|
MVI,ADULT NO.4 WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$47.17
|
|
|
Service Code
|
NDC 54643564901
|
| Hospital Charge Code |
161578
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.45 |
| Max. Negotiated Rate |
$42.45 |
| Rate for Payer: Aetna American Axle |
$30.66
|
| Rate for Payer: Aetna Commercial |
$40.09
|
| Rate for Payer: Aetna Medicare |
$23.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.66
|
| Rate for Payer: BCBS Complete |
$18.87
|
| Rate for Payer: Cash Price |
$37.74
|
| Rate for Payer: Cofinity Commercial |
$33.02
|
| Rate for Payer: Cofinity Commercial |
$40.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.74
|
| Rate for Payer: Healthscope Commercial |
$42.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.09
|
| Rate for Payer: PHP Commercial |
$40.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.66
|
| Rate for Payer: Priority Health SBD |
$29.72
|
| Rate for Payer: UMR Bronson Commercial |
$17.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.38
|
|
|
MVI,ADULT NO.4 WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$47.17
|
|
|
Service Code
|
NDC 54643564901
|
| Hospital Charge Code |
161578
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.75 |
| Max. Negotiated Rate |
$42.45 |
| Rate for Payer: Aetna American Axle |
$30.66
|
| Rate for Payer: Aetna Commercial |
$40.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.66
|
| Rate for Payer: Cash Price |
$37.74
|
| Rate for Payer: Cofinity Commercial |
$33.02
|
| Rate for Payer: Cofinity Commercial |
$40.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.74
|
| Rate for Payer: Healthscope Commercial |
$42.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.09
|
| Rate for Payer: PHP Commercial |
$40.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.66
|
| Rate for Payer: Priority Health SBD |
$29.72
|
| Rate for Payer: UMR Bronson Commercial |
$20.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.38
|
|
|
MVI,ADULT NO.4 WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$319.15
|
|
|
Service Code
|
NDC 54643565002
|
| Hospital Charge Code |
161578
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$140.43 |
| Max. Negotiated Rate |
$287.24 |
| Rate for Payer: Aetna American Axle |
$207.45
|
| Rate for Payer: Aetna Commercial |
$271.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$207.45
|
| Rate for Payer: Cash Price |
$255.32
|
| Rate for Payer: Cofinity Commercial |
$223.41
|
| Rate for Payer: Cofinity Commercial |
$274.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$223.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$255.32
|
| Rate for Payer: Healthscope Commercial |
$287.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$223.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$239.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$271.28
|
| Rate for Payer: PHP Commercial |
$271.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.45
|
| Rate for Payer: Priority Health SBD |
$201.06
|
| Rate for Payer: UMR Bronson Commercial |
$140.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$239.36
|
|
|
MVI,ADULT NO.4 WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$63.68
|
|
|
Service Code
|
NDC 54643900701
|
| Hospital Charge Code |
161578
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.02 |
| Max. Negotiated Rate |
$57.31 |
| Rate for Payer: Aetna American Axle |
$41.39
|
| Rate for Payer: Aetna Commercial |
$54.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.39
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cofinity Commercial |
$44.58
|
| Rate for Payer: Cofinity Commercial |
$54.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.94
|
| Rate for Payer: Healthscope Commercial |
$57.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.13
|
| Rate for Payer: PHP Commercial |
$54.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.39
|
| Rate for Payer: Priority Health SBD |
$40.12
|
| Rate for Payer: UMR Bronson Commercial |
$28.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.76
|
|
|
MVI,ADULT NO.4 WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$63.68
|
|
|
Service Code
|
NDC 54643900701
|
| Hospital Charge Code |
161578
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.56 |
| Max. Negotiated Rate |
$57.31 |
| Rate for Payer: Aetna American Axle |
$41.39
|
| Rate for Payer: Aetna Commercial |
$54.13
|
| Rate for Payer: Aetna Medicare |
$31.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.39
|
| Rate for Payer: BCBS Complete |
$25.47
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cofinity Commercial |
$44.58
|
| Rate for Payer: Cofinity Commercial |
$54.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.94
|
| Rate for Payer: Healthscope Commercial |
$57.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.13
|
| Rate for Payer: PHP Commercial |
$54.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.39
|
| Rate for Payer: Priority Health SBD |
$40.12
|
| Rate for Payer: UMR Bronson Commercial |
$23.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.76
|
|
|
MVI,ADULT NO.4 WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$319.15
|
|
|
Service Code
|
NDC 54643565002
|
| Hospital Charge Code |
161578
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$118.09 |
| Max. Negotiated Rate |
$287.24 |
| Rate for Payer: Aetna American Axle |
$207.45
|
| Rate for Payer: Aetna Commercial |
$271.28
|
| Rate for Payer: Aetna Medicare |
$159.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$207.45
|
| Rate for Payer: BCBS Complete |
$127.66
|
| Rate for Payer: Cash Price |
$255.32
|
| Rate for Payer: Cofinity Commercial |
$223.41
|
| Rate for Payer: Cofinity Commercial |
$274.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$223.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$255.32
|
| Rate for Payer: Healthscope Commercial |
$287.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$223.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$239.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$271.28
|
| Rate for Payer: PHP Commercial |
$271.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.45
|
| Rate for Payer: Priority Health SBD |
$201.06
|
| Rate for Payer: UMR Bronson Commercial |
$118.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$239.36
|
|
|
MVI, PEDI NO.1 WITH VIT K 80 MG-400 UNIT-200 MCG/5 ML INTRAVENOUS SOLN
|
Facility
|
IP
|
$73.74
|
|
|
Service Code
|
NDC 54643564601
|
| Hospital Charge Code |
115531
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.45 |
| Max. Negotiated Rate |
$66.37 |
| Rate for Payer: Aetna American Axle |
$47.93
|
| Rate for Payer: Aetna Commercial |
$62.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.93
|
| Rate for Payer: Cash Price |
$58.99
|
| Rate for Payer: Cofinity Commercial |
$51.62
|
| Rate for Payer: Cofinity Commercial |
$63.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.99
|
| Rate for Payer: Healthscope Commercial |
$66.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.68
|
| Rate for Payer: PHP Commercial |
$62.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.93
|
