDC 50742024001
|
| Hospital Charge Code |
10596
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.05 |
| Max. Negotiated Rate |
$233.28 |
| Rate for Payer: Aetna American Axle |
$168.48
|
| Rate for Payer: Aetna Commercial |
$220.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.48
|
| Rate for Payer: Cash Price |
$207.36
|
| Rate for Payer: Cofinity Advantage |
$181.44
|
| Rate for Payer: Cofinity Commercial |
$222.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.36
|
| Rate for Payer: Healthscope Commercial |
$233.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$181.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.40
|
| Rate for Payer: PHP Commercial |
$220.32
|
| Rate for Payer: Priority Health SBD |
$163.30
|
| Rate for Payer: UMR Bronson Commercial |
$114.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.40
|
|
|
MEXILETINE 200 MG CAPSULE
|
Facility
|
OP
|
$702.24
|
|
|
Service Code
|
NDC 00093874001
|
| Hospital Charge Code |
10596
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$259.83 |
| Max. Negotiated Rate |
$632.02 |
| Rate for Payer: Aetna American Axle |
$456.46
|
| Rate for Payer: Aetna Commercial |
$596.90
|
| Rate for Payer: Aetna Medicare |
$351.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$456.46
|
| Rate for Payer: BCBS Complete |
$280.90
|
| Rate for Payer: Cash Price |
$561.79
|
| Rate for Payer: Cofinity Advantage |
$491.57
|
| Rate for Payer: Cofinity Commercial |
$603.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.79
|
| Rate for Payer: Healthscope Commercial |
$632.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$491.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$526.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$561.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$526.68
|
| Rate for Payer: PHP Commercial |
$596.90
|
| Rate for Payer: Priority Health SBD |
$442.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$456.46
|
| Rate for Payer: UHC Core |
$365.87
|
| Rate for Payer: UHC Exchange |
$275.98
|
| Rate for Payer: UMR Bronson Commercial |
$259.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$526.68
|
|
|
MEXILETINE 200 MG CAPSULE
|
Facility
|
OP
|
$259.20
|
|
|
Service Code
|
NDC 50742024001
|
| Hospital Charge Code |
10596
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.90 |
| Max. Negotiated Rate |
$233.28 |
| Rate for Payer: Aetna American Axle |
$168.48
|
| Rate for Payer: Aetna Commercial |
$220.32
|
| Rate for Payer: Aetna Medicare |
$129.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.48
|
| Rate for Payer: BCBS Complete |
$103.68
|
| Rate for Payer: Cash Price |
$207.36
|
| Rate for Payer: Cofinity Advantage |
$181.44
|
| Rate for Payer: Cofinity Commercial |
$222.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.36
|
| Rate for Payer: Healthscope Commercial |
$233.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$181.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$207.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.40
|
| Rate for Payer: PHP Commercial |
$220.32
|
| Rate for Payer: Priority Health SBD |
$163.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.48
|
| Rate for Payer: UHC Core |
$135.04
|
| Rate for Payer: UHC Exchange |
$101.87
|
| Rate for Payer: UMR Bronson Commercial |
$95.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.40
|
|
|
MEXILETINE 250 MG CAPSULE
|
Facility
|
OP
|
$822.24
|
|
|
Service Code
|
NDC 00093874101
|
| Hospital Charge Code |
10597
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$304.23 |
| Max. Negotiated Rate |
$740.02 |
| Rate for Payer: Aetna American Axle |
$534.46
|
| Rate for Payer: Aetna Commercial |
$698.90
|
| Rate for Payer: Aetna Medicare |
$411.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$534.46
|
| Rate for Payer: BCBS Complete |
$328.90
|
| Rate for Payer: Cash Price |
$657.79
|
| Rate for Payer: Cofinity Advantage |
$575.57
|
| Rate for Payer: Cofinity Commercial |
$707.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$657.79
|
| Rate for Payer: Healthscope Commercial |
$740.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$575.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$616.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$657.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$698.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$616.68
|
| Rate for Payer: PHP Commercial |
$698.90
|
| Rate for Payer: Priority Health SBD |
$518.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$534.46
|
| Rate for Payer: UHC Core |
$428.39
|
| Rate for Payer: UHC Exchange |
$323.14
|
| Rate for Payer: UMR Bronson Commercial |
$304.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$616.68
|
|
|
MEXILETINE 250 MG CAPSULE
|
Facility
|
IP
|
$822.24
|
|
