|
MYCOPHENOLATE MOFETIL 250 MG CAPSULE
|
Facility
|
OP
|
$445.55
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
15113
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$401.00 |
| Rate for Payer: Aetna American Axle |
$289.61
|
| Rate for Payer: Aetna American Axle |
$2.96
|
| Rate for Payer: Aetna American Axle |
$240.82
|
| Rate for Payer: Aetna American Axle |
$261.14
|
| Rate for Payer: Aetna American Axle |
$2.90
|
| Rate for Payer: Aetna American Axle |
$186.58
|
| Rate for Payer: Aetna American Axle |
$206.24
|
| Rate for Payer: Aetna American Axle |
$262.73
|
| Rate for Payer: Aetna American Axle |
$295.16
|
| Rate for Payer: Aetna Commercial |
$343.57
|
| Rate for Payer: Aetna Commercial |
$385.98
|
| Rate for Payer: Aetna Commercial |
$341.50
|
| 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 |
$314.92
|
| Rate for Payer: Aetna Commercial |
$243.98
|
| Rate for Payer: Aetna Commercial |
$269.70
|
| Rate for Payer: Aetna Medicare |
$2.23
|
| Rate for Payer: Aetna Medicare |
$200.88
|
| Rate for Payer: Aetna Medicare |
$158.65
|
| Rate for Payer: Aetna Medicare |
$143.52
|
| Rate for Payer: Aetna Medicare |
$202.10
|
| Rate for Payer: Aetna Medicare |
$185.25
|
| Rate for Payer: Aetna Medicare |
$2.28
|
| Rate for Payer: Aetna Medicare |
$222.78
|
| Rate for Payer: Aetna Medicare |
$227.05
|
| 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) |
$289.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$295.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.58
|
| Rate for Payer: BCBS Complete |
$178.22
|
| Rate for Payer: BCBS Complete |
$160.70
|
| Rate for Payer: BCBS Complete |
$1.78
|
| 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 |
$148.20
|
| Rate for Payer: BCBS Complete |
$114.82
|
| Rate for Payer: BCBS Complete |
$126.92
|
| 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: Cash Price |
$321.41
|
| Rate for Payer: Cash Price |
$356.44
|
| Rate for Payer: Cash Price |
$253.84
|
| 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 |
$229.63
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cash Price |
$3.64
|
| Rate for Payer: Cash Price |
$3.64
|
| Rate for Payer: Cash Price |
$363.28
|
| Rate for Payer: Cash Price |
$363.28
|
| Rate for Payer: Cash Price |
$3.57
|
| Rate for Payer: Cash Price |
$321.41
|
| Rate for Payer: Cash Price |
$3.57
|
| Rate for Payer: Cash Price |
$356.44
|
| Rate for Payer: Cash Price |
$323.36
|
| Rate for Payer: Cash Price |
$323.36
|
| Rate for Payer: Cofinity Commercial |
$383.17
|
| Rate for Payer: Cofinity Commercial |
$311.88
|
| Rate for Payer: Cofinity Commercial |
$347.61
|
| Rate for Payer: Cofinity Commercial |
$3.84
|
| Rate for Payer: Cofinity Commercial |
$317.87
|
| Rate for Payer: Cofinity Commercial |
$390.53
|
| Rate for Payer: Cofinity Commercial |
$3.18
|
| Rate for Payer: Cofinity Commercial |
$3.91
|
| Rate for Payer: Cofinity Commercial |
$318.63
|
| Rate for Payer: Cofinity Commercial |
$282.94
|
| Rate for Payer: Cofinity Commercial |
$259.35
|
| Rate for Payer: Cofinity Commercial |
$222.11
|
| Rate for Payer: Cofinity Commercial |
$246.85
|
| Rate for Payer: Cofinity Commercial |
$200.93
|
| Rate for Payer: Cofinity Commercial |
$345.51
|
| Rate for Payer: Cofinity Commercial |
$272.88
|
| Rate for Payer: Cofinity Commercial |
$281.23
|
| Rate for Payer: Cofinity Commercial |
$3.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$282.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$259.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$222.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$281.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$311.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$317.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.64
|
| 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 |
$363.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.63
|
| Rate for Payer: Healthscope Commercial |
$4.01
|
| Rate for Payer: Healthscope Commercial |
$4.10
|
| Rate for Payer: Healthscope Commercial |
$401.00
|
| Rate for Payer: Healthscope Commercial |
$361.58
|
| Rate for Payer: Healthscope Commercial |
$408.69
|
| Rate for Payer: Healthscope Commercial |
$285.57
|
| Rate for Payer: Healthscope Commercial |
$333.45
|
| Rate for Payer: Healthscope Commercial |
$258.34
|
| Rate for Payer: Healthscope Commercial |
$363.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$259.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$222.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$311.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$281.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.18
|
| 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: Lakeland Regional Health Systems Commercial |
$3.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$334.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$340.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$237.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$277.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.87
|
| 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 |
$243.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$385.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$269.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.79
|
| Rate for Payer: PHP Commercial |
$341.50
|
| Rate for Payer: PHP Commercial |
$3.87
|
| Rate for Payer: PHP Commercial |
$3.79
|
| Rate for Payer: PHP Commercial |
$343.57
|
| Rate for Payer: PHP Commercial |
$385.98
|
| Rate for Payer: PHP Commercial |
$269.70
|
| Rate for Payer: PHP Commercial |
$243.98
|
| Rate for Payer: PHP Commercial |
$314.92
|
| Rate for Payer: PHP Commercial |
$378.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$295.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.82
|
| 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 Cigna Priority Health |
$289.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.58
|
| Rate for Payer: Priority Health SBD |
$254.65
|
| Rate for Payer: Priority Health SBD |
$253.11
|