| Rate for Payer: Priority Health SBD |
$46.46
|
| Rate for Payer: UMR Bronson Commercial |
$32.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.30
|
|
|
MVI, PEDI NO.1 WITH VIT K 80 MG-400 UNIT-200 MCG/5 ML INTRAVENOUS SOLN
|
Facility
|
OP
|
$73.74
|
|
|
Service Code
|
NDC 54643564601
|
| Hospital Charge Code |
115531
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.28 |
| Max. Negotiated Rate |
$66.37 |
| Rate for Payer: Aetna American Axle |
$47.93
|
| Rate for Payer: Aetna Commercial |
$62.68
|
| Rate for Payer: Aetna Medicare |
$36.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.93
|
| Rate for Payer: BCBS Complete |
$29.50
|
| Rate for Payer: Cash Price |
$58.99
|
| Rate for Payer: Cofinity Commercial |
$51.62
|
| Rate for Payer: Cofinity Commercial |
$63.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.99
|
| Rate for Payer: Healthscope Commercial |
$66.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.68
|
| Rate for Payer: PHP Commercial |
$62.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.93
|
| Rate for Payer: Priority Health SBD |
$46.46
|
| Rate for Payer: UMR Bronson Commercial |
$27.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.30
|
|
|
MVI, PEDI NO.1 WITH VIT K 80 MG-400 UNIT-200 MCG/5 ML INTRAVENOUS SOLN
|
Facility
|
OP
|
$99.51
|
|
|
Service Code
|
NDC 54643902301
|
| Hospital Charge Code |
115531
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.82 |
| Max. Negotiated Rate |
$89.56 |
| Rate for Payer: Aetna American Axle |
$64.68
|
| Rate for Payer: Aetna Commercial |
$84.58
|
| Rate for Payer: Aetna Medicare |
$49.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.68
|
| Rate for Payer: BCBS Complete |
$39.80
|
| Rate for Payer: Cash Price |
$79.61
|
| Rate for Payer: Cofinity Commercial |
$69.66
|
| Rate for Payer: Cofinity Commercial |
$85.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.61
|
| Rate for Payer: Healthscope Commercial |
$89.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.58
|
| Rate for Payer: PHP Commercial |
$84.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.68
|
| Rate for Payer: Priority Health SBD |
$62.69
|
| Rate for Payer: UMR Bronson Commercial |
$36.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.63
|
|
|
MVI, PEDI NO.1 WITH VIT K 80 MG-400 UNIT-200 MCG/5 ML INTRAVENOUS SOLN
|
Facility
|
IP
|
$812.07
|
|
|
Service Code
|
NDC 54643903100
|
| Hospital Charge Code |
115531
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$357.31 |
| Max. Negotiated Rate |
$730.86 |
| Rate for Payer: Aetna American Axle |
$527.85
|
| Rate for Payer: Aetna Commercial |
$690.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$527.85
|
| Rate for Payer: Cash Price |
$649.66
|
| Rate for Payer: Cofinity Commercial |
$568.45
|
| Rate for Payer: Cofinity Commercial |
$698.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$568.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$649.66
|
| Rate for Payer: Healthscope Commercial |
$730.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$568.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$609.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$690.26
|
| Rate for Payer: PHP Commercial |
$690.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$527.85
|
| Rate for Payer: Priority Health SBD |
$511.60
|
| Rate for Payer: UMR Bronson Commercial |
$357.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$609.05
|
|
|
MVI, PEDI NO.1 WITH VIT K 80 MG-400 UNIT-200 MCG/5 ML INTRAVENOUS SOLN
|
Facility
|
IP
|
$601.73
|
|
|
Service Code
|
NDC 54643564700
|
| Hospital Charge Code |
115531
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$264.76 |
| Max. Negotiated Rate |
$541.56 |
| Rate for Payer: Aetna American Axle |
$391.12
|
| Rate for Payer: Aetna Commercial |
$511.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$391.12
|
| Rate for Payer: Cash Price |
$481.38
|
| Rate for Payer: Cofinity Commercial |
$421.21
|
| Rate for Payer: Cofinity Commercial |
$517.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$421.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$481.38
|
| Rate for Payer: Healthscope Commercial |
$541.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$421.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$451.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$511.47
|
| Rate for Payer: PHP Commercial |
$511.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$391.12
|
| Rate for Payer: Priority Health SBD |
$379.09
|
| Rate for Payer: UMR Bronson Commercial |
$264.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$451.30
|
|
|
MVI, PEDI NO.1 WITH VIT K 80 MG-400 UNIT-200 MCG/5 ML INTRAVENOUS SOLN
|
Facility
|
IP
|
$99.51
|
|
|
Service Code
|
NDC 54643902301
|
| Hospital Charge Code |
115531
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.78 |
| Max. Negotiated Rate |
$89.56 |
| Rate for Payer: Aetna American Axle |
$64.68
|
| Rate for Payer: Aetna Commercial |
$84.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.68
|
| Rate for Payer: Cash Price |
$79.61
|
| Rate for Payer: Cofinity Commercial |
$69.66
|
| Rate for Payer: Cofinity Commercial |
$85.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.61
|
| Rate for Payer: Healthscope Commercial |
$89.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.58
|
| Rate for Payer: PHP Commercial |
$84.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.68
|
| Rate for Payer: Priority Health SBD |
$62.69
|
| Rate for Payer: UMR Bronson Commercial |
$43.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.63
|
|
|
MVI, PEDI NO.1 WITH VIT K 80 MG-400 UNIT-200 MCG/5 ML INTRAVENOUS SOLN
|
Facility
|
OP
|
$812.07
|
|
|
Service Code
|
NDC 54643903100
|
| Hospital Charge Code |
115531
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$300.47 |
| Max. Negotiated Rate |
$730.86 |
| Rate for Payer: Aetna American Axle |
$527.85
|
| Rate for Payer: Aetna Commercial |
$690.26
|
| Rate for Payer: Aetna Medicare |
$406.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$527.85
|
| Rate for Payer: BCBS Complete |
$324.83
|
| Rate for Payer: Cash Price |
$649.66
|
| Rate for Payer: Cofinity Commercial |
$568.45
|
| Rate for Payer: Cofinity Commercial |
$698.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$568.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$649.66
|
| Rate for Payer: Healthscope Commercial |
$730.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$568.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$609.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$690.26
|
| Rate for Payer: PHP Commercial |
$690.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$527.85
|
| Rate for Payer: Priority Health SBD |
$511.60
|
| Rate for Payer: UMR Bronson Commercial |
$300.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$609.05
|
|
|
MVI, PEDI NO.1 WITH VIT K 80 MG-400 UNIT-200 MCG/5 ML INTRAVENOUS SOLN
|
Facility
|
OP
|
$601.73
|
|
|
Service Code
|
NDC 54643564700
|
| Hospital Charge Code |
115531
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$222.64 |
| Max. Negotiated Rate |
$541.56 |
| Rate for Payer: Aetna American Axle |
