|
MYCOPHENOLATE MOFETIL 200 MG/ML ORAL POWDER FOR SUSPENSION
|
Facility
|
IP
|
$3,706.52
|
|
|
Service Code
|
HCPCS J7528
|
| Hospital Charge Code |
25005
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,630.87 |
| Max. Negotiated Rate |
$3,335.87 |
| Rate for Payer: Aetna American Axle |
$2,409.24
|
| Rate for Payer: Aetna American Axle |
$941.99
|
| Rate for Payer: Aetna American Axle |
$2,594.71
|
| Rate for Payer: Aetna American Axle |
$828.18
|
| Rate for Payer: Aetna Commercial |
$3,393.08
|
| Rate for Payer: Aetna Commercial |
$3,150.54
|
| Rate for Payer: Aetna Commercial |
$1,083.00
|
| Rate for Payer: Aetna Commercial |
$1,231.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,594.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,409.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$941.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$828.18
|
| Rate for Payer: Cash Price |
$1,019.30
|
| Rate for Payer: Cash Price |
$3,193.49
|
| Rate for Payer: Cash Price |
$1,159.38
|
| Rate for Payer: Cash Price |
$2,965.22
|
| Rate for Payer: Cofinity Advantage |
$1,014.45
|
| Rate for Payer: Cofinity Advantage |
$891.88
|
| Rate for Payer: Cofinity Advantage |
$2,594.56
|
| Rate for Payer: Cofinity Advantage |
$2,794.30
|
| Rate for Payer: Cofinity Commercial |
$3,187.61
|
| Rate for Payer: Cofinity Commercial |
$1,095.74
|
| Rate for Payer: Cofinity Commercial |
$1,246.33
|
| Rate for Payer: Cofinity Commercial |
$3,433.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,965.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,019.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,193.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,159.38
|
| Rate for Payer: Healthscope Commercial |
$1,304.30
|
| Rate for Payer: Healthscope Commercial |
$3,592.67
|
| Rate for Payer: Healthscope Commercial |
$3,335.87
|
| Rate for Payer: Healthscope Commercial |
$1,146.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,594.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$891.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,014.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,794.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,086.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,779.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,993.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$955.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,393.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,083.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,231.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,150.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,993.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,086.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,779.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$955.59
|
| Rate for Payer: PHP Commercial |
$1,083.00
|
| Rate for Payer: PHP Commercial |
$3,150.54
|
| Rate for Payer: PHP Commercial |
$1,231.84
|
| Rate for Payer: PHP Commercial |
$3,393.08
|
| Rate for Payer: Priority Health SBD |
$2,514.87
|
| Rate for Payer: Priority Health SBD |
$802.70
|
| Rate for Payer: Priority Health SBD |
$2,335.11
|
| Rate for Payer: Priority Health SBD |
$913.01
|
| Rate for Payer: UMR Bronson Commercial |
$637.66
|
| Rate for Payer: UMR Bronson Commercial |
$1,630.87
|
| Rate for Payer: UMR Bronson Commercial |
$560.61
|
| Rate for Payer: UMR Bronson Commercial |
$1,756.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$955.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,779.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,086.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,993.89
|
|
|
MYCOPHENOLATE MOFETIL 250 MG CAPSULE
|
Facility
|
OP
|
$454.10
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
15113
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$408.69 |
| Rate for Payer: Aetna American Axle |
$295.17
|
| Rate for Payer: Aetna American Axle |
$261.14
|
| Rate for Payer: Aetna American Axle |
$289.61
|
| Rate for Payer: Aetna American Axle |
$186.58
|
| Rate for Payer: Aetna American Axle |
$2.96
|
| Rate for Payer: Aetna American Axle |
$2.90
|
| Rate for Payer: Aetna American Axle |
$281.06
|
| Rate for Payer: Aetna American Axle |
$262.73
|
| Rate for Payer: Aetna American Axle |
$284.12
|
| Rate for Payer: Aetna American Axle |
$1.65
|
| Rate for Payer: Aetna American Axle |
$165.05
|
| Rate for Payer: Aetna American Axle |
$240.82
|
| Rate for Payer: Aetna Commercial |
$3.87
|
| Rate for Payer: Aetna Commercial |
$341.50
|
| Rate for Payer: Aetna Commercial |
$367.54
|
| Rate for Payer: Aetna Commercial |
$371.54
|
| Rate for Payer: Aetna Commercial |
$378.72
|
| Rate for Payer: Aetna Commercial |
$343.57
|
| Rate for Payer: Aetna Commercial |
$314.93
|
| Rate for Payer: Aetna Commercial |
$2.16
|
| Rate for Payer: Aetna Commercial |
$385.99
|
| Rate for Payer: Aetna Commercial |
$3.79
|
| Rate for Payer: Aetna Commercial |
$215.83
|
| Rate for Payer: Aetna Commercial |
$243.98
|
| Rate for Payer: Aetna Medicare |
$200.88
|
| Rate for Payer: Aetna Medicare |
$227.05
|
| Rate for Payer: Aetna Medicare |
$202.10
|
| Rate for Payer: Aetna Medicare |
$126.96
|
| Rate for Payer: Aetna Medicare |
$1.27
|
| Rate for Payer: Aetna Medicare |
$216.20
|
| Rate for Payer: Aetna Medicare |
$218.55
|
| Rate for Payer: Aetna Medicare |
$222.78
|
| Rate for Payer: Aetna Medicare |
$185.25
|
| Rate for Payer: Aetna Medicare |
$2.23
|
| Rate for Payer: Aetna Medicare |
$143.52
|
| Rate for Payer: Aetna Medicare |
$2.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$295.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.14
|
| Rate for Payer: BCBS Complete |
$160.70
|
| Rate for Payer: BCBS Complete |
$101.57
|
| Rate for Payer: BCBS Complete |
$1.02
|
| Rate for Payer: BCBS Complete |
$114.82
|
| Rate for Payer: BCBS Complete |
$1.82
|
| Rate for Payer: BCBS Complete |
$181.64
|
| Rate for Payer: BCBS Complete |
$1.78
|
| Rate for Payer: BCBS Complete |
$148.20
|
| Rate for Payer: BCBS Complete |
$178.22
|
| Rate for Payer: BCBS Complete |
$174.84
|
| Rate for Payer: BCBS Complete |
$161.68
|
| Rate for Payer: BCBS Complete |
$172.96
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: Cash Price |
$323.36
|
| Rate for Payer: Cash Price |
$363.28
|
| Rate for Payer: Cash Price |
$3.57
|
| Rate for Payer: Cash Price |
$3.64
|
| Rate for Payer: Cash Price |
$3.57
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cash Price |
$356.44
|
| Rate for Payer: Cash Price |
$356.44
|
| Rate for Payer: Cash Price |
$321.41
|
| Rate for Payer: Cash Price |
$203.14
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Cash Price |
$229.63
|
| Rate for Payer: Cash Price |
$203.14
|
| Rate for Payer: Cash Price |
$321.41
|
| Rate for Payer: Cash Price |
$229.63
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cash Price |
$323.36
|
| Rate for Payer: Cash Price |
$345.92
|
| Rate for Payer: Cash Price |
$3.64
|
| Rate for Payer: Cash Price |
$363.28
|
| Rate for Payer: Cash Price |
$345.92
|
| Rate for Payer: Cofinity Advantage |
$259.35
|
| Rate for Payer: Cofinity Advantage |
$1.78
|
| Rate for Payer: Cofinity Advantage |
$3.19
|
| Rate for Payer: Cofinity Advantage |
$317.87
|
| Rate for Payer: Cofinity Advantage |
$200.93
|
| Rate for Payer: Cofinity Advantage |
$311.88
|
| Rate for Payer: Cofinity Advantage |
$177.74
|
| Rate for Payer: Cofinity Advantage |
$281.23
|
| Rate for Payer: Cofinity Advantage |
$305.97
|
| Rate for Payer: Cofinity Advantage |
$282.94
|
| Rate for Payer: Cofinity Advantage |
$302.68
|
| Rate for Payer: Cofinity Advantage |
$3.12
|
| Rate for Payer: Cofinity Commercial |
$347.61
|
| Rate for Payer: Cofinity Commercial |
$345.51
|
| Rate for Payer: Cofinity Commercial |
$375.91
|
| Rate for Payer: Cofinity Commercial |
$390.53
|
| Rate for Payer: Cofinity Commercial |
$318.63
|
| Rate for Payer: Cofinity Commercial |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$3.84
|
| Rate for Payer: Cofinity Commercial |
$371.86
|
| Rate for Payer: Cofinity Commercial |
$218.37
|
| Rate for Payer: Cofinity Commercial |
$383.17
|
| Rate for Payer: Cofinity Commercial |
$246.85
|
| Rate for Payer: Cofinity Commercial |
$3.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$363.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.63
|
| Rate for Payer: Healthscope Commercial |
$408.69
|
| Rate for Payer: Healthscope Commercial |
$228.53
|
| Rate for Payer: Healthscope Commercial |
$2.29
|
| Rate for Payer: Healthscope Commercial |
$258.34
|
| Rate for Payer: Healthscope Commercial |
$333.45
|
| Rate for Payer: Healthscope Commercial |
$361.58
|
| Rate for Payer: Healthscope Commercial |
$363.78
|
| Rate for Payer: Healthscope Commercial |
$389.16
|
| Rate for Payer: Healthscope Commercial |
$393.39
|
| Rate for Payer: Healthscope Commercial |
$401.00
|
| Rate for Payer: Healthscope Commercial |
$4.01
|
| Rate for Payer: Healthscope Commercial |
