|
ACETAMINOPHEN 80 MG CHEWABLE TABLET
|
Facility
|
IP
|
$48.65
|
|
|
Service Code
|
NDC 00904579146
|
| Hospital Charge Code |
99
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.86 |
| Max. Negotiated Rate |
$43.78 |
| Rate for Payer: Aetna Commercial |
$41.35
|
| Rate for Payer: BCBS Trust/PPO |
$40.18
|
| Rate for Payer: BCN Commercial |
$40.18
|
| Rate for Payer: Cash Price |
$38.92
|
| Rate for Payer: Cofinity Commercial |
$41.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.92
|
| Rate for Payer: Healthscope Commercial |
$43.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.35
|
| Rate for Payer: Nomi Health Commercial |
$39.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.49
|
| Rate for Payer: PHP Commercial |
$41.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$42.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.81
|
| Rate for Payer: UHC Core |
$40.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.49
|
|
|
ACETAZOLAMIDE 250 MG TABLET
|
Facility
|
OP
|
$309.70
|
|
|
Service Code
|
NDC 23155028801
|
| Hospital Charge Code |
113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$278.73 |
| Rate for Payer: Aetna Commercial |
$263.25
|
| Rate for Payer: Aetna Medicare |
$80.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$96.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$96.78
|
| Rate for Payer: BCBS Complete |
$57.33
|
| Rate for Payer: BCBS MAPPO |
$77.42
|
| Rate for Payer: BCBS Trust/PPO |
$254.60
|
| Rate for Payer: BCN Commercial |
$254.60
|
| Rate for Payer: BCN Medicare Advantage |
$77.42
|
| Rate for Payer: Cash Price |
$247.76
|
| Rate for Payer: Cofinity Commercial |
$266.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.42
|
| Rate for Payer: Healthscope Commercial |
$278.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.28
|
| Rate for Payer: Mclaren Medicaid |
$54.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$81.30
|
| Rate for Payer: Meridian Medicaid |
$57.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$85.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.25
|
| Rate for Payer: Nomi Health Commercial |
$253.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.28
|
| Rate for Payer: PACE Senior Care Partners |
$73.55
|
| Rate for Payer: PACE SWMI |
$77.42
|
| Rate for Payer: PHP Commercial |
$263.25
|
| Rate for Payer: PHP Medicare Advantage |
$77.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$269.44
|
| Rate for Payer: Priority Health Medicare |
$78.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$215.55
|
| Rate for Payer: Railroad Medicare Medicare |
$77.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.54
|
| Rate for Payer: UHC Core |
$258.60
|
| Rate for Payer: UHC Exchange |
$77.42
|
| Rate for Payer: UHC Medicaid |
$54.60
|
| Rate for Payer: UHC Medicare Advantage |
$77.42
|
| Rate for Payer: UHCCP Medicaid |
$54.60
|
| Rate for Payer: VA VA |
$77.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.28
|
|
|
ACETAZOLAMIDE 250 MG TABLET
|
Facility
|
IP
|
$7.80
|
|
|
Service Code
|
NDC 50268005411
|
| Hospital Charge Code |
113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$7.02 |
| Rate for Payer: Aetna Commercial |
$6.63
|
| Rate for Payer: BCBS Trust/PPO |
$6.44
|
| Rate for Payer: BCN Commercial |
$6.44
|
| Rate for Payer: Cash Price |
$6.24
|
| Rate for Payer: Cofinity Commercial |
$6.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.24
|
| Rate for Payer: Healthscope Commercial |
$7.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.63
|
| Rate for Payer: Nomi Health Commercial |
$6.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.85
|
| Rate for Payer: PHP Commercial |
$6.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.86
|
| Rate for Payer: UHC Core |
$6.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.85
|
|
|
ACETAZOLAMIDE 250 MG TABLET
|
Facility
|
IP
|
$309.70
|
|
|
Service Code
|
NDC 51672402301
|
| Hospital Charge Code |
113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$215.55 |
| Max. Negotiated Rate |
$278.73 |
| Rate for Payer: Aetna Commercial |
$263.25
|
| Rate for Payer: BCBS Trust/PPO |
$255.78
|
| Rate for Payer: BCN Commercial |
$255.78
|
| Rate for Payer: Cash Price |
$247.76
|
| Rate for Payer: Cofinity Commercial |
$266.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.76
|
| Rate for Payer: Healthscope Commercial |
$278.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.25
|
| Rate for Payer: Nomi Health Commercial |
$253.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.28
|
| Rate for Payer: PHP Commercial |
$263.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$269.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$215.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.54
|
| Rate for Payer: UHC Core |
$258.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.28
|
|
|
ACETAZOLAMIDE 250 MG TABLET
|
Facility
|
IP
|
$389.98
|
|
|
Service Code
|
NDC 50268005415
|
| Hospital Charge Code |
113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$271.43 |
| Max. Negotiated Rate |
$350.98 |
| Rate for Payer: Aetna Commercial |
$331.48
|
| Rate for Payer: BCBS Trust/PPO |
$322.08
|
| Rate for Payer: BCN Commercial |
$322.08
|