| Rate for Payer: Priority Health SBD |
$280.70
|
| Rate for Payer: Priority Health SBD |
$180.84
|
| Rate for Payer: Priority Health SBD |
$233.42
|
| Rate for Payer: Priority Health SBD |
$2.87
|
| Rate for Payer: Priority Health SBD |
$2.81
|
| Rate for Payer: Priority Health SBD |
$199.90
|
| Rate for Payer: Priority Health SBD |
$286.08
|
| Rate for Payer: UMR Bronson Commercial |
$168.02
|
| Rate for Payer: UMR Bronson Commercial |
$1.65
|
| Rate for Payer: UMR Bronson Commercial |
$137.08
|
| Rate for Payer: UMR Bronson Commercial |
$106.20
|
| Rate for Payer: UMR Bronson Commercial |
$164.85
|
| Rate for Payer: UMR Bronson Commercial |
$148.65
|
| Rate for Payer: UMR Bronson Commercial |
$1.68
|
| Rate for Payer: UMR Bronson Commercial |
$117.40
|
| Rate for Payer: UMR Bronson Commercial |
$149.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$340.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$237.98
|
| 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 |
$301.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.15
|
|
|
MYCOPHENOLATE MOFETIL 500 MG TABLET
|
Facility
|
OP
|
$498.72
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
21374
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$448.85 |
| Rate for Payer: Aetna Commercial |
$325.18
|
| Rate for Payer: Aetna Commercial |
$379.52
|
| Rate for Payer: Aetna Commercial |
$217.22
|
| Rate for Payer: Aetna Commercial |
$423.91
|
| Rate for Payer: Aetna Commercial |
$168.77
|
| Rate for Payer: Aetna Commercial |
$295.39
|
| Rate for Payer: Aetna Commercial |
$4.24
|
| Rate for Payer: Aetna Medicare |
$173.76
|
| Rate for Payer: Aetna Medicare |
$223.25
|
| Rate for Payer: Aetna Medicare |
$1.92
|
| Rate for Payer: Aetna Medicare |
$202.32
|
| Rate for Payer: Aetna Medicare |
$99.28
|
| Rate for Payer: Aetna Medicare |
$264.00
|
| Rate for Payer: Aetna Medicare |
$127.78
|
| Rate for Payer: Aetna Medicare |
$2.50
|
| Rate for Payer: Aetna Medicare |
$191.28
|
| Rate for Payer: Aetna Medicare |
$249.36
|
| Rate for Payer: Priority Health SBD |
$241.01
|
| Rate for Payer: UMR Bronson Commercial |
$73.46
|
| Rate for Payer: UMR Bronson Commercial |
$184.53
|
| Rate for Payer: UMR Bronson Commercial |
$141.55
|
| Rate for Payer: UMR Bronson Commercial |
$1.85
|
| Rate for Payer: UMR Bronson Commercial |
$195.36
|
| Rate for Payer: UMR Bronson Commercial |
$128.58
|
| Rate for Payer: UMR Bronson Commercial |
$165.20
|
| Rate for Payer: UMR Bronson Commercial |
$149.72
|
| Rate for Payer: UMR Bronson Commercial |
$94.55
|
| Rate for Payer: UMR Bronson Commercial |
$1.42
|
| Rate for Payer: Aetna American Axle |
$324.17
|
| Rate for Payer: Aetna American Axle |
$263.02
|
| Rate for Payer: Aetna American Axle |
$290.22
|
| Rate for Payer: Aetna American Axle |
$248.66
|
| Rate for Payer: Aetna American Axle |
$3.24
|
| Rate for Payer: Aetna American Axle |
$343.20
|
| Rate for Payer: Aetna American Axle |
$129.06
|
| Rate for Payer: Aetna American Axle |
$166.11
|
| Rate for Payer: Aetna American Axle |
$225.89
|
| Rate for Payer: Aetna American Axle |
$2.49
|
| Rate for Payer: Aetna Commercial |
$3.26
|
| Rate for Payer: Aetna Commercial |
$448.80
|
| Rate for Payer: Aetna Commercial |
$343.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.66
|
| 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) |
$3.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.06
|
| 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) |
$290.22
|
| Rate for Payer: BCBS Complete |
$79.42
|
| Rate for Payer: BCBS Complete |
$139.01
|
| Rate for Payer: BCBS Complete |
$102.22
|
| Rate for Payer: BCBS Complete |
$211.20
|
| Rate for Payer: BCBS Complete |
$153.02
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCBS Complete |
$178.60
|
| Rate for Payer: BCBS Complete |
$1.53
|
| Rate for Payer: BCBS Complete |
$199.49
|
| Rate for Payer: BCBS Complete |
$161.86
|
| 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 |
$398.98
|
| Rate for Payer: Cash Price |
$398.98
|
| Rate for Payer: Cash Price |
$3.99
|
| Rate for Payer: Cash Price |
$3.99
|
| Rate for Payer: Cash Price |
$306.05
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cash Price |
$357.20
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cash Price |
$278.02
|
| Rate for Payer: Cash Price |
$323.71
|
| Rate for Payer: Cash Price |
$158.84
|
| Rate for Payer: Cash Price |
$204.44
|
| Rate for Payer: Cash Price |
$158.84
|
| Rate for Payer: Cash Price |
$278.02
|
| Rate for Payer: Cash Price |
$204.44
|
| Rate for Payer: Cash Price |
$323.71
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cash Price |
$306.05
|
| Rate for Payer: Cash Price |
$357.20
|
| Rate for Payer: Cofinity Commercial |
$219.77
|
| Rate for Payer: Cofinity Commercial |
$138.98
|
| Rate for Payer: Cofinity Commercial |
$170.75
|
| Rate for Payer: Cofinity Commercial |
$178.88
|
| Rate for Payer: Cofinity Commercial |
$243.26
|
| Rate for Payer: Cofinity Commercial |
$298.87
|
| Rate for Payer: Cofinity Commercial |
$267.79
|
| Rate for Payer: Cofinity Commercial |
$329.00
|
| 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 |
$243.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$283.25
|
| 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 |
$178.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$138.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$267.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$422.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.02
|
| Rate for Payer: Healthscope Commercial |
$312.77
|
| Rate for Payer: Healthscope Commercial |
$230.00
|
| Rate for Payer: Healthscope Commercial |
$344.30
|
| Rate for Payer: Healthscope Commercial |
$178.70
|
| Rate for Payer: Healthscope Commercial |
$3.45
|
| Rate for Payer: Healthscope Commercial |
$364.18
|
| Rate for Payer: Healthscope Commercial |
$4.49
|
| Rate for Payer: Healthscope Commercial |
$475.20
|
| Rate for Payer: Healthscope Commercial |
$448.85
|
| Rate for Payer: Healthscope Commercial |
$401.85
|
| 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 |
