|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
OP
|
$794.88
|
|
|
Service Code
|
NDC 68084004101
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$294.11 |
| Max. Negotiated Rate |
$715.39 |
| Rate for Payer: Aetna American Axle |
$516.67
|
| Rate for Payer: Aetna Commercial |
$675.65
|
| Rate for Payer: Aetna Medicare |
$397.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$516.67
|
| Rate for Payer: BCBS Complete |
$317.95
|
| Rate for Payer: Cash Price |
$635.90
|
| Rate for Payer: Cofinity Commercial |
$556.42
|
| Rate for Payer: Cofinity Commercial |
$683.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$556.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$635.90
|
| Rate for Payer: Healthscope Commercial |
$715.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$556.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$596.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$675.65
|
| Rate for Payer: PHP Commercial |
$675.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$516.67
|
| Rate for Payer: Priority Health SBD |
$500.77
|
| Rate for Payer: UMR Bronson Commercial |
$294.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$596.16
|
|
|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
OP
|
$431.04
|
|
|
Service Code
|
NDC 43386016101
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.48 |
| Max. Negotiated Rate |
$387.94 |
| Rate for Payer: Aetna American Axle |
$280.18
|
| Rate for Payer: Aetna Commercial |
$366.38
|
| Rate for Payer: Aetna Medicare |
$215.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.18
|
| Rate for Payer: BCBS Complete |
$172.42
|
| Rate for Payer: Cash Price |
$344.83
|
| Rate for Payer: Cofinity Commercial |
$301.73
|
| Rate for Payer: Cofinity Commercial |
$370.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$301.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.83
|
| Rate for Payer: Healthscope Commercial |
$387.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$301.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.38
|
| Rate for Payer: PHP Commercial |
$366.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.18
|
| Rate for Payer: Priority Health SBD |
$271.56
|
| Rate for Payer: UMR Bronson Commercial |
$159.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.28
|
|
|
MISOPROSTOL 25 MCG CUSTOM TAB
|
Facility
|
IP
|
$1,442.63
|
|
|
Service Code
|
NDC 09900000016
|
| Hospital Charge Code |
150707
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$634.76 |
| Max. Negotiated Rate |
$1,298.37 |
| Rate for Payer: Aetna American Axle |
$937.71
|
| Rate for Payer: Aetna Commercial |
$1,226.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$937.71
|
| Rate for Payer: Cash Price |
$1,154.10
|
| Rate for Payer: Cofinity Commercial |
$1,009.84
|
| Rate for Payer: Cofinity Commercial |
$1,240.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,009.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,154.10
|
| Rate for Payer: Healthscope Commercial |
$1,298.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,009.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,081.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,226.24
|
| Rate for Payer: PHP Commercial |
$1,226.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$937.71
|
| Rate for Payer: Priority Health SBD |
$908.86
|
| Rate for Payer: UMR Bronson Commercial |
$634.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,081.97
|
|
|
MISOPROSTOL 25 MCG CUSTOM TAB
|
Facility
|
OP
|
$1,442.63
|
|
|
Service Code
|
NDC 09900000016
|
| Hospital Charge Code |
150707
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$533.77 |
| Max. Negotiated Rate |
$1,298.37 |
| Rate for Payer: Aetna American Axle |
$937.71
|
| Rate for Payer: Aetna Commercial |
$1,226.24
|
| Rate for Payer: Aetna Medicare |
$721.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$937.71
|
| Rate for Payer: BCBS Complete |
$577.05
|
| Rate for Payer: Cash Price |
$1,154.10
|
| Rate for Payer: Cofinity Commercial |
$1,009.84
|
| Rate for Payer: Cofinity Commercial |
$1,240.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,009.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,154.10
|
| Rate for Payer: Healthscope Commercial |
$1,298.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,009.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,081.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,226.24
|
| Rate for Payer: PHP Commercial |
$1,226.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$937.71
|
| Rate for Payer: Priority Health SBD |
$908.86
|
| Rate for Payer: UMR Bronson Commercial |
$533.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,081.97
|
|
|
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 |
$948.36 |
| 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: BCBS Trust/PPO |
$948.36
|
| Rate for Payer: BCN Commercial |
$948.36
|
| Rate for Payer: Cash Price |
$203.62
|
| 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 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 20 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$463.71
|
|
|
Service Code
|
HCPCS J9280
|
| Hospital Charge Code |
10630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.84 |
| Max. Negotiated Rate |
$417.34 |
| Rate for Payer: Aetna American Axle |
$301.41
|
| Rate for Payer: Aetna American Axle |
$456.14
|
| Rate for Payer: Aetna American Axle |
$501.12
|
| Rate for Payer: Aetna Commercial |
$655.31
|
| Rate for Payer: Aetna Commercial |
$394.15
|
| Rate for Payer: Aetna Commercial |
$596.49
|
| Rate for Payer: Aetna Medicare |
$48.20
|
| Rate for Payer: Aetna Medicare |
