|
MITOMYCIN 0.2 MG/ML OCULAR SOLUTION
|
Facility
|
IP
|
$254.52
|
|
|
Service Code
|
HCPCS J7315
|
| Hospital Charge Code |
151070
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$111.99 |
| Max. Negotiated Rate |
$229.07 |
| Rate for Payer: Aetna American Axle |
$165.44
|
| Rate for Payer: Aetna Commercial |
$216.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.44
|
| Rate for Payer: Cash Price |
$203.62
|
| Rate for Payer: Cofinity Commercial |
$178.16
|
| Rate for Payer: Cofinity Commercial |
$218.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.62
|
| Rate for Payer: Healthscope Commercial |
$229.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.34
|
| Rate for Payer: PHP Commercial |
$216.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.44
|
| Rate for Payer: Priority Health SBD |
$160.35
|
| Rate for Payer: UMR Bronson Commercial |
$111.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.89
|
|
|
MITOMYCIN 0.2 MG/ML OCULAR SOLUTION
|
Facility
|
OP
|
$254.52
|
|
|
Service Code
|
HCPCS J7315
|
| Hospital Charge Code |
151070
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.17 |
| Max. Negotiated Rate |
$229.07 |
| Rate for Payer: Aetna American Axle |
$165.44
|
| Rate for Payer: Aetna Commercial |
$216.34
|
| Rate for Payer: Aetna Medicare |
$127.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.44
|
| Rate for Payer: BCBS Complete |
$101.81
|
| Rate for Payer: Cash Price |
$203.62
|
| Rate for Payer: Cofinity Commercial |
$178.16
|
| Rate for Payer: Cofinity Commercial |
$218.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.62
|
| Rate for Payer: Healthscope Commercial |
$229.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.34
|
| Rate for Payer: PHP Commercial |
$216.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.44
|
| Rate for Payer: Priority Health SBD |
$160.35
|
| Rate for Payer: UMR Bronson Commercial |
$94.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.89
|
|
|
MITOMYCIN 20 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$770.95
|
|
|
Service Code
|
HCPCS J9280
|
| Hospital Charge Code |
10630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.91 |
| Max. Negotiated Rate |
$693.86 |
| Rate for Payer: Aetna American Axle |
$501.12
|
| Rate for Payer: Aetna American Axle |
$456.14
|
| Rate for Payer: Aetna American Axle |
$301.41
|
| Rate for Payer: Aetna Commercial |
$655.31
|
| Rate for Payer: Aetna Commercial |
$394.15
|
| Rate for Payer: Aetna Commercial |
$596.49
|
| Rate for Payer: Aetna Medicare |
$21.16
|
| Rate for Payer: Aetna Medicare |
$21.16
|
| Rate for Payer: Aetna Medicare |
$21.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$456.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$501.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.44
|
| Rate for Payer: BCBS Complete |
$11.45
|
| Rate for Payer: BCBS Complete |
$11.45
|
| Rate for Payer: BCBS Complete |
$11.45
|
| Rate for Payer: BCBS MAPPO |
$20.35
|
| Rate for Payer: BCBS MAPPO |
$20.35
|
| Rate for Payer: BCBS MAPPO |
$20.35
|
| Rate for Payer: BCN Medicare Advantage |
$20.35
|
| Rate for Payer: BCN Medicare Advantage |
$20.35
|
| Rate for Payer: BCN Medicare Advantage |
$20.35
|
| Rate for Payer: Cash Price |
$561.40
|
| Rate for Payer: Cash Price |
$561.40
|
| Rate for Payer: Cash Price |
$370.97
|
| Rate for Payer: Cash Price |
$370.97
|
| Rate for Payer: Cash Price |
$616.76
|
| Rate for Payer: Cash Price |
$616.76
|
| Rate for Payer: Cofinity Commercial |
$324.60
|
| Rate for Payer: Cofinity Commercial |
$663.02
|
| Rate for Payer: Cofinity Commercial |
$539.66
|
| Rate for Payer: Cofinity Commercial |
$491.23
|
| Rate for Payer: Cofinity Commercial |
$398.79
|
| Rate for Payer: Cofinity Commercial |
$603.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$539.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$491.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$324.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$616.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.35
|
| Rate for Payer: Healthscope Commercial |
$417.34
|
| Rate for Payer: Healthscope Commercial |
$693.86
|
| Rate for Payer: Healthscope Commercial |
$631.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$491.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$539.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$324.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$578.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$347.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$526.31
|
| Rate for Payer: Mclaren Medicaid |
$10.91
|
| Rate for Payer: Mclaren Medicaid |
$10.91
|
| Rate for Payer: Mclaren Medicaid |
$10.91
|
| Rate for Payer: Mclaren Medicare |
$20.35
|
| Rate for Payer: Mclaren Medicare |
$20.35
|
| Rate for Payer: Mclaren Medicare |
$20.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.37
|
| Rate for Payer: Meridian Medicaid |
$11.45
|
| Rate for Payer: Meridian Medicaid |
$11.45
|
| Rate for Payer: Meridian Medicaid |
$11.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$655.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$394.15
|
| Rate for Payer: PACE Medicare |
$19.33
|
| Rate for Payer: PACE Medicare |
$19.33
|
| Rate for Payer: PACE Medicare |
$19.33
|
| Rate for Payer: PACE SWMI |
$20.35
|
| Rate for Payer: PACE SWMI |
$20.35
|
| Rate for Payer: PACE SWMI |
$20.35
|
| Rate for Payer: PHP Commercial |
$655.31
|
| Rate for Payer: PHP Commercial |
$394.15
|
| Rate for Payer: PHP Commercial |
$596.49
|
| Rate for Payer: PHP Medicare Advantage |
$20.35
|
| Rate for Payer: PHP Medicare Advantage |
$20.35
|
| Rate for Payer: PHP Medicare Advantage |
$20.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$456.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$501.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.41
|
| Rate for Payer: Priority Health Medicare |
$20.35
|
| Rate for Payer: Priority Health Medicare |
$20.35
|
| Rate for Payer: Priority Health Medicare |
$20.35
|
| Rate for Payer: Priority Health SBD |
$292.14
|
| Rate for Payer: Priority Health SBD |
$442.10
|
| Rate for Payer: Priority Health SBD |
$485.70
|
| Rate for Payer: Railroad Medicare Medicare |
$20.35
|
| Rate for Payer: Railroad Medicare Medicare |
$20.35
|
| Rate for Payer: Railroad Medicare Medicare |
$20.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.35
|
| Rate for Payer: UHC Exchange |
$38.89
|
| Rate for Payer: UHC Exchange |
$38.89
|
| Rate for Payer: UHC Exchange |
$38.89
|
| Rate for Payer: UHC Medicare Advantage |
$20.35
|
| Rate for Payer: UHC Medicare Advantage |
$20.35
|
| Rate for Payer: UHC Medicare Advantage |
$20.35
|
| Rate for Payer: UHCCP Medicaid |
$10.91
|
| Rate for Payer: UHCCP Medicaid |
$10.91
|
| Rate for Payer: UHCCP Medicaid |
$10.91
|
| Rate for Payer: UMR Bronson Commercial |
$259.65
|
| Rate for Payer: UMR Bronson Commercial |
$285.25
|
| Rate for Payer: UMR Bronson Commercial |
$171.57
|
| Rate for Payer: VA VA |
$20.35
|
| Rate for Payer: VA VA |
$20.35
|
| Rate for Payer: VA VA |
$20.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$526.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$578.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$347.78
|
|
|
MITOMYCIN 20 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$463.71
|
|
|
Service Code
|
HCPCS J9280
|
| Hospital Charge Code |
10630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$204.03 |
| Max. Negotiated Rate |
$417.34 |
| Rate for Payer: Aetna American Axle |
$301.41
|
| Rate for Payer: Aetna American Axle |
$501.12
|
| Rate for Payer: Aetna Commercial |
$394.15
|
| Rate for Payer: Aetna Commercial |
$655.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$501.12
|
| Rate for Payer: Cash Price |
$370.97
|
| Rate for Payer: Cash Price |
$616.76
|
| Rate for Payer: Cofinity Commercial |
$663.02
|
| Rate for Payer: Cofinity Commercial |
$539.66
|
| Rate for Payer: Cofinity Commercial |
$324.60
|
| Rate for Payer: Cofinity Commercial |
$398.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$324.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$539.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$616.76