$391.12
|
| Rate for Payer: Aetna Commercial |
$511.47
|
| Rate for Payer: Aetna Medicare |
$300.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$391.12
|
| Rate for Payer: BCBS Complete |
$240.69
|
| Rate for Payer: Cash Price |
$481.38
|
| Rate for Payer: Cofinity Commercial |
$421.21
|
| Rate for Payer: Cofinity Commercial |
$517.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$421.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$481.38
|
| Rate for Payer: Healthscope Commercial |
$541.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$421.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$451.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$511.47
|
| Rate for Payer: PHP Commercial |
$511.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$391.12
|
| Rate for Payer: Priority Health SBD |
$379.09
|
| Rate for Payer: UMR Bronson Commercial |
$222.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$451.30
|
|
|
MVI, PEDI NO.1 WITH VIT K 80 MG-400 UNIT-200 MCG/5 ML INTRAVENOUS SOLN
|
Facility
|
IP
|
$73.74
|
|
|
Service Code
|
NDC 05464356499
|
| Hospital Charge Code |
115531
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.45 |
| Max. Negotiated Rate |
$66.37 |
| Rate for Payer: Aetna American Axle |
$47.93
|
| Rate for Payer: Aetna Commercial |
$62.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.93
|
| Rate for Payer: Cash Price |
$58.99
|
| Rate for Payer: Cofinity Commercial |
$51.62
|
| Rate for Payer: Cofinity Commercial |
$63.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.99
|
| Rate for Payer: Healthscope Commercial |
$66.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.68
|
| Rate for Payer: PHP Commercial |
$62.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.93
|
| Rate for Payer: Priority Health SBD |
$46.46
|
| Rate for Payer: UMR Bronson Commercial |
$32.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.30
|
|
|
MVI, PEDI NO.1 WITH VIT K 80 MG-400 UNIT-200 MCG/5 ML INTRAVENOUS SOLN
|
Facility
|
OP
|
$73.74
|
|
|
Service Code
|
NDC 05464356499
|
| Hospital Charge Code |
115531
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.28 |
| Max. Negotiated Rate |
$66.37 |
| Rate for Payer: Aetna American Axle |
$47.93
|
| Rate for Payer: Aetna Commercial |
$62.68
|
| Rate for Payer: Aetna Medicare |
$36.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.93
|
| Rate for Payer: BCBS Complete |
$29.50
|
| Rate for Payer: Cash Price |
$58.99
|
| Rate for Payer: Cofinity Commercial |
$51.62
|
| Rate for Payer: Cofinity Commercial |
$63.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.99
|
| Rate for Payer: Healthscope Commercial |
$66.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.68
|
| Rate for Payer: PHP Commercial |
$62.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.93
|
| Rate for Payer: Priority Health SBD |
$46.46
|
| Rate for Payer: UMR Bronson Commercial |
$27.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.30
|
|
|
MYCOPHENOLATE 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$228.16
|
|
|
Service Code
|
HCPCS J7519
|
| Hospital Charge Code |
23968
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$84.42 |
| Max. Negotiated Rate |
$205.34 |
| Rate for Payer: Aetna American Axle |
$148.30
|
| Rate for Payer: Aetna American Axle |
$47.29
|
| Rate for Payer: Aetna Commercial |
$193.94
|
| Rate for Payer: Aetna Commercial |
$61.85
|
| Rate for Payer: Aetna Medicare |
$114.08
|
| Rate for Payer: Aetna Medicare |
$36.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.29
|
| Rate for Payer: BCBS Complete |
$29.10
|
| Rate for Payer: BCBS Complete |
$91.26
|
| Rate for Payer: Cash Price |
$182.53
|
| Rate for Payer: Cash Price |
$58.21
|
| Rate for Payer: Cofinity Commercial |
$196.22
|
| Rate for Payer: Cofinity Commercial |
$159.71
|
| Rate for Payer: Cofinity Commercial |
$50.93
|
| Rate for Payer: Cofinity Commercial |
$62.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$159.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.21
|
| Rate for Payer: Healthscope Commercial |
$65.48
|
| Rate for Payer: Healthscope Commercial |
$205.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$159.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.85
|
| Rate for Payer: PHP Commercial |
$61.85
|
| Rate for Payer: PHP Commercial |
$193.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.29
|
| Rate for Payer: Priority Health SBD |
$45.84
|
| Rate for Payer: Priority Health SBD |
$143.74
|
| Rate for Payer: UMR Bronson Commercial |
$84.42
|
| Rate for Payer: UMR Bronson Commercial |
$26.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.12
|
|
|
MYCOPHENOLATE 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$228.16
|
|
|
Service Code
|
HCPCS J7519
|
| Hospital Charge Code |
23968
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.39 |
| Max. Negotiated Rate |
$205.34 |
| Rate for Payer: Aetna American Axle |
$148.30
|
| Rate for Payer: Aetna American Axle |
$47.29
|
| Rate for Payer: Aetna Commercial |
$193.94
|
| Rate for Payer: Aetna Commercial |
$61.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.29
|
| Rate for Payer: Cash Price |
$182.53
|
| Rate for Payer: Cash Price |
$58.21
|
| Rate for Payer: Cofinity Commercial |
$62.57
|
| Rate for Payer: Cofinity Commercial |
$50.93
|
| Rate for Payer: Cofinity Commercial |
$159.71
|
| Rate for Payer: Cofinity Commercial |
$196.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$159.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.21
|
| Rate for Payer: Healthscope Commercial |
$205.34
|
| Rate for Payer: Healthscope Commercial |
$65.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$159.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.94
|
| Rate for Payer: PHP Commercial |
$61.85
|
| Rate for Payer: PHP Commercial |
$193.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.29
|
| Rate for Payer: Priority Health SBD |
$143.74
|
| Rate for Payer: Priority Health SBD |
$45.84
|
| Rate for Payer: UMR Bronson Commercial |
$100.39
|
| Rate for Payer: UMR Bronson Commercial |
$32.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.57
|
|
|
MYCOPHENOLATE MOFETIL 200 MG/ML ORAL POWDER FOR SUSPENSION
|
Facility
|
IP
|
$1,449.22
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
25005
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$637.66 |
| Max. Negotiated Rate |
$1,304.30 |
| Rate for Payer: Aetna American Axle |
$941.99
|
| Rate for Payer: Aetna American Axle |
$2,409.24
|
| Rate for Payer: Aetna American Axle |
$2,594.71
|
| Rate for Payer: Aetna Commercial |
$3,150.54
|
| Rate for Payer: Aetna Commercial |
$1,231.84
|
| Rate for Payer: Aetna Commercial |
$3,393.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$941.99
|
| 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: Cash Price |
$3,193.49
|
| Rate for Payer: Cash Price |
$2,965.22
|
| Rate for Payer: Cash Price |
$1,159.38
|
| Rate for Payer: Cofinity Commercial |
$1,246.33
|
| Rate for Payer: Cofinity Commercial |
$3,187.61
|
| Rate for Payer: Cofinity Commercial |
$2,594.56
|
| Rate for Payer: Cofinity Commercial |
$3,433.00
|