$48.20
|
| Rate for Payer: Aetna Medicare |
$48.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$456.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$501.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57.94
|
| Rate for Payer: BCBS Complete |
$26.09
|
| Rate for Payer: BCBS Complete |
$26.09
|
| Rate for Payer: BCBS Complete |
$26.09
|
| Rate for Payer: BCBS MAPPO |
$46.35
|
| Rate for Payer: BCBS MAPPO |
$46.35
|
| Rate for Payer: BCBS MAPPO |
$46.35
|
| Rate for Payer: BCBS Trust/PPO |
$114.59
|
| Rate for Payer: BCBS Trust/PPO |
$114.59
|
| Rate for Payer: BCBS Trust/PPO |
$114.59
|
| Rate for Payer: BCN Commercial |
$114.59
|
| Rate for Payer: BCN Commercial |
$114.59
|
| Rate for Payer: BCN Commercial |
$114.59
|
| Rate for Payer: BCN Medicare Advantage |
$46.35
|
| Rate for Payer: BCN Medicare Advantage |
$46.35
|
| Rate for Payer: BCN Medicare Advantage |
$46.35
|
| Rate for Payer: Cash Price |
$616.76
|
| 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 |
$561.40
|
| Rate for Payer: Cash Price |
$561.40
|
| Rate for Payer: Cofinity Commercial |
$663.02
|
| Rate for Payer: Cofinity Commercial |
$398.79
|
| Rate for Payer: Cofinity Commercial |
$324.60
|
| Rate for Payer: Cofinity Commercial |
$603.50
|
| Rate for Payer: Cofinity Commercial |
$491.22
|
| Rate for Payer: Cofinity Commercial |
$539.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$539.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$491.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$324.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$616.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.35
|
| 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 |
$539.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$491.22
|
| 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 |
$526.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$347.78
|
| Rate for Payer: Mclaren Medicaid |
$24.84
|
| Rate for Payer: Mclaren Medicaid |
$24.84
|
| Rate for Payer: Mclaren Medicaid |
$24.84
|
| Rate for Payer: Mclaren Medicare |
$46.35
|
| Rate for Payer: Mclaren Medicare |
$46.35
|
| Rate for Payer: Mclaren Medicare |
$46.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.67
|
| Rate for Payer: Meridian Medicaid |
$26.09
|
| Rate for Payer: Meridian Medicaid |
$26.09
|
| Rate for Payer: Meridian Medicaid |
$26.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$655.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$394.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.49
|
| Rate for Payer: Nomi Health Commercial |
$139.05
|
| Rate for Payer: Nomi Health Commercial |
$139.05
|
| Rate for Payer: Nomi Health Commercial |
$139.05
|
| Rate for Payer: PACE Medicare |
$44.03
|
| Rate for Payer: PACE Medicare |
$44.03
|
| Rate for Payer: PACE Medicare |
$44.03
|
| Rate for Payer: PACE SWMI |
$46.35
|
| Rate for Payer: PACE SWMI |
$46.35
|
| Rate for Payer: PACE SWMI |
$46.35
|
| Rate for Payer: PHP Commercial |
$596.49
|
| Rate for Payer: PHP Commercial |
$394.15
|
| Rate for Payer: PHP Commercial |
$655.31
|
| Rate for Payer: PHP Medicare Advantage |
$46.35
|
| Rate for Payer: PHP Medicare Advantage |
$46.35
|
| Rate for Payer: PHP Medicare Advantage |
$46.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$501.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$456.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$122.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$122.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$122.34
|
| Rate for Payer: Priority Health Medicare |
$46.35
|
| Rate for Payer: Priority Health Medicare |
$46.35
|
| Rate for Payer: Priority Health Medicare |
$46.35
|
| Rate for Payer: Priority Health Narrow Network |
$97.87
|
| Rate for Payer: Priority Health Narrow Network |
$97.87
|
| Rate for Payer: Priority Health Narrow Network |
$97.87
|
| 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 |
$46.35
|
| Rate for Payer: Railroad Medicare Medicare |
$46.35
|
| Rate for Payer: Railroad Medicare Medicare |
$46.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.35
|
| Rate for Payer: UHC Exchange |
$88.58
|
| Rate for Payer: UHC Exchange |
$88.58
|
| Rate for Payer: UHC Exchange |
$88.58
|
| Rate for Payer: UHC Medicare Advantage |
$46.35
|
| Rate for Payer: UHC Medicare Advantage |
$46.35
|
| Rate for Payer: UHC Medicare Advantage |
$46.35
|
| Rate for Payer: UHCCP Medicaid |
$24.84
|
| Rate for Payer: UHCCP Medicaid |
$24.84
|
| Rate for Payer: UHCCP Medicaid |
$24.84
|
| Rate for Payer: UMR Bronson Commercial |
$259.65
|
| Rate for Payer: UMR Bronson Commercial |
$171.57
|
| Rate for Payer: UMR Bronson Commercial |
$285.25
|
| Rate for Payer: VA VA |
$46.35
|
| Rate for Payer: VA VA |
$46.35
|
| Rate for Payer: VA VA |
$46.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$347.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$578.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$526.31
|
|
|
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 |
$24.84 |
| Max. Negotiated Rate |
$693.86 |
| Rate for Payer: PHP Commercial |
$655.31
|
| Rate for Payer: PHP Medicare Advantage |
$46.35
|
| Rate for Payer: Aetna American Axle |
$501.12
|
| Rate for Payer: Aetna Commercial |
$655.31
|
| Rate for Payer: Aetna Medicare |
$48.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$501.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57.94
|
| Rate for Payer: BCBS Complete |
$26.09
|
| Rate for Payer: BCBS MAPPO |
$46.35
|
| Rate for Payer: BCBS Trust/PPO |
$114.59
|
| Rate for Payer: BCN Commercial |
$114.59
|
| Rate for Payer: BCN Medicare Advantage |