|
Service Code
|
NDC 00093874101
|
| Hospital Charge Code |
10597
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$361.79 |
| Max. Negotiated Rate |
$740.02 |
| Rate for Payer: Aetna American Axle |
$534.46
|
| Rate for Payer: Aetna Commercial |
$698.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$534.46
|
| Rate for Payer: Cash Price |
$657.79
|
| Rate for Payer: Cofinity Advantage |
$575.57
|
| Rate for Payer: Cofinity Commercial |
$707.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$657.79
|
| Rate for Payer: Healthscope Commercial |
$740.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$575.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$616.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$698.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$616.68
|
| Rate for Payer: PHP Commercial |
$698.90
|
| Rate for Payer: Priority Health SBD |
$518.01
|
| Rate for Payer: UMR Bronson Commercial |
$361.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$616.68
|
|
|
MICAFUNGIN 100 MG INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$99.33
|
|
|
Service Code
|
HCPCS J2247
|
| Hospital Charge Code |
301720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$89.40 |
| Rate for Payer: Aetna American Axle |
$64.56
|
| Rate for Payer: Aetna Commercial |
$84.43
|
| Rate for Payer: Aetna Medicare |
$49.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.56
|
| Rate for Payer: BCBS Complete |
$39.73
|
| Rate for Payer: BCBS Trust/PPO |
$0.70
|
| Rate for Payer: BCN Commercial |
$0.70
|
| Rate for Payer: Cash Price |
$79.46
|
| Rate for Payer: Cash Price |
$79.46
|
| Rate for Payer: Cofinity Advantage |
$69.53
|
| Rate for Payer: Cofinity Commercial |
$85.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.46
|
| Rate for Payer: Healthscope Commercial |
$89.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.50
|
| Rate for Payer: PHP Commercial |
$84.43
|
| Rate for Payer: Priority Health SBD |
$62.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.36
|
| Rate for Payer: UHC Core |
$0.36
|
| Rate for Payer: UHC Exchange |
$0.36
|
| Rate for Payer: UMR Bronson Commercial |
$36.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.50
|
|
|
MICAFUNGIN 100 MG INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$99.33
|
|
|
Service Code
|
HCPCS J2247
|
| Hospital Charge Code |
301720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.71 |
| Max. Negotiated Rate |
$89.40 |
| Rate for Payer: Aetna American Axle |
$64.56
|
| Rate for Payer: Aetna Commercial |
$84.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.56
|
| Rate for Payer: Cash Price |
$79.46
|
| Rate for Payer: Cofinity Advantage |
$69.53
|
| Rate for Payer: Cofinity Commercial |
$85.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.46
|
| Rate for Payer: Healthscope Commercial |
$89.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.50
|
| Rate for Payer: PHP Commercial |
$84.43
|
| Rate for Payer: Priority Health SBD |
$62.58
|
| Rate for Payer: UMR Bronson Commercial |
$43.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.50
|
|
|
MICAFUNGIN 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$99.33
|
|
|
Service Code
|
HCPCS J2247
|
| Hospital Charge Code |
77685
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.71 |
| Max. Negotiated Rate |
$89.40 |
| Rate for Payer: Aetna American Axle |
$64.56
|
| Rate for Payer: Aetna Commercial |
$84.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.56
|
| Rate for Payer: Cash Price |
$79.46
|
| Rate for Payer: Cofinity Advantage |
$69.53
|
| Rate for Payer: Cofinity Commercial |
$85.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.46
|
| Rate for Payer: Healthscope Commercial |
$89.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.50
|
| Rate for Payer: PHP Commercial |
$84.43
|
| Rate for Payer: Priority Health SBD |
$62.58
|
| Rate for Payer: UMR Bronson Commercial |
$43.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.50
|
|
|
MICAFUNGIN 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$99.11
|
|
|
Service Code
|
HCPCS J2248
|
| Hospital Charge Code |
77685
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.61 |
| Max. Negotiated Rate |
$89.20 |
| Rate for Payer: Aetna American Axle |
$64.42
|
| Rate for Payer: Aetna American Axle |
$64.42
|
| Rate for Payer: Aetna American Axle |
$62.17
|
| Rate for Payer: Aetna American Axle |
$73.81
|
| Rate for Payer: Aetna American Axle |
$91.46
|
| Rate for Payer: Aetna American Axle |
$73.82
|
| Rate for Payer: Aetna Commercial |
$84.24
|
| Rate for Payer: Aetna Commercial |
$119.60
|
| Rate for Payer: Aetna Commercial |
$81.29
|
| Rate for Payer: Aetna Commercial |
$96.53
|
| Rate for Payer: Aetna Commercial |
$84.23
|
| Rate for Payer: Aetna Commercial |