| Rate for Payer: Cash Price |
$311.98
|
| Rate for Payer: Cofinity Commercial |
$335.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.98
|
| Rate for Payer: Healthscope Commercial |
$350.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.48
|
| Rate for Payer: Nomi Health Commercial |
$319.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.49
|
| Rate for Payer: PHP Commercial |
$331.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$339.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$271.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$343.18
|
| Rate for Payer: UHC Core |
$325.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.49
|
|
|
ACETAZOLAMIDE 250 MG TABLET
|
Facility
|
OP
|
$309.70
|
|
|
Service Code
|
NDC 51672402301
|
| Hospital Charge Code |
113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$278.73 |
| Rate for Payer: Aetna Commercial |
$263.25
|
| Rate for Payer: Aetna Medicare |
$80.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$96.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$96.78
|
| Rate for Payer: BCBS Complete |
$57.33
|
| Rate for Payer: BCBS MAPPO |
$77.42
|
| Rate for Payer: BCBS Trust/PPO |
$254.60
|
| Rate for Payer: BCN Commercial |
$254.60
|
| Rate for Payer: BCN Medicare Advantage |
$77.42
|
| Rate for Payer: Cash Price |
$247.76
|
| Rate for Payer: Cofinity Commercial |
$266.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.42
|
| Rate for Payer: Healthscope Commercial |
$278.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.28
|
| Rate for Payer: Mclaren Medicaid |
$54.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$81.30
|
| Rate for Payer: Meridian Medicaid |
$57.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$85.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.25
|
| Rate for Payer: Nomi Health Commercial |
$253.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.28
|
| Rate for Payer: PACE Senior Care Partners |
$73.55
|
| Rate for Payer: PACE SWMI |
$77.42
|
| Rate for Payer: PHP Commercial |
$263.25
|
| Rate for Payer: PHP Medicare Advantage |
$77.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$269.44
|
| Rate for Payer: Priority Health Medicare |
$78.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$215.55
|
| Rate for Payer: Railroad Medicare Medicare |
$77.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.54
|
| Rate for Payer: UHC Core |
$258.60
|
| Rate for Payer: UHC Exchange |
$77.42
|
| Rate for Payer: UHC Medicaid |
$54.60
|
| Rate for Payer: UHC Medicare Advantage |
$77.42
|
| Rate for Payer: UHCCP Medicaid |
$54.60
|
| Rate for Payer: VA VA |
$77.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.28
|
|
|
ACETAZOLAMIDE 250 MG TABLET
|
Facility
|
OP
|
$7.80
|
|
|
Service Code
|
NDC 50268005411
|
| Hospital Charge Code |
113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$7.02 |
| Rate for Payer: Aetna Commercial |
$6.63
|
| Rate for Payer: Aetna Medicare |
$2.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.44
|
| Rate for Payer: BCBS Complete |
$1.44
|
| Rate for Payer: BCBS MAPPO |
$1.95
|
| Rate for Payer: BCBS Trust/PPO |
$6.41
|
| Rate for Payer: BCN Commercial |
$6.41
|
| Rate for Payer: BCN Medicare Advantage |
$1.95
|
| Rate for Payer: Cash Price |
$6.24
|
| Rate for Payer: Cofinity Commercial |
$6.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.95
|
| Rate for Payer: Healthscope Commercial |
$7.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.85
|
| Rate for Payer: Mclaren Medicaid |
$1.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.05
|
| Rate for Payer: Meridian Medicaid |
$1.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.63
|
| Rate for Payer: Nomi Health Commercial |
$6.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.85
|
| Rate for Payer: PACE Senior Care Partners |
$1.85
|
| Rate for Payer: PACE SWMI |
$1.95
|
| Rate for Payer: PHP Commercial |
$6.63
|
| Rate for Payer: PHP Medicare Advantage |
$1.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.79
|
| Rate for Payer: Priority Health Medicare |
$1.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.43
|
| Rate for Payer: Railroad Medicare Medicare |
$1.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.86
|
| Rate for Payer: UHC Core |
$6.51
|
| Rate for Payer: UHC Exchange |
$1.95
|
| Rate for Payer: UHC Medicaid |
$1.38
|
| Rate for Payer: UHC Medicare Advantage |
$1.95
|
| Rate for Payer: UHCCP Medicaid |
$1.38
|
| Rate for Payer: VA VA |
$1.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.85
|
|
|
ACETAZOLAMIDE 250 MG TABLET
|
Facility
|
OP
|
$389.98
|
|
|
Service Code
|
NDC 50268005415
|
| Hospital Charge Code |
113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.75 |
| Max. Negotiated Rate |
$350.98 |
| Rate for Payer: Aetna Commercial |
$331.48
|
| Rate for Payer: Aetna Medicare |
$101.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$121.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$121.87
|
| Rate for Payer: BCBS Complete |
$72.19
|
| Rate for Payer: BCBS MAPPO |
$97.50
|
| Rate for Payer: BCBS Trust/PPO |
$320.60
|
| Rate for Payer: BCN Commercial |
$320.60
|
| Rate for Payer: BCN Medicare Advantage |
$97.50
|
| Rate for Payer: Cash Price |
