|
METRONIDAZOLE 50 MG/ML SUSPENSION (SIMPLE)
|
Facility
|
IP
|
$164.50
|
|
|
Service Code
|
NDC 09900001032
|
| Hospital Charge Code |
200170
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.38 |
| Max. Negotiated Rate |
$148.05 |
| Rate for Payer: Cash Price |
$131.60
|
| Rate for Payer: Cofinity Commercial |
$115.15
|
| Rate for Payer: Cofinity Commercial |
$141.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.15
|
| Rate for Payer: Aetna American Axle |
$106.92
|
| Rate for Payer: Aetna Commercial |
$139.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.60
|
| Rate for Payer: Healthscope Commercial |
$148.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.82
|
| Rate for Payer: PHP Commercial |
$139.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.92
|
| Rate for Payer: Priority Health SBD |
$103.64
|
| Rate for Payer: UMR Bronson Commercial |
$72.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.38
|
|
|
METRONIDAZOLE 50 MG/ML SUSPENSION (SIMPLE)
|
Facility
|
OP
|
$662.63
|
|
|
Service Code
|
NDC 65628020205
|
| Hospital Charge Code |
200170
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$245.17 |
| Max. Negotiated Rate |
$596.37 |
| Rate for Payer: Aetna American Axle |
$430.71
|
| Rate for Payer: Aetna Commercial |
$563.24
|
| Rate for Payer: Aetna Medicare |
$331.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$430.71
|
| Rate for Payer: BCBS Complete |
$265.05
|
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: Cofinity Commercial |
$463.84
|
| Rate for Payer: Cofinity Commercial |
$569.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$463.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$530.10
|
| Rate for Payer: Healthscope Commercial |
$596.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$463.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$496.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.24
|
| Rate for Payer: PHP Commercial |
$563.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$430.71
|
| Rate for Payer: Priority Health SBD |
$417.46
|
| Rate for Payer: UMR Bronson Commercial |
$245.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$496.97
|
|
|
METRONIDAZOLE 50 MG/ML SUSPENSION (SIMPLE)
|
Facility
|
OP
|
$164.50
|
|
|
Service Code
|
NDC 09900001032
|
| Hospital Charge Code |
200170
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.86 |
| Max. Negotiated Rate |
$148.05 |
| Rate for Payer: Aetna American Axle |
$106.92
|
| Rate for Payer: Aetna Commercial |
$139.82
|
| Rate for Payer: Aetna Medicare |
$82.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.92
|
| Rate for Payer: BCBS Complete |
$65.80
|
| Rate for Payer: Cash Price |
$131.60
|
| Rate for Payer: Cofinity Commercial |
$115.15
|
| Rate for Payer: Cofinity Commercial |
$141.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.60
|
| Rate for Payer: Healthscope Commercial |
$148.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.82
|
| Rate for Payer: PHP Commercial |
$139.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.92
|
| Rate for Payer: Priority Health SBD |
$103.64
|
| Rate for Payer: UMR Bronson Commercial |
$60.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.38
|
|
|
METRONIDAZOLE 50 MG/ML SUSPENSION (SIMPLE)
|
Facility
|
IP
|
$662.63
|
|
|
Service Code
|
NDC 65628020205
|
| Hospital Charge Code |
200170
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$291.56 |
| Max. Negotiated Rate |
$596.37 |
| Rate for Payer: Aetna American Axle |
$430.71
|
| Rate for Payer: Aetna Commercial |
$563.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$430.71
|
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: Cofinity Commercial |
$463.84
|
| Rate for Payer: Cofinity Commercial |
$569.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$463.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$530.10
|
| Rate for Payer: Healthscope Commercial |
$596.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$463.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$496.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.24
|
| Rate for Payer: PHP Commercial |
$563.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$430.71
|
| Rate for Payer: Priority Health SBD |
$417.46
|
| Rate for Payer: UMR Bronson Commercial |