$283.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.49
|
| 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 |
$138.98
|
| 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 |
$303.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$286.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.87
|
| 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 |
$260.64
|
| 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 |
$3.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.18
|
| 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 |
$423.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.26
|
| Rate for Payer: PHP Commercial |
$379.52
|
| Rate for Payer: PHP Commercial |
$325.18
|
| Rate for Payer: PHP Commercial |
$4.24
|
| Rate for Payer: PHP Commercial |
$3.26
|
| Rate for Payer: PHP Commercial |
$343.94
|
| Rate for Payer: PHP Commercial |
$423.91
|
| Rate for Payer: PHP Commercial |
$217.22
|
| Rate for Payer: PHP Commercial |
$168.77
|
| Rate for Payer: PHP Commercial |
$295.39
|
| Rate for Payer: PHP Commercial |
$448.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$263.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.89
|
| Rate for Payer: Priority Health SBD |
$3.14
|
| Rate for Payer: Priority Health SBD |
$314.19
|
| Rate for Payer: Priority Health SBD |
$2.41
|
| Rate for Payer: Priority Health SBD |
$161.00
|
| Rate for Payer: Priority Health SBD |
$218.94
|
| Rate for Payer: Priority Health SBD |
$125.09
|
| Rate for Payer: Priority Health SBD |
$332.64
|
| Rate for Payer: Priority Health SBD |
$281.30
|
| Rate for Payer: Priority Health SBD |
$254.92
|
| 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 |
$303.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$374.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$396.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$286.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.66
|
|
|
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 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 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 |
$290.22
|
| 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 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) |
$290.22
|
| 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 |
$138.98
|
| 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 |
$138.98
|
| 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 |
$178.70
|
| 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 |
$138.98
|
| 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 |
$290.22
|
| 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 |
$1,191.96
|
| 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 |
$1,191.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.93
|
| Rate for Payer: PHP Commercial |
$1,130.31
|
| Rate for Payer: PHP Commercial |
$1,191.96
|
| 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
|
|
|
MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$485.04
|
|
|
Service Code
|
HCPCS J7518
|
| Hospital Charge Code |
38062
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$436.54 |
| Rate for Payer: Aetna American Axle |
$315.28
|
| Rate for Payer: Aetna American Axle |
$911.50
|
| Rate for Payer: Aetna American Axle |
$864.36
|
| Rate for Payer: Aetna American Axle |
$9.12
|
| Rate for Payer: Aetna American Axle |
$1,821.36
|
| Rate for Payer: Aetna American Axle |
$183.77
|
| Rate for Payer: Aetna Commercial |
$11.93
|
| Rate for Payer: Aetna Commercial |
$240.31
|
| Rate for Payer: Aetna Commercial |
$1,191.96
|
| Rate for Payer: Aetna Commercial |
$1,130.31
|
| Rate for Payer: Aetna Commercial |
$412.28
|
| Rate for Payer: Aetna Commercial |
$2,381.78
|
| Rate for Payer: Aetna Medicare |
$242.52
|
| Rate for Payer: Aetna Medicare |
$1,401.04
|
| Rate for Payer: Aetna Medicare |
$701.15
|
| Rate for Payer: Aetna Medicare |
$141.36
|
| Rate for Payer: Aetna Medicare |
$7.02
|
| Rate for Payer: Aetna Medicare |
$664.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$864.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.12
|
| 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) |
$183.77
|
| Rate for Payer: BCBS Complete |
$113.09
|
| Rate for Payer: BCBS Complete |
$1,120.84
|
| Rate for Payer: BCBS Complete |
$531.91
|
| Rate for Payer: BCBS Complete |
$5.61
|
| Rate for Payer: BCBS Complete |
$560.92
|
| Rate for Payer: BCBS Complete |
$194.02
|
| Rate for Payer: BCBS Trust/PPO |
$1.19
|
| Rate for Payer: BCBS Trust/PPO |
$1.19
|
| Rate for Payer: BCBS Trust/PPO |
$1.19
|
| Rate for Payer: BCBS Trust/PPO |
$1.19
|
| Rate for Payer: BCBS Trust/PPO |
$1.19
|
| Rate for Payer: BCBS Trust/PPO |
$1.19
|
| Rate for Payer: BCN Commercial |
$1.19
|
| Rate for Payer: BCN Commercial |
$1.19
|
| Rate for Payer: BCN Commercial |
$1.19
|
| Rate for Payer: BCN Commercial |
$1.19
|
| Rate for Payer: BCN Commercial |
$1.19
|
| Rate for Payer: BCN Commercial |
$1.19
|
| Rate for Payer: Cash Price |
$388.03
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Cash Price |
$226.18
|
| Rate for Payer: Cash Price |
$1,121.84
|
| Rate for Payer: Cash Price |
$1,063.82
|
| Rate for Payer: Cash Price |
$1,121.84
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Cash Price |
$226.18
|
| Rate for Payer: Cash Price |
$388.03
|
| Rate for Payer: Cash Price |
$2,241.67
|
| Rate for Payer: Cash Price |
$2,241.67
|
| Rate for Payer: Cash Price |
$1,063.82
|
| Rate for Payer: Cofinity Commercial |
$12.07
|
| Rate for Payer: Cofinity Commercial |
$339.53
|
| Rate for Payer: Cofinity Commercial |
$1,205.98
|
| Rate for Payer: Cofinity Commercial |
$930.85
|
| Rate for Payer: Cofinity Commercial |
$1,143.61
|
| Rate for Payer: Cofinity Commercial |
$981.61
|
| Rate for Payer: Cofinity Commercial |
$243.14
|
| Rate for Payer: Cofinity Commercial |
$197.90
|
| Rate for Payer: Cofinity Commercial |
$2,409.80
|
| Rate for Payer: Cofinity Commercial |
$1,961.46
|
| Rate for Payer: Cofinity Commercial |
$9.82
|
| Rate for Payer: Cofinity Commercial |