$311.98
|
| Rate for Payer: Cofinity Commercial |
$335.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.50
|
| Rate for Payer: Healthscope Commercial |
$350.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.49
|
| Rate for Payer: Mclaren Medicaid |
$68.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$102.37
|
| Rate for Payer: Meridian Medicaid |
$72.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$107.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.48
|
| Rate for Payer: Nomi Health Commercial |
$319.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.49
|
| Rate for Payer: PACE Senior Care Partners |
$92.62
|
| Rate for Payer: PACE SWMI |
$97.50
|
| Rate for Payer: PHP Commercial |
$331.48
|
| Rate for Payer: PHP Medicare Advantage |
$97.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$339.28
|
| Rate for Payer: Priority Health Medicare |
$98.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$271.43
|
| Rate for Payer: Railroad Medicare Medicare |
$97.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$343.18
|
| Rate for Payer: UHC Core |
$325.63
|
| Rate for Payer: UHC Exchange |
$97.50
|
| Rate for Payer: UHC Medicaid |
$68.75
|
| Rate for Payer: UHC Medicare Advantage |
$97.50
|
| Rate for Payer: UHCCP Medicaid |
$68.75
|
| Rate for Payer: VA VA |
$97.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.49
|
|
|
ACETAZOLAMIDE 250 MG TABLET
|
Facility
|
IP
|
$309.70
|
|
|
Service Code
|
NDC 23155028801
|
| Hospital Charge Code |
113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$215.55 |
| Max. Negotiated Rate |
$278.73 |
| Rate for Payer: Aetna Commercial |
$263.25
|
| Rate for Payer: BCBS Trust/PPO |
$255.78
|
| Rate for Payer: BCN Commercial |
$255.78
|
| Rate for Payer: Cash Price |
$247.76
|
| Rate for Payer: Cofinity Commercial |
$266.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.76
|
| Rate for Payer: Healthscope Commercial |
$278.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.25
|
| Rate for Payer: Nomi Health Commercial |
$253.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.28
|
| Rate for Payer: PHP Commercial |
$263.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$269.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$215.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.54
|
| Rate for Payer: UHC Core |
$258.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.28
|
|
|
ACETAZOLAMIDE 500 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$101.42
|
|
|
Service Code
|
HCPCS J1120
|
| Hospital Charge Code |
114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.59 |
| Max. Negotiated Rate |
$91.28 |
| Rate for Payer: Aetna Commercial |
$86.21
|
| Rate for Payer: Aetna Commercial |
$102.88
|
| Rate for Payer: Aetna Commercial |
$140.68
|
| Rate for Payer: BCBS Trust/PPO |
$99.97
|
| Rate for Payer: BCBS Trust/PPO |
$83.76
|
| Rate for Payer: BCBS Trust/PPO |
$136.69
|
| Rate for Payer: BCN Commercial |
$99.97
|
| Rate for Payer: BCN Commercial |
$83.76
|
| Rate for Payer: BCN Commercial |
$136.69
|
| Rate for Payer: Cash Price |
$81.14
|
| Rate for Payer: Cash Price |
$132.40
|
| Rate for Payer: Cash Price |
$96.83
|
| Rate for Payer: Cofinity Commercial |
$142.33
|
| Rate for Payer: Cofinity Commercial |
$104.09
|
| Rate for Payer: Cofinity Commercial |
$87.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.40
|
| Rate for Payer: Healthscope Commercial |
$108.94
|
| Rate for Payer: Healthscope Commercial |
$91.28
|
| Rate for Payer: Healthscope Commercial |
$148.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.68
|
| Rate for Payer: Nomi Health Commercial |
$83.16
|
| Rate for Payer: Nomi Health Commercial |
$99.25
|
| Rate for Payer: Nomi Health Commercial |
$135.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$90.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.12
|
| Rate for Payer: PHP Commercial |
$86.21
|
| Rate for Payer: PHP Commercial |
$140.68
|
| Rate for Payer: PHP Commercial |
$102.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$143.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$105.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$88.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$84.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$115.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.25
|
| Rate for Payer: UHC Core |
$84.69
|
| Rate for Payer: UHC Core |
$138.19
|
| Rate for Payer: UHC Core |
$101.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.78
|
|
|
ACETAZOLAMIDE 500 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$101.42
|
|
|
Service Code
|
HCPCS J1120
|
| Hospital Charge Code |
114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.88 |
| Max. Negotiated Rate |
$91.28 |
| Rate for Payer: Aetna Commercial |
$86.21
|
| Rate for Payer: Aetna Commercial |
$140.68
|
| Rate for Payer: Aetna Commercial |
$102.88
|
| Rate for Payer: Aetna Medicare |
$43.03
|
| Rate for Payer: Aetna Medicare |
$26.37
|
| Rate for Payer: Aetna Medicare |
$31.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.72
|
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: BCBS Complete |
$18.77
|
| Rate for Payer: BCBS Complete |
$30.63
|
| Rate for Payer: BCBS MAPPO |
$41.38
|