|
| Rate for Payer: Healthscope Commercial |
$417.34
|
| Rate for Payer: Healthscope Commercial |
$693.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$324.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$539.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$347.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$578.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$655.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$394.15
|
| Rate for Payer: PHP Commercial |
$655.31
|
| Rate for Payer: PHP Commercial |
$394.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$501.12
|
| Rate for Payer: Priority Health SBD |
$292.14
|
| Rate for Payer: Priority Health SBD |
$485.70
|
| Rate for Payer: UMR Bronson Commercial |
$204.03
|
| Rate for Payer: UMR Bronson Commercial |
$339.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$347.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$578.21
|
|
|
MITOMYCIN 20 MG SOLUTION FOR BLADDER IRRIGATION (CUSTOM)
|
Facility
|
OP
|
$770.95
|
|
|
Service Code
|
HCPCS J9280
|
| Hospital Charge Code |
300956
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.91 |
| Max. Negotiated Rate |
$693.86 |
| Rate for Payer: Aetna American Axle |
$501.12
|
| Rate for Payer: Aetna Commercial |
$655.31
|
| Rate for Payer: Aetna Medicare |
$21.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$501.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.44
|
| Rate for Payer: BCBS Complete |
$11.45
|
| Rate for Payer: BCBS MAPPO |
$20.35
|
| Rate for Payer: BCN Medicare Advantage |
$20.35
|
| Rate for Payer: Cash Price |
$616.76
|
| Rate for Payer: Cash Price |
$616.76
|
| Rate for Payer: Cofinity Commercial |
$539.66
|
| Rate for Payer: Cofinity Commercial |
$663.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$539.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$616.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.35
|
| Rate for Payer: Healthscope Commercial |
$693.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$539.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$578.21
|
| Rate for Payer: Mclaren Medicaid |
$10.91
|
| Rate for Payer: Mclaren Medicare |
$20.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.37
|
| Rate for Payer: Meridian Medicaid |
$11.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$655.31
|
| Rate for Payer: PACE Medicare |
$19.33
|
| Rate for Payer: PACE SWMI |
$20.35
|
| Rate for Payer: PHP Commercial |
$655.31
|
| Rate for Payer: PHP Medicare Advantage |
$20.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$501.12
|
| Rate for Payer: Priority Health Medicare |
$20.35
|
| Rate for Payer: Priority Health SBD |
$485.70
|
| Rate for Payer: Railroad Medicare Medicare |
$20.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.35
|
| Rate for Payer: UHC Exchange |
$38.89
|
| Rate for Payer: UHC Medicare Advantage |
$20.35
|
| Rate for Payer: UHCCP Medicaid |
$10.91
|
| Rate for Payer: UMR Bronson Commercial |
$285.25
|
| Rate for Payer: VA VA |
$20.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$578.21
|
|
|
MITOMYCIN 40 MG/20 ML BLADDER FOR IRRIGATION SOLUTION CUSTOM
|
Facility
|
OP
|
$927.32
|
|
|
Service Code
|
HCPCS J9280
|
| Hospital Charge Code |
301471
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.91 |
| Max. Negotiated Rate |
$834.59 |
| Rate for Payer: Aetna American Axle |
$602.76
|
| Rate for Payer: Aetna American Axle |
$3,619.97
|
| Rate for Payer: Aetna Commercial |
$4,733.80
|
| Rate for Payer: Aetna Commercial |
$788.22
|
| Rate for Payer: Aetna Medicare |
$21.16
|
| Rate for Payer: Aetna Medicare |
$21.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$602.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,619.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.44
|
| Rate for Payer: BCBS Complete |
$11.45
|
| Rate for Payer: BCBS Complete |
$11.45
|
| Rate for Payer: BCBS MAPPO |
$20.35
|
| Rate for Payer: BCBS MAPPO |
$20.35
|
| Rate for Payer: BCN Medicare Advantage |
$20.35
|
| Rate for Payer: BCN Medicare Advantage |
$20.35
|
| Rate for Payer: Cash Price |
$4,455.34
|
| Rate for Payer: Cash Price |
$741.86
|
| Rate for Payer: Cash Price |
$741.86
|
| Rate for Payer: Cash Price |
$4,455.34
|
| Rate for Payer: Cofinity Commercial |
$3,898.43
|
| Rate for Payer: Cofinity Commercial |
$4,789.49
|
| Rate for Payer: Cofinity Commercial |
$649.12
|
| Rate for Payer: Cofinity Commercial |
$797.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,898.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$649.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$741.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,455.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.35
|
| Rate for Payer: Healthscope Commercial |
$834.59
|
| Rate for Payer: Healthscope Commercial |
$5,012.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$649.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,898.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,176.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$695.49
|
| Rate for Payer: Mclaren Medicaid |
$10.91
|
| Rate for Payer: Mclaren Medicaid |
$10.91
|
| Rate for Payer: Mclaren Medicare |
$20.35
|
| Rate for Payer: Mclaren Medicare |
$20.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.37
|
| Rate for Payer: Meridian Medicaid |
$11.45
|
| Rate for Payer: Meridian Medicaid |
$11.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$788.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,733.80
|
| Rate for Payer: PACE Medicare |
$19.33
|
| Rate for Payer: PACE Medicare |
$19.33
|
| Rate for Payer: PACE SWMI |
$20.35
|
| Rate for Payer: PACE SWMI |
$20.35
|
| Rate for Payer: PHP Commercial |
$4,733.80
|
| Rate for Payer: PHP Commercial |
$788.22
|
| Rate for Payer: PHP Medicare Advantage |
$20.35
|
| Rate for Payer: PHP Medicare Advantage |
$20.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,619.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$602.76
|
| Rate for Payer: Priority Health Medicare |
$20.35
|
| Rate for Payer: Priority Health Medicare |
$20.35
|
| Rate for Payer: Priority Health SBD |
$3,508.58
|
| Rate for Payer: Priority Health SBD |
$584.21
|
| Rate for Payer: Railroad Medicare Medicare |
$20.35
|
| Rate for Payer: Railroad Medicare Medicare |
$20.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.35
|
| Rate for Payer: UHC Exchange |
$38.89
|
| Rate for Payer: UHC Exchange |
$38.89
|
| Rate for Payer: UHC Medicare Advantage |
$20.35
|
| Rate for Payer: UHC Medicare Advantage |
$20.35
|
| Rate for Payer: UHCCP Medicaid |
$10.91
|
| Rate for Payer: UHCCP Medicaid |
$10.91
|
| Rate for Payer: UMR Bronson Commercial |
$2,060.60
|
| Rate for Payer: UMR Bronson Commercial |
$343.11
|
| Rate for Payer: VA VA |
$20.35
|
| Rate for Payer: VA VA |
$20.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$695.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,176.89
|
|
|
MITOMYCIN 40 MG/20 ML BLADDER FOR IRRIGATION SOLUTION CUSTOM
|
Facility
|
IP
|
$5,569.18
|
|
|
Service Code
|
HCPCS J9280
|
| Hospital Charge Code |
301471
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,450.44 |
| Max. Negotiated Rate |
$5,012.26 |
| Rate for Payer: Aetna American Axle |
$3,619.97
|
| Rate for Payer: Aetna American Axle |
$602.76
|
| Rate for Payer: Aetna Commercial |
$4,733.80
|
| Rate for Payer: Aetna Commercial |
$788.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,619.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$602.76
|
| Rate for Payer: Cash Price |
$4,455.34
|
| Rate for Payer: Cash Price |
$741.86
|
| Rate for Payer: Cofinity Commercial |
$797.50
|
| Rate for Payer: Cofinity Commercial |
$649.12
|
| Rate for Payer: Cofinity Commercial |
$3,898.43
|
| Rate for Payer: Cofinity Commercial |
$4,789.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,898.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$649.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,455.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$741.86