$417.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$197.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$930.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$981.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,961.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$339.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,241.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.22
|
| 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 |
$1,121.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.03
|
| Rate for Payer: Healthscope Commercial |
$254.45
|
| Rate for Payer: Healthscope Commercial |
$436.54
|
| Rate for Payer: Healthscope Commercial |
$2,521.88
|
| Rate for Payer: Healthscope Commercial |
$12.63
|
| Rate for Payer: Healthscope Commercial |
$1,262.07
|
| Rate for Payer: Healthscope Commercial |
$1,196.80
|
| 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 |
$9.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,961.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$339.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$197.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$363.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.52
|
| 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 |
$997.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,101.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,130.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,191.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,381.78
|
| Rate for Payer: PHP Commercial |
$11.93
|
| Rate for Payer: PHP Commercial |
$2,381.78
|
| Rate for Payer: PHP Commercial |
$1,191.96
|
| Rate for Payer: PHP Commercial |
$1,130.31
|
| Rate for Payer: PHP Commercial |
$240.31
|
| Rate for Payer: PHP Commercial |
$412.28
|
| 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 Cigna Priority Health |
$183.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,821.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$864.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$911.50
|
| Rate for Payer: Priority Health SBD |
$178.11
|
| Rate for Payer: Priority Health SBD |
$883.45
|
| Rate for Payer: Priority Health SBD |
$8.84
|
| Rate for Payer: Priority Health SBD |
$1,765.32
|
| Rate for Payer: Priority Health SBD |
$837.76
|
| Rate for Payer: Priority Health SBD |
$305.58
|
| Rate for Payer: UMR Bronson Commercial |
$104.61
|
| Rate for Payer: UMR Bronson Commercial |
$179.46
|
| Rate for Payer: UMR Bronson Commercial |
$5.19
|
| Rate for Payer: UMR Bronson Commercial |
$492.02
|
| Rate for Payer: UMR Bronson Commercial |
$518.85
|
| Rate for Payer: UMR Bronson Commercial |
$1,036.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$997.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$363.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,051.72
|
| 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 |
$2,101.57
|
|
|
MYOMECTOMY, EXCISION OF FIBROID TUMOR(S) OF UTERUS, 1 TO 4 INTRAMURAL MYOMA(S) WITH TOTAL WEIGHT OF 250 G OR LESS AND/OR REMOVAL OF SURFACE MYOMAS; VAGINAL APPROACH
|
Facility
|
OP
|
$9,791.14
|
|
|
Service Code
|
CPT 58145
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.68 |
| Max. Negotiated Rate |
$9,791.14 |
| Rate for Payer: Aetna Medicare |
$3,239.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,894.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,894.05
|
| Rate for Payer: BCBS Complete |
$1,753.26
|
| Rate for Payer: BCBS MAPPO |
$3,115.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,145.13
|
| Rate for Payer: BCN Commercial |
$2,145.13
|
| Rate for Payer: BCN Medicare Advantage |
$3,115.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,115.24
|
| Rate for Payer: Mclaren Medicaid |
$1,669.77
|
| Rate for Payer: Mclaren Medicare |
$3,115.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,271.00
|
| Rate for Payer: Meridian Medicaid |
$1,753.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,582.53
|
| Rate for Payer: Nomi Health Commercial |
$6,542.00
|
| Rate for Payer: PACE Medicare |
$2,959.48
|
| Rate for Payer: PACE SWMI |
$3,115.24
|
| Rate for Payer: PHP Medicare Advantage |
$3,115.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,669.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,791.14
|
| Rate for Payer: Priority Health Medicare |
$3,115.24
|
| Rate for Payer: Priority Health Narrow Network |
$7,832.91
|
| Rate for Payer: Railroad Medicare Medicare |
$3,115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$607.95
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Exchange |
$552.68
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.24
|
| Rate for Payer: UHCCP Medicaid |
$1,669.77
|
| Rate for Payer: VA VA |
$3,115.24
|
|
|
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
|
$5,042.00
|
|
|
Service Code
|
CPT 58146
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,125.46 |
| Max. Negotiated Rate |
$5,042.00 |
| Rate for Payer: BCBS Trust/PPO |
$4,142.93
|
| Rate for Payer: BCN Commercial |
$4,142.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,238.01
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Exchange |
$1,125.46
|
|
|
MYRINGOPLASTY (SURGERY CONFINED TO DRUMHEAD AND DONOR AREA)
|
Facility
|
OP
|
$9,986.81
|
|
|
Service Code
|
CPT 69620
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$471.76 |
| Max. Negotiated Rate |
$9,986.81 |
| Rate for Payer: Aetna Medicare |
$3,304.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,971.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,971.88
|
| Rate for Payer: BCBS Complete |
$1,788.30
|
| Rate for Payer: BCBS MAPPO |
$3,177.50
|
| Rate for Payer: BCBS Trust/PPO |
$2,744.13
|
| Rate for Payer: BCN Commercial |
$2,744.13
|
| Rate for Payer: BCN Medicare Advantage |
$3,177.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,177.50
|
| Rate for Payer: Mclaren Medicaid |
$1,703.14
|
| Rate for Payer: Mclaren Medicare |
$3,177.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,336.38
|
| Rate for Payer: Meridian Medicaid |
$1,788.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,654.12