| Rate for Payer: BCBS MAPPO |
$25.36
|
| Rate for Payer: BCBS MAPPO |
$30.26
|
| Rate for Payer: BCBS Trust/PPO |
$83.38
|
| Rate for Payer: BCBS Trust/PPO |
$99.51
|
| Rate for Payer: BCBS Trust/PPO |
$136.06
|
| Rate for Payer: BCN Commercial |
$99.51
|
| Rate for Payer: BCN Commercial |
$136.06
|
| Rate for Payer: BCN Commercial |
$83.38
|
| Rate for Payer: BCN Medicare Advantage |
$41.38
|
| Rate for Payer: BCN Medicare Advantage |
$30.26
|
| Rate for Payer: BCN Medicare Advantage |
$25.36
|
| Rate for Payer: Cash Price |
$132.40
|
| Rate for Payer: Cash Price |
$96.83
|
| Rate for Payer: Cash Price |
$81.14
|
| Rate for Payer: Cofinity Commercial |
$87.22
|
| Rate for Payer: Cofinity Commercial |
$104.09
|
| Rate for Payer: Cofinity Commercial |
$142.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.36
|
| Rate for Payer: Healthscope Commercial |
$108.94
|
| Rate for Payer: Healthscope Commercial |
$91.28
|
| Rate for Payer: Healthscope Commercial |
$148.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.78
|
| Rate for Payer: Mclaren Medicaid |
$17.88
|
| Rate for Payer: Mclaren Medicaid |
$29.18
|
| Rate for Payer: Mclaren Medicaid |
$21.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.44
|
| Rate for Payer: Meridian Medicaid |
$30.63
|
| Rate for Payer: Meridian Medicaid |
$18.77
|
| Rate for Payer: Meridian Medicaid |
$22.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$45.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$33.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$27.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.88
|
| Rate for Payer: Nomi Health Commercial |
$135.71
|
| Rate for Payer: Nomi Health Commercial |
$99.25
|
| Rate for Payer: Nomi Health Commercial |
$83.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$90.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.06
|
| Rate for Payer: PACE Senior Care Partners |
$28.75
|
| Rate for Payer: PACE Senior Care Partners |
$24.09
|
| Rate for Payer: PACE Senior Care Partners |
$39.31
|
| Rate for Payer: PACE SWMI |
$41.38
|
| Rate for Payer: PACE SWMI |
$30.26
|
| Rate for Payer: PACE SWMI |
$25.36
|
| Rate for Payer: PHP Commercial |
$86.21
|
| Rate for Payer: PHP Commercial |
$140.68
|
| Rate for Payer: PHP Commercial |
$102.88
|
| Rate for Payer: PHP Medicare Advantage |
$30.26
|
| Rate for Payer: PHP Medicare Advantage |
$25.36
|
| Rate for Payer: PHP Medicare Advantage |
$41.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$105.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$88.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$143.99
|
| Rate for Payer: Priority Health Medicare |
$41.79
|
| Rate for Payer: Priority Health Medicare |
$30.56
|
| Rate for Payer: Priority Health Medicare |
$25.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$84.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$115.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.59
|
| Rate for Payer: Railroad Medicare Medicare |
$30.26
|
| Rate for Payer: Railroad Medicare Medicare |
$41.38
|
| Rate for Payer: Railroad Medicare Medicare |
$25.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.25
|
| Rate for Payer: UHC Core |
$84.69
|
| Rate for Payer: UHC Core |
$138.19
|
| Rate for Payer: UHC Core |
$101.07
|
| Rate for Payer: UHC Exchange |
$41.38
|
| Rate for Payer: UHC Exchange |
$30.26
|
| Rate for Payer: UHC Exchange |
$25.36
|
| Rate for Payer: UHC Medicaid |
$17.88
|
| Rate for Payer: UHC Medicaid |
$29.18
|
| Rate for Payer: UHC Medicaid |
$21.34
|
| Rate for Payer: UHC Medicare Advantage |
$30.26
|
| Rate for Payer: UHC Medicare Advantage |
$25.36
|
| Rate for Payer: UHC Medicare Advantage |
$41.38
|
| Rate for Payer: UHCCP Medicaid |
$21.34
|
| Rate for Payer: UHCCP Medicaid |
$17.88
|
| Rate for Payer: UHCCP Medicaid |
$29.18
|
| Rate for Payer: VA VA |
$25.36
|
| Rate for Payer: VA VA |
$41.38
|
| Rate for Payer: VA VA |
$30.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.12
|
|
|
ACETIC ACID 2 % EAR SOLUTION
|
Facility
|
OP
|
$96.35
|
|
|
Service Code
|
NDC 60432074115
|
| Hospital Charge Code |
17801
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.99 |
| Max. Negotiated Rate |
$86.72 |
| Rate for Payer: Aetna Commercial |
$81.90
|
| Rate for Payer: Aetna Medicare |
$25.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.11
|
| Rate for Payer: BCBS Complete |
$17.83
|
| Rate for Payer: BCBS MAPPO |
$24.09
|
| Rate for Payer: BCBS Trust/PPO |
$79.21
|
| Rate for Payer: BCN Commercial |
$79.21
|
| Rate for Payer: BCN Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$77.08
|
| Rate for Payer: Cofinity Commercial |
$82.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.09
|
| Rate for Payer: Healthscope Commercial |
$86.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.26
|
| Rate for Payer: Mclaren Medicaid |
$16.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.29
|
| Rate for Payer: Meridian Medicaid |
$17.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.90
|
| Rate for Payer: Nomi Health Commercial |
$79.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.26
|
| Rate for Payer: PACE Senior Care Partners |
$22.88
|
| Rate for Payer: PACE SWMI |
$24.09
|