|
| Rate for Payer: Healthscope Commercial |
$5,012.26
|
| Rate for Payer: Healthscope Commercial |
$834.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,898.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$649.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,176.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$695.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$788.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,733.80
|
| Rate for Payer: PHP Commercial |
$788.22
|
| Rate for Payer: PHP Commercial |
$4,733.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,619.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$602.76
|
| Rate for Payer: Priority Health SBD |
$3,508.58
|
| Rate for Payer: Priority Health SBD |
$584.21
|
| Rate for Payer: UMR Bronson Commercial |
$2,450.44
|
| Rate for Payer: UMR Bronson Commercial |
$408.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,176.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$695.49
|
|
|
MITOMYCIN 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,196.90
|
|
|
Service Code
|
HCPCS J9280
|
| Hospital Charge Code |
10631
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$526.64 |
| Max. Negotiated Rate |
$1,077.21 |
| Rate for Payer: Aetna American Axle |
$777.99
|
| Rate for Payer: Aetna American Axle |
$602.76
|
| Rate for Payer: Aetna American Axle |
$581.85
|
| Rate for Payer: Aetna American Axle |
$3,430.64
|
| Rate for Payer: Aetna American Axle |
$3,619.97
|
| Rate for Payer: Aetna American Axle |
$617.91
|
| Rate for Payer: Aetna Commercial |
$1,017.37
|
| Rate for Payer: Aetna Commercial |
$4,486.22
|
| Rate for Payer: Aetna Commercial |
$760.88
|
| Rate for Payer: Aetna Commercial |
$808.04
|
| Rate for Payer: Aetna Commercial |
$788.22
|
| Rate for Payer: Aetna Commercial |
$4,733.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$777.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$617.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,430.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,619.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$602.76
|
| Rate for Payer: Cash Price |
$741.86
|
| Rate for Payer: Cash Price |
$716.12
|
| Rate for Payer: Cash Price |
$957.52
|
| Rate for Payer: Cash Price |
$4,455.34
|
| Rate for Payer: Cash Price |
$4,222.33
|
| Rate for Payer: Cash Price |
$760.50
|
| Rate for Payer: Cofinity Commercial |
$797.50
|
| Rate for Payer: Cofinity Commercial |
$1,029.33
|
| Rate for Payer: Cofinity Commercial |
$769.83
|
| Rate for Payer: Cofinity Commercial |
$626.61
|
| Rate for Payer: Cofinity Commercial |
$3,898.43
|
| Rate for Payer: Cofinity Commercial |
$3,694.54
|
| Rate for Payer: Cofinity Commercial |
$4,539.00
|
| Rate for Payer: Cofinity Commercial |
$4,789.49
|
| Rate for Payer: Cofinity Commercial |
$837.83
|
| Rate for Payer: Cofinity Commercial |
$817.54
|
| Rate for Payer: Cofinity Commercial |
$665.44
|
| Rate for Payer: Cofinity Commercial |
$649.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$626.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,694.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$665.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$649.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$837.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,898.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$957.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$741.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,455.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$716.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,222.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$760.50
|
| Rate for Payer: Healthscope Commercial |
$805.63
|
| Rate for Payer: Healthscope Commercial |
$855.57
|
| Rate for Payer: Healthscope Commercial |
$834.59
|
| Rate for Payer: Healthscope Commercial |
$4,750.12
|
| Rate for Payer: Healthscope Commercial |
$5,012.26
|
| Rate for Payer: Healthscope Commercial |
$1,077.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$649.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$837.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,694.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$626.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,898.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$665.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$695.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$712.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,958.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$897.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,176.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$671.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$788.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$808.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$760.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,017.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,486.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,733.80
|
| Rate for Payer: PHP Commercial |
$1,017.37
|
| Rate for Payer: PHP Commercial |
$4,486.22
|
| Rate for Payer: PHP Commercial |
$760.88
|
| Rate for Payer: PHP Commercial |
$788.22
|
| Rate for Payer: PHP Commercial |
$4,733.80
|
| Rate for Payer: PHP Commercial |
$808.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,430.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$777.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$602.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$581.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,619.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$617.91
|
| Rate for Payer: Priority Health SBD |
$584.21
|
| Rate for Payer: Priority Health SBD |
$563.94
|
| Rate for Payer: Priority Health SBD |
$754.05
|
| Rate for Payer: Priority Health SBD |
$3,325.08
|
| Rate for Payer: Priority Health SBD |
$3,508.58
|
| Rate for Payer: Priority Health SBD |
$598.90
|
| Rate for Payer: UMR Bronson Commercial |
$418.28
|
| Rate for Payer: UMR Bronson Commercial |
$2,322.28
|
| Rate for Payer: UMR Bronson Commercial |
$2,450.44
|
| Rate for Payer: UMR Bronson Commercial |
$408.02
|
| Rate for Payer: UMR Bronson Commercial |
$393.87
|
| Rate for Payer: UMR Bronson Commercial |
$526.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,958.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$671.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,176.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$695.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$712.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$897.67
|
|
|
MITOMYCIN 40 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$5,277.91
|
|
|
Service Code
|
HCPCS J9280
|
| Hospital Charge Code |
10631
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.91 |
| Max. Negotiated Rate |
$4,750.12 |
| Rate for Payer: Aetna American Axle |
$3,430.64
|
| Rate for Payer: Aetna American Axle |
$3,619.97
|
| Rate for Payer: Aetna American Axle |
$777.99
|
| Rate for Payer: Aetna American Axle |
$617.91
|
| Rate for Payer: Aetna American Axle |
$581.85
|
| Rate for Payer: Aetna American Axle |
$602.76
|
| Rate for Payer: Aetna Commercial |
$760.88
|
| Rate for Payer: Aetna Commercial |
$788.22
|
| Rate for Payer: Aetna Commercial |
$4,486.22
|
| Rate for Payer: Aetna Commercial |
$4,733.80
|
| Rate for Payer: Aetna Commercial |
$1,017.37
|
| Rate for Payer: Aetna Commercial |
$808.04
|
| Rate for Payer: Aetna Medicare |
$21.16
|
| Rate for Payer: Aetna Medicare |
$21.16
|
| Rate for Payer: Aetna Medicare |
$21.16
|
| Rate for Payer: Aetna Medicare |
$21.16
|
| Rate for Payer: Aetna Medicare |
$21.16
|
| Rate for Payer: Aetna Medicare |
$21.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,430.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$602.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$617.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$777.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,619.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.44
|