$4.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$317.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$302.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$281.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$311.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$282.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$259.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$305.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$334.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$340.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$277.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$324.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$296.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$323.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$345.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$321.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$203.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$356.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$363.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$385.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$378.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$301.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$324.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$277.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$327.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$340.57
|
| Rate for Payer: PHP Commercial |
$3.87
|
| Rate for Payer: PHP Commercial |
$371.54
|
| Rate for Payer: PHP Commercial |
$314.93
|
| Rate for Payer: PHP Commercial |
$341.50
|
| Rate for Payer: PHP Commercial |
$343.57
|
| Rate for Payer: PHP Commercial |
$367.54
|
| Rate for Payer: PHP Commercial |
$243.98
|
| Rate for Payer: PHP Commercial |
$378.72
|
| Rate for Payer: PHP Commercial |
$2.16
|
| Rate for Payer: PHP Commercial |
$215.83
|
| Rate for Payer: PHP Commercial |
$3.79
|
| Rate for Payer: PHP Commercial |
$385.99
|
| Rate for Payer: Priority Health SBD |
$254.65
|
| Rate for Payer: Priority Health SBD |
$272.41
|
| Rate for Payer: Priority Health SBD |
$253.11
|
| Rate for Payer: Priority Health SBD |
$275.37
|
| Rate for Payer: Priority Health SBD |
$233.41
|
| Rate for Payer: Priority Health SBD |
$280.70
|
| Rate for Payer: Priority Health SBD |
$180.84
|
| Rate for Payer: Priority Health SBD |
$2.81
|
| Rate for Payer: Priority Health SBD |
$159.97
|
| Rate for Payer: Priority Health SBD |
$1.60
|
| Rate for Payer: Priority Health SBD |
$286.08
|
| Rate for Payer: Priority Health SBD |
$2.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$281.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$295.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$240.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$284.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$261.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$289.61
|
| Rate for Payer: UHC Core |
$2.37
|
| Rate for Payer: UHC Core |
$193.03
|
| Rate for Payer: UHC Core |
$149.55
|
| Rate for Payer: UHC Core |
$227.73
|
| Rate for Payer: UHC Core |
$210.59
|
| Rate for Payer: UHC Core |
$236.59
|
| Rate for Payer: UHC Core |
$225.28
|
| Rate for Payer: UHC Core |
$209.32
|
| Rate for Payer: UHC Core |
$2.32
|
| Rate for Payer: UHC Core |
$1.32
|
| Rate for Payer: UHC Core |
$132.29
|
| Rate for Payer: UHC Core |
$232.13
|
| Rate for Payer: UHC Exchange |
$112.81
|
| Rate for Payer: UHC Exchange |
$1.75
|
| Rate for Payer: UHC Exchange |
$99.79
|
| Rate for Payer: UHC Exchange |
$1.00
|
| Rate for Payer: UHC Exchange |
$158.85
|
| Rate for Payer: UHC Exchange |
$175.10
|
| Rate for Payer: UHC Exchange |
$1.79
|
| Rate for Payer: UHC Exchange |
$145.61
|
| Rate for Payer: UHC Exchange |
$178.46
|
| Rate for Payer: UHC Exchange |
$171.78
|
| Rate for Payer: UHC Exchange |
$157.89
|
| Rate for Payer: UHC Exchange |
$169.93
|
| Rate for Payer: UMR Bronson Commercial |
$93.95
|
| Rate for Payer: UMR Bronson Commercial |
$159.99
|
| Rate for Payer: UMR Bronson Commercial |
$106.20
|
| Rate for Payer: UMR Bronson Commercial |
$0.94
|
| Rate for Payer: UMR Bronson Commercial |
$1.65
|
| Rate for Payer: UMR Bronson Commercial |
$161.73
|
| Rate for Payer: UMR Bronson Commercial |
$164.85
|
| Rate for Payer: UMR Bronson Commercial |
$1.68
|
| Rate for Payer: UMR Bronson Commercial |
$148.65
|
| Rate for Payer: UMR Bronson Commercial |
$168.02
|
| Rate for Payer: UMR Bronson Commercial |
$137.09
|
| Rate for Payer: UMR Bronson Commercial |
$149.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$277.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$324.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$340.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.82
|
|
|
MYCOPHENOLATE MOFETIL 250 MG CAPSULE
|
Facility
|
IP
|
$4.55
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
15113
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Aetna American Axle |
$2.96
|
| Rate for Payer: Aetna American Axle |
$261.14
|
| Rate for Payer: Aetna American Axle |
$240.82
|
| Rate for Payer: Aetna American Axle |
$186.58
|
| Rate for Payer: Aetna American Axle |
$1.65
|
| Rate for Payer: Aetna American Axle |
$284.12
|
| Rate for Payer: Aetna American Axle |
$281.06
|
| Rate for Payer: Aetna American Axle |
$262.73
|
| Rate for Payer: Aetna American Axle |
$165.05
|
| Rate for Payer: Aetna American Axle |
$289.61
|
| Rate for Payer: Aetna American Axle |
$2.90
|
| Rate for Payer: Aetna American Axle |
$295.17
|
| Rate for Payer: Aetna Commercial |
$341.50
|
| Rate for Payer: Aetna Commercial |
$385.99
|
| Rate for Payer: Aetna Commercial |
$3.79
|
| Rate for Payer: Aetna Commercial |
$3.87
|
| Rate for Payer: Aetna Commercial |
$378.72
|
| Rate for Payer: Aetna Commercial |
$243.98
|
| Rate for Payer: Aetna Commercial |
$343.57
|
| Rate for Payer: Aetna Commercial |
$314.93
|
| Rate for Payer: Aetna Commercial |
$2.16
|
| Rate for Payer: Aetna Commercial |
$367.54
|
| Rate for Payer: Aetna Commercial |
$215.83
|
| Rate for Payer: Aetna Commercial |
$371.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$295.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.12
|
| Rate for Payer: Cash Price |
$356.44
|
| Rate for Payer: Cash Price |
$363.28
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cash Price |
$3.64
|
| Rate for Payer: Cash Price |
$323.36
|
| Rate for Payer: Cash Price |
$229.63
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Cash Price |
$345.92
|
| Rate for Payer: Cash Price |
$203.14
|
| Rate for Payer: Cash Price |
$3.57
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cash Price |
$321.41
|
| Rate for Payer: Cofinity Advantage |
$177.74
|
| Rate for Payer: Cofinity Advantage |
$302.68
|
| Rate for Payer: Cofinity Advantage |
$282.94
|
| Rate for Payer: Cofinity Advantage |
$311.88
|
| Rate for Payer: Cofinity Advantage |
$259.35
|
| Rate for Payer: Cofinity Advantage |
$1.78
|
| Rate for Payer: Cofinity Advantage |
$281.23
|
| Rate for Payer: Cofinity Advantage |
$3.19
|
| Rate for Payer: Cofinity Advantage |
$317.87
|
| Rate for Payer: Cofinity Advantage |
$305.97
|
| Rate for Payer: Cofinity Advantage |
$3.12
|
| Rate for Payer: Cofinity Advantage |
$200.93
|
| Rate for Payer: Cofinity Commercial |
$318.63
|
| Rate for Payer: Cofinity Commercial |
$3.91
|
| Rate for Payer: Cofinity Commercial |
$375.91
|
| Rate for Payer: Cofinity Commercial |
$246.85
|
| Rate for Payer: Cofinity Commercial |
$390.53
|
| Rate for Payer: Cofinity Commercial |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$218.37
|
| Rate for Payer: Cofinity Commercial |
$3.84
|
| Rate for Payer: Cofinity Commercial |
$383.17
|
| Rate for Payer: Cofinity Commercial |
$345.51
|
| Rate for Payer: Cofinity Commercial |
$347.61
|
| Rate for Payer: Cofinity Commercial |
$371.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$363.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.64
|
| Rate for Payer: Healthscope Commercial |
$361.58
|
| Rate for Payer: Healthscope Commercial |
$401.00
|
| Rate for Payer: Healthscope Commercial |
$4.01
|
| Rate for Payer: Healthscope Commercial |
$393.39
|
| Rate for Payer: Healthscope Commercial |
$408.69
|
| Rate for Payer: Healthscope Commercial |
$4.09
|
| Rate for Payer: Healthscope Commercial |
$363.78
|
| Rate for Payer: Healthscope Commercial |
$228.53
|
| Rate for Payer: Healthscope Commercial |
$333.45
|
| Rate for Payer: Healthscope Commercial |
$2.29
|
| Rate for Payer: Healthscope Commercial |
$258.34
|
| Rate for Payer: Healthscope Commercial |
$389.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$305.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$259.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$281.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$282.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$302.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$311.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$317.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$334.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$340.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$277.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$324.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$378.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$385.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$324.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$327.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$301.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$340.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$277.88