|
| Rate for Payer: Nomi Health Commercial |
$6,672.75
|
| Rate for Payer: PACE Medicare |
$3,018.62
|
| Rate for Payer: PACE SWMI |
$3,177.50
|
| Rate for Payer: PHP Medicare Advantage |
$3,177.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,986.81
|
| Rate for Payer: Priority Health Medicare |
$3,177.50
|
| Rate for Payer: Priority Health Narrow Network |
$7,989.45
|
| Rate for Payer: Railroad Medicare Medicare |
$3,177.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$518.94
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,177.50
|
| Rate for Payer: UHC Exchange |
$471.76
|
| Rate for Payer: UHC Medicare Advantage |
$3,177.50
|
| Rate for Payer: UHCCP Medicaid |
$1,703.14
|
| Rate for Payer: VA VA |
$3,177.50
|
|
|
MYRINGOTOMY INCLUDING ASPIRATION AND/OR EUSTACHIAN TUBE INFLATION
|
Facility
|
OP
|
$715.11
|
|
|
Service Code
|
CPT 69420
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$114.92 |
| Max. Negotiated Rate |
$715.11 |
| Rate for Payer: Aetna Medicare |
$236.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$284.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$284.40
|
| Rate for Payer: BCBS Complete |
$128.05
|
| Rate for Payer: BCBS MAPPO |
$227.52
|
| Rate for Payer: BCBS Trust/PPO |
$126.71
|
| Rate for Payer: BCN Commercial |
$126.71
|
| Rate for Payer: BCN Medicare Advantage |
$227.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$227.52
|
| Rate for Payer: Mclaren Medicaid |
$121.95
|
| Rate for Payer: Mclaren Medicare |
$227.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$238.90
|
| Rate for Payer: Meridian Medicaid |
$128.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$261.65
|
| Rate for Payer: Nomi Health Commercial |
$477.79
|
| Rate for Payer: PACE Medicare |
$216.14
|
| Rate for Payer: PACE SWMI |
$227.52
|
| Rate for Payer: PHP Medicare Advantage |
$227.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$715.11
|
| Rate for Payer: Priority Health Medicare |
$227.52
|
| Rate for Payer: Priority Health Narrow Network |
$572.09
|
| Rate for Payer: Railroad Medicare Medicare |
$227.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.41
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$227.52
|
| Rate for Payer: UHC Exchange |
$114.92
|
| Rate for Payer: UHC Medicare Advantage |
$227.52
|
| Rate for Payer: UHCCP Medicaid |
$121.95
|
| Rate for Payer: VA VA |
$227.52
|
|
|
MYRINGOTOMY INCLUDING ASPIRATION AND/OR EUSTACHIAN TUBE INFLATION REQUIRING GENERAL ANESTHESIA
|
Facility
|
OP
|
$9,986.81
|
|
|
Service Code
|
CPT 69421
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$144.25 |
| Max. Negotiated Rate |
$9,986.81 |
| Rate for Payer: Aetna Medicare |
$3,304.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,971.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,971.88
|
| Rate for Payer: BCBS Complete |
$1,788.30
|
| Rate for Payer: BCBS MAPPO |
$3,177.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,464.71
|
| Rate for Payer: BCN Commercial |
$1,464.71
|
| Rate for Payer: BCN Medicare Advantage |
$3,177.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,177.50
|
| Rate for Payer: Mclaren Medicaid |
$1,703.14
|
| Rate for Payer: Mclaren Medicare |
$3,177.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,336.38
|
| Rate for Payer: Meridian Medicaid |
$1,788.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,654.12
|
| Rate for Payer: Nomi Health Commercial |
$6,672.75
|
| Rate for Payer: PACE Medicare |
$3,018.62
|
| Rate for Payer: PACE SWMI |
$3,177.50
|
| Rate for Payer: PHP Medicare Advantage |
$3,177.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,986.81
|
| Rate for Payer: Priority Health Medicare |
$3,177.50
|
| Rate for Payer: Priority Health Narrow Network |
$7,989.45
|
| Rate for Payer: Railroad Medicare Medicare |
$3,177.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.68
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,177.50
|
| Rate for Payer: UHC Exchange |
$144.25
|
| Rate for Payer: UHC Medicare Advantage |
$3,177.50
|
| Rate for Payer: UHCCP Medicaid |
$1,703.14
|
| Rate for Payer: VA VA |
$3,177.50
|
|
|
NADOLOL 40 MG TABLET
|
Facility
|
OP
|
$199.50
|
|
|
Service Code
|
NDC 69097086807
|
| Hospital Charge Code |
5331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.82 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Aetna American Axle |
$129.68
|
| Rate for Payer: Aetna Commercial |
$169.58
|
| 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 Commercial |
$139.65
|
| Rate for Payer: Cofinity Commercial |
$171.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.65
|
| 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 |
$169.58
|
| Rate for Payer: PHP Commercial |
$169.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.68
|
| Rate for Payer: Priority Health SBD |
$125.68
|
| Rate for Payer: UMR Bronson Commercial |
$73.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.62
|
|
|
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 Commercial |
$1,050.38
|
| Rate for Payer: Cofinity Commercial |
$854.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$854.96
|
| 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: PHP Commercial |
$1,038.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$793.89
|
| Rate for Payer: Priority Health SBD |
$769.46
|
| Rate for Payer: UMR Bronson Commercial |
$451.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$916.03
|
|
|
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 |
$169.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.68
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cofinity Commercial |
$139.65
|
| Rate for Payer: Cofinity Commercial |
$171.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.65
|
| 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 |
$169.58
|
| Rate for Payer: PHP Commercial |
$169.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.68
|
| Rate for Payer: Priority Health SBD |
$125.68
|
| Rate for Payer: UMR Bronson Commercial |
$87.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.62