| Rate for Payer: BCBS Complete |
$11.45
|
| Rate for Payer: BCBS Complete |
$11.45
|
| Rate for Payer: BCBS Complete |
$11.45
|
| Rate for Payer: BCBS Complete |
$11.45
|
| Rate for Payer: BCBS Complete |
$11.45
|
| Rate for Payer: BCBS Complete |
$11.45
|
| Rate for Payer: BCBS MAPPO |
$20.35
|
| Rate for Payer: BCBS MAPPO |
$20.35
|
| Rate for Payer: BCBS MAPPO |
$20.35
|
| Rate for Payer: BCBS MAPPO |
$20.35
|
| Rate for Payer: BCBS MAPPO |
$20.35
|
| Rate for Payer: BCBS MAPPO |
$20.35
|
| Rate for Payer: BCN Medicare Advantage |
$20.35
|
| Rate for Payer: BCN Medicare Advantage |
$20.35
|
| Rate for Payer: BCN Medicare Advantage |
$20.35
|
| Rate for Payer: BCN Medicare Advantage |
$20.35
|
| Rate for Payer: BCN Medicare Advantage |
$20.35
|
| Rate for Payer: BCN Medicare Advantage |
$20.35
|
| Rate for Payer: Cash Price |
$716.12
|
| Rate for Payer: Cash Price |
$4,455.34
|
| Rate for Payer: Cash Price |
$957.52
|
| Rate for Payer: Cash Price |
$716.12
|
| Rate for Payer: Cash Price |
$4,222.33
|
| Rate for Payer: Cash Price |
$741.86
|
| Rate for Payer: Cash Price |
$741.86
|
| Rate for Payer: Cash Price |
$4,455.34
|
| Rate for Payer: Cash Price |
$760.50
|
| Rate for Payer: Cash Price |
$760.50
|
| Rate for Payer: Cash Price |
$957.52
|
| Rate for Payer: Cash Price |
$4,222.33
|
| Rate for Payer: Cofinity Commercial |
$626.61
|
| Rate for Payer: Cofinity Commercial |
$797.50
|
| Rate for Payer: Cofinity Commercial |
$649.12
|
| Rate for Payer: Cofinity Commercial |
$665.44
|
| Rate for Payer: Cofinity Commercial |
$4,789.49
|
| Rate for Payer: Cofinity Commercial |
$3,898.43
|
| Rate for Payer: Cofinity Commercial |
$817.54
|
| Rate for Payer: Cofinity Commercial |
$3,694.54
|
| Rate for Payer: Cofinity Commercial |
$4,539.00
|
| Rate for Payer: Cofinity Commercial |
$1,029.33
|
| Rate for Payer: Cofinity Commercial |
$837.83
|
| Rate for Payer: Cofinity Commercial |
$769.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$626.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,898.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$649.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,694.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$665.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$837.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,455.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$741.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$760.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,222.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$716.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$957.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.35
|
| Rate for Payer: Healthscope Commercial |
$855.57
|
| Rate for Payer: Healthscope Commercial |
$4,750.12
|
| Rate for Payer: Healthscope Commercial |
$1,077.21
|
| Rate for Payer: Healthscope Commercial |
$805.63
|
| Rate for Payer: Healthscope Commercial |
$834.59
|
| Rate for Payer: Healthscope Commercial |
$5,012.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,694.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$837.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$665.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,898.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$626.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$649.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$897.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$695.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$671.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$712.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,958.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,176.89
|
| Rate for Payer: Mclaren Medicaid |
$10.91
|
| Rate for Payer: Mclaren Medicaid |
$10.91
|
| Rate for Payer: Mclaren Medicaid |
$10.91
|
| Rate for Payer: Mclaren Medicaid |
$10.91
|
| Rate for Payer: Mclaren Medicaid |
$10.91
|
| Rate for Payer: Mclaren Medicaid |
$10.91
|
| Rate for Payer: Mclaren Medicare |
$20.35
|
| Rate for Payer: Mclaren Medicare |
$20.35
|
| Rate for Payer: Mclaren Medicare |
$20.35
|
| Rate for Payer: Mclaren Medicare |
$20.35
|
| Rate for Payer: Mclaren Medicare |
$20.35
|
| Rate for Payer: Mclaren Medicare |
$20.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.37
|
| Rate for Payer: Meridian Medicaid |
$11.45
|
| Rate for Payer: Meridian Medicaid |
$11.45
|
| Rate for Payer: Meridian Medicaid |
$11.45
|
| Rate for Payer: Meridian Medicaid |
$11.45
|
| Rate for Payer: Meridian Medicaid |
$11.45
|
| Rate for Payer: Meridian Medicaid |
$11.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,733.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$808.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,017.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$760.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,486.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$788.22
|
| Rate for Payer: PACE Medicare |
$19.33
|
| Rate for Payer: PACE Medicare |
$19.33
|
| Rate for Payer: PACE Medicare |
$19.33
|
| Rate for Payer: PACE Medicare |
$19.33
|
| Rate for Payer: PACE Medicare |
$19.33
|
| Rate for Payer: PACE Medicare |
$19.33
|
| Rate for Payer: PACE SWMI |
$20.35
|
| Rate for Payer: PACE SWMI |
$20.35
|
| Rate for Payer: PACE SWMI |
$20.35
|
| Rate for Payer: PACE SWMI |
$20.35
|
| Rate for Payer: PACE SWMI |
$20.35
|
| Rate for Payer: PACE SWMI |
$20.35
|
| Rate for Payer: PHP Commercial |
$4,486.22
|
| Rate for Payer: PHP Commercial |
$808.04
|
| Rate for Payer: PHP Commercial |
$760.88
|
| Rate for Payer: PHP Commercial |
$4,733.80
|
| Rate for Payer: PHP Commercial |
$788.22
|
| Rate for Payer: PHP Commercial |
$1,017.37
|
| Rate for Payer: PHP Medicare Advantage |
$20.35
|
| Rate for Payer: PHP Medicare Advantage |
$20.35
|
| Rate for Payer: PHP Medicare Advantage |
$20.35
|
| Rate for Payer: PHP Medicare Advantage |
$20.35
|
| Rate for Payer: PHP Medicare Advantage |
$20.35
|
| Rate for Payer: PHP Medicare Advantage |
$20.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,619.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$581.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,430.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$602.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$777.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$617.91
|
| Rate for Payer: Priority Health Medicare |
$20.35
|
| Rate for Payer: Priority Health Medicare |
$20.35
|
| Rate for Payer: Priority Health Medicare |
$20.35
|
| Rate for Payer: Priority Health Medicare |
$20.35
|
| Rate for Payer: Priority Health Medicare |
$20.35
|
| Rate for Payer: Priority Health Medicare |
$20.35
|
| Rate for Payer: Priority Health SBD |
$563.94
|
| Rate for Payer: Priority Health SBD |
$3,325.08
|
| Rate for Payer: Priority Health SBD |
$584.21
|
| Rate for Payer: Priority Health SBD |
$3,508.58
|
| Rate for Payer: Priority Health SBD |
$598.90
|
| Rate for Payer: Priority Health SBD |
$754.05
|
| Rate for Payer: Railroad Medicare Medicare |
$20.35
|
| Rate for Payer: Railroad Medicare Medicare |
$20.35
|
| Rate for Payer: Railroad Medicare Medicare |
$20.35
|
| Rate for Payer: Railroad Medicare Medicare |
$20.35
|
| Rate for Payer: Railroad Medicare Medicare |
$20.35
|
| Rate for Payer: Railroad Medicare Medicare |
$20.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.35
|
| Rate for Payer: UHC Exchange |
$38.89
|
| Rate for Payer: UHC Exchange |
$38.89
|
| Rate for Payer: UHC Exchange |
$38.89
|
| Rate for Payer: UHC Exchange |
$38.89
|
| Rate for Payer: UHC Exchange |
$38.89
|
| Rate for Payer: UHC Exchange |
$38.89
|
| Rate for Payer: UHC Medicare Advantage |
$20.35
|
| Rate for Payer: UHC Medicare Advantage |
$20.35
|
| Rate for Payer: UHC Medicare Advantage |
$20.35
|
| Rate for Payer: UHC Medicare Advantage |
$20.35
|
| Rate for Payer: UHC Medicare Advantage |
$20.35
|
| Rate for Payer: UHC Medicare Advantage |
$20.35
|
| Rate for Payer: UHCCP Medicaid |
$10.91
|
| Rate for Payer: UHCCP Medicaid |
$10.91
|
| Rate for Payer: UHCCP Medicaid |
$10.91
|
