|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT
|
Facility
|
IP
|
$10.26
|
|
|
Service Code
|
NDC 00713026831
|
| Hospital Charge Code |
854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.14 |
| Max. Negotiated Rate |
$9.23 |
| Rate for Payer: Aetna Commercial |
$8.72
|
| Rate for Payer: BCBS Trust/PPO |
$8.47
|
| Rate for Payer: BCN Commercial |
$8.47
|
| Rate for Payer: Cash Price |
$8.21
|
| Rate for Payer: Cofinity Commercial |
$8.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.21
|
| Rate for Payer: Healthscope Commercial |
$9.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.72
|
| Rate for Payer: Nomi Health Commercial |
$8.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.70
|
| Rate for Payer: PHP Commercial |
$8.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.03
|
| Rate for Payer: UHC Core |
$8.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.70
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT
|
Facility
|
OP
|
$9.71
|
|
|
Service Code
|
NDC 45802014303
|
| Hospital Charge Code |
854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$8.74 |
| Rate for Payer: Aetna Commercial |
$8.25
|
| Rate for Payer: Aetna Medicare |
$2.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.03
|
| Rate for Payer: BCBS Complete |
$1.80
|
| Rate for Payer: BCBS MAPPO |
$2.43
|
| Rate for Payer: BCBS Trust/PPO |
$7.98
|
| Rate for Payer: BCN Commercial |
$7.98
|
| Rate for Payer: BCN Medicare Advantage |
$2.43
|
| Rate for Payer: Cash Price |
$7.77
|
| Rate for Payer: Cofinity Commercial |
$8.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.43
|
| Rate for Payer: Healthscope Commercial |
$8.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.28
|
| Rate for Payer: Mclaren Medicaid |
$1.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.55
|
| Rate for Payer: Meridian Medicaid |
$1.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.25
|
| Rate for Payer: Nomi Health Commercial |
$7.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.28
|
| Rate for Payer: PACE Senior Care Partners |
$2.31
|
| Rate for Payer: PACE SWMI |
$2.43
|
| Rate for Payer: PHP Commercial |
$8.25
|
| Rate for Payer: PHP Medicare Advantage |
$2.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.45
|
| Rate for Payer: Priority Health Medicare |
$2.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.76
|
| Rate for Payer: Railroad Medicare Medicare |
$2.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.54
|
| Rate for Payer: UHC Core |
$8.11
|
| Rate for Payer: UHC Exchange |
$2.43
|
| Rate for Payer: UHC Medicaid |
$1.71
|
| Rate for Payer: UHC Medicare Advantage |
$2.43
|
| Rate for Payer: UHCCP Medicaid |
$1.71
|
| Rate for Payer: VA VA |
$2.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.28
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT
|
Facility
|
IP
|
$9.71
|
|
|
Service Code
|
NDC 45802014303
|
| Hospital Charge Code |
854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$8.74 |
| Rate for Payer: Aetna Commercial |
$8.25
|
| Rate for Payer: BCBS Trust/PPO |
$8.02
|
| Rate for Payer: BCN Commercial |
$8.02
|
| Rate for Payer: Cash Price |
$7.77
|
| Rate for Payer: Cofinity Commercial |
$8.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.77
|
| Rate for Payer: Healthscope Commercial |
$8.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.25
|
| Rate for Payer: Nomi Health Commercial |
$7.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.28
|
| Rate for Payer: PHP Commercial |
$8.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.54
|
| Rate for Payer: UHC Core |
$8.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.28
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT
|
Facility
|
IP
|
$10.26
|
|
|
Service Code
|
NDC 00904073431
|
| Hospital Charge Code |
854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.14 |
| Max. Negotiated Rate |
$9.23 |
| Rate for Payer: Aetna Commercial |
$8.72
|