$96.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.81
|
| Rate for Payer: Cash Price |
$79.29
|
| Rate for Payer: Cash Price |
$79.28
|
| Rate for Payer: Cash Price |
$76.51
|
| Rate for Payer: Cash Price |
$90.85
|
| Rate for Payer: Cash Price |
$112.57
|
| Rate for Payer: Cash Price |
$90.86
|
| Rate for Payer: Cofinity Advantage |
$66.95
|
| Rate for Payer: Cofinity Advantage |
$79.50
|
| Rate for Payer: Cofinity Advantage |
$79.49
|
| Rate for Payer: Cofinity Advantage |
$69.37
|
| Rate for Payer: Cofinity Advantage |
$98.50
|
| Rate for Payer: Cofinity Advantage |
$69.38
|
| Rate for Payer: Cofinity Commercial |
$97.67
|
| Rate for Payer: Cofinity Commercial |
$82.25
|
| Rate for Payer: Cofinity Commercial |
$85.23
|
| Rate for Payer: Cofinity Commercial |
$97.66
|
| Rate for Payer: Cofinity Commercial |
$121.01
|
| Rate for Payer: Cofinity Commercial |
$85.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.29
|
| Rate for Payer: Healthscope Commercial |
$89.19
|
| Rate for Payer: Healthscope Commercial |
$102.20
|
| Rate for Payer: Healthscope Commercial |
$86.08
|
| Rate for Payer: Healthscope Commercial |
$102.21
|
| Rate for Payer: Healthscope Commercial |
$126.64
|
| Rate for Payer: Healthscope Commercial |
$89.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.53
|
| Rate for Payer: PHP Commercial |
$119.60
|
| Rate for Payer: PHP Commercial |
$84.24
|
| Rate for Payer: PHP Commercial |
$84.23
|
| Rate for Payer: PHP Commercial |
$81.29
|
| Rate for Payer: PHP Commercial |
$96.53
|
| Rate for Payer: PHP Commercial |
$96.53
|
| Rate for Payer: Priority Health SBD |
$62.43
|
| Rate for Payer: Priority Health SBD |
$71.55
|
| Rate for Payer: Priority Health SBD |
$71.54
|
| Rate for Payer: Priority Health SBD |
$88.65
|
| Rate for Payer: Priority Health SBD |
$60.25
|
| Rate for Payer: Priority Health SBD |
$62.44
|
| Rate for Payer: UMR Bronson Commercial |
$43.60
|
| Rate for Payer: UMR Bronson Commercial |
$61.91
|
| Rate for Payer: UMR Bronson Commercial |
$42.08
|
| Rate for Payer: UMR Bronson Commercial |
$49.97
|
| Rate for Payer: UMR Bronson Commercial |
$43.61
|
| Rate for Payer: UMR Bronson Commercial |
$49.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.53
|
|
|
MICAFUNGIN 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$99.10
|
|
|
Service Code
|
HCPCS J2248
|
| Hospital Charge Code |
77685
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$89.19 |
| Rate for Payer: Aetna American Axle |
$64.42
|
| Rate for Payer: Aetna American Axle |
$62.17
|
| Rate for Payer: Aetna American Axle |
$91.46
|
| Rate for Payer: Aetna American Axle |
$118.81
|
| Rate for Payer: Aetna American Axle |
$401.30
|
| Rate for Payer: Aetna American Axle |
$73.81
|
| Rate for Payer: Aetna American Axle |
$73.82
|
| Rate for Payer: Aetna American Axle |
$64.42
|
| Rate for Payer: Aetna Commercial |
$119.60
|
| Rate for Payer: Aetna Commercial |
$96.53
|
| Rate for Payer: Aetna Commercial |
$524.78
|
| Rate for Payer: Aetna Commercial |
$155.36
|
| Rate for Payer: Aetna Commercial |
$81.29
|
| Rate for Payer: Aetna Commercial |
$84.23
|
| Rate for Payer: Aetna Commercial |
$84.24
|
| Rate for Payer: Aetna Commercial |
$96.53
|
| Rate for Payer: Aetna Medicare |
$70.36
|
| Rate for Payer: Aetna Medicare |
$56.78
|
| Rate for Payer: Aetna Medicare |
$49.55
|
| Rate for Payer: Aetna Medicare |
$56.78
|
| Rate for Payer: Aetna Medicare |
$308.69
|
| Rate for Payer: Aetna Medicare |
$91.39
|
| Rate for Payer: Aetna Medicare |
$49.55
|
| Rate for Payer: Aetna Medicare |
$47.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$401.30
|
| Rate for Payer: BCBS Complete |
$39.64
|
| Rate for Payer: BCBS Complete |
$38.26
|
| Rate for Payer: BCBS Complete |
$73.11
|
| Rate for Payer: BCBS Complete |
$45.42
|
| Rate for Payer: BCBS Complete |
$56.28
|
| Rate for Payer: BCBS Complete |
$45.43
|
| Rate for Payer: BCBS Complete |
$39.64
|
| Rate for Payer: BCBS Complete |
$246.96
|
| Rate for Payer: BCBS Trust/PPO |
$0.80
|
| Rate for Payer: BCBS Trust/PPO |
$0.80
|
| Rate for Payer: BCBS Trust/PPO |
$0.80
|
| Rate for Payer: BCBS Trust/PPO |
$0.80
|
| Rate for Payer: BCBS Trust/PPO |
$0.80
|
| Rate for Payer: BCBS Trust/PPO |
$0.80
|
| Rate for Payer: BCBS Trust/PPO |
$0.80
|
| Rate for Payer: BCBS Trust/PPO |
$0.80
|
| Rate for Payer: BCN Commercial |
$0.80
|
| Rate for Payer: BCN Commercial |
$0.80
|
| Rate for Payer: BCN Commercial |
$0.80
|
| Rate for Payer: BCN Commercial |
$0.80
|
| Rate for Payer: BCN Commercial |
$0.80
|
| Rate for Payer: BCN Commercial |
$0.80
|
| Rate for Payer: BCN Commercial |
$0.80
|
| Rate for Payer: BCN Commercial |
$0.80
|
| Rate for Payer: Cash Price |
$90.86
|
| Rate for Payer: Cash Price |
$90.85
|
| Rate for Payer: Cash Price |
$90.85
|