| Rate for Payer: UHCCP Medicaid |
$10.91
|
| Rate for Payer: UHCCP Medicaid |
$10.91
|
| Rate for Payer: UHCCP Medicaid |
$10.91
|
| Rate for Payer: UMR Bronson Commercial |
$331.21
|
| Rate for Payer: UMR Bronson Commercial |
$1,952.83
|
| Rate for Payer: UMR Bronson Commercial |
$2,060.60
|
| Rate for Payer: UMR Bronson Commercial |
$351.73
|
| Rate for Payer: UMR Bronson Commercial |
$343.11
|
| Rate for Payer: UMR Bronson Commercial |
$442.85
|
| Rate for Payer: VA VA |
$20.35
|
| Rate for Payer: VA VA |
$20.35
|
| Rate for Payer: VA VA |
$20.35
|
| Rate for Payer: VA VA |
$20.35
|
| Rate for Payer: VA VA |
$20.35
|
| Rate for Payer: VA VA |
$20.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,958.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$671.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$712.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$897.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,176.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$695.49
|
|
|
MITOMYCIN 5 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,018.05
|
|
|
Service Code
|
HCPCS J9280
|
| Hospital Charge Code |
10632
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$447.94 |
| Max. Negotiated Rate |
$916.25 |
| Rate for Payer: Aetna American Axle |
$661.73
|
| Rate for Payer: Aetna American Axle |
$320.35
|
| Rate for Payer: Aetna Commercial |
$865.34
|
| Rate for Payer: Aetna Commercial |
$418.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$661.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.35
|
| Rate for Payer: Cash Price |
$814.44
|
| Rate for Payer: Cash Price |
$394.27
|
| Rate for Payer: Cofinity Commercial |
$423.84
|
| Rate for Payer: Cofinity Commercial |
$344.99
|
| Rate for Payer: Cofinity Commercial |
$712.63
|
| Rate for Payer: Cofinity Commercial |
$875.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$712.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$344.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$814.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$394.27
|
| Rate for Payer: Healthscope Commercial |
$916.25
|
| Rate for Payer: Healthscope Commercial |
$443.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$712.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$344.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$763.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$369.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$418.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$865.34
|
| Rate for Payer: PHP Commercial |
$418.91
|
| Rate for Payer: PHP Commercial |
$865.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$661.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.35
|
| Rate for Payer: Priority Health SBD |
$641.37
|
| Rate for Payer: Priority Health SBD |
$310.49
|
| Rate for Payer: UMR Bronson Commercial |
$447.94
|
| Rate for Payer: UMR Bronson Commercial |
$216.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$763.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$369.63
|
|
|
MITOMYCIN 5 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$492.84
|
|
|
Service Code
|
HCPCS J9280
|
| Hospital Charge Code |
10632
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.91 |
| Max. Negotiated Rate |
$443.56 |
| Rate for Payer: Aetna American Axle |
$320.35
|
| Rate for Payer: Aetna American Axle |
$661.73
|
| Rate for Payer: Aetna Commercial |
$865.34
|
| Rate for Payer: Aetna Commercial |
$418.91
|
| Rate for Payer: Aetna Medicare |
$21.16
|
| Rate for Payer: Aetna Medicare |
$21.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$661.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.44
|
| Rate for Payer: BCBS Complete |
$11.45
|
| Rate for Payer: BCBS Complete |
$11.45
|
| Rate for Payer: BCBS MAPPO |
$20.35
|
| Rate for Payer: BCBS MAPPO |
$20.35
|
| Rate for Payer: BCN Medicare Advantage |
$20.35
|
| Rate for Payer: BCN Medicare Advantage |
$20.35
|
| Rate for Payer: Cash Price |
$814.44
|
| Rate for Payer: Cash Price |
$394.27
|
| Rate for Payer: Cash Price |
$394.27
|
| Rate for Payer: Cash Price |
$814.44
|
| Rate for Payer: Cofinity Commercial |
$712.63
|
| Rate for Payer: Cofinity Commercial |
$875.52
|
| Rate for Payer: Cofinity Commercial |
$344.99
|
| Rate for Payer: Cofinity Commercial |
$423.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$712.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$344.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$394.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$814.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.35
|
| Rate for Payer: Healthscope Commercial |
$443.56
|
| Rate for Payer: Healthscope Commercial |
$916.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$344.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$712.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$763.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$369.63
|
| Rate for Payer: Mclaren Medicaid |
$10.91
|
| Rate for Payer: Mclaren Medicaid |
$10.91
|
| Rate for Payer: Mclaren Medicare |
$20.35
|
| Rate for Payer: Mclaren Medicare |
$20.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.37
|
| Rate for Payer: Meridian Medicaid |
$11.45
|
| Rate for Payer: Meridian Medicaid |
$11.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$418.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$865.34
|
| Rate for Payer: PACE Medicare |
$19.33
|
| Rate for Payer: PACE Medicare |
$19.33
|
| Rate for Payer: PACE SWMI |
$20.35
|
| Rate for Payer: PACE SWMI |
$20.35
|
| Rate for Payer: PHP Commercial |
$865.34
|
| Rate for Payer: PHP Commercial |
$418.91
|
| Rate for Payer: PHP Medicare Advantage |
$20.35
|
| Rate for Payer: PHP Medicare Advantage |
$20.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$661.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.35
|
| Rate for Payer: Priority Health Medicare |
$20.35
|
| Rate for Payer: Priority Health Medicare |
$20.35
|
| Rate for Payer: Priority Health SBD |
$641.37
|
| Rate for Payer: Priority Health SBD |
$310.49
|
| Rate for Payer: Railroad Medicare Medicare |
$20.35
|
| Rate for Payer: Railroad Medicare Medicare |
$20.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.35
|
| Rate for Payer: UHC Exchange |
$38.89
|
| Rate for Payer: UHC Exchange |
$38.89
|
| Rate for Payer: UHC Medicare Advantage |
$20.35
|
| Rate for Payer: UHC Medicare Advantage |
$20.35
|
| Rate for Payer: UHCCP Medicaid |
$10.91
|
| Rate for Payer: UHCCP Medicaid |
$10.91
|
| Rate for Payer: UMR Bronson Commercial |
$376.68
|
| Rate for Payer: UMR Bronson Commercial |
$182.35
|
| Rate for Payer: VA VA |
$20.35
|
| Rate for Payer: VA VA |
$20.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$369.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$763.54
|
|
|
MITOXANTRONE 2 MG/ML CONCENTRATE,INTRAVENOUS
|
Facility
|
IP
|
$802.15
|
|
|
Service Code
|
HCPCS J9293
|
| Hospital Charge Code |
10634
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$352.95 |
| Max. Negotiated Rate |
$721.93 |
| Rate for Payer: Aetna American Axle |
$521.40
|
| Rate for Payer: Aetna American Axle |
$729.26
|
| Rate for Payer: Aetna American Axle |
$651.79
|
| Rate for Payer: Aetna American Axle |
$543.77
|
| Rate for Payer: Aetna Commercial |
$681.83
|
| Rate for Payer: Aetna Commercial |
$711.08
|
| Rate for Payer: Aetna Commercial |
$953.65
|
| Rate for Payer: Aetna Commercial |
$852.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$651.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$729.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$543.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$521.40
|
| Rate for Payer: Cash Price |
$897.55
|
| Rate for Payer: Cash Price |
$641.72
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cash Price |
$669.26
|
| Rate for Payer: Cofinity Commercial |
$701.92
|
| Rate for Payer: Cofinity Commercial |
$719.45
|
| Rate for Payer: Cofinity Commercial |
$585.60
|
| Rate for Payer: Cofinity Commercial |
$561.50
|
| Rate for Payer: Cofinity Commercial |
$785.36
|
| Rate for Payer: Cofinity Commercial |