|
| Rate for Payer: PHP Commercial |
$378.72
|
| Rate for Payer: PHP Commercial |
$343.57
|
| Rate for Payer: PHP Commercial |
$371.54
|
| Rate for Payer: PHP Commercial |
$341.50
|
| Rate for Payer: PHP Commercial |
$3.87
|
| Rate for Payer: PHP Commercial |
$367.54
|
| Rate for Payer: PHP Commercial |
$3.79
|
| Rate for Payer: PHP Commercial |
$314.93
|
| Rate for Payer: PHP Commercial |
$215.83
|
| Rate for Payer: PHP Commercial |
$2.16
|
| Rate for Payer: PHP Commercial |
$243.98
|
| Rate for Payer: PHP Commercial |
$385.99
|
| Rate for Payer: Priority Health SBD |
$254.65
|
| Rate for Payer: Priority Health SBD |
$1.60
|
| Rate for Payer: Priority Health SBD |
$280.70
|
| Rate for Payer: Priority Health SBD |
$233.41
|
| Rate for Payer: Priority Health SBD |
$272.41
|
| Rate for Payer: Priority Health SBD |
$286.08
|
| Rate for Payer: Priority Health SBD |
$2.81
|
| Rate for Payer: Priority Health SBD |
$180.84
|
| Rate for Payer: Priority Health SBD |
$253.11
|
| Rate for Payer: Priority Health SBD |
$275.37
|
| Rate for Payer: Priority Health SBD |
$159.97
|
| Rate for Payer: Priority Health SBD |
$2.87
|
| Rate for Payer: UMR Bronson Commercial |
$1.12
|
| Rate for Payer: UMR Bronson Commercial |
$1.96
|
| Rate for Payer: UMR Bronson Commercial |
$177.85
|
| Rate for Payer: UMR Bronson Commercial |
$190.26
|
| Rate for Payer: UMR Bronson Commercial |
$163.02
|
| Rate for Payer: UMR Bronson Commercial |
$111.72
|
| Rate for Payer: UMR Bronson Commercial |
$126.30
|
| Rate for Payer: UMR Bronson Commercial |
$2.00
|
| Rate for Payer: UMR Bronson Commercial |
$196.04
|
| Rate for Payer: UMR Bronson Commercial |
$199.80
|
| Rate for Payer: UMR Bronson Commercial |
$192.32
|
| Rate for Payer: UMR Bronson Commercial |
$176.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$340.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$324.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$277.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.82
|
|
|
MYCOPHENOLATE MOFETIL 500 MG TABLET
|
Facility
|
OP
|
$404.64
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
21374
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$364.18 |
| Rate for Payer: Aetna American Axle |
$263.02
|
| Rate for Payer: Aetna American Axle |
$224.54
|
| Rate for Payer: Aetna American Axle |
$255.22
|
| Rate for Payer: Aetna American Axle |
$2.89
|
| Rate for Payer: Aetna American Axle |
$319.18
|
| Rate for Payer: Aetna American Axle |
$288.91
|
| Rate for Payer: Aetna American Axle |
$280.96
|
| Rate for Payer: Aetna American Axle |
$2.55
|
| Rate for Payer: Aetna American Axle |
$231.82
|
| Rate for Payer: Aetna American Axle |
$166.11
|
| Rate for Payer: Aetna Commercial |
$367.41
|
| Rate for Payer: Aetna Commercial |
$343.94
|
| Rate for Payer: Aetna Commercial |
$293.63
|
| Rate for Payer: Aetna Commercial |
$3.78
|
| Rate for Payer: Aetna Commercial |
$417.38
|
| Rate for Payer: Aetna Commercial |
$217.22
|
| Rate for Payer: Aetna Commercial |
$333.74
|
| Rate for Payer: Aetna Commercial |
$377.81
|
| Rate for Payer: Aetna Commercial |
$3.34
|
| Rate for Payer: Aetna Commercial |
$303.14
|
| Rate for Payer: Aetna Medicare |
$245.52
|
| Rate for Payer: Aetna Medicare |
$222.24
|
| Rate for Payer: Aetna Medicare |
$172.72
|
| Rate for Payer: Aetna Medicare |
$127.78
|
| Rate for Payer: Aetna Medicare |
$178.32
|
| Rate for Payer: Aetna Medicare |
$1.97
|
| Rate for Payer: Aetna Medicare |
$196.32
|
| Rate for Payer: Aetna Medicare |
$202.32
|
| Rate for Payer: Aetna Medicare |
$216.12
|
| Rate for Payer: Aetna Medicare |
$2.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$319.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.91
|
| Rate for Payer: BCBS Complete |
$172.90
|
| Rate for Payer: BCBS Complete |
$1.57
|
| Rate for Payer: BCBS Complete |
$177.79
|
| Rate for Payer: BCBS Complete |
$161.86
|
| Rate for Payer: BCBS Complete |
$142.66
|
| Rate for Payer: BCBS Complete |
$196.42
|
| Rate for Payer: BCBS Complete |
$1.78
|
| Rate for Payer: BCBS Complete |
$138.18
|
| Rate for Payer: BCBS Complete |
$102.22
|
| Rate for Payer: BCBS Complete |
$157.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: Cash Price |
$355.58
|
| Rate for Payer: Cash Price |
$345.80
|
| Rate for Payer: Cash Price |
$3.56
|
| Rate for Payer: Cash Price |
$392.83
|
| Rate for Payer: Cash Price |
$392.83
|
| Rate for Payer: Cash Price |
$345.80
|
| Rate for Payer: Cash Price |
$323.71
|
| Rate for Payer: Cash Price |
$3.14
|
| Rate for Payer: Cash Price |
$314.11
|
| Rate for Payer: Cash Price |
$276.36
|
| Rate for Payer: Cash Price |
$285.31
|
| Rate for Payer: Cash Price |
$285.31
|
| Rate for Payer: Cash Price |
$314.11
|
| Rate for Payer: Cash Price |
$204.44
|
| Rate for Payer: Cash Price |
$204.44
|
| Rate for Payer: Cash Price |
$323.71
|
| Rate for Payer: Cash Price |
$3.14
|
| Rate for Payer: Cash Price |
$355.58
|
| Rate for Payer: Cash Price |
$3.56
|
| Rate for Payer: Cash Price |
$276.36
|
| Rate for Payer: Cofinity Advantage |
$178.88
|
| Rate for Payer: Cofinity Advantage |
$241.81
|
| Rate for Payer: Cofinity Advantage |
$249.65
|
| Rate for Payer: Cofinity Advantage |
$311.14
|
| Rate for Payer: Cofinity Advantage |
$343.73
|
| Rate for Payer: Cofinity Advantage |
$302.57
|
| Rate for Payer: Cofinity Advantage |
$283.25
|
| Rate for Payer: Cofinity Advantage |
$3.12
|
| Rate for Payer: Cofinity Advantage |
$274.85
|
| Rate for Payer: Cofinity Advantage |
$2.75
|
| Rate for Payer: Cofinity Commercial |
$297.09
|
| Rate for Payer: Cofinity Commercial |
$219.77
|
| Rate for Payer: Cofinity Commercial |
$306.71
|
| Rate for Payer: Cofinity Commercial |
$337.67
|
| Rate for Payer: Cofinity Commercial |
$3.38
|
| Rate for Payer: Cofinity Commercial |
$347.99
|
| Rate for Payer: Cofinity Commercial |
$371.74
|
| Rate for Payer: Cofinity Commercial |
$382.25
|
| Rate for Payer: Cofinity Commercial |
$3.83
|
| Rate for Payer: Cofinity Commercial |
$422.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$314.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.36
|
| Rate for Payer: Healthscope Commercial |
$320.98
|
| Rate for Payer: Healthscope Commercial |
$389.02
|
| Rate for Payer: Healthscope Commercial |
$3.54
|
| Rate for Payer: Healthscope Commercial |
$441.94
|
| Rate for Payer: Healthscope Commercial |
$310.90
|
| Rate for Payer: Healthscope Commercial |
$353.38
|
| Rate for Payer: Healthscope Commercial |
$230.00
|
| Rate for Payer: Healthscope Commercial |
$364.18
|
| Rate for Payer: Healthscope Commercial |
$4.00
|
| Rate for Payer: Healthscope Commercial |
$400.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$311.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$283.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$302.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$343.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$274.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$249.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$241.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$324.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$333.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$368.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$355.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$345.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$285.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$276.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$314.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$392.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$323.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$417.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$377.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$368.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$324.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$267.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$294.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$333.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.95
|
| Rate for Payer: PHP Commercial |
$333.74
|
| Rate for Payer: PHP Commercial |
$417.38
|
| Rate for Payer: PHP Commercial |
$3.78
|
| Rate for Payer: PHP Commercial |
$3.34
|
| Rate for Payer: PHP Commercial |
$377.81
|
| Rate for Payer: PHP Commercial |
$293.63
|
| Rate for Payer: PHP Commercial |
$217.22
|
| Rate for Payer: PHP Commercial |
$343.94
|
| Rate for Payer: PHP Commercial |
$367.41
|
| Rate for Payer: PHP Commercial |
$303.14
|
| Rate for Payer: Priority Health SBD |
$254.92
|
| Rate for Payer: Priority Health SBD |
$224.68
|
| Rate for Payer: Priority Health SBD |
$247.36
|
| Rate for Payer: Priority Health SBD |