$291.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$496.97
|
|
|
MEXILETINE 150 MG CAPSULE
|
Facility
|
IP
|
$577.44
|
|
|
Service Code
|
NDC 00093873901
|
| Hospital Charge Code |
10595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$254.07 |
| Max. Negotiated Rate |
$519.70 |
| Rate for Payer: Aetna American Axle |
$375.34
|
| Rate for Payer: Aetna Commercial |
$490.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$375.34
|
| Rate for Payer: Cash Price |
$461.95
|
| Rate for Payer: Cofinity Commercial |
$404.21
|
| Rate for Payer: Cofinity Commercial |
$496.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$404.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$461.95
|
| Rate for Payer: Healthscope Commercial |
$519.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$404.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$433.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$490.82
|
| Rate for Payer: PHP Commercial |
$490.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$375.34
|
| Rate for Payer: Priority Health SBD |
$363.79
|
| Rate for Payer: UMR Bronson Commercial |
$254.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$433.08
|
|
|
MEXILETINE 150 MG CAPSULE
|
Facility
|
OP
|
$308.75
|
|
|
Service Code
|
NDC 50742023901
|
| Hospital Charge Code |
10595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.24 |
| Max. Negotiated Rate |
$277.88 |
| Rate for Payer: Aetna American Axle |
$200.69
|
| Rate for Payer: Aetna Commercial |
$262.44
|
| Rate for Payer: Aetna Medicare |
$154.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.69
|
| Rate for Payer: BCBS Complete |
$123.50
|
| Rate for Payer: Cash Price |
$247.00
|
| Rate for Payer: Cofinity Commercial |
$216.12
|
| Rate for Payer: Cofinity Commercial |
$265.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$216.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.00
|
| Rate for Payer: Healthscope Commercial |
$277.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.44
|
| Rate for Payer: PHP Commercial |
$262.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.69
|
| Rate for Payer: Priority Health SBD |
$194.51
|
| Rate for Payer: UMR Bronson Commercial |
$114.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.56
|
|
|
MEXILETINE 150 MG CAPSULE
|
Facility
|
OP
|
$577.44
|
|
|
Service Code
|
NDC 00093873901
|
| Hospital Charge Code |
10595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.65 |
| Max. Negotiated Rate |
$519.70 |
| Rate for Payer: Aetna American Axle |
$375.34
|
| Rate for Payer: Aetna Commercial |
$490.82
|
| Rate for Payer: Aetna Medicare |
$288.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$375.34
|
| Rate for Payer: BCBS Complete |
$230.98
|
| Rate for Payer: Cash Price |
$461.95
|
| Rate for Payer: Cofinity Commercial |
$404.21
|
| Rate for Payer: Cofinity Commercial |
$496.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$404.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$461.95
|
| Rate for Payer: Healthscope Commercial |
$519.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$404.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$433.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$490.82
|
| Rate for Payer: PHP Commercial |
$490.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$375.34
|
| Rate for Payer: Priority Health SBD |
$363.79
|
| Rate for Payer: UMR Bronson Commercial |
$213.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$433.08
|
|
|
MEXILETINE 150 MG CAPSULE
|
Facility
|
IP
|
$308.75
|
|
|
Service Code
|
NDC 50742023901
|
| Hospital Charge Code |
10595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.85 |
| Max. Negotiated Rate |
$277.88 |
| Rate for Payer: Aetna American Axle |
$200.69
|
| Rate for Payer: Aetna Commercial |
$262.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.69
|
| Rate for Payer: Cash Price |
$247.00
|
| Rate for Payer: Cofinity Commercial |
$216.12
|
| Rate for Payer: Cofinity Commercial |
$265.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$216.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.00
|
| Rate for Payer: Healthscope Commercial |
$277.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.44
|
| Rate for Payer: PHP Commercial |
$262.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.69
|