| Rate for Payer: BCBS Trust/PPO |
$8.47
|
| Rate for Payer: BCN Commercial |
$8.47
|
| Rate for Payer: Cash Price |
$8.21
|
| Rate for Payer: Cofinity Commercial |
$8.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.21
|
| Rate for Payer: Healthscope Commercial |
$9.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.72
|
| Rate for Payer: Nomi Health Commercial |
$8.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.70
|
| Rate for Payer: PHP Commercial |
$8.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.03
|
| Rate for Payer: UHC Core |
$8.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.70
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT
|
Facility
|
OP
|
$10.26
|
|
|
Service Code
|
NDC 00713026831
|
| Hospital Charge Code |
854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$9.23 |
| Rate for Payer: Aetna Commercial |
$8.72
|
| Rate for Payer: Aetna Medicare |
$2.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.21
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: BCBS MAPPO |
$2.56
|
| Rate for Payer: BCBS Trust/PPO |
$8.43
|
| Rate for Payer: BCN Commercial |
$8.43
|
| Rate for Payer: BCN Medicare Advantage |
$2.56
|
| Rate for Payer: Cash Price |
$8.21
|
| Rate for Payer: Cofinity Commercial |
$8.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.56
|
| Rate for Payer: Healthscope Commercial |
$9.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.70
|
| Rate for Payer: Mclaren Medicaid |
$1.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.69
|
| Rate for Payer: Meridian Medicaid |
$1.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.72
|
| Rate for Payer: Nomi Health Commercial |
$8.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.70
|
| Rate for Payer: PACE Senior Care Partners |
$2.44
|
| Rate for Payer: PACE SWMI |
$2.56
|
| Rate for Payer: PHP Commercial |
$8.72
|
| Rate for Payer: PHP Medicare Advantage |
$2.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.93
|
| Rate for Payer: Priority Health Medicare |
$2.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.14
|
| Rate for Payer: Railroad Medicare Medicare |
$2.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.03
|
| Rate for Payer: UHC Core |
$8.57
|
| Rate for Payer: UHC Exchange |
$2.56
|
| Rate for Payer: UHC Medicaid |
$1.81
|
| Rate for Payer: UHC Medicare Advantage |
$2.56
|
| Rate for Payer: UHCCP Medicaid |
$1.81
|
| Rate for Payer: VA VA |
$2.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.70
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT
|
Facility
|
OP
|
$10.26
|
|
|
Service Code
|
NDC 00904073431
|
| Hospital Charge Code |
854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$9.23 |
| Rate for Payer: Aetna Commercial |
$8.72
|
| Rate for Payer: Aetna Medicare |
$2.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.21
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: BCBS MAPPO |
$2.56
|
| Rate for Payer: BCBS Trust/PPO |
$8.43
|
| Rate for Payer: BCN Commercial |
$8.43
|
| Rate for Payer: BCN Medicare Advantage |
$2.56
|
| Rate for Payer: Cash Price |
$8.21
|
| Rate for Payer: Cofinity Commercial |
$8.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.56
|
| Rate for Payer: Healthscope Commercial |
$9.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.70
|
| Rate for Payer: Mclaren Medicaid |
$1.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.69
|
| Rate for Payer: Meridian Medicaid |
$1.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.72
|
| Rate for Payer: Nomi Health Commercial |
$8.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.70
|
| Rate for Payer: PACE Senior Care Partners |
$2.44
|
| Rate for Payer: PACE SWMI |
$2.56
|
| Rate for Payer: PHP Commercial |
$8.72
|
| Rate for Payer: PHP Medicare Advantage |
$2.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.93
|
| Rate for Payer: Priority Health Medicare |
$2.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.14