| Rate for Payer: PHP Commercial |
$81.90
|
| Rate for Payer: PHP Medicare Advantage |
$24.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$83.82
|
| Rate for Payer: Priority Health Medicare |
$24.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.06
|
| Rate for Payer: Railroad Medicare Medicare |
$24.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.79
|
| Rate for Payer: UHC Core |
$80.45
|
| Rate for Payer: UHC Exchange |
$24.09
|
| Rate for Payer: UHC Medicaid |
$16.99
|
| Rate for Payer: UHC Medicare Advantage |
$24.09
|
| Rate for Payer: UHCCP Medicaid |
$16.99
|
| Rate for Payer: VA VA |
$24.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.26
|
|
|
ACETIC ACID 2 % EAR SOLUTION
|
Facility
|
IP
|
$96.35
|
|
|
Service Code
|
NDC 60432074115
|
| Hospital Charge Code |
17801
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.06 |
| Max. Negotiated Rate |
$86.72 |
| Rate for Payer: Aetna Commercial |
$81.90
|
| Rate for Payer: BCBS Trust/PPO |
$79.58
|
| Rate for Payer: BCN Commercial |
$79.58
|
| Rate for Payer: Cash Price |
$77.08
|
| Rate for Payer: Cofinity Commercial |
$82.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.08
|
| Rate for Payer: Healthscope Commercial |
$86.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.90
|
| Rate for Payer: Nomi Health Commercial |
$79.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.26
|
| Rate for Payer: PHP Commercial |
$81.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$83.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.79
|
| Rate for Payer: UHC Core |
$80.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.26
|
|
|
ACETIC ACID (BULK) 3 % LIQUID
|
Facility
|
OP
|
$258.00
|
|
|
Service Code
|
NDC 51552005106
|
| Hospital Charge Code |
15091
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.49 |
| Max. Negotiated Rate |
$232.20 |
| Rate for Payer: Aetna Commercial |
$219.30
|
| Rate for Payer: Aetna Medicare |
$67.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$80.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$80.62
|
| Rate for Payer: BCBS Complete |
$47.76
|
| Rate for Payer: BCBS MAPPO |
$64.50
|
| Rate for Payer: BCBS Trust/PPO |
$212.10
|
| Rate for Payer: BCN Commercial |
$212.10
|
| Rate for Payer: BCN Medicare Advantage |
$64.50
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Cofinity Commercial |
$221.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.50
|
| Rate for Payer: Healthscope Commercial |
$232.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.50
|
| Rate for Payer: Mclaren Medicaid |
$45.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.72
|
| Rate for Payer: Meridian Medicaid |
$47.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$70.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.30
|
| Rate for Payer: Nomi Health Commercial |
$211.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.50
|
| Rate for Payer: PACE Senior Care Partners |
$61.27
|
| Rate for Payer: PACE SWMI |
$64.50
|
| Rate for Payer: PHP Commercial |
$219.30
|
| Rate for Payer: PHP Medicare Advantage |
$64.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$224.46
|
| Rate for Payer: Priority Health Medicare |
$65.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.57
|
| Rate for Payer: Railroad Medicare Medicare |
$64.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.04
|
| Rate for Payer: UHC Core |
$215.43
|
| Rate for Payer: UHC Exchange |
$64.50
|
| Rate for Payer: UHC Medicaid |
$45.49
|
| Rate for Payer: UHC Medicare Advantage |
$64.50
|
| Rate for Payer: UHCCP Medicaid |
$45.49
|
| Rate for Payer: VA VA |
$64.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.50
|
|
|
ACETIC ACID (BULK) 3 % LIQUID
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
NDC 51552005106
|
| Hospital Charge Code |
15091
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.57 |
| Max. Negotiated Rate |
$232.20 |
| Rate for Payer: Aetna Commercial |
$219.30
|
| Rate for Payer: BCBS Trust/PPO |
$213.08
|
| Rate for Payer: BCN Commercial |
$213.08
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Cofinity Commercial |
$221.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.40
|
| Rate for Payer: Healthscope Commercial |
$232.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.30
|
| Rate for Payer: Nomi Health Commercial |
$211.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.50
|
| Rate for Payer: PHP Commercial |
$219.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$224.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.04
|
| Rate for Payer: UHC Core |
$215.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.50
|
|
|
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) INTRAOCULAR KIT
|
Facility
|
OP
|
$270.17
|
|
|
Service Code
|
NDC 24208053920
|
| Hospital Charge Code |
32559
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.63 |
| Max. Negotiated Rate |
$243.15 |
| Rate for Payer: Aetna Commercial |
$229.64
|
| Rate for Payer: Aetna Medicare |
$70.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$84.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$84.43
|
| Rate for Payer: BCBS Complete |
$50.01
|
| Rate for Payer: BCBS MAPPO |
$67.54
|
| Rate for Payer: BCBS Trust/PPO |
$222.11