| Rate for Payer: Cofinity Commercial |
$2,794.30
|
| Rate for Payer: Cofinity Commercial |
$1,014.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,594.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,014.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,794.30
|
| 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: Encore Health Key Benefits Commercial |
$2,965.22
|
| Rate for Payer: Healthscope Commercial |
$3,335.87
|
| Rate for Payer: Healthscope Commercial |
$1,304.30
|
| Rate for Payer: Healthscope Commercial |
$3,592.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,014.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,594.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,794.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,779.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,086.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,993.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,231.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,393.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,150.54
|
| Rate for Payer: PHP Commercial |
$3,393.08
|
| Rate for Payer: PHP Commercial |
$3,150.54
|
| Rate for Payer: PHP Commercial |
$1,231.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,409.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,594.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$941.99
|
| Rate for Payer: Priority Health SBD |
$2,514.87
|
| 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 |
$1,756.42
|
| Rate for Payer: UMR Bronson Commercial |
$1,630.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,993.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,086.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,779.89
|
|
|
MYCOPHENOLATE MOFETIL 200 MG/ML ORAL POWDER FOR SUSPENSION
|
Facility
|
OP
|
$3,991.86
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
25005
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,476.99 |
| Max. Negotiated Rate |
$3,592.67 |
| Rate for Payer: Aetna American Axle |
$2,594.71
|
| Rate for Payer: Aetna American Axle |
$941.99
|
| Rate for Payer: Aetna American Axle |
$2,409.24
|
| Rate for Payer: Aetna Commercial |
$3,393.08
|
| Rate for Payer: Aetna Commercial |
$3,150.54
|
| Rate for Payer: Aetna Commercial |
$1,231.84
|
| Rate for Payer: Aetna Medicare |
$1,995.93
|
| Rate for Payer: Aetna Medicare |
$1,853.26
|
| Rate for Payer: Aetna Medicare |
$724.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,409.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,594.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$941.99
|
| Rate for Payer: BCBS Complete |
$579.69
|
| Rate for Payer: BCBS Complete |
$1,482.61
|
| Rate for Payer: BCBS Complete |
$1,596.74
|
| Rate for Payer: Cash Price |
$3,193.49
|
| Rate for Payer: Cash Price |
$2,965.22
|
| Rate for Payer: Cash Price |
$1,159.38
|
| Rate for Payer: Cofinity Commercial |
$3,187.61
|
| Rate for Payer: Cofinity Commercial |
$1,014.45
|
| Rate for Payer: Cofinity Commercial |
$1,246.33
|
| Rate for Payer: Cofinity Commercial |
$3,433.00
|
| Rate for Payer: Cofinity Commercial |
$2,794.30
|
| Rate for Payer: Cofinity Commercial |
$2,594.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,014.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,594.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,794.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,965.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,159.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,193.49
|
| Rate for Payer: Healthscope Commercial |
$1,304.30
|
| Rate for Payer: Healthscope Commercial |
$3,335.87
|
| Rate for Payer: Healthscope Commercial |
$3,592.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,594.56
|
| 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: Multiplan/Beech St/PHCS Commercial |
$3,150.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,231.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,393.08
|
| Rate for Payer: PHP Commercial |
$1,231.84
|
| Rate for Payer: PHP Commercial |
$3,150.54
|
| Rate for Payer: PHP Commercial |
$3,393.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,594.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,409.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$941.99
|
| Rate for Payer: Priority Health SBD |
$2,335.11
|
| Rate for Payer: Priority Health SBD |
$913.01
|
| Rate for Payer: Priority Health SBD |
$2,514.87
|
| Rate for Payer: UMR Bronson Commercial |
$1,476.99
|
| Rate for Payer: UMR Bronson Commercial |
$536.21
|
| Rate for Payer: UMR Bronson Commercial |
$1,371.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,086.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,779.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,993.89
|
|
|
MYCOPHENOLATE MOFETIL 250 MG CAPSULE
|
Facility
|
OP
|
$401.76
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
15113
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$148.65 |
| Max. Negotiated Rate |
$361.58 |
| Rate for Payer: Aetna American Axle |
$261.14
|
| Rate for Payer: Aetna American Axle |
$206.25
|
| Rate for Payer: Aetna American Axle |
$240.82
|
| Rate for Payer: Aetna American Axle |
$2.96
|
| Rate for Payer: Aetna American Axle |
$186.58
|
| Rate for Payer: Aetna American Axle |
$2.90
|
| Rate for Payer: Aetna American Axle |
$295.17
|
| Rate for Payer: Aetna American Axle |
$262.73
|
| Rate for Payer: Aetna American Axle |
$289.61
|
| Rate for Payer: Aetna Commercial |
$343.57
|
| Rate for Payer: Aetna Commercial |
$3.79
|
| Rate for Payer: Aetna Commercial |
$269.70
|
| Rate for Payer: Aetna Commercial |
$378.72
|
| Rate for Payer: Aetna Commercial |
$243.98
|
| Rate for Payer: Aetna Commercial |
$3.87
|
| Rate for Payer: Aetna Commercial |
$385.99
|
| Rate for Payer: Aetna Commercial |
$314.93
|
| Rate for Payer: Aetna Commercial |
$341.50
|
| Rate for Payer: Aetna Medicare |
$227.05
|
| Rate for Payer: Aetna Medicare |
$2.27
|
| Rate for Payer: Aetna Medicare |
$185.25
|
| Rate for Payer: Aetna Medicare |
$143.52
|
| Rate for Payer: Aetna Medicare |
$200.88
|
| Rate for Payer: Aetna Medicare |
$158.65
|
| Rate for Payer: Aetna Medicare |
$222.78
|
| Rate for Payer: Aetna Medicare |
$2.23
|
| Rate for Payer: Aetna Medicare |
$202.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.96
|
| 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) |
$186.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$295.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.61
|
| Rate for Payer: BCBS Complete |
$178.22
|
| Rate for Payer: BCBS Complete |
$126.92
|
| Rate for Payer: BCBS Complete |
$1.78
|
| Rate for Payer: BCBS Complete |
$148.20
|
| Rate for Payer: BCBS Complete |
$161.68
|
| Rate for Payer: BCBS Complete |
$1.82
|
| Rate for Payer: BCBS Complete |
$181.64
|
| Rate for Payer: BCBS Complete |
$160.70
|
| Rate for Payer: BCBS Complete |
$114.82
|
| Rate for Payer: Cash Price |
$3.64
|
| Rate for Payer: Cash Price |
$356.44
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cash Price |
$229.63
|
| Rate for Payer: Cash Price |
$253.84
|
| Rate for Payer: Cash Price |
$321.41
|
| Rate for Payer: Cash Price |