$46.35
|
| Rate for Payer: Cash Price |
$616.76
|
| Rate for Payer: Cash Price |
$616.76
|
| Rate for Payer: Cofinity Commercial |
$663.02
|
| Rate for Payer: Cofinity Commercial |
$539.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$539.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$616.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.35
|
| 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 |
$24.84
|
| Rate for Payer: Mclaren Medicare |
$46.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.67
|
| Rate for Payer: Meridian Medicaid |
$26.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$655.31
|
| Rate for Payer: Nomi Health Commercial |
$139.05
|
| Rate for Payer: PACE Medicare |
$44.03
|
| Rate for Payer: PACE SWMI |
$46.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$501.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$122.34
|
| Rate for Payer: Priority Health Medicare |
$46.35
|
| Rate for Payer: Priority Health Narrow Network |
$97.87
|
| Rate for Payer: Priority Health SBD |
$485.70
|
| Rate for Payer: Railroad Medicare Medicare |
$46.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.35
|
| Rate for Payer: UHC Exchange |
$88.58
|
| Rate for Payer: UHC Medicare Advantage |
$46.35
|
| Rate for Payer: UHCCP Medicaid |
$24.84
|
| Rate for Payer: UMR Bronson Commercial |
$285.25
|
| Rate for Payer: VA VA |
$46.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$578.21
|
|
|
MITOMYCIN 40 MG/20 ML BLADDER FOR IRRIGATION SOLUTION CUSTOM
|
Facility
|
OP
|
$5,569.18
|
|
|
Service Code
|
HCPCS J9280
|
| Hospital Charge Code |
301471
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.84 |
| 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 |
$788.22
|
| Rate for Payer: Aetna Commercial |
$4,733.80
|
| Rate for Payer: Aetna Medicare |
$48.20
|
| Rate for Payer: Aetna Medicare |
$48.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,619.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$602.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57.94
|
| Rate for Payer: BCBS Complete |
$26.09
|
| Rate for Payer: BCBS Complete |
$26.09
|
| Rate for Payer: BCBS MAPPO |
$46.35
|
| Rate for Payer: BCBS MAPPO |
$46.35
|
| Rate for Payer: BCBS Trust/PPO |
$114.59
|
| Rate for Payer: BCBS Trust/PPO |
$114.59
|
| Rate for Payer: BCN Commercial |
$114.59
|
| Rate for Payer: BCN Commercial |
$114.59
|
| Rate for Payer: BCN Medicare Advantage |
$46.35
|
| Rate for Payer: BCN Medicare Advantage |
$46.35
|
| Rate for Payer: Cash Price |
$741.86
|
| Rate for Payer: Cash Price |
$4,455.34
|
| Rate for Payer: Cash Price |
$741.86
|
| Rate for Payer: Cash Price |
$4,455.34
|
| 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 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 |
$4,455.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$741.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.35
|
| Rate for Payer: Healthscope Commercial |
$5,012.26
|
| Rate for Payer: Healthscope Commercial |
$834.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$649.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,898.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,176.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$695.49
|
| Rate for Payer: Mclaren Medicaid |
$24.84
|
| Rate for Payer: Mclaren Medicaid |
$24.84
|
| Rate for Payer: Mclaren Medicare |
$46.35
|
| Rate for Payer: Mclaren Medicare |
$46.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.67
|
| Rate for Payer: Meridian Medicaid |
$26.09
|
| Rate for Payer: Meridian Medicaid |
$26.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,733.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$788.22
|
| Rate for Payer: Nomi Health Commercial |
$139.05
|
| Rate for Payer: Nomi Health Commercial |
$139.05
|
| Rate for Payer: PACE Medicare |
$44.03
|
| Rate for Payer: PACE Medicare |
$44.03
|
| Rate for Payer: PACE SWMI |
$46.35
|
| Rate for Payer: PACE SWMI |
$46.35
|
| Rate for Payer: PHP Commercial |
$4,733.80
|
| Rate for Payer: PHP Commercial |
$788.22
|
| Rate for Payer: PHP Medicare Advantage |
$46.35
|
| Rate for Payer: PHP Medicare Advantage |
$46.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.84
|
| 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 HMO/PPO/Tiered Network |
$122.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$122.34
|
| Rate for Payer: Priority Health Medicare |
$46.35
|
| Rate for Payer: Priority Health Medicare |
$46.35
|
| Rate for Payer: Priority Health Narrow Network |
$97.87
|
| Rate for Payer: Priority Health Narrow Network |
$97.87
|
| Rate for Payer: Priority Health SBD |
$3,508.58
|
| Rate for Payer: Priority Health SBD |
$584.21
|
| Rate for Payer: Railroad Medicare Medicare |
$46.35
|
| Rate for Payer: Railroad Medicare Medicare |
$46.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.35
|
| Rate for Payer: UHC Exchange |
$88.58
|
| Rate for Payer: UHC Exchange |
$88.58
|
| Rate for Payer: UHC Medicare Advantage |
$46.35
|
| Rate for Payer: UHC Medicare Advantage |
$46.35
|
| Rate for Payer: UHCCP Medicaid |
$24.84
|
| Rate for Payer: UHCCP Medicaid |
$24.84
|
| Rate for Payer: UMR Bronson Commercial |
$2,060.60
|
| Rate for Payer: UMR Bronson Commercial |
$343.11
|
| Rate for Payer: VA VA |
$46.35
|
| Rate for Payer: VA VA |
$46.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,176.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$695.49
|
|
|
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 |
$4,176.88
|
| 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 |
$4,176.88
|
| 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 |