| Rate for Payer: Priority Health SBD |
$194.51
|
| Rate for Payer: UMR Bronson Commercial |
$135.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.56
|
|
|
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 Commercial |
$491.57
|
| Rate for Payer: Cofinity Commercial |
$603.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$491.57
|
| 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: Multiplan/Beech St/PHCS Commercial |
$596.90
|
| Rate for Payer: PHP Commercial |
$596.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$456.46
|
| Rate for Payer: Priority Health SBD |
$442.41
|
| 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
|
$424.65
|
|
|
Service Code
|
NDC 50742024001
|
| Hospital Charge Code |
10596
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.12 |
| Max. Negotiated Rate |
$382.18 |
| Rate for Payer: Aetna American Axle |
$276.02
|
| Rate for Payer: Aetna Commercial |
$360.95
|
| Rate for Payer: Aetna Medicare |
$212.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.02
|
| Rate for Payer: BCBS Complete |
$169.86
|
| Rate for Payer: Cash Price |
$339.72
|
| Rate for Payer: Cofinity Commercial |
$297.26
|
| Rate for Payer: Cofinity Commercial |
$365.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$297.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.72
|
| Rate for Payer: Healthscope Commercial |
$382.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$297.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.95
|
| Rate for Payer: PHP Commercial |
$360.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.02
|
| Rate for Payer: Priority Health SBD |
$267.53
|
| Rate for Payer: UMR Bronson Commercial |
$157.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.49
|
|
|
MEXILETINE 200 MG CAPSULE
|
Facility
|
IP
|
$424.65
|
|
|
Service Code
|
NDC 50742024001
|
| Hospital Charge Code |
10596
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$186.85 |
| Max. Negotiated Rate |
$382.18 |
| Rate for Payer: Aetna American Axle |
$276.02
|
| Rate for Payer: Aetna Commercial |
$360.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.02
|
| Rate for Payer: Cash Price |
$339.72
|
| Rate for Payer: Cofinity Commercial |
$297.26
|
| Rate for Payer: Cofinity Commercial |
$365.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$297.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.72
|
| Rate for Payer: Healthscope Commercial |
$382.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$297.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.95
|
| Rate for Payer: PHP Commercial |
$360.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.02
|
| Rate for Payer: Priority Health SBD |
$267.53
|
| Rate for Payer: UMR Bronson Commercial |
$186.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.49
|
|
|
MEXILETINE 200 MG CAPSULE
|
Facility
|
IP
|
$702.24
|
|
|
Service Code
|
NDC 00093874001
|
| Hospital Charge Code |
10596
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$308.99 |
| Max. Negotiated Rate |
$632.02 |
| Rate for Payer: Aetna American Axle |
$456.46
|
| Rate for Payer: Aetna Commercial |
$596.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$456.46
|
| Rate for Payer: Cash Price |
$561.79
|
| Rate for Payer: Cofinity Commercial |
$491.57
|
| Rate for Payer: Cofinity Commercial |
$603.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$491.57
|
| 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: Multiplan/Beech St/PHCS Commercial |
$596.90
|
| Rate for Payer: PHP Commercial |
$596.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$456.46
|
| Rate for Payer: Priority Health SBD |
$442.41
|
| Rate for Payer: UMR Bronson Commercial |
$308.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$526.68
|
|
|
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 Commercial |
$575.57
|
| Rate for Payer: Cofinity Commercial |
$707.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$575.57
|
| 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: PHP Commercial |
$698.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$534.46
|
| Rate for Payer: Priority Health SBD |
$518.01
|
| 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 Commercial |
$575.57
|
| Rate for Payer: Cofinity Commercial |
$707.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$575.57
|