$363.28
|
| Rate for Payer: Cash Price |
$3.57
|
| Rate for Payer: Cash Price |
$323.36
|
| Rate for Payer: Cofinity Commercial |
$222.11
|
| Rate for Payer: Cofinity Commercial |
$282.94
|
| Rate for Payer: Cofinity Commercial |
$347.61
|
| Rate for Payer: Cofinity Commercial |
$345.51
|
| Rate for Payer: Cofinity Commercial |
$200.93
|
| Rate for Payer: Cofinity Commercial |
$390.53
|
| Rate for Payer: Cofinity Commercial |
$318.63
|
| Rate for Payer: Cofinity Commercial |
$317.87
|
| Rate for Payer: Cofinity Commercial |
$3.84
|
| Rate for Payer: Cofinity Commercial |
$3.12
|
| Rate for Payer: Cofinity Commercial |
$383.17
|
| Rate for Payer: Cofinity Commercial |
$311.88
|
| Rate for Payer: Cofinity Commercial |
$3.91
|
| Rate for Payer: Cofinity Commercial |
$259.35
|
| Rate for Payer: Cofinity Commercial |
$246.85
|
| Rate for Payer: Cofinity Commercial |
$281.23
|
| Rate for Payer: Cofinity Commercial |
$3.19
|
| Rate for Payer: Cofinity Commercial |
$272.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$282.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$259.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$317.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$222.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$311.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$281.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$363.28
|
| 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 |
$229.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.44
|
| Rate for Payer: Healthscope Commercial |
$4.01
|
| Rate for Payer: Healthscope Commercial |
$361.58
|
| Rate for Payer: Healthscope Commercial |
$333.45
|
| Rate for Payer: Healthscope Commercial |
$258.34
|
| Rate for Payer: Healthscope Commercial |
$401.00
|
| Rate for Payer: Healthscope Commercial |
$408.69
|
| Rate for Payer: Healthscope Commercial |
$285.57
|
| Rate for Payer: Healthscope Commercial |
$4.09
|
| Rate for Payer: Healthscope Commercial |
$363.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$311.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$259.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$222.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.93
|
| 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 |
$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 |
$334.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$237.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$277.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$340.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$269.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.79
|
| 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 |
$385.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$378.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.50
|
| Rate for Payer: PHP Commercial |
$243.98
|
| Rate for Payer: PHP Commercial |
$385.99
|
| Rate for Payer: PHP Commercial |
$3.87
|
| Rate for Payer: PHP Commercial |
$378.72
|
| Rate for Payer: PHP Commercial |
$343.57
|
| Rate for Payer: PHP Commercial |
$341.50
|
| Rate for Payer: PHP Commercial |
$3.79
|
| Rate for Payer: PHP Commercial |
$269.70
|
| Rate for Payer: PHP Commercial |
$314.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$295.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.96
|
| Rate for Payer: Priority Health SBD |
$280.70
|
| Rate for Payer: Priority Health SBD |
$254.65
|
| Rate for Payer: Priority Health SBD |
$253.11
|
| Rate for Payer: Priority Health SBD |
$2.87
|
| Rate for Payer: Priority Health SBD |
$286.08
|
| Rate for Payer: Priority Health SBD |
$2.81
|
| Rate for Payer: Priority Health SBD |
$233.41
|
| Rate for Payer: Priority Health SBD |
$180.84
|
| Rate for Payer: Priority Health SBD |
$199.90
|
| Rate for Payer: UMR Bronson Commercial |
$164.85
|
| Rate for Payer: UMR Bronson Commercial |
$106.20
|
| Rate for Payer: UMR Bronson Commercial |
$117.40
|
| Rate for Payer: UMR Bronson Commercial |
$168.02
|
| Rate for Payer: UMR Bronson Commercial |
$149.55
|
| Rate for Payer: UMR Bronson Commercial |
$1.65
|
| Rate for Payer: UMR Bronson Commercial |
$148.65
|
| Rate for Payer: UMR Bronson Commercial |
$137.09
|
| Rate for Payer: UMR Bronson Commercial |
$1.68
|
| 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 |
$277.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$237.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$340.57
|
|
|
MYCOPHENOLATE MOFETIL 250 MG CAPSULE
|
Facility
|
IP
|
$401.76
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
15113
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$176.77 |
| Max. Negotiated Rate |
$361.58 |
| Rate for Payer: Aetna American Axle |
$261.14
|
| Rate for Payer: Aetna American Axle |
$2.96
|
| Rate for Payer: Aetna American Axle |
$240.82
|
| Rate for Payer: Aetna American Axle |
$295.17
|
| Rate for Payer: Aetna American Axle |
$262.73
|
| Rate for Payer: Aetna American Axle |
$2.90
|
| Rate for Payer: Aetna American Axle |
$289.61
|
| Rate for Payer: Aetna American Axle |
$186.58
|
| Rate for Payer: Aetna American Axle |
$206.25
|
| Rate for Payer: Aetna Commercial |
$3.87
|
| Rate for Payer: Aetna Commercial |
$269.70
|
| Rate for Payer: Aetna Commercial |
$243.98
|
| Rate for Payer: Aetna Commercial |
$314.93
|
| Rate for Payer: Aetna Commercial |
$385.99
|
| Rate for Payer: Aetna Commercial |
$378.72
|
| Rate for Payer: Aetna Commercial |
$343.57
|
| Rate for Payer: Aetna Commercial |
$341.50
|
| Rate for Payer: Aetna Commercial |
$3.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$295.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.73
|
| Rate for Payer: Cash Price |
$3.57
|
| Rate for Payer: Cash Price |
$321.41
|
| Rate for Payer: Cash Price |
$323.36
|
| Rate for Payer: Cash Price |
$363.28
|
| Rate for Payer: Cash Price |
$229.63
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cash Price |
$253.84
|
| Rate for Payer: Cash Price |
$356.44
|
| Rate for Payer: Cash Price |
$3.64
|
| Rate for Payer: Cofinity Commercial |
$318.63
|
| Rate for Payer: Cofinity Commercial |
$200.93
|
| Rate for Payer: Cofinity Commercial |
$345.51
|
| Rate for Payer: Cofinity Commercial |
$281.23
|
| Rate for Payer: Cofinity Commercial |
$259.35
|
| Rate for Payer: Cofinity Commercial |
$222.11
|
| Rate for Payer: Cofinity Commercial |
$272.88
|
| Rate for Payer: Cofinity Commercial |
$383.17
|
| Rate for Payer: Cofinity Commercial |
$246.85
|
| Rate for Payer: Cofinity Commercial |
$3.91
|
| Rate for Payer: Cofinity Commercial |
$3.19
|
| Rate for Payer: Cofinity Commercial |
$390.53
|
| Rate for Payer: Cofinity Commercial |
$317.87
|
| Rate for Payer: Cofinity Commercial |
$282.94
|
| Rate for Payer: Cofinity Commercial |
$347.61
|
| Rate for Payer: Cofinity Commercial |
$3.84
|
| Rate for Payer: Cofinity Commercial |
$3.12
|
| Rate for Payer: Cofinity Commercial |
$311.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$311.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$281.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$222.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$317.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$282.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$259.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$363.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.44