|
|
|
NADOLOL 40 MG TABLET
|
Facility
|
OP
|
$203.30
|
|
|
Service Code
|
NDC 76385013401
|
| Hospital Charge Code |
5331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.22 |
| Max. Negotiated Rate |
$182.97 |
| Rate for Payer: Aetna American Axle |
$132.14
|
| Rate for Payer: Aetna Commercial |
$172.80
|
| Rate for Payer: Aetna Medicare |
$101.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.14
|
| Rate for Payer: BCBS Complete |
$81.32
|
| Rate for Payer: Cash Price |
$162.64
|
| Rate for Payer: Cofinity Commercial |
$142.31
|
| Rate for Payer: Cofinity Commercial |
$174.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$142.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.64
|
| Rate for Payer: Healthscope Commercial |
$182.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.80
|
| Rate for Payer: PHP Commercial |
$172.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.14
|
| Rate for Payer: Priority Health SBD |
$128.08
|
| Rate for Payer: UMR Bronson Commercial |
$75.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.48
|
|
|
NADOLOL 40 MG TABLET
|
Facility
|
IP
|
$203.30
|
|
|
Service Code
|
NDC 76385013401
|
| Hospital Charge Code |
5331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.45 |
| Max. Negotiated Rate |
$182.97 |
| Rate for Payer: Aetna American Axle |
$132.14
|
| Rate for Payer: Aetna Commercial |
$172.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.14
|
| Rate for Payer: Cash Price |
$162.64
|
| Rate for Payer: Cofinity Commercial |
$142.31
|
| Rate for Payer: Cofinity Commercial |
$174.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$142.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.64
|
| Rate for Payer: Healthscope Commercial |
$182.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.80
|
| Rate for Payer: PHP Commercial |
$172.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.14
|
| Rate for Payer: Priority Health SBD |
$128.08
|
| Rate for Payer: UMR Bronson Commercial |
$89.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.48
|
|
|
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 Commercial |
$1,050.38
|
| Rate for Payer: Cofinity Commercial |
$854.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$854.96
|
| 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: PHP Commercial |
$1,038.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$793.89
|
| 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
|
|
|
NAFCILLIN 10 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$147.74
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
5334
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$132.97 |
| Rate for Payer: Aetna American Axle |
$96.03
|
| Rate for Payer: Aetna American Axle |
$236.06
|
| Rate for Payer: Aetna American Axle |
$96.52
|
| Rate for Payer: Aetna American Axle |
$91.32
|
| Rate for Payer: Aetna American Axle |
$303.74
|
| Rate for Payer: Aetna Commercial |
$125.58
|
| Rate for Payer: Aetna Commercial |
$119.42
|
| Rate for Payer: Aetna Commercial |
$397.20
|
| Rate for Payer: Aetna Commercial |
$126.22
|
| Rate for Payer: Aetna Commercial |
$308.69
|
| Rate for Payer: Aetna Medicare |
$74.25
|
| Rate for Payer: Aetna Medicare |
$181.58
|
| Rate for Payer: Aetna Medicare |
$73.87
|
| Rate for Payer: Aetna Medicare |
$70.24
|
| Rate for Payer: Aetna Medicare |
$233.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.06
|
| 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) |
$96.52
|
| Rate for Payer: BCBS Complete |
$59.10
|
| Rate for Payer: BCBS Complete |
$56.20
|
| Rate for Payer: BCBS Complete |
$145.27
|
| Rate for Payer: BCBS Complete |
$186.92
|
| Rate for Payer: BCBS Complete |
$59.40
|
| Rate for Payer: BCBS Trust/PPO |
$0.50
|
| Rate for Payer: BCBS Trust/PPO |
$0.50
|
| Rate for Payer: BCBS Trust/PPO |
$0.50
|
| Rate for Payer: BCBS Trust/PPO |
$0.50
|
| Rate for Payer: BCBS Trust/PPO |
$0.50
|
| Rate for Payer: BCN Commercial |
$0.50
|
| Rate for Payer: BCN Commercial |
$0.50
|
| Rate for Payer: BCN Commercial |
$0.50
|
| Rate for Payer: BCN Commercial |
$0.50
|
| Rate for Payer: BCN Commercial |
$0.50
|
| Rate for Payer: Cash Price |
$118.19
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$112.39
|
| Rate for Payer: Cash Price |
$118.19
|
| Rate for Payer: Cash Price |
$112.39
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$373.83
|
| Rate for Payer: Cash Price |
$373.83
|
| Rate for Payer: Cash Price |
$290.54
|
| Rate for Payer: Cash Price |
$290.54
|
| Rate for Payer: Cofinity Commercial |
$103.42
|
| Rate for Payer: Cofinity Commercial |
$401.87
|
| Rate for Payer: Cofinity Commercial |
$120.82
|
| Rate for Payer: Cofinity Commercial |
$127.71
|
| Rate for Payer: Cofinity Commercial |
$103.95
|
| Rate for Payer: Cofinity Commercial |
$327.10
|
| Rate for Payer: Cofinity Commercial |
$312.33
|
| Rate for Payer: Cofinity Commercial |
$254.22
|
| Rate for Payer: Cofinity Commercial |
$127.06
|
| Rate for Payer: Cofinity Commercial |
$98.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$254.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$327.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$373.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.54
|
| Rate for Payer: Healthscope Commercial |
$326.85
|
| Rate for Payer: Healthscope Commercial |
$126.44
|
| Rate for Payer: Healthscope Commercial |
$132.97
|
| Rate for Payer: Healthscope Commercial |
$133.65
|
| Rate for Payer: Healthscope Commercial |
$420.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$254.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$272.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.42
|
| Rate for Payer: PHP Commercial |
$397.20
|
| Rate for Payer: PHP Commercial |
$308.69
|
| Rate for Payer: PHP Commercial |
$125.58
|
| Rate for Payer: PHP Commercial |
$119.42
|
| Rate for Payer: PHP Commercial |
$126.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$303.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.03
|
| Rate for Payer: Priority Health SBD |
$93.08
|
| Rate for Payer: Priority Health SBD |