| 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: PHP Commercial |
$698.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$534.46
|
| 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
|
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 Commercial |
$69.53
|
| Rate for Payer: Cofinity Commercial |
$85.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.53
|
| 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: PHP Commercial |
$84.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.56
|
| 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 MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$99.33
|
|
|
Service Code
|
HCPCS J2247
|
| Hospital Charge Code |
301720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.93 |
| 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 |
$0.93
|
| Rate for Payer: BCN Commercial |
$0.93
|
| Rate for Payer: Cash Price |
$79.46
|
| Rate for Payer: Cash Price |
$79.46
|
| Rate for Payer: Cofinity Commercial |
$69.53
|
| Rate for Payer: Cofinity Commercial |
$85.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.53
|
| 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: PHP Commercial |
$84.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.56
|
| Rate for Payer: Priority Health SBD |
$62.58
|
| Rate for Payer: UMR Bronson Commercial |
$36.75
|
| 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 Commercial |
$69.53
|
| Rate for Payer: Cofinity Commercial |
$85.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.53
|
| 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: PHP Commercial |
$84.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.56
|
| 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
|
OP
|
$99.33
|
|
|
Service Code
|
HCPCS J2247
|
| Hospital Charge Code |
77685
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.93 |
| 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 |
$0.93
|
| Rate for Payer: BCN Commercial |
$0.93
|
| Rate for Payer: Cash Price |
$79.46
|
| Rate for Payer: Cash Price |
$79.46
|
| Rate for Payer: Cofinity Commercial |
$69.53
|
| Rate for Payer: Cofinity Commercial |
$85.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.53
|
| 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: PHP Commercial |
$84.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.56
|
| Rate for Payer: Priority Health SBD |
$62.58
|
| Rate for Payer: UMR Bronson Commercial |
$36.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.50
|
|
|
MICAFUNGIN 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$113.56
|
|
|
Service Code
|
HCPCS J2248
|
| Hospital Charge Code |
77685
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.97 |
| Max. Negotiated Rate |
$102.20 |
| Rate for Payer: Aetna American Axle |
$73.81
|
| Rate for Payer: Aetna American Axle |
$64.42
|
| Rate for Payer: Aetna American Axle |
$99.53
|
| Rate for Payer: Aetna American Axle |
$73.82
|
| Rate for Payer: Aetna American Axle |
$91.44
|
| Rate for Payer: Aetna American Axle |
$64.43
|
| Rate for Payer: Aetna Commercial |
$96.53
|
| Rate for Payer: Aetna Commercial |
$96.53
|
| Rate for Payer: Aetna Commercial |
$130.16
|
| Rate for Payer: Aetna Commercial |
$84.25
|
| Rate for Payer: Aetna Commercial |
$84.24
|
| Rate for Payer: Aetna Commercial |
$119.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.42
|
| Rate for Payer: Cash Price |
$79.29
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cash Price |
$90.85
|
| Rate for Payer: Cash Price |
$112.54
|
| Rate for Payer: Cash Price |
$90.86
|
| Rate for Payer: Cash Price |
$79.30
|
| Rate for Payer: Cofinity Commercial |
$85.23
|
| Rate for Payer: Cofinity Commercial |
$79.49
|
| Rate for Payer: Cofinity Commercial |
$131.69
|
| Rate for Payer: Cofinity Commercial |
$107.19
|
| Rate for Payer: Cofinity Commercial |
$120.98
|
| Rate for Payer: Cofinity Commercial |
$79.50
|
| Rate for Payer: Cofinity Commercial |
$97.67
|
| Rate for Payer: Cofinity Commercial |
$98.47
|
| Rate for Payer: Cofinity Commercial |
$97.66
|
| Rate for Payer: Cofinity Commercial |
$85.24
|
| Rate for Payer: Cofinity Commercial |
$69.38
|
| Rate for Payer: Cofinity Commercial |
$69.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.30
|
| Rate for Payer: Healthscope Commercial |
$137.82
|
| Rate for Payer: Healthscope Commercial |