|
| 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 |
$253.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.41
|
| Rate for Payer: Healthscope Commercial |
$333.45
|
| Rate for Payer: Healthscope Commercial |
$4.01
|
| Rate for Payer: Healthscope Commercial |
$4.09
|
| Rate for Payer: Healthscope Commercial |
$258.34
|
| Rate for Payer: Healthscope Commercial |
$401.00
|
| Rate for Payer: Healthscope Commercial |
$363.78
|
| Rate for Payer: Healthscope Commercial |
$408.69
|
| Rate for Payer: Healthscope Commercial |
$361.58
|
| Rate for Payer: Healthscope Commercial |
$285.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$222.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$311.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$282.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.19
|
| 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 |
$317.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$334.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$237.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$277.88
|
| 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 |
$3.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$340.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$269.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$385.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$378.72
|
| Rate for Payer: PHP Commercial |
$343.57
|
| Rate for Payer: PHP Commercial |
$385.99
|
| Rate for Payer: PHP Commercial |
$3.87
|
| Rate for Payer: PHP Commercial |
$378.72
|
| Rate for Payer: PHP Commercial |
$3.79
|
| Rate for Payer: PHP Commercial |
$314.93
|
| Rate for Payer: PHP Commercial |
$341.50
|
| Rate for Payer: PHP Commercial |
$243.98
|
| Rate for Payer: PHP Commercial |
$269.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$295.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.96
|
| Rate for Payer: Priority Health SBD |
$180.84
|
| Rate for Payer: Priority Health SBD |
$254.65
|
| Rate for Payer: Priority Health SBD |
$253.11
|
| Rate for Payer: Priority Health SBD |
$2.87
|
| Rate for Payer: Priority Health SBD |
$2.81
|
| Rate for Payer: Priority Health SBD |
$233.41
|
| Rate for Payer: Priority Health SBD |
$199.90
|
| Rate for Payer: Priority Health SBD |
$280.70
|
| Rate for Payer: Priority Health SBD |
$286.08
|
| Rate for Payer: UMR Bronson Commercial |
$196.04
|
| Rate for Payer: UMR Bronson Commercial |
$199.80
|
| Rate for Payer: UMR Bronson Commercial |
$2.00
|
| Rate for Payer: UMR Bronson Commercial |
$139.61
|
| Rate for Payer: UMR Bronson Commercial |
$163.02
|
| Rate for Payer: UMR Bronson Commercial |
$126.30
|
| Rate for Payer: UMR Bronson Commercial |
$1.96
|
| Rate for Payer: UMR Bronson Commercial |
$176.77
|
| Rate for Payer: UMR Bronson Commercial |
$177.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$277.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.16
|
| 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 |
$237.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.35
|
|
|
MYCOPHENOLATE MOFETIL 500 MG TABLET
|
Facility
|
OP
|
$347.52
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
21374
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$128.58 |
| Max. Negotiated Rate |
$312.77 |
| Rate for Payer: Aetna American Axle |
$225.89
|
| Rate for Payer: Aetna American Axle |
$290.23
|
| Rate for Payer: Aetna American Axle |
$263.02
|
| Rate for Payer: Aetna American Axle |
$324.17
|
| Rate for Payer: Aetna American Axle |
$2.49
|
| Rate for Payer: Aetna American Axle |
$343.20
|
| Rate for Payer: Aetna American Axle |
$129.06
|
| Rate for Payer: Aetna American Axle |
$3.24
|
| Rate for Payer: Aetna American Axle |
$248.66
|
| Rate for Payer: Aetna American Axle |
$166.11
|
| Rate for Payer: Aetna Commercial |
$217.22
|
| Rate for Payer: Aetna Commercial |
$4.24
|
| Rate for Payer: Aetna Commercial |
$168.77
|
| Rate for Payer: Aetna Commercial |
$423.91
|
| Rate for Payer: Aetna Commercial |
$3.26
|
| Rate for Payer: Aetna Commercial |
$295.39
|
| Rate for Payer: Aetna Commercial |
$343.94
|
| Rate for Payer: Aetna Commercial |
$379.52
|
| Rate for Payer: Aetna Commercial |
$325.18
|
| Rate for Payer: Aetna Commercial |
$448.80
|
| Rate for Payer: Aetna Medicare |
$191.28
|
| Rate for Payer: Aetna Medicare |
$99.28
|
| Rate for Payer: Aetna Medicare |
$173.76
|
| Rate for Payer: Aetna Medicare |
$249.36
|
| Rate for Payer: Aetna Medicare |
$223.25
|
| Rate for Payer: Aetna Medicare |
$2.50
|
| Rate for Payer: Aetna Medicare |
$1.92
|
| Rate for Payer: Aetna Medicare |
$264.00
|
| Rate for Payer: Aetna Medicare |
$202.32
|
| Rate for Payer: Aetna Medicare |
$127.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$343.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.02
|
| Rate for Payer: BCBS Complete |
$79.42
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCBS Complete |
$211.20
|
| Rate for Payer: BCBS Complete |
$102.22
|
| Rate for Payer: BCBS Complete |
$161.86
|
| Rate for Payer: BCBS Complete |
$1.53
|
| Rate for Payer: BCBS Complete |
$139.01
|
| Rate for Payer: BCBS Complete |
$153.02
|
| Rate for Payer: BCBS Complete |
$199.49
|
| Rate for Payer: BCBS Complete |
$178.60
|
| Rate for Payer: Cash Price |
$306.05
|
| Rate for Payer: Cash Price |
$278.02
|
| Rate for Payer: Cash Price |
$158.84
|
| Rate for Payer: Cash Price |
$204.44
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cash Price |
$323.71
|
| Rate for Payer: Cash Price |
$357.20
|
| Rate for Payer: Cash Price |
$398.98
|
| Rate for Payer: Cash Price |
$3.99
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cofinity Commercial |
$347.99
|
| Rate for Payer: Cofinity Commercial |
$283.25
|
| Rate for Payer: Cofinity Commercial |
$3.49
|
| Rate for Payer: Cofinity Commercial |
$298.87
|
| Rate for Payer: Cofinity Commercial |
$138.99
|
| Rate for Payer: Cofinity Commercial |
$383.99
|
| Rate for Payer: Cofinity Commercial |
$2.68
|
| Rate for Payer: Cofinity Commercial |
$3.29
|
| Rate for Payer: Cofinity Commercial |
$267.79
|
| Rate for Payer: Cofinity Commercial |
$312.55
|
| Rate for Payer: Cofinity Commercial |
$329.00
|
| Rate for Payer: Cofinity Commercial |
$219.77
|
| Rate for Payer: Cofinity Commercial |
$454.08
|
| Rate for Payer: Cofinity Commercial |
$369.60
|
| Rate for Payer: Cofinity Commercial |
$170.75
|
| Rate for Payer: Cofinity Commercial |
$4.29
|
| Rate for Payer: Cofinity Commercial |
$178.88
|
| Rate for Payer: Cofinity Commercial |
$243.26
|
| Rate for Payer: Cofinity Commercial |
$428.90
|
| Rate for Payer: Cofinity Commercial |
$349.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$369.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$349.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$283.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$312.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$243.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$138.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$267.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$422.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.98