|
| Rate for Payer: Railroad Medicare Medicare |
$2.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.03
|
| Rate for Payer: UHC Core |
$8.57
|
| Rate for Payer: UHC Exchange |
$2.56
|
| Rate for Payer: UHC Medicaid |
$1.81
|
| Rate for Payer: UHC Medicare Advantage |
$2.56
|
| Rate for Payer: UHCCP Medicaid |
$1.81
|
| Rate for Payer: VA VA |
$2.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.70
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT
|
Facility
|
OP
|
$3.06
|
|
|
Service Code
|
NDC 45802014370
|
| Hospital Charge Code |
116684
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.75 |
| Rate for Payer: Aetna Commercial |
$2.60
|
| Rate for Payer: Aetna Medicare |
$0.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.96
|
| Rate for Payer: BCBS Complete |
$0.57
|
| Rate for Payer: BCBS MAPPO |
$0.77
|
| Rate for Payer: BCBS Trust/PPO |
$2.52
|
| Rate for Payer: BCN Commercial |
$2.52
|
| Rate for Payer: BCN Medicare Advantage |
$0.77
|
| Rate for Payer: Cash Price |
$2.45
|
| Rate for Payer: Cofinity Commercial |
$2.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.77
|
| Rate for Payer: Healthscope Commercial |
$2.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.29
|
| Rate for Payer: Mclaren Medicaid |
$0.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.80
|
| Rate for Payer: Meridian Medicaid |
$0.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.60
|
| Rate for Payer: Nomi Health Commercial |
$2.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.29
|
| Rate for Payer: PACE Senior Care Partners |
$0.73
|
| Rate for Payer: PACE SWMI |
$0.77
|
| Rate for Payer: PHP Commercial |
$2.60
|
| Rate for Payer: PHP Medicare Advantage |
$0.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.66
|
| Rate for Payer: Priority Health Medicare |
$0.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.13
|
| Rate for Payer: Railroad Medicare Medicare |
$0.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.69
|
| Rate for Payer: UHC Core |
$2.56
|
| Rate for Payer: UHC Exchange |
$0.77
|
| Rate for Payer: UHC Medicaid |
$0.54
|
| Rate for Payer: UHC Medicare Advantage |
$0.77
|
| Rate for Payer: UHCCP Medicaid |
$0.54
|
| Rate for Payer: VA VA |
$0.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.29
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT
|
Facility
|
IP
|
$3.06
|
|
|
Service Code
|
NDC 45802014370
|
| Hospital Charge Code |
116684
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$2.75 |
| Rate for Payer: Aetna Commercial |
$2.60
|
| Rate for Payer: BCBS Trust/PPO |
$2.53
|
| Rate for Payer: BCN Commercial |
$2.53
|
| Rate for Payer: Cash Price |
$2.45
|
| Rate for Payer: Cofinity Commercial |
$2.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.45
|
| Rate for Payer: Healthscope Commercial |
$2.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.60
|
| Rate for Payer: Nomi Health Commercial |
$2.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.29
|
| Rate for Payer: PHP Commercial |
$2.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.69
|
| Rate for Payer: UHC Core |
$2.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.29
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG-10,000 UNIT/ML-1 % EAR DROPS,SUSP
|
Facility
|
IP
|
$157.82
|
|
|
Service Code
|
NDC 24208063562
|
| Hospital Charge Code |
28810
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.84 |
| Max. Negotiated Rate |
$142.04 |
| Rate for Payer: Aetna Commercial |
$134.15
|
| Rate for Payer: BCBS Trust/PPO |
$130.34
|
| Rate for Payer: BCN Commercial |
$130.34
|
| Rate for Payer: Cash Price |
$126.26
|
| Rate for Payer: Cofinity Commercial |
$135.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.26
|
| Rate for Payer: Healthscope Commercial |
$142.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.15
|
| Rate for Payer: Nomi Health Commercial |
$129.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.36