$280.02
|
| Rate for Payer: Priority Health SBD |
$272.32
|
| Rate for Payer: Priority Health SBD |
$309.36
|
| Rate for Payer: Priority Health SBD |
$2.80
|
| Rate for Payer: Priority Health SBD |
$161.00
|
| Rate for Payer: Priority Health SBD |
$217.63
|
| Rate for Payer: Priority Health SBD |
$2.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
| Rate for Payer: UMR Bronson Commercial |
$94.55
|
| Rate for Payer: UMR Bronson Commercial |
$1.45
|
| Rate for Payer: UMR Bronson Commercial |
$159.93
|
| Rate for Payer: UMR Bronson Commercial |
$164.46
|
| Rate for Payer: UMR Bronson Commercial |
$127.82
|
| Rate for Payer: UMR Bronson Commercial |
$145.28
|
| Rate for Payer: UMR Bronson Commercial |
$131.96
|
| Rate for Payer: UMR Bronson Commercial |
$181.68
|
| Rate for Payer: UMR Bronson Commercial |
$149.72
|
| Rate for Payer: UMR Bronson Commercial |
$1.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$333.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$368.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$324.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.48
|
|
|
MYCOPHENOLATE MOFETIL 500 MG TABLET
|
Facility
|
IP
|
$404.64
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
21374
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$178.04 |
| Max. Negotiated Rate |
$364.18 |
| Rate for Payer: Aetna American Axle |
$263.02
|
| Rate for Payer: Aetna American Axle |
$2.55
|
| Rate for Payer: Aetna American Axle |
$224.54
|
| Rate for Payer: Aetna American Axle |
$231.82
|
| Rate for Payer: Aetna American Axle |
$255.22
|
| Rate for Payer: Aetna American Axle |
$166.11
|
| Rate for Payer: Aetna American Axle |
$319.18
|
| Rate for Payer: Aetna American Axle |
$2.89
|
| Rate for Payer: Aetna American Axle |
$288.91
|
| Rate for Payer: Aetna American Axle |
$280.96
|
| Rate for Payer: Aetna Commercial |
$367.41
|
| Rate for Payer: Aetna Commercial |
$3.34
|
| Rate for Payer: Aetna Commercial |
$303.14
|
| Rate for Payer: Aetna Commercial |
$417.38
|
| Rate for Payer: Aetna Commercial |
$343.94
|
| Rate for Payer: Aetna Commercial |
$3.78
|
| Rate for Payer: Aetna Commercial |
$217.22
|
| Rate for Payer: Aetna Commercial |
$293.63
|
| Rate for Payer: Aetna Commercial |
$377.81
|
| Rate for Payer: Aetna Commercial |
$333.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$319.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.82
|
| Rate for Payer: Cash Price |
$204.44
|
| Rate for Payer: Cash Price |
$3.14
|
| Rate for Payer: Cash Price |
$314.11
|
| Rate for Payer: Cash Price |
$392.83
|
| Rate for Payer: Cash Price |
$345.80
|
| Rate for Payer: Cash Price |
$276.36
|
| Rate for Payer: Cash Price |
$285.31
|
| Rate for Payer: Cash Price |
$3.56
|
| Rate for Payer: Cash Price |
$323.71
|
| Rate for Payer: Cash Price |
$355.58
|
| Rate for Payer: Cofinity Advantage |
$178.88
|
| Rate for Payer: Cofinity Advantage |
$241.81
|
| Rate for Payer: Cofinity Advantage |
$274.85
|
| Rate for Payer: Cofinity Advantage |
$249.65
|
| Rate for Payer: Cofinity Advantage |
$2.75
|
| Rate for Payer: Cofinity Advantage |
$283.25
|
| Rate for Payer: Cofinity Advantage |
$302.57
|
| Rate for Payer: Cofinity Advantage |
$311.14
|
| Rate for Payer: Cofinity Advantage |
$3.12
|
| Rate for Payer: Cofinity Advantage |
$343.73
|
| Rate for Payer: Cofinity Commercial |
$3.38
|
| Rate for Payer: Cofinity Commercial |
$371.74
|
| Rate for Payer: Cofinity Commercial |
$3.83
|
| Rate for Payer: Cofinity Commercial |
$297.09
|
| Rate for Payer: Cofinity Commercial |
$347.99
|
| Rate for Payer: Cofinity Commercial |
$219.77
|
| Rate for Payer: Cofinity Commercial |
$422.29
|
| Rate for Payer: Cofinity Commercial |
$306.71
|
| Rate for Payer: Cofinity Commercial |
$337.67
|
| Rate for Payer: Cofinity Commercial |
$382.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$314.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.71
|
| Rate for Payer: Healthscope Commercial |
$4.00
|
| Rate for Payer: Healthscope Commercial |
$3.54
|
| Rate for Payer: Healthscope Commercial |
$364.18
|
| Rate for Payer: Healthscope Commercial |
$230.00
|
| Rate for Payer: Healthscope Commercial |
$353.38
|
| Rate for Payer: Healthscope Commercial |
$310.90
|
| Rate for Payer: Healthscope Commercial |
$320.98
|
| Rate for Payer: Healthscope Commercial |
$441.94
|
| Rate for Payer: Healthscope Commercial |
$400.03
|
| Rate for Payer: Healthscope Commercial |
$389.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$311.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$283.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$343.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$274.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$241.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$302.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$249.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$324.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$333.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$368.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$377.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$417.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$267.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$368.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$333.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$324.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$294.48
|
| Rate for Payer: PHP Commercial |
$417.38
|
| Rate for Payer: PHP Commercial |
$343.94
|
| Rate for Payer: PHP Commercial |
$293.63
|
| Rate for Payer: PHP Commercial |
$367.41
|
| Rate for Payer: PHP Commercial |
$3.34
|
| Rate for Payer: PHP Commercial |
$377.81
|
| Rate for Payer: PHP Commercial |
$3.78
|
| Rate for Payer: PHP Commercial |
$333.74
|
| Rate for Payer: PHP Commercial |
$217.22
|
| Rate for Payer: PHP Commercial |
$303.14
|
| Rate for Payer: Priority Health SBD |
$272.32
|
| Rate for Payer: Priority Health SBD |
$2.80
|
| Rate for Payer: Priority Health SBD |
$309.36
|
| Rate for Payer: Priority Health SBD |
$224.68
|
| Rate for Payer: Priority Health SBD |
$280.02
|
| Rate for Payer: Priority Health SBD |
$161.00
|
| Rate for Payer: Priority Health SBD |
$217.63
|
| Rate for Payer: Priority Health SBD |
$2.48
|
| Rate for Payer: Priority Health SBD |
$254.92
|
| Rate for Payer: Priority Health SBD |
$247.36
|
| Rate for Payer: UMR Bronson Commercial |
$152.00
|
| Rate for Payer: UMR Bronson Commercial |
$216.06
|
| Rate for Payer: UMR Bronson Commercial |
$156.92
|
| Rate for Payer: UMR Bronson Commercial |
$112.44
|
| Rate for Payer: UMR Bronson Commercial |
$1.73
|
| Rate for Payer: UMR Bronson Commercial |
$1.96
|
| Rate for Payer: UMR Bronson Commercial |
$172.76
|
| Rate for Payer: UMR Bronson Commercial |
$178.04
|
| Rate for Payer: UMR Bronson Commercial |
$190.19
|
| Rate for Payer: UMR Bronson Commercial |
$195.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$333.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$324.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$368.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.34
|
|
|
MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$496.32
|
|
|
Service Code
|
HCPCS J7518
|
| Hospital Charge Code |
38062
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$218.38 |
| Max. Negotiated Rate |
$446.69 |
| Rate for Payer: Aetna American Axle |
$322.61
|
| Rate for Payer: Aetna American Axle |
$2,041.85
|
| Rate for Payer: Aetna American Axle |
$183.77
|
| Rate for Payer: Aetna American Axle |
$864.36
|
| Rate for Payer: Aetna American Axle |
$9.12
|
| Rate for Payer: Aetna American Axle |
$911.50
|
| Rate for Payer: Aetna Commercial |
$421.87
|
| Rate for Payer: Aetna Commercial |
$11.93
|
| Rate for Payer: Aetna Commercial |
$240.31
|
| Rate for Payer: Aetna Commercial |
$1,191.95
|
| Rate for Payer: Aetna Commercial |
$2,670.11
|
| Rate for Payer: Aetna Commercial |
$1,130.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,041.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$322.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$911.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$864.36
|
| Rate for Payer: Cash Price |
$397.06
|
| Rate for Payer: Cash Price |
$2,513.04
|
| Rate for Payer: Cash Price |
$226.18
|
| Rate for Payer: Cash Price |
$1,063.82
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Cash Price |
$1,121.84
|
| Rate for Payer: Cofinity Advantage |
$197.90
|
| Rate for Payer: Cofinity Advantage |
$981.61
|
| Rate for Payer: Cofinity Advantage |
$930.85
|
| Rate for Payer: Cofinity Advantage |
$2,198.91
|
| Rate for Payer: Cofinity Advantage |
$9.82
|
| Rate for Payer: Cofinity Advantage |
$347.42
|
| Rate for Payer: Cofinity Commercial |
$1,205.98
|
| Rate for Payer: Cofinity Commercial |
$243.14
|
| Rate for Payer: Cofinity Commercial |
$2,701.52
|
| Rate for Payer: Cofinity Commercial |
$1,143.61
|
| Rate for Payer: Cofinity Commercial |
$12.07
|
| Rate for Payer: Cofinity Commercial |