|
| Rate for Payer: Healthscope Commercial |
$3.45
|
| Rate for Payer: Healthscope Commercial |
$401.85
|
| Rate for Payer: Healthscope Commercial |
$448.85
|
| Rate for Payer: Healthscope Commercial |
$364.18
|
| Rate for Payer: Healthscope Commercial |
$344.30
|
| Rate for Payer: Healthscope Commercial |
$4.49
|
| Rate for Payer: Healthscope Commercial |
$475.20
|
| Rate for Payer: Healthscope Commercial |
$230.00
|
| Rate for Payer: Healthscope Commercial |
$178.69
|
| Rate for Payer: Healthscope Commercial |
$312.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$369.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$312.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$349.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$267.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$283.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$138.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$243.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$334.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$396.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$374.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$286.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$260.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$448.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.52
|
| Rate for Payer: PHP Commercial |
$448.80
|
| Rate for Payer: PHP Commercial |
$217.22
|
| Rate for Payer: PHP Commercial |
$168.77
|
| Rate for Payer: PHP Commercial |
$379.52
|
| Rate for Payer: PHP Commercial |
$4.24
|
| Rate for Payer: PHP Commercial |
$295.39
|
| Rate for Payer: PHP Commercial |
$423.91
|
| Rate for Payer: PHP Commercial |
$3.26
|
| Rate for Payer: PHP Commercial |
$325.18
|
| Rate for Payer: PHP Commercial |
$343.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$263.02
|
| Rate for Payer: Priority Health SBD |
$2.41
|
| Rate for Payer: Priority Health SBD |
$241.01
|
| Rate for Payer: Priority Health SBD |
$254.92
|
| Rate for Payer: Priority Health SBD |
$281.30
|
| Rate for Payer: Priority Health SBD |
$332.64
|
| Rate for Payer: Priority Health SBD |
$314.19
|
| Rate for Payer: Priority Health SBD |
$3.14
|
| Rate for Payer: Priority Health SBD |
$218.94
|
| Rate for Payer: Priority Health SBD |
$125.09
|
| Rate for Payer: Priority Health SBD |
$161.00
|
| Rate for Payer: UMR Bronson Commercial |
$149.72
|
| Rate for Payer: UMR Bronson Commercial |
$141.55
|
| Rate for Payer: UMR Bronson Commercial |
$165.21
|
| Rate for Payer: UMR Bronson Commercial |
$184.53
|
| Rate for Payer: UMR Bronson Commercial |
$1.42
|
| Rate for Payer: UMR Bronson Commercial |
$94.55
|
| Rate for Payer: UMR Bronson Commercial |
$195.36
|
| Rate for Payer: UMR Bronson Commercial |
$73.46
|
| Rate for Payer: UMR Bronson Commercial |
$128.58
|
| Rate for Payer: UMR Bronson Commercial |
$1.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$286.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$396.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$260.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$374.04
|
|
|
MYCOPHENOLATE MOFETIL 500 MG TABLET
|
Facility
|
IP
|
$382.56
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
21374
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$168.33 |
| Max. Negotiated Rate |
$344.30 |
| Rate for Payer: Aetna American Axle |
$248.66
|
| Rate for Payer: Aetna American Axle |
$166.11
|
| Rate for Payer: Aetna American Axle |
$225.89
|
| Rate for Payer: Aetna American Axle |
$263.02
|
| Rate for Payer: Aetna American Axle |
$324.17
|
| Rate for Payer: Aetna American Axle |
$3.24
|
| Rate for Payer: Aetna American Axle |
$290.23
|
| Rate for Payer: Aetna American Axle |
$2.49
|
| Rate for Payer: Aetna American Axle |
$343.20
|
| Rate for Payer: Aetna American Axle |
$129.06
|
| Rate for Payer: Aetna Commercial |
$325.18
|
| Rate for Payer: Aetna Commercial |
$343.94
|
| Rate for Payer: Aetna Commercial |
$3.26
|
| Rate for Payer: Aetna Commercial |
$295.39
|
| Rate for Payer: Aetna Commercial |
$217.22
|
| Rate for Payer: Aetna Commercial |
$168.77
|
| Rate for Payer: Aetna Commercial |
$448.80
|
| Rate for Payer: Aetna Commercial |
$4.24
|
| Rate for Payer: Aetna Commercial |
$423.91
|
| Rate for Payer: Aetna Commercial |
$379.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$343.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.66
|
| Rate for Payer: Cash Price |
$204.44
|
| Rate for Payer: Cash Price |
$323.71
|
| Rate for Payer: Cash Price |
$398.98
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cash Price |
$278.02
|
| Rate for Payer: Cash Price |
$357.20
|
| Rate for Payer: Cash Price |
$158.84
|
| Rate for Payer: Cash Price |
$3.99
|
| Rate for Payer: Cash Price |
$306.05
|
| Rate for Payer: Cofinity Commercial |
$219.77
|
| Rate for Payer: Cofinity Commercial |
$138.99
|
| Rate for Payer: Cofinity Commercial |
$329.00
|
| Rate for Payer: Cofinity Commercial |
$267.79
|
| Rate for Payer: Cofinity Commercial |
$243.26
|
| Rate for Payer: Cofinity Commercial |
$178.88
|
| Rate for Payer: Cofinity Commercial |
$298.87
|
| Rate for Payer: Cofinity Commercial |
$170.75
|
| Rate for Payer: Cofinity Commercial |
$2.68
|
| Rate for Payer: Cofinity Commercial |
$3.29
|
| Rate for Payer: Cofinity Commercial |
$283.25
|
| Rate for Payer: Cofinity Commercial |
$347.99
|
| Rate for Payer: Cofinity Commercial |
$312.55
|
| Rate for Payer: Cofinity Commercial |
$383.99
|
| Rate for Payer: Cofinity Commercial |
$349.10
|
| Rate for Payer: Cofinity Commercial |
$428.90
|
| Rate for Payer: Cofinity Commercial |
$3.49
|
| Rate for Payer: Cofinity Commercial |
$4.29
|
| Rate for Payer: Cofinity Commercial |
$369.60
|
| Rate for Payer: Cofinity Commercial |
$454.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$138.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$312.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$349.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$369.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$283.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$243.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$267.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$422.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.71
|
| Rate for Payer: Healthscope Commercial |
$178.69
|
| Rate for Payer: Healthscope Commercial |
$230.00
|
| Rate for Payer: Healthscope Commercial |
$312.77
|
| Rate for Payer: Healthscope Commercial |
$344.30
|
| Rate for Payer: Healthscope Commercial |
$401.85
|
| Rate for Payer: Healthscope Commercial |
$475.20
|
| Rate for Payer: Healthscope Commercial |
$4.49
|
| Rate for Payer: Healthscope Commercial |
$3.45
|
| Rate for Payer: Healthscope Commercial |
$364.18
|
| Rate for Payer: Healthscope Commercial |