$89.21
|
| Rate for Payer: Healthscope Commercial |
$89.20
|
| Rate for Payer: Healthscope Commercial |
$102.21
|
| Rate for Payer: Healthscope Commercial |
$126.60
|
| Rate for Payer: Healthscope Commercial |
$102.20
|
| 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 |
$79.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.16
|
| 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 |
$119.57
|
| Rate for Payer: PHP Commercial |
$96.53
|
| Rate for Payer: PHP Commercial |
$96.53
|
| Rate for Payer: PHP Commercial |
$130.16
|
| Rate for Payer: PHP Commercial |
$84.24
|
| Rate for Payer: PHP Commercial |
$119.57
|
| Rate for Payer: PHP Commercial |
$84.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.43
|
| Rate for Payer: Priority Health SBD |
$62.44
|
| Rate for Payer: Priority Health SBD |
$96.47
|
| Rate for Payer: Priority Health SBD |
$71.54
|
| Rate for Payer: Priority Health SBD |
$71.55
|
| Rate for Payer: Priority Health SBD |
$88.62
|
| Rate for Payer: Priority Health SBD |
$62.45
|
| Rate for Payer: UMR Bronson Commercial |
$43.61
|
| Rate for Payer: UMR Bronson Commercial |
$49.97
|
| Rate for Payer: UMR Bronson Commercial |
$61.89
|
| Rate for Payer: UMR Bronson Commercial |
$43.61
|
| Rate for Payer: UMR Bronson Commercial |
$67.38
|
| 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 |
$114.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.17
|
|
|
MICAFUNGIN 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$99.12
|
|
|
Service Code
|
HCPCS J2248
|
| Hospital Charge Code |
77685
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$89.21 |
| Rate for Payer: Aetna American Axle |
$64.43
|
| Rate for Payer: Aetna American Axle |
$64.42
|
| Rate for Payer: Aetna American Axle |
$118.81
|
| Rate for Payer: Aetna American Axle |
$99.53
|
| Rate for Payer: Aetna American Axle |
$401.30
|
| Rate for Payer: Aetna American Axle |
$73.81
|
| Rate for Payer: Aetna American Axle |
$91.44
|
| Rate for Payer: Aetna American Axle |
$73.82
|
| Rate for Payer: Aetna Commercial |
$119.57
|
| Rate for Payer: Aetna Commercial |
$96.53
|
| Rate for Payer: Aetna Commercial |
$96.53
|
| Rate for Payer: Aetna Commercial |
$155.36
|
| Rate for Payer: Aetna Commercial |
$130.16
|
| Rate for Payer: Aetna Commercial |
$524.78
|
| Rate for Payer: Aetna Commercial |
$84.24
|
| Rate for Payer: Aetna Commercial |
$84.25
|
| Rate for Payer: Aetna Medicare |
$76.56
|
| Rate for Payer: Aetna Medicare |
$56.78
|
| Rate for Payer: Aetna Medicare |
$49.56
|
| Rate for Payer: Aetna Medicare |
$70.34
|
| Rate for Payer: Aetna Medicare |
$49.56
|
| Rate for Payer: Aetna Medicare |
$91.39
|
| Rate for Payer: Aetna Medicare |
$56.78
|
| Rate for Payer: Aetna Medicare |
$308.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$401.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.81
|
| Rate for Payer: BCBS Complete |
$39.65
|
| Rate for Payer: BCBS Complete |
$246.96
|
| Rate for Payer: BCBS Complete |
$61.25
|
| Rate for Payer: BCBS Complete |
$45.43
|
| Rate for Payer: BCBS Complete |
$45.42
|
| Rate for Payer: BCBS Complete |
$56.27
|
| Rate for Payer: BCBS Complete |
$39.64
|
| Rate for Payer: BCBS Complete |
$73.11
|
| Rate for Payer: BCBS Trust/PPO |
$0.77
|
| Rate for Payer: BCBS Trust/PPO |
$0.77
|
| Rate for Payer: BCBS Trust/PPO |
$0.77
|
| Rate for Payer: BCBS Trust/PPO |
$0.77
|
| Rate for Payer: BCBS Trust/PPO |
$0.77
|
| Rate for Payer: BCBS Trust/PPO |
$0.77
|
| Rate for Payer: BCBS Trust/PPO |
$0.77
|
| Rate for Payer: BCBS Trust/PPO |
$0.77
|
| Rate for Payer: BCN Commercial |
$0.77
|
| Rate for Payer: BCN Commercial |
$0.77
|
| Rate for Payer: BCN Commercial |
$0.77
|
| Rate for Payer: BCN Commercial |
$0.77
|
| Rate for Payer: BCN Commercial |
$0.77
|
| Rate for Payer: BCN Commercial |
$0.77
|
| Rate for Payer: BCN Commercial |
$0.77
|
| Rate for Payer: BCN Commercial |
$0.77
|
| Rate for Payer: Cash Price |
$112.54
|
| Rate for Payer: Cash Price |
$90.86
|
| Rate for Payer: Cash Price |
$90.85
|
| Rate for Payer: Cash Price |
$90.86
|
| Rate for Payer: Cash Price |
$90.85
|
| Rate for Payer: Cash Price |
$112.54
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cash Price |
$122.50
|
| 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 |
$79.29
|
| Rate for Payer: Cash Price |