$964.87
|
| Rate for Payer: Cofinity Commercial |
$689.85
|
| Rate for Payer: Cofinity Commercial |
$862.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$785.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$561.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$585.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$701.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$802.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$669.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$641.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$897.55
|
| Rate for Payer: Healthscope Commercial |
$721.93
|
| Rate for Payer: Healthscope Commercial |
$902.48
|
| Rate for Payer: Healthscope Commercial |
$1,009.75
|
| Rate for Payer: Healthscope Commercial |
$752.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$701.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$785.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$585.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$561.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$841.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$752.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$601.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$627.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$711.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$852.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$953.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$681.83
|
| Rate for Payer: PHP Commercial |
$681.83
|
| Rate for Payer: PHP Commercial |
$711.08
|
| Rate for Payer: PHP Commercial |
$852.34
|
| Rate for Payer: PHP Commercial |
$953.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$521.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$543.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$729.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$651.79
|
| Rate for Payer: Priority Health SBD |
$527.04
|
| Rate for Payer: Priority Health SBD |
$631.73
|
| Rate for Payer: Priority Health SBD |
$706.82
|
| Rate for Payer: Priority Health SBD |
$505.35
|
| Rate for Payer: UMR Bronson Commercial |
$352.95
|
| Rate for Payer: UMR Bronson Commercial |
$368.09
|
| Rate for Payer: UMR Bronson Commercial |
$493.65
|
| Rate for Payer: UMR Bronson Commercial |
$441.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$627.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$752.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$841.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$601.61
|
|
|
MITOXANTRONE 2 MG/ML CONCENTRATE,INTRAVENOUS
|
Facility
|
OP
|
$1,002.75
|
|
|
Service Code
|
HCPCS J9293
|
| Hospital Charge Code |
10634
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$902.48 |
| Rate for Payer: Aetna American Axle |
$651.79
|
| Rate for Payer: Aetna American Axle |
$729.26
|
| Rate for Payer: Aetna American Axle |
$543.77
|
| Rate for Payer: Aetna American Axle |
$521.40
|
| Rate for Payer: Aetna Commercial |
$711.08
|
| Rate for Payer: Aetna Commercial |
$852.34
|
| Rate for Payer: Aetna Commercial |
$953.65
|
| Rate for Payer: Aetna Commercial |
$681.83
|
| Rate for Payer: Aetna Medicare |
$24.84
|
| Rate for Payer: Aetna Medicare |
$24.84
|
| Rate for Payer: Aetna Medicare |
$24.84
|
| Rate for Payer: Aetna Medicare |
$24.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$521.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$651.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$543.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$729.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.85
|
| Rate for Payer: BCBS Complete |
$13.44
|
| Rate for Payer: BCBS Complete |
$13.44
|
| Rate for Payer: BCBS Complete |
$13.44
|
| Rate for Payer: BCBS Complete |
$13.44
|
| Rate for Payer: BCBS MAPPO |
$23.88
|
| Rate for Payer: BCBS MAPPO |
$23.88
|
| Rate for Payer: BCBS MAPPO |
$23.88
|
| Rate for Payer: BCBS MAPPO |
$23.88
|
| Rate for Payer: BCN Medicare Advantage |
$23.88
|
| Rate for Payer: BCN Medicare Advantage |
$23.88
|
| Rate for Payer: BCN Medicare Advantage |
$23.88
|
| Rate for Payer: BCN Medicare Advantage |
$23.88
|
| Rate for Payer: Cash Price |
$641.72
|
| Rate for Payer: Cash Price |
$669.26
|
| Rate for Payer: Cash Price |
$641.72
|
| Rate for Payer: Cash Price |
$897.55
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cash Price |
$897.55
|
| Rate for Payer: Cash Price |
$669.26
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cofinity Commercial |
$964.87
|
| Rate for Payer: Cofinity Commercial |
$701.92
|
| Rate for Payer: Cofinity Commercial |
$862.37
|
| Rate for Payer: Cofinity Commercial |
$785.36
|
| Rate for Payer: Cofinity Commercial |
$719.45
|
| Rate for Payer: Cofinity Commercial |
$585.60
|
| Rate for Payer: Cofinity Commercial |
$561.50
|
| Rate for Payer: Cofinity Commercial |
$689.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$701.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$561.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$585.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$785.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$641.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$802.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$669.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$897.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.88
|
| Rate for Payer: Healthscope Commercial |
$902.48
|
| Rate for Payer: Healthscope Commercial |
$1,009.75
|
| Rate for Payer: Healthscope Commercial |
$752.91
|
| Rate for Payer: Healthscope Commercial |
$721.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$785.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$585.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$561.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$701.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$841.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$627.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$752.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$601.61
|
| Rate for Payer: Mclaren Medicaid |
$12.80
|
| Rate for Payer: Mclaren Medicaid |
$12.80
|
| Rate for Payer: Mclaren Medicaid |
$12.80
|
| Rate for Payer: Mclaren Medicaid |
$12.80
|
| Rate for Payer: Mclaren Medicare |
$23.88
|
| Rate for Payer: Mclaren Medicare |
$23.88
|
| Rate for Payer: Mclaren Medicare |
$23.88
|
| Rate for Payer: Mclaren Medicare |
$23.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.07
|
| Rate for Payer: Meridian Medicaid |
$13.44
|
| Rate for Payer: Meridian Medicaid |
$13.44
|
| Rate for Payer: Meridian Medicaid |
$13.44
|
| Rate for Payer: Meridian Medicaid |
$13.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$852.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$711.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$953.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$681.83
|
| Rate for Payer: PACE Medicare |
$22.69
|
| Rate for Payer: PACE Medicare |
$22.69
|
| Rate for Payer: PACE Medicare |
$22.69
|
| Rate for Payer: PACE Medicare |
$22.69
|
| Rate for Payer: PACE SWMI |
$23.88
|
| Rate for Payer: PACE SWMI |
$23.88
|
| Rate for Payer: PACE SWMI |
$23.88
|
| Rate for Payer: PACE SWMI |
$23.88
|
| Rate for Payer: PHP Commercial |
$681.83
|
| Rate for Payer: PHP Commercial |
$852.34
|
| Rate for Payer: PHP Commercial |
$953.65
|
| Rate for Payer: PHP Commercial |
$711.08
|
| Rate for Payer: PHP Medicare Advantage |
$23.88
|
| Rate for Payer: PHP Medicare Advantage |
$23.88
|
| Rate for Payer: PHP Medicare Advantage |
$23.88
|
| Rate for Payer: PHP Medicare Advantage |
$23.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$521.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$543.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$651.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$729.26
|
| Rate for Payer: Priority Health Medicare |
$23.88
|
| Rate for Payer: Priority Health Medicare |
$23.88
|
| Rate for Payer: Priority Health Medicare |
$23.88
|
| Rate for Payer: Priority Health Medicare |
$23.88
|
| Rate for Payer: Priority Health SBD |