| Rate for Payer: Cash Price |
$112.57
|
| Rate for Payer: Cash Price |
$112.57
|
| Rate for Payer: Cash Price |
$90.86
|
| Rate for Payer: Cash Price |
$146.22
|
| Rate for Payer: Cash Price |
$146.22
|
| Rate for Payer: Cash Price |
$493.91
|
| Rate for Payer: Cash Price |
$493.91
|
| Rate for Payer: Cash Price |
$76.51
|
| Rate for Payer: Cash Price |
$76.51
|
| Rate for Payer: Cash Price |
$79.28
|
| Rate for Payer: Cash Price |
$79.28
|
| Rate for Payer: Cash Price |
$79.29
|
| Rate for Payer: Cash Price |
$79.29
|
| Rate for Payer: Cofinity Advantage |
$66.95
|
| Rate for Payer: Cofinity Advantage |
$69.38
|
| Rate for Payer: Cofinity Advantage |
$98.50
|
| Rate for Payer: Cofinity Advantage |
$432.17
|
| Rate for Payer: Cofinity Advantage |
$69.37
|
| Rate for Payer: Cofinity Advantage |
$127.95
|
| Rate for Payer: Cofinity Advantage |
$79.49
|
| Rate for Payer: Cofinity Advantage |
$79.50
|
| Rate for Payer: Cofinity Commercial |
$157.19
|
| Rate for Payer: Cofinity Commercial |
$82.25
|
| Rate for Payer: Cofinity Commercial |
$85.23
|
| Rate for Payer: Cofinity Commercial |
$97.66
|
| Rate for Payer: Cofinity Commercial |
$97.67
|
| Rate for Payer: Cofinity Commercial |
$121.01
|
| Rate for Payer: Cofinity Commercial |
$85.23
|
| Rate for Payer: Cofinity Commercial |
$530.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$493.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.28
|
| Rate for Payer: Healthscope Commercial |
$102.20
|
| Rate for Payer: Healthscope Commercial |
$89.20
|
| Rate for Payer: Healthscope Commercial |
$126.64
|
| Rate for Payer: Healthscope Commercial |
$164.50
|
| Rate for Payer: Healthscope Commercial |
$89.19
|
| Rate for Payer: Healthscope Commercial |
$86.08
|
| Rate for Payer: Healthscope Commercial |
$102.21
|
| Rate for Payer: Healthscope Commercial |
$555.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$432.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$463.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$493.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$524.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$463.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$137.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.53
|
| Rate for Payer: PHP Commercial |
$96.53
|
| Rate for Payer: PHP Commercial |
$155.36
|
| Rate for Payer: PHP Commercial |
$81.29
|
| Rate for Payer: PHP Commercial |
$119.60
|
| Rate for Payer: PHP Commercial |
$84.24
|
| Rate for Payer: PHP Commercial |
$84.23
|
| Rate for Payer: PHP Commercial |
$524.78
|
| Rate for Payer: PHP Commercial |
$96.53
|
| Rate for Payer: Priority Health SBD |
$71.55
|
| Rate for Payer: Priority Health SBD |
$62.44
|
| Rate for Payer: Priority Health SBD |
$71.54
|
| Rate for Payer: Priority Health SBD |
$60.25
|
| Rate for Payer: Priority Health SBD |
$62.43
|
| Rate for Payer: Priority Health SBD |
$88.65
|
| Rate for Payer: Priority Health SBD |
$115.15
|
| Rate for Payer: Priority Health SBD |
$388.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.41
|
| Rate for Payer: UHC Core |
$0.41
|
| Rate for Payer: UHC Core |
$0.41
|
| Rate for Payer: UHC Core |
$0.41
|
| Rate for Payer: UHC Core |
$0.41
|
| Rate for Payer: UHC Core |
$0.41
|
| Rate for Payer: UHC Core |
$0.41
|
| Rate for Payer: UHC Core |
$0.41
|
| Rate for Payer: UHC Core |
$0.41
|
| Rate for Payer: UHC Exchange |
$0.41
|
| Rate for Payer: UHC Exchange |
$0.41
|
| Rate for Payer: UHC Exchange |
$0.41
|
| Rate for Payer: UHC Exchange |
$0.41
|
| Rate for Payer: UHC Exchange |
$0.41
|
| Rate for Payer: UHC Exchange |
$0.41
|
| Rate for Payer: UHC Exchange |
$0.41
|
| Rate for Payer: UHC Exchange |
$0.41
|
| Rate for Payer: UMR Bronson Commercial |
$36.67
|
| Rate for Payer: UMR Bronson Commercial |
$36.67
|
| Rate for Payer: UMR Bronson Commercial |
$228.43
|
| Rate for Payer: UMR Bronson Commercial |
$52.06
|
| Rate for Payer: UMR Bronson Commercial |
$35.39
|
| Rate for Payer: UMR Bronson Commercial |
$42.02
|
| Rate for Payer: UMR Bronson Commercial |
$42.02
|
| Rate for Payer: UMR Bronson Commercial |
$67.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$463.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.33
|
|
|
MICAFUNGIN 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$99.33
|
|
|
Service Code
|
HCPCS J2247
|
| Hospital Charge Code |
77685
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$89.40 |
| Rate for Payer: Aetna American Axle |
$64.56
|
| Rate for Payer: Aetna Commercial |
$84.43
|
| Rate for Payer: Aetna Medicare |
$49.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.56
|
| Rate for Payer: BCBS Complete |
$39.73
|
| Rate for Payer: BCBS Trust/PPO |
$0.70
|
| Rate for Payer: BCN Commercial |
$0.70
|
| Rate for Payer: Cash Price |
$79.46
|
| Rate for Payer: Cash Price |