$79.29
|
| Rate for Payer: Cash Price |
$79.30
|
| Rate for Payer: Cash Price |
$79.30
|
| Rate for Payer: Cofinity Commercial |
$107.19
|
| Rate for Payer: Cofinity Commercial |
$530.96
|
| Rate for Payer: Cofinity Commercial |
$432.17
|
| Rate for Payer: Cofinity Commercial |
$79.49
|
| Rate for Payer: Cofinity Commercial |
$97.67
|
| Rate for Payer: Cofinity Commercial |
$69.38
|
| Rate for Payer: Cofinity Commercial |
$131.69
|
| Rate for Payer: Cofinity Commercial |
$157.19
|
| Rate for Payer: Cofinity Commercial |
$120.98
|
| Rate for Payer: Cofinity Commercial |
$79.50
|
| Rate for Payer: Cofinity Commercial |
$97.66
|
| Rate for Payer: Cofinity Commercial |
$98.47
|
| Rate for Payer: Cofinity Commercial |
$127.95
|
| Rate for Payer: Cofinity Commercial |
$85.23
|
| Rate for Payer: Cofinity Commercial |
$69.38
|
| Rate for Payer: Cofinity Commercial |
$85.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$127.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$432.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$493.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.85
|
| Rate for Payer: Healthscope Commercial |
$126.60
|
| Rate for Payer: Healthscope Commercial |
$137.82
|
| Rate for Payer: Healthscope Commercial |
$89.20
|
| Rate for Payer: Healthscope Commercial |
$89.21
|
| Rate for Payer: Healthscope Commercial |
$555.65
|
| Rate for Payer: Healthscope Commercial |
$102.20
|
| Rate for Payer: Healthscope Commercial |
$102.21
|
| Rate for Payer: Healthscope Commercial |
$164.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$432.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$463.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.36
|
| 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 |
$119.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$524.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.16
|
| Rate for Payer: PHP Commercial |
$524.78
|
| Rate for Payer: PHP Commercial |
$96.53
|
| Rate for Payer: PHP Commercial |
$84.25
|
| Rate for Payer: PHP Commercial |
$155.36
|
| Rate for Payer: PHP Commercial |
$96.53
|
| Rate for Payer: PHP Commercial |
$119.57
|
| Rate for Payer: PHP Commercial |
$84.24
|
| Rate for Payer: PHP Commercial |
$130.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.42
|
| Rate for Payer: Priority Health SBD |
$71.54
|
| Rate for Payer: Priority Health SBD |
$62.45
|
| Rate for Payer: Priority Health SBD |
$96.47
|
| Rate for Payer: Priority Health SBD |
$115.15
|
| Rate for Payer: Priority Health SBD |
$71.55
|
| Rate for Payer: Priority Health SBD |
$88.62
|
| Rate for Payer: Priority Health SBD |
$62.44
|
| Rate for Payer: Priority Health SBD |
$388.96
|
| 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 |
$67.63
|
| Rate for Payer: UMR Bronson Commercial |
$56.66
|
| Rate for Payer: UMR Bronson Commercial |
$42.02
|
| Rate for Payer: UMR Bronson Commercial |
$42.02
|
| Rate for Payer: UMR Bronson Commercial |
$52.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$463.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.17
|
|
|
MICAFUNGIN 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$60.84
|
|
|
Service Code
|
HCPCS J2248
|
| Hospital Charge Code |
41144
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.77 |
| Max. Negotiated Rate |
$54.76 |
| Rate for Payer: Aetna American Axle |
$39.55
|
| Rate for Payer: Aetna American Axle |
$104.99
|
| Rate for Payer: Aetna American Axle |
$200.66
|
| Rate for Payer: Aetna American Axle |
$48.56
|
| Rate for Payer: Aetna American Axle |
$35.64
|
| Rate for Payer: Aetna Commercial |
$51.71
|
| Rate for Payer: Aetna Commercial |
$262.40
|
| Rate for Payer: Aetna Commercial |
$137.29
|
| Rate for Payer: Aetna Commercial |
$63.50
|
| Rate for Payer: Aetna Commercial |
$46.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.66
|
| Rate for Payer: Cash Price |
$48.67
|
| Rate for Payer: Cash Price |
$59.77
|
| Rate for Payer: Cash Price |
$246.97
|
| Rate for Payer: Cash Price |
$43.86
|
| Rate for Payer: Cash Price |
$129.22
|
| Rate for Payer: Cofinity Commercial |
$52.30
|
| Rate for Payer: Cofinity Commercial |
$113.06
|
| Rate for Payer: Cofinity Commercial |
$52.32
|
| Rate for Payer: Cofinity Commercial |
$42.59
|
| Rate for Payer: Cofinity Commercial |
$38.38
|