$706.82
|
| Rate for Payer: Priority Health SBD |
$505.35
|
| Rate for Payer: Priority Health SBD |
$631.73
|
| Rate for Payer: Priority Health SBD |
$527.04
|
| Rate for Payer: Railroad Medicare Medicare |
$23.88
|
| Rate for Payer: Railroad Medicare Medicare |
$23.88
|
| Rate for Payer: Railroad Medicare Medicare |
$23.88
|
| Rate for Payer: Railroad Medicare Medicare |
$23.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.88
|
| Rate for Payer: UHC Exchange |
$45.64
|
| Rate for Payer: UHC Exchange |
$45.64
|
| Rate for Payer: UHC Exchange |
$45.64
|
| Rate for Payer: UHC Exchange |
$45.64
|
| Rate for Payer: UHC Medicare Advantage |
$23.88
|
| Rate for Payer: UHC Medicare Advantage |
$23.88
|
| Rate for Payer: UHC Medicare Advantage |
$23.88
|
| Rate for Payer: UHC Medicare Advantage |
$23.88
|
| Rate for Payer: UHCCP Medicaid |
$12.80
|
| Rate for Payer: UHCCP Medicaid |
$12.80
|
| Rate for Payer: UHCCP Medicaid |
$12.80
|
| Rate for Payer: UHCCP Medicaid |
$12.80
|
| Rate for Payer: UMR Bronson Commercial |
$296.80
|
| Rate for Payer: UMR Bronson Commercial |
$415.12
|
| Rate for Payer: UMR Bronson Commercial |
$371.02
|
| Rate for Payer: UMR Bronson Commercial |
$309.53
|
| Rate for Payer: VA VA |
$23.88
|
| Rate for Payer: VA VA |
$23.88
|
| Rate for Payer: VA VA |
$23.88
|
| Rate for Payer: VA VA |
$23.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$752.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$841.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$601.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$627.43
|
|
|
MODAFINIL 200 MG TABLET
|
Facility
|
OP
|
$107.43
|
|
|
Service Code
|
NDC 62332038630
|
| Hospital Charge Code |
24703
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.75 |
| Max. Negotiated Rate |
$96.69 |
| Rate for Payer: Aetna American Axle |
$69.83
|
| Rate for Payer: Aetna Commercial |
$91.32
|
| Rate for Payer: Aetna Medicare |
$53.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.83
|
| Rate for Payer: BCBS Complete |
$42.97
|
| Rate for Payer: Cash Price |
$85.94
|
| Rate for Payer: Cofinity Commercial |
$75.20
|
| Rate for Payer: Cofinity Commercial |
$92.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.94
|
| Rate for Payer: Healthscope Commercial |
$96.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.32
|
| Rate for Payer: PHP Commercial |
$91.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.83
|
| Rate for Payer: Priority Health SBD |
$67.68
|
| Rate for Payer: UMR Bronson Commercial |
$39.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.57
|
|
|
MODAFINIL 200 MG TABLET
|
Facility
|
OP
|
$8,704.07
|
|
|
Service Code
|
NDC 63459020130
|
| Hospital Charge Code |
24703
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,220.51 |
| Max. Negotiated Rate |
$7,833.66 |
| Rate for Payer: Aetna American Axle |
$5,657.65
|
| Rate for Payer: Aetna Commercial |
$7,398.46
|
| Rate for Payer: Aetna Medicare |
$4,352.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,657.65
|
| Rate for Payer: BCBS Complete |
$3,481.63
|
| Rate for Payer: Cash Price |
$6,963.26
|
| Rate for Payer: Cofinity Commercial |
$6,092.85
|
| Rate for Payer: Cofinity Commercial |
$7,485.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,092.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,963.26
|
| Rate for Payer: Healthscope Commercial |
$7,833.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,092.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,528.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,398.46
|
| Rate for Payer: PHP Commercial |
$7,398.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,657.65
|
| Rate for Payer: Priority Health SBD |
$5,483.56
|
| Rate for Payer: UMR Bronson Commercial |
$3,220.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,528.05
|
|
|
MODAFINIL 200 MG TABLET
|
Facility
|
IP
|
$107.43
|
|
|
Service Code
|
NDC 62332038630
|
| Hospital Charge Code |
24703
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.27 |
| Max. Negotiated Rate |
$96.69 |
| Rate for Payer: Aetna American Axle |
$69.83
|
| Rate for Payer: Aetna Commercial |
$91.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.83
|
| Rate for Payer: Cash Price |
$85.94
|
| Rate for Payer: Cofinity Commercial |
$75.20
|
| Rate for Payer: Cofinity Commercial |
$92.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.94
|
| Rate for Payer: Healthscope Commercial |
$96.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.32
|
| Rate for Payer: PHP Commercial |
$91.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.83
|
| Rate for Payer: Priority Health SBD |
$67.68
|
| Rate for Payer: UMR Bronson Commercial |
$47.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.57
|
|
|
MODAFINIL 200 MG TABLET
|
Facility
|
IP
|
$8,704.07
|
|
|
Service Code
|
NDC 63459020130
|
| Hospital Charge Code |
24703
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,829.79 |
| Max. Negotiated Rate |
$7,833.66 |
| Rate for Payer: Aetna American Axle |
$5,657.65
|
| Rate for Payer: Aetna Commercial |
$7,398.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,657.65
|
| Rate for Payer: Cash Price |
$6,963.26
|
| Rate for Payer: Cofinity Commercial |
$6,092.85
|
| Rate for Payer: Cofinity Commercial |
$7,485.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,092.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,963.26
|
| Rate for Payer: Healthscope Commercial |
$7,833.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,092.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,528.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,398.46
|
| Rate for Payer: PHP Commercial |
$7,398.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,657.65
|
| Rate for Payer: Priority Health SBD |
$5,483.56
|
| Rate for Payer: UMR Bronson Commercial |
$3,829.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,528.05
|
|
|
MODAFINIL 200 MG TABLET
|
Facility
|
OP
|
$716.95
|
|
|
Service Code
|
NDC 55253080230
|
| Hospital Charge Code |
24703
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$265.27 |
| Max. Negotiated Rate |
$645.25 |
| Rate for Payer: Aetna American Axle |
$466.02
|
| Rate for Payer: Aetna Commercial |
$609.41
|
| Rate for Payer: Aetna Medicare |
$358.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$466.02
|
| Rate for Payer: BCBS Complete |
$286.78
|
| Rate for Payer: Cash Price |
$573.56
|
| Rate for Payer: Cofinity Commercial |
$501.87
|
| Rate for Payer: Cofinity Commercial |
$616.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$501.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$573.56
|
| Rate for Payer: Healthscope Commercial |
$645.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$501.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$537.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$609.41
|
| Rate for Payer: PHP Commercial |
$609.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$466.02
|
| Rate for Payer: Priority Health SBD |
$451.68
|
| Rate for Payer: UMR Bronson Commercial |
$265.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$537.71
|
|
|
MODAFINIL 200 MG TABLET
|
Facility
|
IP
|
$716.95
|
|
|
Service Code
|
NDC 55253080230
|
| Hospital Charge Code |
24703
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$315.46 |
| Max. Negotiated Rate |
$645.25 |
| Rate for Payer: Aetna American Axle |
$466.02
|
| Rate for Payer: Aetna Commercial |
$609.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$466.02
|
| Rate for Payer: Cash Price |
$573.56
|
| Rate for Payer: Cofinity Commercial |
$501.87
|
| Rate for Payer: Cofinity Commercial |
$616.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$501.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$573.56
|
| Rate for Payer: Healthscope Commercial |
$645.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$501.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$537.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$609.41
|
| Rate for Payer: PHP Commercial |
$609.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$466.02
|