$426.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,513.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,063.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,121.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$397.06
|
| Rate for Payer: Healthscope Commercial |
$2,827.17
|
| Rate for Payer: Healthscope Commercial |
$1,196.80
|
| Rate for Payer: Healthscope Commercial |
$254.45
|
| Rate for Payer: Healthscope Commercial |
$1,262.07
|
| Rate for Payer: Healthscope Commercial |
$12.63
|
| Rate for Payer: Healthscope Commercial |
$446.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$981.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,198.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$197.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$347.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$930.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$372.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,051.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$212.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,355.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$997.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,191.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,130.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,670.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$997.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$212.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,051.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,355.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$372.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.52
|
| Rate for Payer: PHP Commercial |
$11.93
|
| Rate for Payer: PHP Commercial |
$421.87
|
| Rate for Payer: PHP Commercial |
$2,670.11
|
| Rate for Payer: PHP Commercial |
$240.31
|
| Rate for Payer: PHP Commercial |
$1,130.31
|
| Rate for Payer: PHP Commercial |
$1,191.95
|
| Rate for Payer: Priority Health SBD |
$1,979.02
|
| Rate for Payer: Priority Health SBD |
$883.45
|
| Rate for Payer: Priority Health SBD |
$837.76
|
| Rate for Payer: Priority Health SBD |
$8.84
|
| Rate for Payer: Priority Health SBD |
$178.11
|
| Rate for Payer: Priority Health SBD |
$312.68
|
| Rate for Payer: UMR Bronson Commercial |
$1,382.17
|
| Rate for Payer: UMR Bronson Commercial |
$6.17
|
| Rate for Payer: UMR Bronson Commercial |
$124.40
|
| Rate for Payer: UMR Bronson Commercial |
$617.01
|
| Rate for Payer: UMR Bronson Commercial |
$218.38
|
| Rate for Payer: UMR Bronson Commercial |
$585.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,051.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,355.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$372.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$212.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$997.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.52
|
|
|
MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$1,402.30
|
|
|
Service Code
|
HCPCS J7518
|
| Hospital Charge Code |
38062
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$1,262.07 |
| Rate for Payer: Aetna American Axle |
$911.50
|
| Rate for Payer: Aetna American Axle |
$183.77
|
| Rate for Payer: Aetna American Axle |
$2,041.85
|
| Rate for Payer: Aetna American Axle |
$864.36
|
| Rate for Payer: Aetna American Axle |
$322.61
|
| Rate for Payer: Aetna American Axle |
$9.12
|
| Rate for Payer: Aetna Commercial |
$421.87
|
| Rate for Payer: Aetna Commercial |
$2,670.11
|
| Rate for Payer: Aetna Commercial |
$11.93
|
| Rate for Payer: Aetna Commercial |
$1,130.31
|
| Rate for Payer: Aetna Commercial |
$240.31
|
| Rate for Payer: Aetna Commercial |
$1,191.95
|
| Rate for Payer: Aetna Medicare |
$664.89
|
| Rate for Payer: Aetna Medicare |
$701.15
|
| Rate for Payer: Aetna Medicare |
$7.01
|
| Rate for Payer: Aetna Medicare |
$248.16
|
| Rate for Payer: Aetna Medicare |
$1,570.65
|
| Rate for Payer: Aetna Medicare |
$141.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,041.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$322.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$864.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$911.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.77
|
| Rate for Payer: BCBS Complete |
$5.61
|
| Rate for Payer: BCBS Complete |
$560.92
|
| Rate for Payer: BCBS Complete |
$531.91
|
| Rate for Payer: BCBS Complete |
$113.09
|
| Rate for Payer: BCBS Complete |
$1,256.52
|
| Rate for Payer: BCBS Complete |
$198.53
|
| Rate for Payer: BCBS Trust/PPO |
$1.02
|
| Rate for Payer: BCBS Trust/PPO |
$1.02
|
| Rate for Payer: BCBS Trust/PPO |
$1.02
|
| Rate for Payer: BCBS Trust/PPO |
$1.02
|
| Rate for Payer: BCBS Trust/PPO |
$1.02
|
| Rate for Payer: BCBS Trust/PPO |
$1.02
|
| Rate for Payer: BCN Commercial |
$1.02
|
| Rate for Payer: BCN Commercial |
$1.02
|
| Rate for Payer: BCN Commercial |
$1.02
|
| Rate for Payer: BCN Commercial |
$1.02
|
| Rate for Payer: BCN Commercial |
$1.02
|
| Rate for Payer: BCN Commercial |
$1.02
|
| Rate for Payer: Cash Price |
$397.06
|
| Rate for Payer: Cash Price |
$1,063.82
|
| Rate for Payer: Cash Price |
$1,063.82
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Cash Price |
$1,121.84
|
| Rate for Payer: Cash Price |
$1,121.84
|
| Rate for Payer: Cash Price |
$397.06
|
| Rate for Payer: Cash Price |
$2,513.04
|
| Rate for Payer: Cash Price |
$226.18
|
| Rate for Payer: Cash Price |
$2,513.04
|
| Rate for Payer: Cash Price |
$226.18
|
| Rate for Payer: Cofinity Advantage |
$197.90
|
| Rate for Payer: Cofinity Advantage |
$9.82
|
| Rate for Payer: Cofinity Advantage |
$347.42
|
| Rate for Payer: Cofinity Advantage |
$930.85
|
| Rate for Payer: Cofinity Advantage |
$981.61
|
| Rate for Payer: Cofinity Advantage |
$2,198.91
|
| Rate for Payer: Cofinity Commercial |
$2,701.52
|
| Rate for Payer: Cofinity Commercial |
$1,143.61
|
| Rate for Payer: Cofinity Commercial |
$1,205.98
|
| Rate for Payer: Cofinity Commercial |
$12.07
|
| Rate for Payer: Cofinity Commercial |
$243.14
|
| Rate for Payer: Cofinity Commercial |
$426.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,121.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,063.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$397.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,513.04
|
| Rate for Payer: Healthscope Commercial |
$1,196.80
|
| Rate for Payer: Healthscope Commercial |
$2,827.17
|
| Rate for Payer: Healthscope Commercial |
$12.63
|
| Rate for Payer: Healthscope Commercial |
$254.45
|
| Rate for Payer: Healthscope Commercial |
$446.69
|
| Rate for Payer: Healthscope Commercial |
$1,262.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$981.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$930.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$197.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,198.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$347.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$372.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$997.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,051.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$212.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,355.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,121.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,513.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$226.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,063.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$397.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,130.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,670.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,191.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$372.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,051.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$212.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$997.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,355.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.52
|
| Rate for Payer: PHP Commercial |
$1,191.95
|
| Rate for Payer: PHP Commercial |
$11.93
|
| Rate for Payer: PHP Commercial |
$240.31
|
| Rate for Payer: PHP Commercial |
$1,130.31
|
| Rate for Payer: PHP Commercial |
$2,670.11
|
| Rate for Payer: PHP Commercial |
$421.87
|
| Rate for Payer: Priority Health SBD |
$178.11
|
| Rate for Payer: Priority Health SBD |
$837.76
|
| Rate for Payer: Priority Health SBD |
$883.45
|
| Rate for Payer: Priority Health SBD |
$312.68
|
| Rate for Payer: Priority Health SBD |
$8.84
|
| Rate for Payer: Priority Health SBD |
$1,979.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.53
|
| Rate for Payer: UHC Core |
$0.53
|
| Rate for Payer: UHC Core |
$0.53
|
| Rate for Payer: UHC Core |
$0.53
|
| Rate for Payer: UHC Core |
$0.53
|
| Rate for Payer: UHC Core |
$0.53
|
| Rate for Payer: UHC Core |
$0.53
|
| Rate for Payer: UHC Exchange |
$0.53
|
| Rate for Payer: UHC Exchange |
$0.53
|
| Rate for Payer: UHC Exchange |
$0.53
|
| Rate for Payer: UHC Exchange |
$0.53
|
| Rate for Payer: UHC Exchange |
$0.53
|
| Rate for Payer: UHC Exchange |
$0.53
|
| Rate for Payer: UMR Bronson Commercial |
$104.61
|