$79.46
|
| Rate for Payer: Cofinity Advantage |
$69.53
|
| Rate for Payer: Cofinity Commercial |
$85.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.46
|
| Rate for Payer: Healthscope Commercial |
$89.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.50
|
| Rate for Payer: PHP Commercial |
$84.43
|
| Rate for Payer: Priority Health SBD |
$62.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.36
|
| Rate for Payer: UHC Core |
$0.36
|
| Rate for Payer: UHC Exchange |
$0.36
|
| Rate for Payer: UMR Bronson Commercial |
$36.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.50
|
|
|
MICAFUNGIN 50 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$161.52
|
|
|
Service Code
|
HCPCS J2248
|
| Hospital Charge Code |
41144
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$145.37 |
| Rate for Payer: Aetna American Axle |
$104.99
|
| Rate for Payer: Aetna American Axle |
$37.93
|
| Rate for Payer: Aetna American Axle |
$32.29
|
| Rate for Payer: Aetna American Axle |
$200.66
|
| Rate for Payer: Aetna American Axle |
$39.55
|
| Rate for Payer: Aetna Commercial |
$137.29
|
| Rate for Payer: Aetna Commercial |
$262.40
|
| Rate for Payer: Aetna Commercial |
$51.71
|
| Rate for Payer: Aetna Commercial |
$49.61
|
| Rate for Payer: Aetna Commercial |
$42.22
|
| Rate for Payer: Aetna Medicare |
$30.42
|
| Rate for Payer: Aetna Medicare |
$154.35
|
| Rate for Payer: Aetna Medicare |
$80.76
|
| Rate for Payer: Aetna Medicare |
$24.84
|
| Rate for Payer: Aetna Medicare |
$29.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.55
|
| Rate for Payer: BCBS Complete |
$23.34
|
| Rate for Payer: BCBS Complete |
$64.61
|
| Rate for Payer: BCBS Complete |
$123.48
|
| Rate for Payer: BCBS Complete |
$19.87
|
| Rate for Payer: BCBS Complete |
$24.34
|
| Rate for Payer: BCBS Trust/PPO |
$0.80
|
| Rate for Payer: BCBS Trust/PPO |
$0.80
|
| Rate for Payer: BCBS Trust/PPO |
$0.80
|
| Rate for Payer: BCBS Trust/PPO |
$0.80
|
| Rate for Payer: BCBS Trust/PPO |
$0.80
|
| Rate for Payer: BCN Commercial |
$0.80
|
| Rate for Payer: BCN Commercial |
$0.80
|
| Rate for Payer: BCN Commercial |
$0.80
|
| Rate for Payer: BCN Commercial |
$0.80
|
| Rate for Payer: BCN Commercial |
$0.80
|
| Rate for Payer: Cash Price |
$46.69
|
| Rate for Payer: Cash Price |
$48.67
|
| Rate for Payer: Cash Price |
$246.97
|
| Rate for Payer: Cash Price |
$129.22
|
| Rate for Payer: Cash Price |
$39.74
|
| Rate for Payer: Cash Price |
$129.22
|
| Rate for Payer: Cash Price |
$39.74
|
| Rate for Payer: Cash Price |
$46.69
|
| Rate for Payer: Cash Price |
$246.97
|
| Rate for Payer: Cash Price |
$48.67
|
| Rate for Payer: Cofinity Advantage |
$40.85
|
| Rate for Payer: Cofinity Advantage |
$216.10
|
| Rate for Payer: Cofinity Advantage |
$34.77
|
| Rate for Payer: Cofinity Advantage |
$42.59
|
| Rate for Payer: Cofinity Advantage |
$113.06
|
| Rate for Payer: Cofinity Commercial |
$50.19
|
| Rate for Payer: Cofinity Commercial |
$138.91
|
| Rate for Payer: Cofinity Commercial |
$265.49
|
| Rate for Payer: Cofinity Commercial |
$42.72
|
| Rate for Payer: Cofinity Commercial |
$52.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.74
|
| Rate for Payer: Healthscope Commercial |
$44.70
|
| Rate for Payer: Healthscope Commercial |
$54.76
|
| Rate for Payer: Healthscope Commercial |
$52.52
|
| Rate for Payer: Healthscope Commercial |
$145.37
|
| Rate for Payer: Healthscope Commercial |
$277.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$246.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$231.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.63
|
| Rate for Payer: PHP Commercial |
$262.40
|
| Rate for Payer: PHP Commercial |
$42.22
|
| Rate for Payer: PHP Commercial |
$51.71
|
| Rate for Payer: PHP Commercial |
$49.61
|
| Rate for Payer: PHP Commercial |
$137.29
|
| Rate for Payer: Priority Health SBD |
$31.29
|
| Rate for Payer: Priority Health SBD |
$101.76
|
| Rate for Payer: Priority Health SBD |
$36.77
|
| Rate for Payer: Priority Health SBD |
$38.33
|
| Rate for Payer: Priority Health SBD |
$194.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.41
|
| Rate for Payer: UHC Core |
$0.41
|
| Rate for Payer: UHC Core |
$0.41
|
| Rate for Payer: UHC Core |
$0.41
|
| Rate for Payer: UHC Core |
$0.41
|
| Rate for Payer: UHC Core |
$0.41
|
| Rate for Payer: UHC Exchange |
$0.41
|
| Rate for Payer: UHC Exchange |
$0.41
|
| Rate for Payer: UHC Exchange |
$0.41
|
| Rate for Payer: UHC Exchange |
$0.41
|
| Rate for Payer: UHC Exchange |
$0.41
|
| Rate for Payer: UMR Bronson Commercial |
$59.76
|
| Rate for Payer: UMR Bronson Commercial |
$21.59
|
| Rate for Payer: UMR Bronson Commercial |
$18.38
|
| Rate for Payer: UMR Bronson Commercial |
$22.51
|
| Rate for Payer: UMR Bronson Commercial |