|
| Rate for Payer: PHP Commercial |
$134.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$137.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$109.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.88
|
| Rate for Payer: UHC Core |
$131.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.36
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG-10,000 UNIT/ML-1 % EAR DROPS,SUSP
|
Facility
|
OP
|
$157.82
|
|
|
Service Code
|
NDC 24208063562
|
| Hospital Charge Code |
28810
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.82 |
| Max. Negotiated Rate |
$142.04 |
| Rate for Payer: Aetna Commercial |
$134.15
|
| Rate for Payer: Aetna Medicare |
$41.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.32
|
| Rate for Payer: BCBS Complete |
$29.21
|
| Rate for Payer: BCBS MAPPO |
$39.45
|
| Rate for Payer: BCBS Trust/PPO |
$129.74
|
| Rate for Payer: BCN Commercial |
$129.74
|
| Rate for Payer: BCN Medicare Advantage |
$39.45
|
| Rate for Payer: Cash Price |
$126.26
|
| Rate for Payer: Cofinity Commercial |
$135.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.45
|
| Rate for Payer: Healthscope Commercial |
$142.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.36
|
| Rate for Payer: Mclaren Medicaid |
$27.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.43
|
| Rate for Payer: Meridian Medicaid |
$29.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$43.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.15
|
| Rate for Payer: Nomi Health Commercial |
$129.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.36
|
| Rate for Payer: PACE Senior Care Partners |
$37.48
|
| Rate for Payer: PACE SWMI |
$39.45
|
| Rate for Payer: PHP Commercial |
$134.15
|
| Rate for Payer: PHP Medicare Advantage |
$39.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$137.30
|
| Rate for Payer: Priority Health Medicare |
$39.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$109.84
|
| Rate for Payer: Railroad Medicare Medicare |
$39.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.88
|
| Rate for Payer: UHC Core |
$131.78
|
| Rate for Payer: UHC Exchange |
$39.45
|
| Rate for Payer: UHC Medicaid |
$27.82
|
| Rate for Payer: UHC Medicare Advantage |
$39.45
|
| Rate for Payer: UHCCP Medicaid |
$27.82
|
| Rate for Payer: VA VA |
$39.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.36
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG/ML-10,000 UNIT/ML-1 % EAR SOLUTION
|
Facility
|
OP
|
$164.15
|
|
|
Service Code
|
NDC 24208063110
|
| Hospital Charge Code |
34814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.94 |
| Max. Negotiated Rate |
$147.74 |
| Rate for Payer: Aetna Commercial |
$139.53
|
| Rate for Payer: Aetna Medicare |
$42.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.30
|
| Rate for Payer: BCBS Complete |
$30.38
|
| Rate for Payer: BCBS MAPPO |
$41.04
|
| Rate for Payer: BCBS Trust/PPO |
$134.95
|
| Rate for Payer: BCN Commercial |
$134.95
|
| Rate for Payer: BCN Medicare Advantage |
$41.04
|
| Rate for Payer: Cash Price |
$131.32
|
| Rate for Payer: Cofinity Commercial |
$141.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.04
|
| Rate for Payer: Healthscope Commercial |
$147.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.11
|
| Rate for Payer: Mclaren Medicaid |
$28.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.09
|
| Rate for Payer: Meridian Medicaid |
$30.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$45.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.53
|
| Rate for Payer: Nomi Health Commercial |
$134.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.11
|
| Rate for Payer: PACE Senior Care Partners |
$38.99
|
| Rate for Payer: PACE SWMI |
$41.04
|
| Rate for Payer: PHP Commercial |
$139.53
|
| Rate for Payer: PHP Medicare Advantage |
$41.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$142.81
|
| Rate for Payer: Priority Health Medicare |