| Rate for Payer: UMR Bronson Commercial |
$1,162.28
|
| Rate for Payer: UMR Bronson Commercial |
$518.85
|
| Rate for Payer: UMR Bronson Commercial |
$492.02
|
| Rate for Payer: UMR Bronson Commercial |
$183.64
|
| Rate for Payer: UMR Bronson Commercial |
$5.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$372.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$212.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,355.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$997.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,051.72
|
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$64,965.54
|
|
|
Service Code
|
MSDRG 827
|
| Min. Negotiated Rate |
$18,924.80 |
| Max. Negotiated Rate |
$64,965.54 |
| Rate for Payer: Aetna Medicare |
$20,717.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24,901.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24,901.05
|
| Rate for Payer: BCBS MAPPO |
$19,920.84
|
| Rate for Payer: BCBS Trust/PPO |
$64,965.54
|
| Rate for Payer: BCN Commercial |
$64,965.54
|
| Rate for Payer: BCN Medicare Advantage |
$19,920.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,920.84
|
| Rate for Payer: Mclaren Medicare |
$19,920.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20,916.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,908.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$21,912.92
|
| Rate for Payer: Nomi Health Commercial |
$29,814.48
|
| Rate for Payer: PACE Medicare |
$18,924.80
|
| Rate for Payer: PACE SWMI |
$19,920.84
|
| Rate for Payer: PHP Medicare Advantage |
$19,920.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$37,261.49
|
| Rate for Payer: Priority Health Medicare |
$19,920.84
|
| Rate for Payer: Priority Health Tiered Network |
$29,809.19
|
| Rate for Payer: Railroad Medicare Medicare |
$19,920.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37,672.56
|
| Rate for Payer: UHC Core |
$31,517.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$19,920.84
|
| Rate for Payer: UHC Exchange |
$25,739.83
|
| Rate for Payer: VA VA |
$19,920.84
|
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$76,248.14
|
|
|
Service Code
|
MSDRG 826
|
| Min. Negotiated Rate |
$37,726.37 |
| Max. Negotiated Rate |
$76,248.14 |
| Rate for Payer: Aetna Medicare |
$41,300.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49,639.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49,639.96
|
| Rate for Payer: BCBS MAPPO |
$39,711.97
|
| Rate for Payer: BCBS Trust/PPO |
$65,583.18
|
| Rate for Payer: BCN Commercial |
$65,583.18
|
| Rate for Payer: BCN Medicare Advantage |
$39,711.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39,711.97
|
| Rate for Payer: Mclaren Medicare |
$39,711.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41,697.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45,668.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$43,683.17
|
| Rate for Payer: Nomi Health Commercial |
$60,343.62
|
| Rate for Payer: PACE Medicare |
$37,726.37
|
| Rate for Payer: PACE SWMI |
$39,711.97
|
| Rate for Payer: PHP Medicare Advantage |
$39,711.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$75,416.15
|
| Rate for Payer: Priority Health Medicare |
$39,711.97
|
| Rate for Payer: Priority Health Tiered Network |
$60,332.91
|
| Rate for Payer: Railroad Medicare Medicare |
$39,711.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76,248.14
|
| Rate for Payer: UHC Core |
$63,791.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$39,711.97
|
| Rate for Payer: UHC Exchange |
$52,096.66
|
| Rate for Payer: VA VA |
$39,711.97
|
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$44,618.86
|
|
|
Service Code
|
MSDRG 828
|
| Min. Negotiated Rate |
$14,099.26 |
| Max. Negotiated Rate |
$44,618.86 |
| Rate for Payer: Aetna Medicare |
$15,434.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,551.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,551.66
|
| Rate for Payer: BCBS MAPPO |
$14,841.33
|
| Rate for Payer: BCBS Trust/PPO |
$44,618.86
|
| Rate for Payer: BCN Commercial |
$44,618.86
|
| Rate for Payer: BCN Medicare Advantage |
$14,841.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,841.33
|
| Rate for Payer: Mclaren Medicare |
$14,841.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,583.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,067.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$16,325.46
|
| Rate for Payer: Nomi Health Commercial |
$21,979.02
|
| Rate for Payer: PACE Medicare |
$14,099.26
|
| Rate for Payer: PACE SWMI |
$14,841.33
|
| Rate for Payer: PHP Medicare Advantage |
$14,841.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$27,468.90
|
| Rate for Payer: Priority Health Medicare |
$14,841.33
|
| Rate for Payer: Priority Health Tiered Network |
$21,975.12
|
| Rate for Payer: Railroad Medicare Medicare |
$14,841.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,771.94
|
| Rate for Payer: UHC Core |
$23,234.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,841.33
|
| Rate for Payer: UHC Exchange |
$18,975.22
|
| Rate for Payer: VA VA |
$14,841.33
|
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$89,125.16
|
|
|
Service Code
|
MSDRG 829
|
| Min. Negotiated Rate |
$25,668.12 |
| Max. Negotiated Rate |
$89,125.16 |
| Rate for Payer: Aetna Medicare |
$28,099.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33,773.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33,773.84
|
| Rate for Payer: BCBS MAPPO |
$27,019.07
|
| Rate for Payer: BCBS Trust/PPO |
$89,125.16
|
| Rate for Payer: BCN Commercial |
$89,125.16
|
| Rate for Payer: BCN Medicare Advantage |
$27,019.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27,019.07
|
| Rate for Payer: Mclaren Medicare |
$27,019.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28,370.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31,071.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$29,720.98
|
| Rate for Payer: Nomi Health Commercial |
$40,764.00
|
| Rate for Payer: PACE Medicare |
$25,668.12
|
| Rate for Payer: PACE SWMI |
$27,019.07
|
| Rate for Payer: PHP Medicare Advantage |
$27,019.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$50,945.96
|
| Rate for Payer: Priority Health Medicare |
$27,019.07
|
| Rate for Payer: Priority Health Tiered Network |
$40,756.76
|
| Rate for Payer: Railroad Medicare Medicare |
$27,019.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51,508.00
|
| Rate for Payer: UHC Core |
$43,092.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27,019.07
|
| Rate for Payer: UHC Exchange |
$35,192.92
|
| Rate for Payer: VA VA |
$27,019.07
|
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$24,531.50
|
|
|
Service Code
|
MSDRG 830
|
| Min. Negotiated Rate |
$12,519.88 |
| Max. Negotiated Rate |
$24,531.50 |
| Rate for Payer: Aetna Medicare |
$13,705.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,473.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,473.53
|
| Rate for Payer: BCBS MAPPO |
$13,178.82
|
| Rate for Payer: BCBS Trust/PPO |
$24,420.41
|
| Rate for Payer: BCN Commercial |
$24,420.41
|
| Rate for Payer: BCN Medicare Advantage |
$13,178.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,178.82
|
| Rate for Payer: Mclaren Medicare |
$13,178.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,837.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,155.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,496.70
|
| Rate for Payer: Nomi Health Commercial |
$19,414.50
|
| Rate for Payer: PACE Medicare |
$12,519.88
|
| Rate for Payer: PACE SWMI |
$13,178.82
|
| Rate for Payer: PHP Medicare Advantage |
$13,178.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24,263.82
|
| Rate for Payer: Priority Health Medicare |
$13,178.82
|
| Rate for Payer: Priority Health Tiered Network |
$19,411.05
|
| Rate for Payer: Railroad Medicare Medicare |
$13,178.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,531.50
|
| Rate for Payer: UHC Core |
$20,523.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,178.82
|
| Rate for Payer: UHC Exchange |
$16,761.19
|
| Rate for Payer: VA VA |
$13,178.82
|
|
|
MYOMECTOMY, EXCISION OF FIBROID TUMOR(S) OF UTERUS, 5 OR MORE INTRAMURAL MYOMAS AND/OR INTRAMURAL MYOMAS WITH TOTAL WEIGHT GREATER THAN 250 G, ABDOMINAL APPROACH
|
Facility
|
OP
|
$5,005.06
|
|
|
Service Code
|
CPT 58146
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,005.06 |
| Max. Negotiated Rate |
$5,005.06 |
| Rate for Payer: BCBS Trust/PPO |
$5,005.06
|
| Rate for Payer: BCN Commercial |
$5,005.06
|
|
|
MYRINGOPLASTY (SURGERY CONFINED TO DRUMHEAD AND DONOR AREA)
|
Facility
|
OP
|
$10,683.35
|
|
|
Service Code
|
CPT 69620
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,727.75 |
| Max. Negotiated Rate |
$10,683.35 |
| Rate for Payer: Aetna Medicare |
$3,435.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,129.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,129.43
|
| Rate for Payer: BCBS Complete |
$1,814.30
|
| Rate for Payer: BCBS MAPPO |
$3,303.54
|
| Rate for Payer: BCBS Trust/PPO |
$3,315.17
|
| Rate for Payer: BCN Commercial |
$3,315.17
|