$114.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.14
|
|
|
MICAFUNGIN 50 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$55.87
|
|
|
Service Code
|
HCPCS J2247
|
| Hospital Charge Code |
41144
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$50.28 |
| Rate for Payer: Aetna American Axle |
$36.32
|
| Rate for Payer: Aetna Commercial |
$47.49
|
| Rate for Payer: Aetna Medicare |
$27.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.32
|
| Rate for Payer: BCBS Complete |
$22.35
|
| Rate for Payer: BCBS Trust/PPO |
$0.70
|
| Rate for Payer: BCN Commercial |
$0.70
|
| Rate for Payer: Cash Price |
$44.70
|
| Rate for Payer: Cash Price |
$44.70
|
| Rate for Payer: Cofinity Advantage |
$39.11
|
| Rate for Payer: Cofinity Commercial |
$48.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.70
|
| Rate for Payer: Healthscope Commercial |
$50.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.90
|
| Rate for Payer: PHP Commercial |
$47.49
|
| Rate for Payer: Priority Health SBD |
$35.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.36
|
| Rate for Payer: UHC Core |
$0.36
|
| Rate for Payer: UHC Exchange |
$0.36
|
| Rate for Payer: UMR Bronson Commercial |
$20.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.90
|
|
|
MICAFUNGIN 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$55.87
|
|
|
Service Code
|
HCPCS J2247
|
| Hospital Charge Code |
41144
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.58 |
| Max. Negotiated Rate |
$50.28 |
| Rate for Payer: Aetna American Axle |
$36.32
|
| Rate for Payer: Aetna Commercial |
$47.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.32
|
| Rate for Payer: Cash Price |
$44.70
|
| Rate for Payer: Cofinity Advantage |
$39.11
|
| Rate for Payer: Cofinity Commercial |
$48.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.70
|
| Rate for Payer: Healthscope Commercial |
$50.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.90
|
| Rate for Payer: PHP Commercial |
$47.49
|
| Rate for Payer: Priority Health SBD |
$35.20
|
| Rate for Payer: UMR Bronson Commercial |
$24.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.90
|
|
|
MICAFUNGIN 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$58.36
|
|
|
Service Code
|
HCPCS J2248
|
| Hospital Charge Code |
41144
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.68 |
| Max. Negotiated Rate |
$52.52 |
| Rate for Payer: Aetna American Axle |
$37.93
|
| Rate for Payer: Aetna American Axle |
$32.29
|
| Rate for Payer: Aetna American Axle |
$39.55
|
| Rate for Payer: Aetna American Axle |
$200.66
|
| Rate for Payer: Aetna American Axle |
$104.99
|
| Rate for Payer: Aetna Commercial |
$137.29
|
| Rate for Payer: Aetna Commercial |
$42.22
|
| Rate for Payer: Aetna Commercial |
$49.61
|
| Rate for Payer: Aetna Commercial |
$51.71
|
| Rate for Payer: Aetna Commercial |
$262.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.55
|
| Rate for Payer: Cash Price |
$39.74
|
| Rate for Payer: Cash Price |
$246.97
|
| Rate for Payer: Cash Price |
$48.67
|
| Rate for Payer: Cash Price |
$46.69
|
| Rate for Payer: Cash Price |
$129.22
|
| Rate for Payer: Cofinity Advantage |
$113.06
|
| Rate for Payer: Cofinity Advantage |
$42.59
|
| Rate for Payer: Cofinity Advantage |
$216.10
|
| Rate for Payer: Cofinity Advantage |
$40.85
|
| Rate for Payer: Cofinity Advantage |
$34.77
|
| Rate for Payer: Cofinity Commercial |
$52.32
|
| Rate for Payer: Cofinity Commercial |
$138.91
|
| Rate for Payer: Cofinity Commercial |
$265.49
|
| Rate for Payer: Cofinity Commercial |
$42.72
|
| Rate for Payer: Cofinity Commercial |
$50.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.67
|
| Rate for Payer: Healthscope Commercial |
$145.37
|
| Rate for Payer: Healthscope Commercial |
$277.84
|
| Rate for Payer: Healthscope Commercial |
$44.70
|
| Rate for Payer: Healthscope Commercial |
$52.52
|
| Rate for Payer: Healthscope Commercial |
$54.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$231.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.77
|
| Rate for Payer: PHP Commercial |
$42.22
|
| Rate for Payer: PHP Commercial |
$137.29
|
| Rate for Payer: PHP Commercial |
$49.61
|
| Rate for Payer: PHP Commercial |
$51.71
|
| Rate for Payer: PHP Commercial |
$262.40
|
| Rate for Payer: Priority Health SBD |
$36.77
|
| Rate for Payer: Priority Health SBD |
$38.33
|
| Rate for Payer: Priority Health SBD |
$194.49
|
| Rate for Payer: Priority Health SBD |
$101.76
|
| Rate for Payer: Priority Health SBD |
$31.29
|
| Rate for Payer: UMR Bronson Commercial |
$135.83
|
| Rate for Payer: UMR Bronson Commercial |
$26.77
|
| Rate for Payer: UMR Bronson Commercial |
$21.85
|
| Rate for Payer: UMR Bronson Commercial |
$71.07
|
| Rate for Payer: UMR Bronson Commercial |
$25.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.53