$777.98
|
| 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 |
$1,017.36
|
| 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) |
$777.98
|
| 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 |
$626.60
|
| 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 |
$626.60
|
| 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 |
$805.64
|
| 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 |
$626.60
|
| 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 |
$897.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,176.88
|
| 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 |
$1,017.36
|
| 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 |
$1,017.36
|
| 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 |
$777.98
|
| 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 |
$4,176.88
|
| 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 |
$897.68
|
|
|
MITOMYCIN 40 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$5,569.18
|
|
|
Service Code
|
HCPCS J9280
|
| Hospital Charge Code |
10631
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.84 |
| Max. Negotiated Rate |
$5,012.26 |
| Rate for Payer: Aetna American Axle |
$3,619.97
|
| Rate for Payer: Aetna American Axle |
$581.85
|
| Rate for Payer: Aetna American Axle |
$3,430.64
|
| Rate for Payer: Aetna American Axle |
$617.91
|
| Rate for Payer: Aetna American Axle |
$602.76
|
| Rate for Payer: Aetna American Axle |
$777.98
|
| Rate for Payer: Aetna Commercial |
$4,733.80
|
| Rate for Payer: Aetna Commercial |
$808.04
|
| Rate for Payer: Aetna Commercial |
$760.88
|
| Rate for Payer: Aetna Commercial |
$1,017.36
|
| Rate for Payer: Aetna Commercial |
$4,486.22
|
| Rate for Payer: Aetna Commercial |
$788.22
|
| Rate for Payer: Aetna Medicare |
$48.20
|
| Rate for Payer: Aetna Medicare |
$48.20
|
| Rate for Payer: Aetna Medicare |
$48.20
|
| Rate for Payer: Aetna Medicare |
$48.20
|
| Rate for Payer: Aetna Medicare |
$48.20
|
| Rate for Payer: Aetna Medicare |
$48.20
|
| 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) |
$602.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$617.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$777.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,619.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57.94
|
| Rate for Payer: BCBS Complete |
$26.09
|
| Rate for Payer: BCBS Complete |
$26.09
|
| Rate for Payer: BCBS Complete |
$26.09
|
| Rate for Payer: BCBS Complete |
$26.09
|
| Rate for Payer: BCBS Complete |
$26.09
|
| Rate for Payer: BCBS Complete |
$26.09
|
| Rate for Payer: BCBS MAPPO |
$46.35
|
| Rate for Payer: BCBS MAPPO |
$46.35
|
| Rate for Payer: BCBS MAPPO |
$46.35
|
| Rate for Payer: BCBS MAPPO |
$46.35
|
| Rate for Payer: BCBS MAPPO |
$46.35
|
| Rate for Payer: BCBS MAPPO |
$46.35
|
| Rate for Payer: BCBS Trust/PPO |
$114.59
|
| Rate for Payer: BCBS Trust/PPO |
$114.59
|
| Rate for Payer: BCBS Trust/PPO |
$114.59
|
| Rate for Payer: BCBS Trust/PPO |
$114.59
|
| Rate for Payer: BCBS Trust/PPO |
$114.59
|
| Rate for Payer: BCBS Trust/PPO |
$114.59
|
| Rate for Payer: BCN Commercial |
$114.59
|
| Rate for Payer: BCN Commercial |
$114.59
|
| Rate for Payer: BCN Commercial |
$114.59
|
| Rate for Payer: BCN Commercial |
$114.59
|
| Rate for Payer: BCN Commercial |
$114.59
|
| Rate for Payer: BCN Commercial |
$114.59
|
| Rate for Payer: BCN Medicare Advantage |
$46.35
|
| Rate for Payer: BCN Medicare Advantage |
$46.35
|
| Rate for Payer: BCN Medicare Advantage |
$46.35
|
| Rate for Payer: BCN Medicare Advantage |
$46.35
|
| Rate for Payer: BCN Medicare Advantage |
$46.35
|
| Rate for Payer: BCN Medicare Advantage |
$46.35
|
| Rate for Payer: Cash Price |
$4,222.33
|
| Rate for Payer: Cash Price |
$741.86
|
| Rate for Payer: Cash Price |
$4,455.34
|
| Rate for Payer: Cash Price |
$4,222.33
|
| Rate for Payer: Cash Price |
$716.12
|
| 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 |
$741.86
|
| Rate for Payer: Cash Price |
$957.52
|
| Rate for Payer: Cash Price |
$760.50
|
| Rate for Payer: Cash Price |
$760.50
|
| Rate for Payer: Cofinity Commercial |
$649.12
|
| Rate for Payer: Cofinity Commercial |
$3,694.54
|
| Rate for Payer: Cofinity Commercial |
$4,539.00
|
| Rate for Payer: Cofinity Commercial |
$665.44
|
| Rate for Payer: Cofinity Commercial |
$817.54
|
| Rate for Payer: Cofinity Commercial |
$769.83
|
| Rate for Payer: Cofinity Commercial |
$626.60
|
| Rate for Payer: Cofinity Commercial |
$1,029.33
|
| Rate for Payer: Cofinity Commercial |
$837.83
|
| Rate for Payer: Cofinity Commercial |
$3,898.43
|
| Rate for Payer: Cofinity Commercial |
$4,789.49
|
| 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: Cofinity Medicare Advantage |
$626.60
|
| 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 |
$760.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$957.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$716.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$741.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,455.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,222.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.35
|
| Rate for Payer: Healthscope Commercial |
$5,012.26
|
| Rate for Payer: Healthscope Commercial |
$1,077.21
|
| Rate for Payer: Healthscope Commercial |
$855.57
|
| Rate for Payer: Healthscope Commercial |
$4,750.12
|
| Rate for Payer: Healthscope Commercial |
$834.59
|
| Rate for Payer: Healthscope Commercial |
$805.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$626.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$665.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$837.83