| Rate for Payer: Priority Health SBD |
$451.68
|
| Rate for Payer: UMR Bronson Commercial |
$315.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$537.71
|
|
|
MOGAMULIZUMAB-KPKC 4 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18,654.02
|
|
|
Service Code
|
HCPCS J9204
|
| Hospital Charge Code |
188111
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8,207.77 |
| Max. Negotiated Rate |
$16,788.62 |
| Rate for Payer: Aetna American Axle |
$12,125.11
|
| Rate for Payer: Aetna Commercial |
$15,855.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,125.11
|
| Rate for Payer: Cash Price |
$14,923.22
|
| Rate for Payer: Cofinity Commercial |
$13,057.81
|
| Rate for Payer: Cofinity Commercial |
$16,042.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$13,057.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,923.22
|
| Rate for Payer: Healthscope Commercial |
$16,788.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13,057.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,990.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,855.92
|
| Rate for Payer: PHP Commercial |
$15,855.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,125.11
|
| Rate for Payer: Priority Health SBD |
$11,752.03
|
| Rate for Payer: UMR Bronson Commercial |
$8,207.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,990.51
|
|
|
MOGAMULIZUMAB-KPKC 4 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18,654.02
|
|
|
Service Code
|
HCPCS J9204
|
| Hospital Charge Code |
188111
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$133.20 |
| Max. Negotiated Rate |
$16,788.62 |
| Rate for Payer: Aetna American Axle |
$12,125.11
|
| Rate for Payer: Aetna Commercial |
$15,855.92
|
| Rate for Payer: Aetna Medicare |
$258.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,125.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$310.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$310.62
|
| Rate for Payer: BCBS Complete |
$139.86
|
| Rate for Payer: BCBS MAPPO |
$248.50
|
| Rate for Payer: BCN Medicare Advantage |
$248.50
|
| Rate for Payer: Cash Price |
$14,923.22
|
| Rate for Payer: Cash Price |
$14,923.22
|
| Rate for Payer: Cofinity Commercial |
$13,057.81
|
| Rate for Payer: Cofinity Commercial |
$16,042.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$13,057.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,923.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.50
|
| Rate for Payer: Healthscope Commercial |
$16,788.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13,057.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,990.51
|
| Rate for Payer: Mclaren Medicaid |
$133.20
|
| Rate for Payer: Mclaren Medicare |
$248.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$260.93
|
| Rate for Payer: Meridian Medicaid |
$139.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$285.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,855.92
|
| Rate for Payer: PACE Medicare |
$236.07
|
| Rate for Payer: PACE SWMI |
$248.50
|
| Rate for Payer: PHP Commercial |
$15,855.92
|
| Rate for Payer: PHP Medicare Advantage |
$248.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$133.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,125.11
|
| Rate for Payer: Priority Health Medicare |
$248.50
|
| Rate for Payer: Priority Health SBD |
$11,752.03
|
| Rate for Payer: Railroad Medicare Medicare |
$248.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$699.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$248.50
|
| Rate for Payer: UHC Exchange |
$474.91
|
| Rate for Payer: UHC Medicare Advantage |
$248.50
|
| Rate for Payer: UHCCP Medicaid |
$133.20
|
| Rate for Payer: UMR Bronson Commercial |
$6,901.99
|
| Rate for Payer: VA VA |
$248.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,990.51
|
|
|
MOLASSES
|
Facility
|
IP
|
$23.94
|
|
|
Service Code
|
NDC 00990000075
|
| Hospital Charge Code |
500563
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.53 |
| Max. Negotiated Rate |
$21.55 |
| Rate for Payer: Aetna American Axle |
$15.56
|
| Rate for Payer: Aetna Commercial |
$20.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.56
|
| Rate for Payer: Cash Price |
$19.15
|
| Rate for Payer: Cofinity Commercial |
$16.76
|
| Rate for Payer: Cofinity Commercial |
$20.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.15
|
| Rate for Payer: Healthscope Commercial |
$21.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.35
|
| Rate for Payer: PHP Commercial |
$20.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.56
|
| Rate for Payer: Priority Health SBD |
$15.08
|
| Rate for Payer: UMR Bronson Commercial |
$10.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.95
|
|
|
MOLASSES
|
Facility
|
OP
|
$23.94
|
|
|
Service Code
|
NDC 00990000075
|
| Hospital Charge Code |
500563
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.86 |
| Max. Negotiated Rate |
$21.55 |
| Rate for Payer: Aetna American Axle |
$15.56
|
| Rate for Payer: Aetna Commercial |
$20.35
|
| Rate for Payer: Aetna Medicare |
$11.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.56
|
| Rate for Payer: BCBS Complete |
$9.58
|
| Rate for Payer: Cash Price |
$19.15
|
| Rate for Payer: Cofinity Commercial |
$16.76
|
| Rate for Payer: Cofinity Commercial |
$20.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.15
|
| Rate for Payer: Healthscope Commercial |
$21.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.35
|
| Rate for Payer: PHP Commercial |
$20.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.56
|
| Rate for Payer: Priority Health SBD |
$15.08
|
| Rate for Payer: UMR Bronson Commercial |
$8.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.95
|
|
|
MOMETASONE 110 MCG/ACTUATION(30 DOSES) BREATH ACTIVATED POWDER INHALER
|
Facility
|
IP
|
$432.53
|
|
|
Service Code
|
NDC 00085146102
|
| Hospital Charge Code |
91877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$190.31 |
| Max. Negotiated Rate |
$389.28 |
| Rate for Payer: Aetna American Axle |
$281.14
|
| Rate for Payer: Aetna Commercial |
$367.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.14
|
| Rate for Payer: Cash Price |
$346.02
|
| Rate for Payer: Cofinity Commercial |
$302.77
|
| Rate for Payer: Cofinity Commercial |
$371.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$302.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$346.02
|
| Rate for Payer: Healthscope Commercial |
$389.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$302.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$324.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.65
|
| Rate for Payer: PHP Commercial |
$367.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.14
|
| Rate for Payer: Priority Health SBD |
$272.49
|
| Rate for Payer: UMR Bronson Commercial |
$190.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$324.40
|
|
|
MOMETASONE 110 MCG/ACTUATION(30 DOSES) BREATH ACTIVATED POWDER INHALER
|
Facility
|
OP
|
$432.53
|
|
|
Service Code
|
NDC 00085146102
|
| Hospital Charge Code |
91877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.04 |
| Max. Negotiated Rate |
$389.28 |
| Rate for Payer: Aetna American Axle |
$281.14
|
| Rate for Payer: Aetna Commercial |
$367.65
|
| Rate for Payer: Aetna Medicare |
$216.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.14
|
| Rate for Payer: BCBS Complete |
$173.01
|
| Rate for Payer: Cash Price |
$346.02
|
| Rate for Payer: Cofinity Commercial |
$302.77
|
| Rate for Payer: Cofinity Commercial |
$371.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$302.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$346.02
|
| Rate for Payer: Healthscope Commercial |
$389.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$302.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$324.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.65
|
| Rate for Payer: PHP Commercial |
$367.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.14
|
| Rate for Payer: Priority Health SBD |
$272.49
|
| Rate for Payer: UMR Bronson Commercial |
$160.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$324.40
|
|