|
|
|
MICONAZOLE NITRATE 200 MG VAGINAL SUPPOSITORY
|
Facility
|
OP
|
$164.32
|
|
|
Service Code
|
NDC 00472173803
|
| Hospital Charge Code |
109535
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.80 |
| Max. Negotiated Rate |
$147.89 |
| Rate for Payer: Aetna American Axle |
$106.81
|
| Rate for Payer: Aetna Commercial |
$139.67
|
| Rate for Payer: Aetna Medicare |
$82.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.81
|
| Rate for Payer: BCBS Complete |
$65.73
|
| Rate for Payer: Cash Price |
$131.46
|
| Rate for Payer: Cofinity Advantage |
$115.02
|
| Rate for Payer: Cofinity Commercial |
$141.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.46
|
| Rate for Payer: Healthscope Commercial |
$147.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$131.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.24
|
| Rate for Payer: PHP Commercial |
$139.67
|
| Rate for Payer: Priority Health SBD |
$103.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.81
|
| Rate for Payer: UHC Core |
$85.61
|
| Rate for Payer: UHC Exchange |
$64.58
|
| Rate for Payer: UMR Bronson Commercial |
$60.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.24
|
|
|
MICONAZOLE NITRATE 200 MG VAGINAL SUPPOSITORY
|
Facility
|
IP
|
$164.32
|
|
|
Service Code
|
NDC 00472173803
|
| Hospital Charge Code |
109535
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.30 |
| Max. Negotiated Rate |
$147.89 |
| Rate for Payer: Aetna American Axle |
$106.81
|
| Rate for Payer: Aetna Commercial |
$139.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.81
|
| Rate for Payer: Cash Price |
$131.46
|
| Rate for Payer: Cofinity Advantage |
$115.02
|
| Rate for Payer: Cofinity Commercial |
$141.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.46
|
| Rate for Payer: Healthscope Commercial |
$147.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.24
|
| Rate for Payer: PHP Commercial |
$139.67
|
| Rate for Payer: Priority Health SBD |
$103.52
|
| Rate for Payer: UMR Bronson Commercial |
$72.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.24
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL CREAM
|
Facility
|
IP
|
$25.11
|
|
|
Service Code
|
NDC 00536113428
|
| Hospital Charge Code |
5039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.05 |
| Max. Negotiated Rate |
$22.60 |
| Rate for Payer: Aetna American Axle |
$16.32
|
| Rate for Payer: Aetna Commercial |
$21.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.32
|
| Rate for Payer: Cash Price |
$20.09
|
| Rate for Payer: Cofinity Advantage |
$17.58
|
| Rate for Payer: Cofinity Commercial |
$21.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.09
|
| Rate for Payer: Healthscope Commercial |
$22.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.83
|
| Rate for Payer: PHP Commercial |
$21.34
|
| Rate for Payer: Priority Health SBD |
$15.82
|
| Rate for Payer: UMR Bronson Commercial |
$11.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.83
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL CREAM
|
Facility
|
OP
|
$9.20
|
|
|
Service Code
|
NDC 61269073556
|
| Hospital Charge Code |
5039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$8.28 |
| Rate for Payer: Aetna American Axle |
$5.98
|
| Rate for Payer: Aetna Commercial |
$7.82
|
| Rate for Payer: Aetna Medicare |
$4.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.98
|
| Rate for Payer: BCBS Complete |
$3.68
|
| Rate for Payer: Cash Price |
$7.36
|
| Rate for Payer: Cofinity Advantage |
$6.44
|
| Rate for Payer: Cofinity Commercial |
$7.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.36
|
| Rate for Payer: Healthscope Commercial |
$8.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.90
|
| Rate for Payer: PHP Commercial |
$7.82
|
| Rate for Payer: Priority Health SBD |
$5.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.98
|
| Rate for Payer: UHC Core |
$4.79
|
| Rate for Payer: UHC Exchange |
$3.62
|
| Rate for Payer: UMR Bronson Commercial |
$3.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.90
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL CREAM
|
Facility
|
IP
|
$9.20
|
|
|
Service Code
|
NDC 61269073556
|
| Hospital Charge Code |
5039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$8.28 |
| Rate for Payer: Aetna American Axle |
$5.98
|
| Rate for Payer: Aetna Commercial |
$7.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.98
|
| Rate for Payer: Cash Price |
$7.36
|
| Rate for Payer: Cofinity Advantage |
$6.44
|
| Rate for Payer: Cofinity Commercial |
$7.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.36
|
| Rate for Payer: Healthscope Commercial |
$8.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.90
|
| Rate for Payer: PHP Commercial |
$7.82
|
| Rate for Payer: Priority Health SBD |