$41.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$114.25
|
| Rate for Payer: Railroad Medicare Medicare |
$41.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.45
|
| Rate for Payer: UHC Core |
$137.07
|
| Rate for Payer: UHC Exchange |
$41.04
|
| Rate for Payer: UHC Medicaid |
$28.94
|
| Rate for Payer: UHC Medicare Advantage |
$41.04
|
| Rate for Payer: UHCCP Medicaid |
$28.94
|
| Rate for Payer: VA VA |
$41.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.11
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG/ML-10,000 UNIT/ML-1 % EAR SOLUTION
|
Facility
|
IP
|
$164.15
|
|
|
Service Code
|
NDC 24208063110
|
| Hospital Charge Code |
34814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.25 |
| Max. Negotiated Rate |
$147.74 |
| Rate for Payer: Aetna Commercial |
$139.53
|
| Rate for Payer: BCBS Trust/PPO |
$135.57
|
| Rate for Payer: BCN Commercial |
$135.57
|
| Rate for Payer: Cash Price |
$131.32
|
| Rate for Payer: Cofinity Commercial |
$141.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.32
|
| Rate for Payer: Healthscope Commercial |
$147.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.53
|
| Rate for Payer: Nomi Health Commercial |
$134.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.11
|
| Rate for Payer: PHP Commercial |
$139.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$142.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$114.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.45
|
| Rate for Payer: UHC Core |
$137.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.11
|
|
|
NEONATAL AFTERCARE
|
Facility
|
IP
|
$50,435.94
|
|
|
Service Code
|
APR-DRG 8634
|
| Min. Negotiated Rate |
$48,034.23 |
| Max. Negotiated Rate |
$50,435.94 |
| Rate for Payer: BCBS Complete |
$50,435.94
|
| Rate for Payer: Mclaren Medicaid |
$48,034.23
|
| Rate for Payer: Meridian Medicaid |
$50,435.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$48,034.23
|
| Rate for Payer: UHC Medicaid |
$48,034.23
|
| Rate for Payer: UHCCP Medicaid |
$48,034.23
|
|
|
NEONATAL AFTERCARE
|
Facility
|
IP
|
$21,302.83
|
|
|
Service Code
|
APR-DRG 8633
|
| Min. Negotiated Rate |
$20,288.41 |
| Max. Negotiated Rate |
$21,302.83 |
| Rate for Payer: BCBS Complete |
$21,302.83
|
| Rate for Payer: Mclaren Medicaid |
$20,288.41
|
| Rate for Payer: Meridian Medicaid |
$21,302.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$20,288.41
|
| Rate for Payer: UHC Medicaid |
$20,288.41
|
| Rate for Payer: UHCCP Medicaid |
$20,288.41
|
|
|
NEONATAL AFTERCARE
|
Facility
|
IP
|
$12,440.32
|
|
|
Service Code
|
APR-DRG 8632
|
| Min. Negotiated Rate |
$11,847.93 |
| Max. Negotiated Rate |
$12,440.32 |
| Rate for Payer: BCBS Complete |
$12,440.32
|
| Rate for Payer: Mclaren Medicaid |
$11,847.93
|
| Rate for Payer: Meridian Medicaid |
$12,440.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,847.93
|
| Rate for Payer: UHC Medicaid |
$11,847.93
|
| Rate for Payer: UHCCP Medicaid |
$11,847.93
|
|
|
NEONATAL AFTERCARE
|
Facility
|
IP
|
$6,388.96
|
|
|
Service Code
|
APR-DRG 8631
|
| Min. Negotiated Rate |
$6,084.72 |
| Max. Negotiated Rate |
$6,388.96 |
| Rate for Payer: BCBS Complete |
$6,388.96
|
| Rate for Payer: Mclaren Medicaid |
$6,084.72
|
| Rate for Payer: Meridian Medicaid |
$6,388.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,084.72
|
| Rate for Payer: UHC Medicaid |
$6,084.72
|
| Rate for Payer: UHCCP Medicaid |
$6,084.72
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION
|
Facility
|
IP
|
$8,290.39
|
|
|
Service Code
|
APR-DRG 6031
|
| Min. Negotiated Rate |
$7,895.61 |
| Max. Negotiated Rate |
$8,290.39 |
| Rate for Payer: BCBS Complete |
$8,290.39
|
| Rate for Payer: Mclaren Medicaid |
$7,895.61
|
| Rate for Payer: Meridian Medicaid |
$8,290.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,895.61
|
| Rate for Payer: UHC Medicaid |
$7,895.61
|
| Rate for Payer: UHCCP Medicaid |
$7,895.61
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION