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$3,694.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,176.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$897.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,958.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$671.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$695.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$712.97
|
| Rate for Payer: Mclaren Medicaid |
$24.84
|
| Rate for Payer: Mclaren Medicaid |
$24.84
|
| Rate for Payer: Mclaren Medicaid |
$24.84
|
| Rate for Payer: Mclaren Medicaid |
$24.84
|
| Rate for Payer: Mclaren Medicaid |
$24.84
|
| Rate for Payer: Mclaren Medicaid |
$24.84
|
| Rate for Payer: Mclaren Medicare |
$46.35
|
| Rate for Payer: Mclaren Medicare |
$46.35
|
| Rate for Payer: Mclaren Medicare |
$46.35
|
| Rate for Payer: Mclaren Medicare |
$46.35
|
| Rate for Payer: Mclaren Medicare |
$46.35
|
| Rate for Payer: Mclaren Medicare |
$46.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.67
|
| Rate for Payer: Meridian Medicaid |
$26.09
|
| Rate for Payer: Meridian Medicaid |
$26.09
|
| Rate for Payer: Meridian Medicaid |
$26.09
|
| Rate for Payer: Meridian Medicaid |
$26.09
|
| Rate for Payer: Meridian Medicaid |
$26.09
|
| Rate for Payer: Meridian Medicaid |
$26.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$760.88
|
| 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 |
$4,486.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,017.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,733.80
|
| Rate for Payer: Nomi Health Commercial |
$139.05
|
| Rate for Payer: Nomi Health Commercial |
$139.05
|
| Rate for Payer: Nomi Health Commercial |
$139.05
|
| Rate for Payer: Nomi Health Commercial |
$139.05
|
| Rate for Payer: Nomi Health Commercial |
$139.05
|
| Rate for Payer: Nomi Health Commercial |
$139.05
|
| Rate for Payer: PACE Medicare |
$44.03
|
| Rate for Payer: PACE Medicare |
$44.03
|
| Rate for Payer: PACE Medicare |
$44.03
|
| Rate for Payer: PACE Medicare |
$44.03
|
| Rate for Payer: PACE Medicare |
$44.03
|
| Rate for Payer: PACE Medicare |
$44.03
|
| Rate for Payer: PACE SWMI |
$46.35
|
| Rate for Payer: PACE SWMI |
$46.35
|
| Rate for Payer: PACE SWMI |
$46.35
|
| Rate for Payer: PACE SWMI |
$46.35
|
| Rate for Payer: PACE SWMI |
$46.35
|
| Rate for Payer: PACE SWMI |
$46.35
|
| Rate for Payer: PHP Commercial |
$788.22
|
| Rate for Payer: PHP Commercial |
$4,486.22
|
| Rate for Payer: PHP Commercial |
$808.04
|
| Rate for Payer: PHP Commercial |
$1,017.36
|
| Rate for Payer: PHP Commercial |
$4,733.80
|
| Rate for Payer: PHP Commercial |
$760.88
|
| Rate for Payer: PHP Medicare Advantage |
$46.35
|
| Rate for Payer: PHP Medicare Advantage |
$46.35
|
| Rate for Payer: PHP Medicare Advantage |
$46.35
|
| Rate for Payer: PHP Medicare Advantage |
$46.35
|
| Rate for Payer: PHP Medicare Advantage |
$46.35
|
| Rate for Payer: PHP Medicare Advantage |
$46.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.84
|
| 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 |
$581.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$617.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,619.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$777.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$122.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$122.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$122.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$122.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$122.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$122.34
|
| Rate for Payer: Priority Health Medicare |
$46.35
|
| Rate for Payer: Priority Health Medicare |
$46.35
|
| Rate for Payer: Priority Health Medicare |
$46.35
|
| Rate for Payer: Priority Health Medicare |
$46.35
|
| Rate for Payer: Priority Health Medicare |
$46.35
|
| Rate for Payer: Priority Health Medicare |
$46.35
|
| Rate for Payer: Priority Health Narrow Network |
$97.87
|
| Rate for Payer: Priority Health Narrow Network |
$97.87
|
| Rate for Payer: Priority Health Narrow Network |
$97.87
|
| Rate for Payer: Priority Health Narrow Network |
$97.87
|
| Rate for Payer: Priority Health Narrow Network |
$97.87
|
| Rate for Payer: Priority Health Narrow Network |
$97.87
|
| Rate for Payer: Priority Health SBD |
$3,508.58
|
| Rate for Payer: Priority Health SBD |
$584.21
|
| Rate for Payer: Priority Health SBD |
$563.94
|
| Rate for Payer: Priority Health SBD |
$598.90
|
| Rate for Payer: Priority Health SBD |
$754.05
|
| Rate for Payer: Priority Health SBD |
$3,325.08
|
| Rate for Payer: Railroad Medicare Medicare |
$46.35
|
| Rate for Payer: Railroad Medicare Medicare |
$46.35
|
| Rate for Payer: Railroad Medicare Medicare |
$46.35
|
| Rate for Payer: Railroad Medicare Medicare |
$46.35
|
| Rate for Payer: Railroad Medicare Medicare |
$46.35
|
| Rate for Payer: Railroad Medicare Medicare |
$46.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.35
|
| Rate for Payer: UHC Exchange |
$88.58
|
| Rate for Payer: UHC Exchange |
$88.58
|
| Rate for Payer: UHC Exchange |
$88.58
|
| Rate for Payer: UHC Exchange |
$88.58
|
| Rate for Payer: UHC Exchange |
$88.58
|
| Rate for Payer: UHC Exchange |
$88.58
|
| Rate for Payer: UHC Medicare Advantage |
$46.35
|
| Rate for Payer: UHC Medicare Advantage |
$46.35
|
| Rate for Payer: UHC Medicare Advantage |
$46.35
|
| Rate for Payer: UHC Medicare Advantage |
$46.35
|
| Rate for Payer: UHC Medicare Advantage |
$46.35
|
| Rate for Payer: UHC Medicare Advantage |
$46.35
|
| Rate for Payer: UHCCP Medicaid |
$24.84
|
| Rate for Payer: UHCCP Medicaid |
$24.84
|
| Rate for Payer: UHCCP Medicaid |