$5.80
|
| Rate for Payer: UMR Bronson Commercial |
$4.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.90
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL CREAM
|
Facility
|
OP
|
$25.11
|
|
|
Service Code
|
NDC 00536113428
|
| Hospital Charge Code |
5039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.29 |
| Max. Negotiated Rate |
$22.60 |
| Rate for Payer: Aetna American Axle |
$16.32
|
| Rate for Payer: Aetna Commercial |
$21.34
|
| Rate for Payer: Aetna Medicare |
$12.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.32
|
| Rate for Payer: BCBS Complete |
$10.04
|
| Rate for Payer: Cash Price |
$20.09
|
| Rate for Payer: Cofinity Advantage |
$17.58
|
| Rate for Payer: Cofinity Commercial |
$21.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.09
|
| Rate for Payer: Healthscope Commercial |
$22.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.83
|
| Rate for Payer: PHP Commercial |
$21.34
|
| Rate for Payer: Priority Health SBD |
$15.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.32
|
| Rate for Payer: UHC Core |
$13.08
|
| Rate for Payer: UHC Exchange |
$9.87
|
| Rate for Payer: UMR Bronson Commercial |
$9.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.83
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL OINTMENT
|
Facility
|
OP
|
$47.72
|
|
|
Service Code
|
NDC 11701006714
|
| Hospital Charge Code |
13651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.66 |
| Max. Negotiated Rate |
$42.95 |
| Rate for Payer: Aetna American Axle |
$31.02
|
| Rate for Payer: Aetna Commercial |
$40.56
|
| Rate for Payer: Aetna Medicare |
$23.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.02
|
| Rate for Payer: BCBS Complete |
$19.09
|
| Rate for Payer: Cash Price |
$38.18
|
| Rate for Payer: Cofinity Advantage |
$33.40
|
| Rate for Payer: Cofinity Commercial |
$41.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.18
|
| Rate for Payer: Healthscope Commercial |
$42.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.79
|
| Rate for Payer: PHP Commercial |
$40.56
|
| Rate for Payer: Priority Health SBD |
$30.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.02
|
| Rate for Payer: UHC Core |
$24.86
|
| Rate for Payer: UHC Exchange |
$18.75
|
| Rate for Payer: UMR Bronson Commercial |
$17.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.79
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$47.72
|
|
|
Service Code
|
NDC 11701006714
|
| Hospital Charge Code |
13651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$42.95 |
| Rate for Payer: Aetna American Axle |
$31.02
|
| Rate for Payer: Aetna Commercial |
$40.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.02
|
| Rate for Payer: Cash Price |
$38.18
|
| Rate for Payer: Cofinity Advantage |
$33.40
|
| Rate for Payer: Cofinity Commercial |
$41.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.18
|
| Rate for Payer: Healthscope Commercial |
$42.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.79
|
| Rate for Payer: PHP Commercial |
$40.56
|
| Rate for Payer: Priority Health SBD |
$30.06
|
| Rate for Payer: UMR Bronson Commercial |
$21.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.79
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$28.33
|
|
|
Service Code
|
NDC 11701006723
|
| Hospital Charge Code |
13651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.47 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna American Axle |
$18.41
|
| Rate for Payer: Aetna Commercial |
$24.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.41
|
| Rate for Payer: Cash Price |
$22.66
|
| Rate for Payer: Cofinity Advantage |
$19.83
|
| Rate for Payer: Cofinity Commercial |
$24.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.66
|
| Rate for Payer: Healthscope Commercial |
$25.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.25
|
| Rate for Payer: PHP Commercial |
$24.08
|
| Rate for Payer: Priority Health SBD |
$17.85
|
| Rate for Payer: UMR Bronson Commercial |
$12.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.25
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$44.49
|
|
|
Service Code
|
NDC 16864004002
|
| Hospital Charge Code |
13651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.58 |
| Max. Negotiated Rate |
$40.04 |
| 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 |
$35.59
|
| Rate for Payer: Cofinity Advantage |
$31.14
|
| Rate for Payer: Cofinity Commercial |
$38.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.59
|
| Rate for Payer: Healthscope Commercial |
$40.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.37
|
| Rate for Payer: PHP Commercial |
$37.82
|
| Rate for Payer: Priority Health SBD |
$28.03
|
| Rate for Payer: UMR Bronson Commercial |
$19.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.37
|
|