|
| Rate for Payer: BCN Commercial |
$222.11
|
| Rate for Payer: BCN Medicare Advantage |
$67.54
|
| Rate for Payer: Cash Price |
$216.14
|
| Rate for Payer: Cofinity Commercial |
$232.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.54
|
| Rate for Payer: Healthscope Commercial |
$243.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.63
|
| Rate for Payer: Mclaren Medicaid |
$47.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.92
|
| Rate for Payer: Meridian Medicaid |
$50.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$74.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.64
|
| Rate for Payer: Nomi Health Commercial |
$221.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$202.63
|
| Rate for Payer: PACE Senior Care Partners |
$64.17
|
| Rate for Payer: PACE SWMI |
$67.54
|
| Rate for Payer: PHP Commercial |
$229.64
|
| Rate for Payer: PHP Medicare Advantage |
$67.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$235.05
|
| Rate for Payer: Priority Health Medicare |
$68.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$188.04
|
| Rate for Payer: Railroad Medicare Medicare |
$67.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.75
|
| Rate for Payer: UHC Core |
$225.59
|
| Rate for Payer: UHC Exchange |
$67.54
|
| Rate for Payer: UHC Medicaid |
$47.63
|
| Rate for Payer: UHC Medicare Advantage |
$67.54
|
| Rate for Payer: UHCCP Medicaid |
$47.63
|
| Rate for Payer: VA VA |
$67.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.63
|
|
|
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) INTRAOCULAR KIT
|
Facility
|
IP
|
$270.17
|
|
|
Service Code
|
NDC 24208053920
|
| Hospital Charge Code |
32559
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$188.04 |
| Max. Negotiated Rate |
$243.15 |
| Rate for Payer: Aetna Commercial |
$229.64
|
| Rate for Payer: BCBS Trust/PPO |
$223.13
|
| Rate for Payer: BCN Commercial |
$223.13
|
| Rate for Payer: Cash Price |
$216.14
|
| Rate for Payer: Cofinity Commercial |
$232.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.14
|
| Rate for Payer: Healthscope Commercial |
$243.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.64
|
| Rate for Payer: Nomi Health Commercial |
$221.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$202.63
|
| Rate for Payer: PHP Commercial |
$229.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$235.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$188.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.75
|
| Rate for Payer: UHC Core |
$225.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.63
|
|
|
ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$78.77
|
|
|
Service Code
|
HCPCS J0132
|
| Hospital Charge Code |
38303
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.82 |
| Max. Negotiated Rate |
$70.89 |
| Rate for Payer: Aetna Commercial |
$66.95
|
| Rate for Payer: Aetna Commercial |
$72.97
|
| Rate for Payer: Aetna Commercial |
$80.91
|
| Rate for Payer: BCBS Trust/PPO |
$70.90
|
| Rate for Payer: BCBS Trust/PPO |
$65.06
|
| Rate for Payer: BCBS Trust/PPO |
$78.62
|
| Rate for Payer: BCN Commercial |
$70.90
|
| Rate for Payer: BCN Commercial |
$65.06
|
| Rate for Payer: BCN Commercial |
$78.62
|
| Rate for Payer: Cash Price |
$63.02
|
| Rate for Payer: Cash Price |
$76.15
|
| Rate for Payer: Cash Price |
$68.68
|
| Rate for Payer: Cofinity Commercial |
$81.86
|
| Rate for Payer: Cofinity Commercial |
$73.83
|
| Rate for Payer: Cofinity Commercial |
$67.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.15
|
| Rate for Payer: Healthscope Commercial |
$77.27
|
| Rate for Payer: Healthscope Commercial |
$70.89
|
| Rate for Payer: Healthscope Commercial |
$85.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.91
|
| Rate for Payer: Nomi Health Commercial |
$64.59
|
| Rate for Payer: Nomi Health Commercial |
$70.40
|
| Rate for Payer: Nomi Health Commercial |
$78.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.39
|
| Rate for Payer: PHP Commercial |
$66.95
|
| Rate for Payer: PHP Commercial |
$80.91
|
| Rate for Payer: PHP Commercial |
$72.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$82.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$74.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$68.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.32
|
| Rate for Payer: UHC Core |
$65.77
|
| Rate for Payer: UHC Core |
$79.48
|
| Rate for Payer: UHC Core |
$71.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.39
|
|
|
ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$78.77
|
|
|
Service Code
|
HCPCS J0132
|
| Hospital Charge Code |
38303
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.89 |
| Max. Negotiated Rate |
$70.89 |
| Rate for Payer: Aetna Commercial |
$66.95
|
| Rate for Payer: Aetna Commercial |
$80.91
|
| Rate for Payer: Aetna Commercial |
$72.97
|
| Rate for Payer: Aetna Medicare |
$24.75
|
| Rate for Payer: Aetna Medicare |
$20.48
|
| Rate for Payer: Aetna Medicare |
$22.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.75
|
| Rate for Payer: BCBS Complete |
$15.89
|
| Rate for Payer: BCBS Complete |
$14.58
|
| Rate for Payer: BCBS Complete |
$17.62
|
| Rate for Payer: BCBS MAPPO |
$23.80
|
| Rate for Payer: BCBS MAPPO |
$19.69