$448.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$243.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$283.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$267.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$138.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$369.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$312.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$349.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$334.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$374.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$396.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$260.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$286.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$448.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.24
|
| Rate for Payer: PHP Commercial |
$4.24
|
| Rate for Payer: PHP Commercial |
$325.18
|
| Rate for Payer: PHP Commercial |
$3.26
|
| Rate for Payer: PHP Commercial |
$217.22
|
| Rate for Payer: PHP Commercial |
$448.80
|
| Rate for Payer: PHP Commercial |
$423.91
|
| Rate for Payer: PHP Commercial |
$168.77
|
| Rate for Payer: PHP Commercial |
$295.39
|
| Rate for Payer: PHP Commercial |
$379.52
|
| Rate for Payer: PHP Commercial |
$343.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$263.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.06
|
| Rate for Payer: Priority Health SBD |
$281.30
|
| Rate for Payer: Priority Health SBD |
$125.09
|
| Rate for Payer: Priority Health SBD |
$161.00
|
| Rate for Payer: Priority Health SBD |
$2.41
|
| Rate for Payer: Priority Health SBD |
$218.94
|
| Rate for Payer: Priority Health SBD |
$314.19
|
| Rate for Payer: Priority Health SBD |
$332.64
|
| Rate for Payer: Priority Health SBD |
$241.01
|
| Rate for Payer: Priority Health SBD |
$3.14
|
| Rate for Payer: Priority Health SBD |
$254.92
|
| Rate for Payer: UMR Bronson Commercial |
$168.33
|
| Rate for Payer: UMR Bronson Commercial |
$2.20
|
| Rate for Payer: UMR Bronson Commercial |
$87.36
|
| Rate for Payer: UMR Bronson Commercial |
$232.32
|
| Rate for Payer: UMR Bronson Commercial |
$219.44
|
| Rate for Payer: UMR Bronson Commercial |
$1.69
|
| Rate for Payer: UMR Bronson Commercial |
$196.46
|
| Rate for Payer: UMR Bronson Commercial |
$178.04
|
| Rate for Payer: UMR Bronson Commercial |
$152.91
|
| Rate for Payer: UMR Bronson Commercial |
$112.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$396.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$260.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$286.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$374.04
|
|
|
MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$1,329.78
|
|
|
Service Code
|
HCPCS J7518
|
| Hospital Charge Code |
38062
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$585.10 |
| Max. Negotiated Rate |
$1,196.80 |
| Rate for Payer: Aetna American Axle |
$864.36
|
| Rate for Payer: Aetna American Axle |
$183.77
|
| Rate for Payer: Aetna American Axle |
$1,821.36
|
| Rate for Payer: Aetna American Axle |
$911.50
|
| Rate for Payer: Aetna American Axle |
$9.12
|
| Rate for Payer: Aetna American Axle |
$315.28
|
| Rate for Payer: Aetna Commercial |
$1,130.31
|
| Rate for Payer: Aetna Commercial |
$1,191.95
|
| Rate for Payer: Aetna Commercial |
$2,381.78
|
| Rate for Payer: Aetna Commercial |
$412.28
|
| Rate for Payer: Aetna Commercial |
$240.31
|
| Rate for Payer: Aetna Commercial |
$11.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$864.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$911.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,821.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.77
|
| Rate for Payer: Cash Price |
$226.18
|
| Rate for Payer: Cash Price |
$2,241.67
|
| 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: Cash Price |
$388.03
|
| Rate for Payer: Cofinity Commercial |
$243.14
|
| Rate for Payer: Cofinity Commercial |
$1,143.61
|
| Rate for Payer: Cofinity Commercial |
$2,409.80
|
| Rate for Payer: Cofinity Commercial |
$1,961.46
|
| Rate for Payer: Cofinity Commercial |
$12.07
|
| Rate for Payer: Cofinity Commercial |
$1,205.98
|
| Rate for Payer: Cofinity Commercial |
$981.61
|
| Rate for Payer: Cofinity Commercial |
$9.82
|
| Rate for Payer: Cofinity Commercial |
$930.85
|
| Rate for Payer: Cofinity Commercial |
$417.13
|
| Rate for Payer: Cofinity Commercial |
$339.53
|
| Rate for Payer: Cofinity Commercial |
$197.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,961.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$981.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$339.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$197.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$930.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.82
|
| 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 |
$11.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,241.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,121.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.03
|
| Rate for Payer: Healthscope Commercial |
$2,521.88
|
| Rate for Payer: Healthscope Commercial |
$436.54
|
| 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 |
$1,196.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$197.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$930.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$981.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,961.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$339.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$212.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$363.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,051.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$997.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,101.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,381.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,130.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,191.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.93
|
| Rate for Payer: PHP Commercial |
$1,130.31
|
| Rate for Payer: PHP Commercial |
$1,191.95
|
| Rate for Payer: PHP Commercial |
$2,381.78
|
| Rate for Payer: PHP Commercial |
$240.31
|
| Rate for Payer: PHP Commercial |
$11.93
|
| Rate for Payer: PHP Commercial |
$412.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$911.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$864.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,821.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.28
|
| Rate for Payer: Priority Health SBD |
$178.11
|
| Rate for Payer: Priority Health SBD |
$1,765.32
|
| Rate for Payer: Priority Health SBD |
$837.76
|
| Rate for Payer: Priority Health SBD |
$883.45
|
| Rate for Payer: Priority Health SBD |
$8.84
|
| Rate for Payer: Priority Health SBD |
$305.58
|
| Rate for Payer: UMR Bronson Commercial |
$213.42
|
| Rate for Payer: UMR Bronson Commercial |
$617.01
|
| Rate for Payer: UMR Bronson Commercial |
$6.17
|
| Rate for Payer: UMR Bronson Commercial |
$124.40
|
| Rate for Payer: UMR Bronson Commercial |
$1,232.92
|
| 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 |
$2,101.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$212.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$363.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$997.34
|
|