$24.84
|
| Rate for Payer: UHCCP Medicaid |
$24.84
|
| Rate for Payer: UHCCP Medicaid |
$24.84
|
| Rate for Payer: UHCCP Medicaid |
$24.84
|
| Rate for Payer: UMR Bronson Commercial |
$2,060.60
|
| Rate for Payer: UMR Bronson Commercial |
$442.85
|
| Rate for Payer: UMR Bronson Commercial |
$1,952.83
|
| Rate for Payer: UMR Bronson Commercial |
$331.21
|
| Rate for Payer: UMR Bronson Commercial |
$343.11
|
| Rate for Payer: UMR Bronson Commercial |
$351.73
|
| Rate for Payer: VA VA |
$46.35
|
| Rate for Payer: VA VA |
$46.35
|
| Rate for Payer: VA VA |
$46.35
|
| Rate for Payer: VA VA |
$46.35
|
| Rate for Payer: VA VA |
$46.35
|
| Rate for Payer: VA VA |
$46.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$671.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,958.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$695.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,176.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$897.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$712.97
|
|
|
MITOMYCIN 5 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,018.05
|
|
|
Service Code
|
HCPCS J9280
|
| Hospital Charge Code |
10632
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$447.94 |
| Max. Negotiated Rate |
$916.24 |
| Rate for Payer: Aetna American Axle |
$661.73
|
| Rate for Payer: Aetna 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 |
$712.64
|
| Rate for Payer: Cofinity Commercial |
$875.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$712.64
|
| 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 |
$916.24
|
| Rate for Payer: Healthscope Commercial |
$443.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$712.64
|
| 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
|
$1,018.05
|
|
|
Service Code
|
HCPCS J9280
|
| Hospital Charge Code |
10632
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.84 |
| Max. Negotiated Rate |
$916.24 |
| Rate for Payer: Aetna American Axle |
$661.73
|
| Rate for Payer: Aetna American Axle |
$320.35
|
| Rate for Payer: Aetna Commercial |
$418.91
|
| Rate for Payer: Aetna Commercial |
$865.34
|
| Rate for Payer: Aetna Medicare |
$48.20
|
| Rate for Payer: Aetna Medicare |
$48.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$661.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57.94
|
| Rate for Payer: BCBS Complete |
$26.09
|
| Rate for Payer: BCBS Complete |
$26.09
|
| Rate for Payer: BCBS MAPPO |
$46.35
|
| Rate for Payer: BCBS MAPPO |
$46.35
|
| Rate for Payer: BCBS Trust/PPO |
$114.59
|
| Rate for Payer: BCBS Trust/PPO |
$114.59
|
| Rate for Payer: BCN Commercial |
$114.59
|
| Rate for Payer: BCN Commercial |
$114.59
|
| Rate for Payer: BCN Medicare Advantage |
$46.35
|
| Rate for Payer: BCN Medicare Advantage |
$46.35
|
| Rate for Payer: Cash Price |
$394.27
|
| Rate for Payer: Cash Price |
$814.44
|
| Rate for Payer: Cash Price |
$394.27
|
| Rate for Payer: Cash Price |
$814.44
|
| Rate for Payer: Cofinity Commercial |
$344.99
|
| Rate for Payer: Cofinity Commercial |
$712.64
|
| Rate for Payer: Cofinity Commercial |
$875.52
|
| Rate for Payer: Cofinity Commercial |
$423.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$712.64
|
| 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: Health Alliance Plan Medicare Advantage |
$46.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.35
|
| Rate for Payer: Healthscope Commercial |
$916.24
|
| Rate for Payer: Healthscope Commercial |
$443.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$344.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$712.64
|
| 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 |
$24.84
|
| Rate for Payer: Mclaren Medicaid |
$24.84
|
| Rate for Payer: Mclaren Medicare |
$46.35
|
| Rate for Payer: Mclaren Medicare |
$46.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.67
|
| Rate for Payer: Meridian Medicaid |
$26.09
|
| Rate for Payer: Meridian Medicaid |
$26.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$865.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$418.91
|
| Rate for Payer: Nomi Health Commercial |
$139.05
|
| Rate for Payer: Nomi Health Commercial |
$139.05
|
| Rate for Payer: PACE Medicare |
$44.03
|
| Rate for Payer: PACE Medicare |
$44.03
|
| Rate for Payer: PACE SWMI |
$46.35
|
| Rate for Payer: PACE SWMI |
$46.35
|
| Rate for Payer: PHP Commercial |
$865.34
|
| Rate for Payer: PHP Commercial |
$418.91
|
| Rate for Payer: PHP Medicare Advantage |
$46.35
|
| Rate for Payer: PHP Medicare Advantage |
$46.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.84
|
| 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 HMO/PPO/Tiered Network |
$122.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$122.34
|
| Rate for Payer: Priority Health Medicare |
$46.35
|
| Rate for Payer: Priority Health Medicare |
$46.35
|
| Rate for Payer: Priority Health Narrow Network |
$97.87
|
| Rate for Payer: Priority Health Narrow Network |
$97.87
|
| Rate for Payer: Priority Health SBD |
$641.37
|
| Rate for Payer: Priority Health SBD |
$310.49
|
| Rate for Payer: Railroad Medicare Medicare |
$46.35
|
| Rate for Payer: Railroad Medicare Medicare |
$46.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.35
|
| Rate for Payer: UHC Exchange |
$88.58
|
| Rate for Payer: UHC Exchange |
$88.58
|
| Rate for Payer: UHC Medicare Advantage |
$46.35
|
| Rate for Payer: UHC Medicare Advantage |
$46.35
|
| Rate for Payer: UHCCP Medicaid |
$24.84
|
| Rate for Payer: UHCCP Medicaid |
$24.84
|
| Rate for Payer: UMR Bronson Commercial |
$376.68
|
| Rate for Payer: UMR Bronson Commercial |
$182.35
|
| Rate for Payer: VA VA |
$46.35