$294.39
|
| Rate for Payer: Priority Health SBD |
$228.80
|
| Rate for Payer: Priority Health SBD |
$88.51
|
| Rate for Payer: Priority Health SBD |
$93.56
|
| Rate for Payer: UMR Bronson Commercial |
$51.98
|
| Rate for Payer: UMR Bronson Commercial |
$54.94
|
| Rate for Payer: UMR Bronson Commercial |
$54.66
|
| Rate for Payer: UMR Bronson Commercial |
$134.37
|
| Rate for Payer: UMR Bronson Commercial |
$172.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.80
|
| 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 |
$111.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.37
|
|
|
NAFCILLIN 10 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$148.50
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
5334
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.34 |
| Max. Negotiated Rate |
$133.65 |
| Rate for Payer: Aetna American Axle |
$96.52
|
| 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 |
$126.22
|
| Rate for Payer: Aetna Commercial |
$397.20
|
| Rate for Payer: Aetna Commercial |
$125.58
|
| Rate for Payer: Aetna Commercial |
$119.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.52
|
| Rate for Payer: Cash Price |
$118.19
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$112.39
|
| Rate for Payer: Cash Price |
$373.83
|
| Rate for Payer: Cofinity Commercial |
$120.82
|
| Rate for Payer: Cofinity Commercial |
$401.87
|
| Rate for Payer: Cofinity Commercial |
$327.10
|
| Rate for Payer: Cofinity Commercial |
$103.95
|
| Rate for Payer: Cofinity Commercial |
$103.42
|
| Rate for Payer: Cofinity Commercial |
$127.06
|
| Rate for Payer: Cofinity Commercial |
$127.71
|
| Rate for Payer: Cofinity Commercial |
$98.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$327.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$373.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.19
|
| Rate for Payer: Healthscope Commercial |
$133.65
|
| Rate for Payer: Healthscope Commercial |
$126.44
|
| Rate for Payer: Healthscope Commercial |
$132.97
|
| Rate for Payer: Healthscope Commercial |
$420.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.20
|
| 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 |
$126.22
|
| Rate for Payer: PHP Commercial |
$126.22
|
| Rate for Payer: PHP Commercial |
$397.20
|
| Rate for Payer: PHP Commercial |
$119.42
|
| Rate for Payer: PHP Commercial |
$125.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$303.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.32
|
| Rate for Payer: Priority Health SBD |
$294.39
|
| Rate for Payer: Priority Health SBD |
$88.51
|
| Rate for Payer: Priority Health SBD |
$93.08
|
| Rate for Payer: Priority Health SBD |
$93.56
|
| Rate for Payer: UMR Bronson Commercial |
$65.34
|
| Rate for Payer: UMR Bronson Commercial |
$205.61
|
| Rate for Payer: UMR Bronson Commercial |
$65.01
|
| Rate for Payer: UMR Bronson Commercial |
$61.82
|
| 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 |
$110.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.38
|
|
|
NAFCILLIN 1 GRAM IVPB (INTRA-OP)
|
Facility
|
OP
|
$5.70
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
168910
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$5.13 |
| Rate for Payer: Aetna American Axle |
$3.70
|
| Rate for Payer: Aetna Commercial |
$4.84
|
| Rate for Payer: Aetna Medicare |
$2.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.70
|
| Rate for Payer: BCBS Complete |
$2.28
|
| Rate for Payer: BCBS Trust/PPO |
$0.50
|
| Rate for Payer: BCN Commercial |
$0.50
|
| Rate for Payer: Cash Price |
$4.56
|
| Rate for Payer: Cash Price |
$4.56
|
| Rate for Payer: Cofinity Commercial |
$3.99
|
| Rate for Payer: Cofinity Commercial |
$4.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.56
|
| Rate for Payer: Healthscope Commercial |
$5.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.84
|
| Rate for Payer: PHP Commercial |
$4.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.70
|
| Rate for Payer: Priority Health SBD |
$3.59
|
| Rate for Payer: UMR Bronson Commercial |
$2.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.28
|
|
|
NAFCILLIN 1 GRAM IVPB (INTRA-OP)
|
Facility
|
IP
|
$5.70
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
168910
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.51 |
| Max. Negotiated Rate |
$5.13 |
| Rate for Payer: Aetna American Axle |
$3.70
|
| Rate for Payer: Aetna Commercial |
$4.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.70
|
| Rate for Payer: Cash Price |
$4.56
|
| Rate for Payer: Cofinity Commercial |
$3.99
|
| Rate for Payer: Cofinity Commercial |
$4.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.56
|
| Rate for Payer: Healthscope Commercial |
$5.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.84
|
| Rate for Payer: PHP Commercial |
$4.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.70
|
| Rate for Payer: Priority Health SBD |
$3.59
|
| Rate for Payer: UMR Bronson Commercial |
$2.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.28
|
|
|
NAFCILLIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$129.29
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
27285
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.89 |
| Max. Negotiated Rate |
$116.36 |
| Rate for Payer: Aetna American Axle |
$84.04
|
| Rate for Payer: Aetna Commercial |
$109.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.04
|
| Rate for Payer: Cash Price |
$103.43
|
| Rate for Payer: Cofinity Commercial |
$111.19
|
| Rate for Payer: Cofinity Commercial |
$90.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$90.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.43
|
| Rate for Payer: Healthscope Commercial |
$116.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.90
|
| Rate for Payer: PHP Commercial |
$109.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.04
|
| Rate for Payer: Priority Health SBD |
$81.45
|
| Rate for Payer: UMR Bronson Commercial |
$56.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.97
|
|
|
NAFCILLIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$129.29