| Rate for Payer: Cofinity Commercial |
$216.10
|
| Rate for Payer: Cofinity Commercial |
$265.49
|
| Rate for Payer: Cofinity Commercial |
$47.15
|
| Rate for Payer: Cofinity Commercial |
$138.91
|
| Rate for Payer: Cofinity Commercial |
$64.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$113.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$216.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$38.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.67
|
| 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 |
$59.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.86
|
| Rate for Payer: Healthscope Commercial |
$277.84
|
| Rate for Payer: Healthscope Commercial |
$54.76
|
| Rate for Payer: Healthscope Commercial |
$49.35
|
| Rate for Payer: Healthscope Commercial |
$67.24
|
| Rate for Payer: Healthscope Commercial |
$145.37
|
| 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 |
$38.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.29
|
| Rate for Payer: PHP Commercial |
$137.29
|
| Rate for Payer: PHP Commercial |
$63.50
|
| Rate for Payer: PHP Commercial |
$46.61
|
| Rate for Payer: PHP Commercial |
$51.71
|
| Rate for Payer: PHP Commercial |
$262.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.99
|
| Rate for Payer: Priority Health SBD |
$47.07
|
| Rate for Payer: Priority Health SBD |
$34.54
|
| Rate for Payer: Priority Health SBD |
$194.49
|
| Rate for Payer: Priority Health SBD |
$101.76
|
| Rate for Payer: Priority Health SBD |
$38.33
|
| Rate for Payer: UMR Bronson Commercial |
$71.07
|
| Rate for Payer: UMR Bronson Commercial |
$135.83
|
| Rate for Payer: UMR Bronson Commercial |
$26.77
|
| Rate for Payer: UMR Bronson Commercial |
$32.87
|
| Rate for Payer: UMR Bronson Commercial |
$24.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.63
|
|
|
MICAFUNGIN 50 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$308.71
|
|
|
Service Code
|
HCPCS J2248
|
| Hospital Charge Code |
41144
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$277.84 |
| Rate for Payer: Aetna American Axle |
$200.66
|
| Rate for Payer: Aetna American Axle |
$39.55
|
| Rate for Payer: Aetna American Axle |
$35.64
|
| Rate for Payer: Aetna American Axle |
$104.99
|
| Rate for Payer: Aetna American Axle |
$48.56
|
| Rate for Payer: Aetna Commercial |
$262.40
|
| Rate for Payer: Aetna Commercial |
$137.29
|
| Rate for Payer: Aetna Commercial |
$63.50
|
| Rate for Payer: Aetna Commercial |
$46.61
|
| Rate for Payer: Aetna Commercial |
$51.71
|
| Rate for Payer: Aetna Medicare |
$27.42
|
| Rate for Payer: Aetna Medicare |
$30.42
|
| Rate for Payer: Aetna Medicare |
$154.36
|
| Rate for Payer: Aetna Medicare |
$80.76
|
| Rate for Payer: Aetna Medicare |
$37.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.56
|
| 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) |
$35.64
|
| Rate for Payer: BCBS Complete |
$123.48
|
| Rate for Payer: BCBS Complete |
$64.61
|
| Rate for Payer: BCBS Complete |
$24.34
|
| Rate for Payer: BCBS Complete |
$29.88
|
| Rate for Payer: BCBS Complete |
$21.93
|
| Rate for Payer: BCBS Trust/PPO |
$0.77
|
| Rate for Payer: BCBS Trust/PPO |
$0.77
|
| Rate for Payer: BCBS Trust/PPO |
$0.77
|
| Rate for Payer: BCBS Trust/PPO |
$0.77
|
| Rate for Payer: BCBS Trust/PPO |
$0.77
|
| Rate for Payer: BCN Commercial |
$0.77
|
| Rate for Payer: BCN Commercial |
$0.77
|
| Rate for Payer: BCN Commercial |
$0.77
|
| Rate for Payer: BCN Commercial |
$0.77
|
| Rate for Payer: BCN Commercial |
$0.77
|
| Rate for Payer: Cash Price |
$246.97
|
| Rate for Payer: Cash Price |
$43.86
|
| Rate for Payer: Cash Price |
$129.22
|
| Rate for Payer: Cash Price |
$246.97
|
| Rate for Payer: Cash Price |
$129.22
|
| Rate for Payer: Cash Price |
$43.86
|
| Rate for Payer: Cash Price |
$59.77
|
| Rate for Payer: Cash Price |
$59.77
|
| Rate for Payer: Cash Price |
$48.67
|
| Rate for Payer: Cash Price |
$48.67
|
| Rate for Payer: Cofinity Commercial |
$216.10
|
| Rate for Payer: Cofinity Commercial |
$64.25
|
| Rate for Payer: Cofinity Commercial |
$113.06
|
| Rate for Payer: Cofinity Commercial |
$47.15
|
| Rate for Payer: Cofinity Commercial |
$38.38
|
| Rate for Payer: Cofinity Commercial |
$52.30
|
| Rate for Payer: Cofinity Commercial |
$52.32
|
| Rate for Payer: Cofinity Commercial |
$42.59
|
| Rate for Payer: Cofinity Commercial |