|
Facility
|
IP
|
$38,778.60
|
|
|
Service Code
|
APR-DRG 6033
|
| Min. Negotiated Rate |
$36,932.00 |
| Max. Negotiated Rate |
$38,778.60 |
| Rate for Payer: BCBS Complete |
$38,778.60
|
| Rate for Payer: Mclaren Medicaid |
$36,932.00
|
| Rate for Payer: Meridian Medicaid |
$38,778.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$36,932.00
|
| Rate for Payer: UHC Medicaid |
$36,932.00
|
| Rate for Payer: UHCCP Medicaid |
$36,932.00
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION
|
Facility
|
IP
|
$62,554.98
|
|
|
Service Code
|
APR-DRG 6034
|
| Min. Negotiated Rate |
$59,576.17 |
| Max. Negotiated Rate |
$62,554.98 |
| Rate for Payer: BCBS Complete |
$62,554.98
|
| Rate for Payer: Mclaren Medicaid |
$59,576.17
|
| Rate for Payer: Meridian Medicaid |
$62,554.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$59,576.17
|
| Rate for Payer: UHC Medicaid |
$59,576.17
|
| Rate for Payer: UHCCP Medicaid |
$59,576.17
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION
|
Facility
|
IP
|
$26,507.07
|
|
|
Service Code
|
APR-DRG 6032
|
| Min. Negotiated Rate |
$25,244.83 |
| Max. Negotiated Rate |
$26,507.07 |
| Rate for Payer: BCBS Complete |
$26,507.07
|
| Rate for Payer: Mclaren Medicaid |
$25,244.83
|
| Rate for Payer: Meridian Medicaid |
$26,507.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$25,244.83
|
| Rate for Payer: UHC Medicaid |
$25,244.83
|
| Rate for Payer: UHCCP Medicaid |
$25,244.83
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJ
|
Facility
|
IP
|
$31,963.71
|
|
|
Service Code
|
APR-DRG 6022
|
| Min. Negotiated Rate |
$30,441.63 |
| Max. Negotiated Rate |
$31,963.71 |
| Rate for Payer: BCBS Complete |
$31,963.71
|
| Rate for Payer: Mclaren Medicaid |
$30,441.63
|
| Rate for Payer: Meridian Medicaid |
$31,963.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$30,441.63
|
| Rate for Payer: UHC Medicaid |
$30,441.63
|
| Rate for Payer: UHCCP Medicaid |
$30,441.63
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJ
|
Facility
|
IP
|
$25,860.29
|
|
|
Service Code
|
APR-DRG 6021
|
| Min. Negotiated Rate |
$24,628.84 |
| Max. Negotiated Rate |
$25,860.29 |
| Rate for Payer: BCBS Complete |
$25,860.29
|
| Rate for Payer: Mclaren Medicaid |
$24,628.84
|
| Rate for Payer: Meridian Medicaid |
$25,860.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$24,628.84
|
| Rate for Payer: UHC Medicaid |
$24,628.84
|
| Rate for Payer: UHCCP Medicaid |
$24,628.84
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJ
|
Facility
|
IP
|
$55,153.78
|
|
|
Service Code
|
APR-DRG 6024
|
| Min. Negotiated Rate |
$52,527.41 |
| Max. Negotiated Rate |
$55,153.78 |
| Rate for Payer: BCBS Complete |
$55,153.78
|
| Rate for Payer: Mclaren Medicaid |
$52,527.41
|
| Rate for Payer: Meridian Medicaid |
$55,153.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$52,527.41
|
| Rate for Payer: UHC Medicaid |
$52,527.41
|
| Rate for Payer: UHCCP Medicaid |
$52,527.41
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJ
|
Facility
|
IP
|
$41,205.35
|
|
|
Service Code
|
APR-DRG 6023
|
| Min. Negotiated Rate |
$39,243.19 |
| Max. Negotiated Rate |
$41,205.35 |
| Rate for Payer: BCBS Complete |
$41,205.35
|
| Rate for Payer: Mclaren Medicaid |
$39,243.19
|
| Rate for Payer: Meridian Medicaid |
$41,205.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$39,243.19
|
| Rate for Payer: UHC Medicaid |
$39,243.19
|
| Rate for Payer: UHCCP Medicaid |
$39,243.19
|
|
|
NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION
|
Facility
|
IP
|
$15,205.72
|
|
|
Service Code
|
APR-DRG 6082
|
| Min. Negotiated Rate |
$14,481.63 |
| Max. Negotiated Rate |
$15,205.72 |
| Rate for Payer: BCBS Complete |
$15,205.72
|
| Rate for Payer: Mclaren Medicaid |
$14,481.63
|
| Rate for Payer: Meridian Medicaid |
$15,205.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,481.63
|
| Rate for Payer: UHC Medicaid |
$14,481.63
|
| Rate for Payer: UHCCP Medicaid |
$14,481.63
|
|