|
| Rate for Payer: BCBS MAPPO |
$21.46
|
| Rate for Payer: BCBS Trust/PPO |
$64.76
|
| Rate for Payer: BCBS Trust/PPO |
$70.58
|
| Rate for Payer: BCBS Trust/PPO |
$78.26
|
| Rate for Payer: BCN Commercial |
$70.58
|
| Rate for Payer: BCN Commercial |
$78.26
|
| Rate for Payer: BCN Commercial |
$64.76
|
| Rate for Payer: BCN Medicare Advantage |
$23.80
|
| Rate for Payer: BCN Medicare Advantage |
$21.46
|
| Rate for Payer: BCN Medicare Advantage |
$19.69
|
| Rate for Payer: Cash Price |
$76.15
|
| Rate for Payer: Cash Price |
$68.68
|
| Rate for Payer: Cash Price |
$63.02
|
| Rate for Payer: Cofinity Commercial |
$67.74
|
| Rate for Payer: Cofinity Commercial |
$73.83
|
| Rate for Payer: Cofinity Commercial |
$81.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.69
|
| Rate for Payer: Healthscope Commercial |
$77.27
|
| Rate for Payer: Healthscope Commercial |
$70.89
|
| Rate for Payer: Healthscope Commercial |
$85.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.39
|
| Rate for Payer: Mclaren Medicaid |
$13.89
|
| Rate for Payer: Mclaren Medicaid |
$16.78
|
| Rate for Payer: Mclaren Medicaid |
$15.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.99
|
| Rate for Payer: Meridian Medicaid |
$17.62
|
| Rate for Payer: Meridian Medicaid |
$14.58
|
| Rate for Payer: Meridian Medicaid |
$15.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.97
|
| Rate for Payer: Nomi Health Commercial |
$78.06
|
| Rate for Payer: Nomi Health Commercial |
$70.40
|
| Rate for Payer: Nomi Health Commercial |
$64.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.08
|
| Rate for Payer: PACE Senior Care Partners |
$20.39
|
| Rate for Payer: PACE Senior Care Partners |
$18.71
|
| Rate for Payer: PACE Senior Care Partners |
$22.61
|
| Rate for Payer: PACE SWMI |
$23.80
|
| Rate for Payer: PACE SWMI |
$21.46
|
| Rate for Payer: PACE SWMI |
$19.69
|
| Rate for Payer: PHP Commercial |
$66.95
|
| Rate for Payer: PHP Commercial |
$80.91
|
| Rate for Payer: PHP Commercial |
$72.97
|
| Rate for Payer: PHP Medicare Advantage |
$21.46
|
| Rate for Payer: PHP Medicare Advantage |
$19.69
|
| Rate for Payer: PHP Medicare Advantage |
$23.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$74.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$68.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$82.82
|
| Rate for Payer: Priority Health Medicare |
$24.04
|
| Rate for Payer: Priority Health Medicare |
$21.68
|
| Rate for Payer: Priority Health Medicare |
$19.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.82
|
| Rate for Payer: Railroad Medicare Medicare |
$21.46
|
| Rate for Payer: Railroad Medicare Medicare |
$23.80
|
| Rate for Payer: Railroad Medicare Medicare |
$19.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.32
|
| Rate for Payer: UHC Core |
$65.77
|
| Rate for Payer: UHC Core |
$79.48
|
| Rate for Payer: UHC Core |
$71.68
|
| Rate for Payer: UHC Exchange |
$23.80
|
| Rate for Payer: UHC Exchange |
$21.46
|
| Rate for Payer: UHC Exchange |
$19.69
|
| Rate for Payer: UHC Medicaid |
$13.89
|
| Rate for Payer: UHC Medicaid |
$16.78
|
| Rate for Payer: UHC Medicaid |
$15.14
|
| Rate for Payer: UHC Medicare Advantage |
$21.46
|
| Rate for Payer: UHC Medicare Advantage |
$19.69
|
| Rate for Payer: UHC Medicare Advantage |
$23.80
|
| Rate for Payer: UHCCP Medicaid |
$15.14
|
| Rate for Payer: UHCCP Medicaid |
$13.89
|
| Rate for Payer: UHCCP Medicaid |
$16.78
|
| Rate for Payer: VA VA |
$19.69
|
| Rate for Payer: VA VA |
$23.80
|
| Rate for Payer: VA VA |
$21.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.39
|
|
|
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSPENSION
|
Facility
|
IP
|
$75.60
|
|
|
Service Code
|
NDC 00574052176
|
| Hospital Charge Code |
115331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.62 |
| Max. Negotiated Rate |
$68.04 |
| Rate for Payer: Aetna Commercial |
$64.26
|
| Rate for Payer: BCBS Trust/PPO |
$62.44
|
| Rate for Payer: BCN Commercial |
$62.44
|
| Rate for Payer: Cash Price |
$60.48
|
| Rate for Payer: Cofinity Commercial |
$65.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.48
|
| Rate for Payer: Healthscope Commercial |
$68.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.26
|
| Rate for Payer: Nomi Health Commercial |
$61.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.70
|
| Rate for Payer: PHP Commercial |
$64.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$65.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.53
|
| Rate for Payer: UHC Core |
$63.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.70
|
|
|
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSPENSION
|
Facility
|
OP
|
$97.44
|
|
|
Service Code
|
NDC 66689020108
|
| Hospital Charge Code |
115331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.18 |
| Max. Negotiated Rate |
$87.70 |
| Rate for Payer: Aetna Commercial |
$82.82
|
| Rate for Payer: Aetna Medicare |
$25.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.45
|
| Rate for Payer: BCBS Complete |
$18.04
|
| Rate for Payer: BCBS MAPPO |
$24.36
|
| Rate for Payer: BCBS Trust/PPO |
$80.11
|
| Rate for Payer: BCN Commercial |
$80.11
|
| Rate for Payer: BCN Medicare Advantage |
$24.36
|
| Rate for Payer: Cash Price |