$265.49
|
| Rate for Payer: Cofinity Commercial |
$138.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$38.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$216.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$113.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.77
|
| 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 |
$48.67
|
| Rate for Payer: Healthscope Commercial |
$54.76
|
| Rate for Payer: Healthscope Commercial |
$145.37
|
| Rate for Payer: Healthscope Commercial |
$277.84
|
| Rate for Payer: Healthscope Commercial |
$49.35
|
| Rate for Payer: Healthscope Commercial |
$67.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.29
|
| Rate for Payer: PHP Commercial |
$63.50
|
| Rate for Payer: PHP Commercial |
$51.71
|
| Rate for Payer: PHP Commercial |
$262.40
|
| Rate for Payer: PHP Commercial |
$137.29
|
| Rate for Payer: PHP Commercial |
$46.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.66
|
| Rate for Payer: Priority Health SBD |
$194.49
|
| Rate for Payer: Priority Health SBD |
$47.07
|
| Rate for Payer: Priority Health SBD |
$38.33
|
| Rate for Payer: Priority Health SBD |
$101.76
|
| Rate for Payer: Priority Health SBD |
$34.54
|
| Rate for Payer: UMR Bronson Commercial |
$59.76
|
| Rate for Payer: UMR Bronson Commercial |
$20.29
|
| Rate for Payer: UMR Bronson Commercial |
$114.22
|
| Rate for Payer: UMR Bronson Commercial |
$22.51
|
| Rate for Payer: UMR Bronson Commercial |
$27.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.14
|
|
|
MICONAZOLE NITRATE 100 MG VAGINAL SUPPOSITORY
|
Facility
|
IP
|
$21.24
|
|
|
Service Code
|
NDC 61269073607
|
| Hospital Charge Code |
10603
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.35 |
| Max. Negotiated Rate |
$19.12 |
| Rate for Payer: Aetna American Axle |
$13.81
|
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.81
|
| Rate for Payer: Cash Price |
$16.99
|
| Rate for Payer: Cofinity Commercial |
$14.87
|
| Rate for Payer: Cofinity Commercial |
$18.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.99
|
| Rate for Payer: Healthscope Commercial |
$19.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: PHP Commercial |
$18.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.81
|
| Rate for Payer: Priority Health SBD |
$13.38
|
| Rate for Payer: UMR Bronson Commercial |
$9.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.93
|
|
|
MICONAZOLE NITRATE 100 MG VAGINAL SUPPOSITORY
|
Facility
|
OP
|
$21.24
|
|
|
Service Code
|
NDC 61269073607
|
| Hospital Charge Code |
10603
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$19.12 |
| Rate for Payer: Aetna American Axle |
$13.81
|
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna Medicare |
$10.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.81
|
| Rate for Payer: BCBS Complete |
$8.50
|
| Rate for Payer: Cash Price |
$16.99
|
| Rate for Payer: Cofinity Commercial |
$14.87
|
| Rate for Payer: Cofinity Commercial |
$18.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.99
|
| Rate for Payer: Healthscope Commercial |
$19.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: PHP Commercial |
$18.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.81
|
| Rate for Payer: Priority Health SBD |
$13.38
|
| Rate for Payer: UMR Bronson Commercial |
$7.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.93
|
|
|
MICONAZOLE NITRATE 200 MG VAGINAL SUPPOSITORY
|
Facility
|
IP
|
$121.96
|
|
|
Service Code
|
NDC 00472173803
|
| Hospital Charge Code |
109535
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.66 |
| Max. Negotiated Rate |
$109.76 |
| Rate for Payer: Aetna American Axle |
$79.27
|
| Rate for Payer: Aetna Commercial |
$103.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.27
|
| Rate for Payer: Cash Price |
$97.57
|
| Rate for Payer: Cofinity Commercial |
$104.89
|
| Rate for Payer: Cofinity Commercial |
$85.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.57
|
| Rate for Payer: Healthscope Commercial |
$109.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.67
|
| Rate for Payer: PHP Commercial |
$103.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.27
|
| Rate for Payer: Priority Health SBD |
$76.83
|
| Rate for Payer: UMR Bronson Commercial |
$53.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.47
|
|