|
| Rate for Payer: VA VA |
$46.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$763.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$369.63
|
|
|
MITOXANTRONE 2 MG/ML CONCENTRATE,INTRAVENOUS
|
Facility
|
OP
|
$836.57
|
|
|
Service Code
|
HCPCS J9293
|
| Hospital Charge Code |
10634
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.60 |
| Max. Negotiated Rate |
$752.91 |
| Rate for Payer: Aetna American Axle |
$543.77
|
| Rate for Payer: Aetna American Axle |
$521.40
|
| Rate for Payer: Aetna American Axle |
$651.79
|
| Rate for Payer: Aetna American Axle |
$729.26
|
| 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 Commercial |
$681.83
|
| Rate for Payer: Aetna Medicare |
$63.25
|
| Rate for Payer: Aetna Medicare |
$63.25
|
| Rate for Payer: Aetna Medicare |
$63.25
|
| Rate for Payer: Aetna Medicare |
$63.25
|
| 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) |
$521.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$543.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.02
|
| Rate for Payer: BCBS Complete |
$34.23
|
| Rate for Payer: BCBS Complete |
$34.23
|
| Rate for Payer: BCBS Complete |
$34.23
|
| Rate for Payer: BCBS Complete |
$34.23
|
| Rate for Payer: BCBS MAPPO |
$60.82
|
| Rate for Payer: BCBS MAPPO |
$60.82
|
| Rate for Payer: BCBS MAPPO |
$60.82
|
| Rate for Payer: BCBS MAPPO |
$60.82
|
| Rate for Payer: BCBS Trust/PPO |
$147.35
|
| Rate for Payer: BCBS Trust/PPO |
$147.35
|
| Rate for Payer: BCBS Trust/PPO |
$147.35
|
| Rate for Payer: BCBS Trust/PPO |
$147.35
|
| Rate for Payer: BCN Commercial |
$147.35
|
| Rate for Payer: BCN Commercial |
$147.35
|
| Rate for Payer: BCN Commercial |
$147.35
|
| Rate for Payer: BCN Commercial |
$147.35
|
| Rate for Payer: BCN Medicare Advantage |
$60.82
|
| Rate for Payer: BCN Medicare Advantage |
$60.82
|
| Rate for Payer: BCN Medicare Advantage |
$60.82
|
| Rate for Payer: BCN Medicare Advantage |
$60.82
|
| 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 |
$641.72
|
| Rate for Payer: Cash Price |
$669.26
|
| Rate for Payer: Cash Price |
$641.72
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cash Price |
$897.55
|
| Rate for Payer: Cofinity Commercial |
$701.92
|
| Rate for Payer: Cofinity Commercial |
$862.36
|
| Rate for Payer: Cofinity Commercial |
$585.60
|
| Rate for Payer: Cofinity Commercial |
$719.45
|
| Rate for Payer: Cofinity Commercial |
$785.36
|
| Rate for Payer: Cofinity Commercial |
$689.85
|
| Rate for Payer: Cofinity Commercial |
$561.50
|
| Rate for Payer: Cofinity Commercial |
$964.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$785.36
|
| 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: Encore Health Key Benefits Commercial |
$641.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$897.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$669.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$802.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.82
|
| Rate for Payer: Healthscope Commercial |
$721.94
|
| Rate for Payer: Healthscope Commercial |
$902.48
|
| Rate for Payer: Healthscope Commercial |
$752.91
|
| Rate for Payer: Healthscope Commercial |
$1,009.75
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$585.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$785.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$601.61
|
| 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 |
$627.43
|
| Rate for Payer: Mclaren Medicaid |
$32.60
|
| Rate for Payer: Mclaren Medicaid |
$32.60
|
| Rate for Payer: Mclaren Medicaid |
$32.60
|
| Rate for Payer: Mclaren Medicaid |
$32.60
|
| Rate for Payer: Mclaren Medicare |
$60.82
|
| Rate for Payer: Mclaren Medicare |
$60.82
|
| Rate for Payer: Mclaren Medicare |
$60.82
|
| Rate for Payer: Mclaren Medicare |
$60.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.86
|
| Rate for Payer: Meridian Medicaid |
$34.23
|
| Rate for Payer: Meridian Medicaid |
$34.23
|
| Rate for Payer: Meridian Medicaid |
$34.23
|
| Rate for Payer: Meridian Medicaid |
$34.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.94
|
| 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 |
$852.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$681.83
|
| Rate for Payer: Nomi Health Commercial |
$182.46
|
| Rate for Payer: Nomi Health Commercial |
$182.46
|
| Rate for Payer: Nomi Health Commercial |
$182.46
|
| Rate for Payer: Nomi Health Commercial |
$182.46
|
| Rate for Payer: PACE Medicare |
$57.78
|
| Rate for Payer: PACE Medicare |
$57.78
|
| Rate for Payer: PACE Medicare |
$57.78
|
| Rate for Payer: PACE Medicare |
$57.78
|
| Rate for Payer: PACE SWMI |
$60.82
|
| Rate for Payer: PACE SWMI |
$60.82
|
| Rate for Payer: PACE SWMI |
$60.82
|
| Rate for Payer: PACE SWMI |
$60.82
|
| Rate for Payer: PHP Commercial |
$711.08
|
| Rate for Payer: PHP Commercial |
$953.65
|
| Rate for Payer: PHP Commercial |
$852.34
|
| Rate for Payer: PHP Commercial |
$681.83
|
| Rate for Payer: PHP Medicare Advantage |
$60.82
|
| Rate for Payer: PHP Medicare Advantage |
$60.82
|
| Rate for Payer: PHP Medicare Advantage |
$60.82
|
| Rate for Payer: PHP Medicare Advantage |
$60.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$521.40
|
| 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 Cigna Priority Health |
$543.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$157.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$157.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$157.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$157.29
|
| Rate for Payer: Priority Health Medicare |
$60.82
|
| Rate for Payer: Priority Health Medicare |
$60.82
|