$77.95
|
| Rate for Payer: Cofinity Commercial |
$83.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.36
|
| Rate for Payer: Healthscope Commercial |
$87.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.08
|
| Rate for Payer: Mclaren Medicaid |
$17.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.58
|
| Rate for Payer: Meridian Medicaid |
$18.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.82
|
| Rate for Payer: Nomi Health Commercial |
$79.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.08
|
| Rate for Payer: PACE Senior Care Partners |
$23.14
|
| Rate for Payer: PACE SWMI |
$24.36
|
| Rate for Payer: PHP Commercial |
$82.82
|
| Rate for Payer: PHP Medicare Advantage |
$24.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$84.77
|
| Rate for Payer: Priority Health Medicare |
$24.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.82
|
| Rate for Payer: Railroad Medicare Medicare |
$24.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.75
|
| Rate for Payer: UHC Core |
$81.36
|
| Rate for Payer: UHC Exchange |
$24.36
|
| Rate for Payer: UHC Medicaid |
$17.18
|
| Rate for Payer: UHC Medicare Advantage |
$24.36
|
| Rate for Payer: UHCCP Medicaid |
$17.18
|
| Rate for Payer: VA VA |
$24.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.08
|
|
|
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSPENSION
|
Facility
|
IP
|
$97.44
|
|
|
Service Code
|
NDC 66689020108
|
| Hospital Charge Code |
115331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.82 |
| Max. Negotiated Rate |
$87.70 |
| Rate for Payer: Aetna Commercial |
$82.82
|
| Rate for Payer: BCBS Trust/PPO |
$80.48
|
| Rate for Payer: BCN Commercial |
$80.48
|
| Rate for Payer: Cash Price |
$77.95
|
| Rate for Payer: Cofinity Commercial |
$83.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.95
|
| Rate for Payer: Healthscope Commercial |
$87.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.82
|
| Rate for Payer: Nomi Health Commercial |
$79.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.08
|
| Rate for Payer: PHP Commercial |
$82.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$84.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.75
|
| Rate for Payer: UHC Core |
$81.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.08
|
|
|
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSPENSION
|
Facility
|
OP
|
$75.60
|
|
|
Service Code
|
NDC 00574052176
|
| Hospital Charge Code |
115331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.33 |
| Max. Negotiated Rate |
$68.04 |
| Rate for Payer: Aetna Commercial |
$64.26
|
| Rate for Payer: Aetna Medicare |
$19.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.62
|
| Rate for Payer: BCBS Complete |
$13.99
|
| Rate for Payer: BCBS MAPPO |
$18.90
|
| Rate for Payer: BCBS Trust/PPO |
$62.15
|
| Rate for Payer: BCN Commercial |
$62.15
|
| Rate for Payer: BCN Medicare Advantage |
$18.90
|
| Rate for Payer: Cash Price |
$60.48
|
| Rate for Payer: Cofinity Commercial |
$65.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.90
|
| Rate for Payer: Healthscope Commercial |
$68.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.70
|
| Rate for Payer: Mclaren Medicaid |
$13.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.84
|
| Rate for Payer: Meridian Medicaid |
$13.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.26
|
| Rate for Payer: Nomi Health Commercial |
$61.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.70
|
| Rate for Payer: PACE Senior Care Partners |
$17.95
|
| Rate for Payer: PACE SWMI |
$18.90
|
| Rate for Payer: PHP Commercial |
$64.26
|
| Rate for Payer: PHP Medicare Advantage |
$18.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$65.77
|
| Rate for Payer: Priority Health Medicare |
$19.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.62
|
| Rate for Payer: Railroad Medicare Medicare |
$18.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.53
|
| Rate for Payer: UHC Core |
$63.13
|
| Rate for Payer: UHC Exchange |
$18.90
|
| Rate for Payer: UHC Medicaid |
$13.33
|
| Rate for Payer: UHC Medicare Advantage |
$18.90
|
| Rate for Payer: UHCCP Medicaid |
$13.33
|
| Rate for Payer: VA VA |
$18.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.70
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS
|
Facility
|
IP
|
$6,266.44
|
|
|
Service Code
|
APR-DRG 1931
|
| Min. Negotiated Rate |
$5,968.03 |
| Max. Negotiated Rate |
$6,266.44 |
| Rate for Payer: BCBS Complete |
$6,266.44
|
| Rate for Payer: Mclaren Medicaid |
$5,968.03
|
| Rate for Payer: Meridian Medicaid |
$6,266.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,968.03
|
| Rate for Payer: UHC Medicaid |
$5,968.03
|
| Rate for Payer: UHCCP Medicaid |
$5,968.03
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS
|
Facility
|
IP
|
$10,745.54
|
|
|
Service Code
|
APR-DRG 1933
|
| Min. Negotiated Rate |
$10,233.85 |
| Max. Negotiated Rate |
$10,745.54 |
| Rate for Payer: BCBS Complete |
$10,745.54
|
| Rate for Payer: Mclaren Medicaid |
$10,233.85
|
| Rate for Payer: Meridian Medicaid |
$10,745.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,233.85
|
| Rate for Payer: UHC Medicaid |
$10,233.85
|
| Rate for Payer: UHCCP Medicaid |
$10,233.85
|
|