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
27285
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$116.36 |
| Rate for Payer: Priority Health SBD |
$81.45
|
| Rate for Payer: UMR Bronson Commercial |
$47.84
|
| Rate for Payer: Aetna American Axle |
$84.04
|
| Rate for Payer: Aetna Commercial |
$109.90
|
| Rate for Payer: Aetna Medicare |
$64.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.04
|
| Rate for Payer: BCBS Complete |
$51.72
|
| Rate for Payer: BCBS Trust/PPO |
$0.50
|
| Rate for Payer: BCN Commercial |
$0.50
|
| Rate for Payer: Cash Price |
$103.43
|
| Rate for Payer: Cash Price |
$103.43
|
| Rate for Payer: Cofinity Commercial |
$111.19
|
| Rate for Payer: Cofinity Commercial |
$90.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$90.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.43
|
| Rate for Payer: Healthscope Commercial |
$116.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.90
|
| Rate for Payer: PHP Commercial |
$109.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.97
|
|
|
NAFCILLIN 2 GRAM IVPB (INTRA-OP)
|
Facility
|
IP
|
$21.20
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
168911
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.33 |
| Max. Negotiated Rate |
$19.08 |
| Rate for Payer: Aetna American Axle |
$13.78
|
| Rate for Payer: Aetna Commercial |
$18.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.78
|
| Rate for Payer: Cash Price |
$16.96
|
| Rate for Payer: Cofinity Commercial |
$14.84
|
| Rate for Payer: Cofinity Commercial |
$18.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.96
|
| Rate for Payer: Healthscope Commercial |
$19.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.02
|
| Rate for Payer: PHP Commercial |
$18.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.78
|
| Rate for Payer: Priority Health SBD |
$13.36
|
| Rate for Payer: UMR Bronson Commercial |
$9.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.90
|
|
|
NAFCILLIN 2 GRAM IVPB (INTRA-OP)
|
Facility
|
OP
|
$21.20
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
168911
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$19.08 |
| Rate for Payer: Aetna American Axle |
$13.78
|
| Rate for Payer: Aetna Commercial |
$18.02
|
| Rate for Payer: Aetna Medicare |
$10.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.78
|
| Rate for Payer: BCBS Complete |
$8.48
|
| Rate for Payer: BCBS Trust/PPO |
$0.50
|
| Rate for Payer: BCN Commercial |
$0.50
|
| Rate for Payer: Cash Price |
$16.96
|
| Rate for Payer: Cash Price |
$16.96
|
| Rate for Payer: Cofinity Commercial |
$14.84
|
| Rate for Payer: Cofinity Commercial |
$18.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.96
|
| Rate for Payer: Healthscope Commercial |
$19.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.02
|
| Rate for Payer: PHP Commercial |
$18.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.78
|
| Rate for Payer: Priority Health SBD |
$13.36
|
| Rate for Payer: UMR Bronson Commercial |
$7.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.90
|
|
|
NAFCILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$94.39
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
5335
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$84.95 |
| Rate for Payer: Aetna American Axle |
$61.35
|
| Rate for Payer: Aetna American Axle |
$60.53
|
| Rate for Payer: Aetna American Axle |
$15.66
|
| Rate for Payer: Aetna American Axle |
$58.38
|
| Rate for Payer: Aetna Commercial |
$80.23
|
| Rate for Payer: Aetna Commercial |
$76.34
|
| Rate for Payer: Aetna Commercial |
$20.48
|
| Rate for Payer: Aetna Commercial |
$79.15
|
| Rate for Payer: Aetna Medicare |
$46.56
|
| Rate for Payer: Aetna Medicare |
$44.90
|
| Rate for Payer: Aetna Medicare |
$12.04
|
| Rate for Payer: Aetna Medicare |
$47.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.38
|
| Rate for Payer: BCBS Complete |
$37.25
|
| Rate for Payer: BCBS Complete |
$9.64
|
| Rate for Payer: BCBS Complete |
$37.76
|
| Rate for Payer: BCBS Complete |
$35.92
|
| Rate for Payer: BCBS Trust/PPO |
$0.50
|
| Rate for Payer: BCBS Trust/PPO |
$0.50
|
| Rate for Payer: BCBS Trust/PPO |
$0.50
|
| Rate for Payer: BCBS Trust/PPO |
$0.50
|
| Rate for Payer: BCN Commercial |
$0.50
|
| Rate for Payer: BCN Commercial |
$0.50
|
| Rate for Payer: BCN Commercial |
$0.50
|
| Rate for Payer: BCN Commercial |
$0.50
|
| Rate for Payer: Cash Price |
$71.85
|
| Rate for Payer: Cash Price |
$75.51
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cash Price |
$71.85
|
| Rate for Payer: Cash Price |
$19.27
|
| Rate for Payer: Cash Price |
$19.27
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cash Price |
$75.51
|
| Rate for Payer: Cofinity Commercial |
$81.18
|
| Rate for Payer: Cofinity Commercial |
$77.24
|
| Rate for Payer: Cofinity Commercial |
$16.86
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$62.87
|
| Rate for Payer: Cofinity Commercial |
$65.18
|
| Rate for Payer: Cofinity Commercial |
$80.08
|
| Rate for Payer: Cofinity Commercial |
$66.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.27
|
| Rate for Payer: Healthscope Commercial |
$21.68
|
| Rate for Payer: Healthscope Commercial |
$84.95
|
| Rate for Payer: Healthscope Commercial |
$83.81
|
| Rate for Payer: Healthscope Commercial |
$80.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.48
|
| Rate for Payer: PHP Commercial |
$80.23
|
| Rate for Payer: PHP Commercial |
$76.34
|
| Rate for Payer: PHP Commercial |
$20.48
|
| Rate for Payer: PHP Commercial |
$79.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.53
|
| Rate for Payer: Priority Health SBD |
$15.18
|
| Rate for Payer: Priority Health SBD |
$58.67
|
| Rate for Payer: Priority Health SBD |
$56.58
|
| Rate for Payer: Priority Health SBD |
$59.47
|
| Rate for Payer: UMR Bronson Commercial |
$8.91
|
| Rate for Payer: UMR Bronson Commercial |
$34.45
|
| Rate for Payer: UMR Bronson Commercial |
$34.92
|
| Rate for Payer: UMR Bronson Commercial |
$33.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.79
|
|