| Rate for Payer: Priority Health Medicare |
$60.82
|
| Rate for Payer: Priority Health Medicare |
$60.82
|
| Rate for Payer: Priority Health Narrow Network |
$125.83
|
| Rate for Payer: Priority Health Narrow Network |
$125.83
|
| Rate for Payer: Priority Health Narrow Network |
$125.83
|
| Rate for Payer: Priority Health Narrow Network |
$125.83
|
| 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: Railroad Medicare Medicare |
$60.82
|
| Rate for Payer: Railroad Medicare Medicare |
$60.82
|
| Rate for Payer: Railroad Medicare Medicare |
$60.82
|
| Rate for Payer: Railroad Medicare Medicare |
$60.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.82
|
| Rate for Payer: UHC Exchange |
$116.23
|
| Rate for Payer: UHC Exchange |
$116.23
|
| Rate for Payer: UHC Exchange |
$116.23
|
| Rate for Payer: UHC Exchange |
$116.23
|
| Rate for Payer: UHC Medicare Advantage |
$60.82
|
| Rate for Payer: UHC Medicare Advantage |
$60.82
|
| Rate for Payer: UHC Medicare Advantage |
$60.82
|
| Rate for Payer: UHC Medicare Advantage |
$60.82
|
| Rate for Payer: UHCCP Medicaid |
$32.60
|
| Rate for Payer: UHCCP Medicaid |
$32.60
|
| Rate for Payer: UHCCP Medicaid |
$32.60
|
| Rate for Payer: UHCCP Medicaid |
$32.60
|
| Rate for Payer: UMR Bronson Commercial |
$296.80
|
| Rate for Payer: UMR Bronson Commercial |
$309.53
|
| Rate for Payer: UMR Bronson Commercial |
$415.12
|
| Rate for Payer: UMR Bronson Commercial |
$371.02
|
| Rate for Payer: VA VA |
$60.82
|
| Rate for Payer: VA VA |
$60.82
|
| Rate for Payer: VA VA |
$60.82
|
| Rate for Payer: VA VA |
$60.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$627.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$841.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$752.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$601.61
|
|
|
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 |
$721.94 |
| 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 |
$862.36
|
| 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 |
$721.94
|
| 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
|
|
|
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 |
$645.26 |
| Rate for Payer: BCBS Complete |
$286.78
|
| Rate for Payer: Cash Price |
$573.56
|
| Rate for Payer: Cofinity Commercial |
$501.86
|
| Rate for Payer: Cofinity Commercial |
$616.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$501.86
|
| 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: Encore Health Key Benefits Commercial |
$573.56
|
| Rate for Payer: Healthscope Commercial |
$645.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$501.86
|
| 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 |
$645.26 |
| 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 |
$501.86
|
| Rate for Payer: Cofinity Commercial |
$616.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$501.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$573.56
|
| Rate for Payer: Healthscope Commercial |
$645.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$501.86
|
| 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
|
|
|
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 |
$4,352.04
|
| 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
|
$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
|
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
|
|
|
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 |
$13,990.52
|
| 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 |
$13,990.52
|
|
|
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 |
$130.42 |
| 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 |
$253.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,125.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$304.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$304.15
|
| Rate for Payer: BCBS Complete |
$136.94
|
| Rate for Payer: BCBS MAPPO |
$243.32
|
| Rate for Payer: BCBS Trust/PPO |
$656.04
|
| Rate for Payer: BCN Commercial |
$656.04
|
| Rate for Payer: BCN Medicare Advantage |
$243.32
|
| Rate for Payer: Cash Price |
$14,923.22
|
| Rate for Payer: Cash Price |
$14,923.22
|
| Rate for Payer: Cofinity Commercial |
$16,042.46
|
| Rate for Payer: Cofinity Commercial |
$13,057.81
|
| 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 |
$243.32
|
| 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 |
$13,990.52
|
| Rate for Payer: Mclaren Medicaid |
$130.42
|
| Rate for Payer: Mclaren Medicare |
$243.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$255.49
|
| Rate for Payer: Meridian Medicaid |
$136.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$279.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,855.92
|
| Rate for Payer: Nomi Health Commercial |
$729.96
|
| Rate for Payer: PACE Medicare |
$231.15
|
| Rate for Payer: PACE SWMI |
$243.32
|
| Rate for Payer: PHP Commercial |
$15,855.92
|
| Rate for Payer: PHP Medicare Advantage |
$243.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,125.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$687.41
|
| Rate for Payer: Priority Health Medicare |
$243.32
|
| Rate for Payer: Priority Health Narrow Network |
$549.93
|
| Rate for Payer: Priority Health SBD |
$11,752.03
|
| Rate for Payer: Railroad Medicare Medicare |
$243.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$684.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$243.32
|
| Rate for Payer: UHC Exchange |
$465.01
|
| Rate for Payer: UHC Medicare Advantage |
$243.32
|
| Rate for Payer: UHCCP Medicaid |
$130.42
|
| Rate for Payer: UMR Bronson Commercial |
$6,901.99
|
| Rate for Payer: VA VA |
$243.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,990.52
|
|