| Rate for Payer: BCN Medicare Advantage |
$3,303.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,303.54
|
| Rate for Payer: Mclaren Medicaid |
$3,303.54
|
| Rate for Payer: Mclaren Medicare |
$3,303.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,468.72
|
| Rate for Payer: Meridian Medicaid |
$3,468.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,799.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,633.89
|
| Rate for Payer: Nomi Health Commercial |
$9,910.62
|
| Rate for Payer: PACE Medicare |
$3,138.36
|
| Rate for Payer: PACE SWMI |
$3,303.54
|
| Rate for Payer: PHP Medicare Advantage |
$3,303.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,727.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,683.35
|
| Rate for Payer: Priority Health Medicare |
$3,303.54
|
| Rate for Payer: Priority Health Tiered Network |
$8,546.68
|
| Rate for Payer: Railroad Medicare Medicare |
$3,303.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,303.54
|
| Rate for Payer: UHC Medicaid |
$1,727.75
|
| Rate for Payer: UHCCP Medicaid |
$1,727.75
|
| Rate for Payer: VA VA |
$3,303.54
|
|
|
MYRINGOTOMY INCLUDING ASPIRATION AND/OR EUSTACHIAN TUBE INFLATION REQUIRING GENERAL ANESTHESIA
|
Facility
|
OP
|
$10,683.35
|
|
|
Service Code
|
CPT 69421
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,727.75 |
| Max. Negotiated Rate |
$10,683.35 |
| Rate for Payer: Aetna Medicare |
$3,435.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,129.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,129.43
|
| Rate for Payer: BCBS Complete |
$1,814.30
|
| Rate for Payer: BCBS MAPPO |
$3,303.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,769.51
|
| Rate for Payer: BCN Commercial |
$1,769.51
|
| Rate for Payer: BCN Medicare Advantage |
$3,303.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,303.54
|
| Rate for Payer: Mclaren Medicaid |
$3,303.54
|
| Rate for Payer: Mclaren Medicare |
$3,303.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,468.72
|
| Rate for Payer: Meridian Medicaid |
$3,468.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,799.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,633.89
|
| Rate for Payer: Nomi Health Commercial |
$9,910.62
|
| Rate for Payer: PACE Medicare |
$3,138.36
|
| Rate for Payer: PACE SWMI |
$3,303.54
|
| Rate for Payer: PHP Medicare Advantage |
$3,303.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,727.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,683.35
|
| Rate for Payer: Priority Health Medicare |
$3,303.54
|
| Rate for Payer: Priority Health Tiered Network |
$8,546.68
|
| Rate for Payer: Railroad Medicare Medicare |
$3,303.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,303.54
|
| Rate for Payer: UHC Medicaid |
$1,727.75
|
| Rate for Payer: UHCCP Medicaid |
$1,727.75
|
| Rate for Payer: VA VA |
$3,303.54
|
|
|
NADOLOL 40 MG TABLET
|
Facility
|
OP
|
$1,221.37
|
|
|
Service Code
|
NDC 00904707161
|
| Hospital Charge Code |
5331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$451.91 |
| Max. Negotiated Rate |
$1,099.23 |
| Rate for Payer: Aetna American Axle |
$793.89
|
| Rate for Payer: Aetna Commercial |
$1,038.16
|
| Rate for Payer: Aetna Medicare |
$610.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$793.89
|
| Rate for Payer: BCBS Complete |
$488.55
|
| Rate for Payer: Cash Price |
$977.10
|
| Rate for Payer: Cofinity Advantage |
$854.96
|
| Rate for Payer: Cofinity Commercial |
$1,050.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$977.10
|
| Rate for Payer: Healthscope Commercial |
$1,099.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$854.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$916.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$977.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,038.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$916.03
|
| Rate for Payer: PHP Commercial |
$1,038.16
|
| Rate for Payer: Priority Health SBD |
$769.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$793.89
|
| Rate for Payer: UHC Core |
$636.33
|
| Rate for Payer: UHC Exchange |
$480.00
|
| Rate for Payer: UMR Bronson Commercial |
$451.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$916.03
|
|
|
NADOLOL 40 MG TABLET
|
Facility
|
OP
|
$199.50
|
|
|
Service Code
|
NDC 69097086807
|
| Hospital Charge Code |
5331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.81 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Aetna American Axle |
$129.68
|
| Rate for Payer: Aetna Commercial |
$169.57
|
| Rate for Payer: Aetna Medicare |
$99.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.68
|
| Rate for Payer: BCBS Complete |
$79.80
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cofinity Advantage |
$139.65
|
| Rate for Payer: Cofinity Commercial |
$171.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.60
|
| Rate for Payer: Healthscope Commercial |
$179.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.62
|
| Rate for Payer: PHP Commercial |
$169.57
|
| Rate for Payer: Priority Health SBD |
$125.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.68
|
| Rate for Payer: UHC Core |
$103.94
|
| Rate for Payer: UHC Exchange |
$78.40
|
| Rate for Payer: UMR Bronson Commercial |
$73.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.62
|
|
|
NADOLOL 40 MG TABLET
|
Facility
|
OP
|
$194.75
|
|
|
Service Code
|
NDC 59651025101
|
| Hospital Charge Code |
5331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.06 |
| Max. Negotiated Rate |
$175.28 |
| Rate for Payer: Aetna American Axle |
$126.59
|
| Rate for Payer: Aetna Commercial |
$165.54
|
| Rate for Payer: Aetna Medicare |
$97.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.59
|
| Rate for Payer: BCBS Complete |
$77.90
|
| Rate for Payer: Cash Price |
$155.80
|
| Rate for Payer: Cofinity Advantage |
$136.32
|
| Rate for Payer: Cofinity Commercial |
$167.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.80
|
| Rate for Payer: Healthscope Commercial |
$175.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$155.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.06
|
| Rate for Payer: PHP Commercial |
$165.54
|
| Rate for Payer: Priority Health SBD |
$122.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.59
|
| Rate for Payer: UHC Core |
$101.46
|
| Rate for Payer: UHC Exchange |
$76.54
|
| Rate for Payer: UMR Bronson Commercial |
$72.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.06
|
|
|
NADOLOL 40 MG TABLET
|
Facility
|
IP
|
$194.75
|
|
|
Service Code
|
NDC 59651025101
|
| Hospital Charge Code |
5331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.69 |
| Max. Negotiated Rate |
$175.28 |
| Rate for Payer: Aetna American Axle |
$126.59
|
| Rate for Payer: Aetna Commercial |
$165.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.59
|
| Rate for Payer: Cash Price |
$155.80
|
| Rate for Payer: Cofinity Advantage |
$136.32
|
| Rate for Payer: Cofinity Commercial |
$167.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.80
|
| Rate for Payer: Healthscope Commercial |
$175.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.06
|
| Rate for Payer: PHP Commercial |
$165.54
|
| Rate for Payer: Priority Health SBD |
$122.69
|
| Rate for Payer: UMR Bronson Commercial |
$85.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.06
|
|
|
NADOLOL 40 MG TABLET
|
Facility
|
OP
|
$194.75
|
|
|
Service Code
|
NDC 76385013401
|
| Hospital Charge Code |
5331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.06 |
| Max. Negotiated Rate |
$175.28 |
| Rate for Payer: Aetna American Axle |
$126.59
|
| Rate for Payer: Aetna Commercial |
$165.54
|
| Rate for Payer: Aetna Medicare |
$97.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.59
|
| Rate for Payer: BCBS Complete |
$77.90
|
| Rate for Payer: Cash Price |
$155.80
|
| Rate for Payer: Cofinity Advantage |
$136.32
|
| Rate for Payer: Cofinity Commercial |
$167.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.80
|
| Rate for Payer: Healthscope Commercial |
$175.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$155.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.06
|
| Rate for Payer: PHP Commercial |
$165.54
|
| Rate for Payer: Priority Health SBD |
$122.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.59
|
| Rate for Payer: UHC Core |
$101.46
|
| Rate for Payer: UHC Exchange |
$76.54
|
| Rate for Payer: UMR Bronson Commercial |
$72.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.06
|
|
|
NADOLOL 40 MG TABLET
|
Facility
|
IP
|
$199.50
|
|
|
Service Code
|
NDC 69097086807
|
| Hospital Charge Code |
5331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.78 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Aetna American Axle |
$129.68
|
| Rate for Payer: Aetna Commercial |
$169.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.68
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cofinity Advantage |
$139.65
|
| Rate for Payer: Cofinity Commercial |
$171.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.60
|
| Rate for Payer: Healthscope Commercial |
$179.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.62
|
| Rate for Payer: PHP Commercial |
$169.57
|
| Rate for Payer: Priority Health SBD |
$125.69
|
| Rate for Payer: UMR Bronson Commercial |
$87.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.62
|
|
|
NADOLOL 40 MG TABLET
|
Facility
|
IP
|
$1,221.37
|
|
|
Service Code
|
NDC 00904707161
|
| Hospital Charge Code |
5331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$537.40 |
| Max. Negotiated Rate |
$1,099.23 |
| Rate for Payer: Aetna American Axle |
$793.89
|
| Rate for Payer: Aetna Commercial |
$1,038.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$793.89
|
| Rate for Payer: Cash Price |
$977.10
|
| Rate for Payer: Cofinity Advantage |
$854.96
|
| Rate for Payer: Cofinity Commercial |
$1,050.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$977.10
|
| Rate for Payer: Healthscope Commercial |
$1,099.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$854.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$916.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,038.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$916.03
|
| Rate for Payer: PHP Commercial |
$1,038.16
|
| Rate for Payer: Priority Health SBD |
$769.46
|
| Rate for Payer: UMR Bronson Commercial |
$537.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$916.03
|
|
|
NADOLOL 40 MG TABLET
|
Facility
|
IP
|
$194.75
|
|
|
Service Code
|
NDC 76385013401
|
| Hospital Charge Code |
5331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.69 |
| Max. Negotiated Rate |
$175.28 |
| Rate for Payer: Aetna American Axle |
$126.59
|
| Rate for Payer: Aetna Commercial |
$165.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.59
|
| Rate for Payer: Cash Price |
$155.80
|
| Rate for Payer: Cofinity Advantage |
$136.32
|
| Rate for Payer: Cofinity Commercial |
$167.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.80
|
| Rate for Payer: Healthscope Commercial |
$175.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.06
|
| Rate for Payer: PHP Commercial |
$165.54
|
| Rate for Payer: Priority Health SBD |
$122.69
|
| Rate for Payer: UMR Bronson Commercial |
$85.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.06
|
|
|
NAFCILLIN 10 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$147.74
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
5334
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.01 |
| Max. Negotiated Rate |
$132.97 |
| Rate for Payer: Aetna American Axle |
$96.03
|
| Rate for Payer: Aetna American Axle |
$91.32
|
| Rate for Payer: Aetna American Axle |
$303.74
|
| Rate for Payer: Aetna American Axle |
$78.01
|
| Rate for Payer: Aetna Commercial |
$397.20
|
| Rate for Payer: Aetna Commercial |
$125.58
|
| Rate for Payer: Aetna Commercial |
$102.02
|
| Rate for Payer: Aetna Commercial |
$119.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.01
|
| Rate for Payer: Cash Price |
$96.02
|
| Rate for Payer: Cash Price |
$373.83
|
| Rate for Payer: Cash Price |
$112.39
|
| Rate for Payer: Cash Price |
$118.19
|
| Rate for Payer: Cofinity Advantage |
$98.34
|
| Rate for Payer: Cofinity Advantage |
$84.01
|
| Rate for Payer: Cofinity Advantage |
$103.42
|
| Rate for Payer: Cofinity Advantage |
$327.10
|
| Rate for Payer: Cofinity Commercial |
$127.06
|
| Rate for Payer: Cofinity Commercial |
$103.22
|
| Rate for Payer: Cofinity Commercial |
$120.82
|
| Rate for Payer: Cofinity Commercial |
$401.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$373.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.39
|
| Rate for Payer: Healthscope Commercial |
$126.44
|
| Rate for Payer: Healthscope Commercial |
$420.56
|
| Rate for Payer: Healthscope Commercial |
$132.97
|
| Rate for Payer: Healthscope Commercial |
$108.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$350.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$90.02
|
| Rate for Payer: PHP Commercial |
$102.02
|
| Rate for Payer: PHP Commercial |
$125.58
|
| Rate for Payer: PHP Commercial |
$119.42
|
| Rate for Payer: PHP Commercial |
$397.20
|
| Rate for Payer: Priority Health SBD |
$294.39
|
| Rate for Payer: Priority Health SBD |
$75.61
|
| Rate for Payer: Priority Health SBD |
$93.08
|
| Rate for Payer: Priority Health SBD |
$88.51
|
| Rate for Payer: UMR Bronson Commercial |
$61.82
|
| Rate for Payer: UMR Bronson Commercial |
$65.01
|
| Rate for Payer: UMR Bronson Commercial |
$52.81
|
| Rate for Payer: UMR Bronson Commercial |
$205.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.47
|
|
|
NAFCILLIN 10 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$120.02
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
5334
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$108.02 |
| Rate for Payer: Aetna American Axle |
$78.01
|
| Rate for Payer: Aetna American Axle |
$236.06
|
| Rate for Payer: Aetna American Axle |
$96.03
|
| Rate for Payer: Aetna American Axle |
$91.32
|
| Rate for Payer: Aetna American Axle |
$303.74
|
| Rate for Payer: Aetna Commercial |
$102.02
|
| Rate for Payer: Aetna Commercial |
$119.42
|
| Rate for Payer: Aetna Commercial |
$397.20
|
| Rate for Payer: Aetna Commercial |
$308.69
|
| Rate for Payer: Aetna Commercial |
$125.58
|
| Rate for Payer: Aetna Medicare |
$233.65
|
| Rate for Payer: Aetna Medicare |
$70.25
|
| Rate for Payer: Aetna Medicare |
$60.01
|
| Rate for Payer: Aetna Medicare |
$73.87
|
| Rate for Payer: Aetna Medicare |
$181.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.74
|
| Rate for Payer: BCBS Complete |
$145.27
|
| Rate for Payer: BCBS Complete |
$48.01
|
| Rate for Payer: BCBS Complete |
$56.20
|
| Rate for Payer: BCBS Complete |
$59.10
|
| Rate for Payer: BCBS Complete |
$186.92
|
| Rate for Payer: BCBS Trust/PPO |
$0.19
|
| Rate for Payer: BCBS Trust/PPO |
$0.19
|
| Rate for Payer: BCBS Trust/PPO |
$0.19
|
| Rate for Payer: BCBS Trust/PPO |
$0.19
|
| Rate for Payer: BCBS Trust/PPO |
$0.19
|
| Rate for Payer: BCN Commercial |
$0.19
|
| Rate for Payer: BCN Commercial |
$0.19
|
| Rate for Payer: BCN Commercial |
$0.19
|
| Rate for Payer: BCN Commercial |
$0.19
|
| Rate for Payer: BCN Commercial |
$0.19
|
| Rate for Payer: Cash Price |
$290.54
|
| Rate for Payer: Cash Price |
$373.83
|
| Rate for Payer: Cash Price |
$112.39
|
| Rate for Payer: Cash Price |
$96.02
|
| Rate for Payer: Cash Price |
$118.19
|
| Rate for Payer: Cash Price |
$96.02
|
| Rate for Payer: Cash Price |
$118.19
|
| Rate for Payer: Cash Price |
$290.54
|
| Rate for Payer: Cash Price |
$112.39
|
| Rate for Payer: Cash Price |
$373.83
|
| Rate for Payer: Cofinity Advantage |
$254.22
|
| Rate for Payer: Cofinity Advantage |
$98.34
|
| Rate for Payer: Cofinity Advantage |
$103.42
|
| Rate for Payer: Cofinity Advantage |
$327.10
|
| Rate for Payer: Cofinity Advantage |
$84.01
|
| Rate for Payer: Cofinity Commercial |
$312.33
|
| Rate for Payer: Cofinity Commercial |
$103.22
|
| Rate for Payer: Cofinity Commercial |
$120.82
|
| Rate for Payer: Cofinity Commercial |
$127.06
|
| Rate for Payer: Cofinity Commercial |
$401.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$373.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.19
|
| Rate for Payer: Healthscope Commercial |
$132.97
|
| Rate for Payer: Healthscope Commercial |
$420.56
|
| Rate for Payer: Healthscope Commercial |
$326.85
|
| Rate for Payer: Healthscope Commercial |
$108.02
|
| Rate for Payer: Healthscope Commercial |
$126.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$254.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$272.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$373.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$290.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$118.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$90.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$272.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$350.47
|
| Rate for Payer: PHP Commercial |
$119.42
|
| Rate for Payer: PHP Commercial |
$125.58
|
| Rate for Payer: PHP Commercial |
$397.20
|
| Rate for Payer: PHP Commercial |
$308.69
|
| Rate for Payer: PHP Commercial |
$102.02
|
| Rate for Payer: Priority Health SBD |
$93.08
|
| Rate for Payer: Priority Health SBD |
$75.61
|
| Rate for Payer: Priority Health SBD |
$228.80
|
| Rate for Payer: Priority Health SBD |
$294.39
|
| Rate for Payer: Priority Health SBD |
$88.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.10
|
| Rate for Payer: UHC Core |
$0.10
|
| Rate for Payer: UHC Core |
$0.10
|
| Rate for Payer: UHC Core |
$0.10
|
| Rate for Payer: UHC Core |
$0.10
|
| Rate for Payer: UHC Core |
$0.10
|
| Rate for Payer: UHC Exchange |
$0.10
|
| Rate for Payer: UHC Exchange |
$0.10
|
| Rate for Payer: UHC Exchange |
$0.10
|
| Rate for Payer: UHC Exchange |
$0.10
|
| Rate for Payer: UHC Exchange |
$0.10
|
| Rate for Payer: UMR Bronson Commercial |
$44.41
|
| Rate for Payer: UMR Bronson Commercial |
$134.37
|
| Rate for Payer: UMR Bronson Commercial |
$54.66
|
| Rate for Payer: UMR Bronson Commercial |
$172.90
|
| Rate for Payer: UMR Bronson Commercial |
$51.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$272.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.02
|
|
