|
ABACAVIR 20 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$1,414.08
|
|
|
Service Code
|
NDC 64980040524
|
| Hospital Charge Code |
24439
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$622.20 |
| Max. Negotiated Rate |
$1,272.67 |
| Rate for Payer: Aetna American Axle |
$919.15
|
| Rate for Payer: Aetna Commercial |
$1,201.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$919.15
|
| Rate for Payer: Cash Price |
$1,131.26
|
| Rate for Payer: Cofinity Advantage |
$989.86
|
| Rate for Payer: Cofinity Commercial |
$1,216.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,131.26
|
| Rate for Payer: Healthscope Commercial |
$1,272.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$989.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,060.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,201.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,060.56
|
| Rate for Payer: PHP Commercial |
$1,201.97
|
| Rate for Payer: Priority Health SBD |
$890.87
|
| Rate for Payer: UMR Bronson Commercial |
$622.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,060.56
|
|
|
ABACAVIR 20 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$1,414.08
|
|
|
Service Code
|
NDC 64980040524
|
| Hospital Charge Code |
24439
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$523.21 |
| Max. Negotiated Rate |
$1,272.67 |
| Rate for Payer: Aetna American Axle |
$919.15
|
| Rate for Payer: Aetna Commercial |
$1,201.97
|
| Rate for Payer: Aetna Medicare |
$707.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$919.15
|
| Rate for Payer: BCBS Complete |
$565.63
|
| Rate for Payer: Cash Price |
$1,131.26
|
| Rate for Payer: Cofinity Advantage |
$989.86
|
| Rate for Payer: Cofinity Commercial |
$1,216.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,131.26
|
| Rate for Payer: Healthscope Commercial |
$1,272.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$989.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,060.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,131.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,201.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,060.56
|
| Rate for Payer: PHP Commercial |
$1,201.97
|
| Rate for Payer: Priority Health SBD |
$890.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$919.15
|
| Rate for Payer: UHC Core |
$736.74
|
| Rate for Payer: UHC Exchange |
$555.73
|
| Rate for Payer: UMR Bronson Commercial |
$523.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,060.56
|
|
|
ABACAVIR 300 MG TABLET
|
Facility
|
OP
|
$1,310.54
|
|
|
Service Code
|
NDC 00904687406
|
| Hospital Charge Code |
24438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$484.90 |
| Max. Negotiated Rate |
$1,179.49 |
| Rate for Payer: Aetna American Axle |
$851.85
|
| Rate for Payer: Aetna Commercial |
$1,113.96
|
| Rate for Payer: Aetna Medicare |
$655.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$851.85
|
| Rate for Payer: BCBS Complete |
$524.22
|
| Rate for Payer: Cash Price |
$1,048.43
|
| Rate for Payer: Cofinity Advantage |
$917.38
|
| Rate for Payer: Cofinity Commercial |
$1,127.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,048.43
|
| Rate for Payer: Healthscope Commercial |
$1,179.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$917.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$982.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,048.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,113.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$982.90
|
| Rate for Payer: PHP Commercial |
$1,113.96
|
| Rate for Payer: Priority Health SBD |
$825.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$851.85
|
| Rate for Payer: UHC Core |
$682.79
|
| Rate for Payer: UHC Exchange |
$515.04
|
| Rate for Payer: UMR Bronson Commercial |
$484.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$982.90
|
|
|
ABACAVIR 300 MG TABLET
|
Facility
|
OP
|
$516.15
|
|
|
Service Code
|
NDC 31722055760
|
| Hospital Charge Code |
24438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$190.98 |
| Max. Negotiated Rate |
$464.54 |
| Rate for Payer: Aetna American Axle |
$335.50
|
| Rate for Payer: Aetna Commercial |
$438.73
|
| Rate for Payer: Aetna Medicare |
$258.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$335.50
|
| Rate for Payer: BCBS Complete |
$206.46
|
| Rate for Payer: Cash Price |
$412.92
|
| Rate for Payer: Cofinity Advantage |
$361.31
|
| Rate for Payer: Cofinity Commercial |
$443.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$412.92
|
| Rate for Payer: Healthscope Commercial |
$464.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$361.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$387.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$412.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$438.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$387.11
|
| Rate for Payer: PHP Commercial |
$438.73
|
| Rate for Payer: Priority Health SBD |
$325.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$335.50
|
| Rate for Payer: UHC Core |
$268.91
|
| Rate for Payer: UHC Exchange |
$202.85
|
| Rate for Payer: UMR Bronson Commercial |
$190.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$387.11
|
|
|
ABACAVIR 300 MG TABLET
|
Facility
|
IP
|
$23.14
|
|
|
Service Code
|
NDC 68084002111
|
| Hospital Charge Code |
24438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$20.83 |
| Rate for Payer: Aetna American Axle |
$15.04
|
| Rate for Payer: Aetna Commercial |
$19.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.04
|
| Rate for Payer: Cash Price |
$18.51
|
| Rate for Payer: Cofinity Advantage |
$16.20
|
| Rate for Payer: Cofinity Commercial |
$19.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.51
|
| Rate for Payer: Healthscope Commercial |
$20.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.36
|
| Rate for Payer: PHP Commercial |
$19.67
|
| Rate for Payer: Priority Health SBD |
$14.58
|
| Rate for Payer: UMR Bronson Commercial |
$10.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.36
|
|
|
ABACAVIR 300 MG TABLET
|
Facility
|
OP
|
$694.09
|
|
|
Service Code
|
NDC 68084002121
|
| Hospital Charge Code |
24438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$256.81 |
| Max. Negotiated Rate |
$624.68 |
| Rate for Payer: Aetna American Axle |
$451.16
|
| Rate for Payer: Aetna Commercial |
$589.98
|
| Rate for Payer: Aetna Medicare |
$347.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$451.16
|
| Rate for Payer: BCBS Complete |
$277.64
|
| Rate for Payer: Cash Price |
$555.27
|
| Rate for Payer: Cofinity Advantage |
$485.86
|
| Rate for Payer: Cofinity Commercial |
$596.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$555.27
|
| Rate for Payer: Healthscope Commercial |
$624.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$485.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$520.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$555.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$589.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$520.57
|
| Rate for Payer: PHP Commercial |
$589.98
|
| Rate for Payer: Priority Health SBD |
$437.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$451.16
|
| Rate for Payer: UHC Core |
$361.62
|
| Rate for Payer: UHC Exchange |
$272.78
|
| Rate for Payer: UMR Bronson Commercial |
$256.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$520.57
|
|
|
ABACAVIR 300 MG TABLET
|
Facility
|
IP
|
$630.93
|
|
|
Service Code
|
NDC 00904687404
|
| Hospital Charge Code |
24438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$277.61 |
| Max. Negotiated Rate |
$567.84 |
| Rate for Payer: Aetna American Axle |
$410.10
|
| Rate for Payer: Aetna Commercial |
$536.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$410.10
|
| Rate for Payer: Cash Price |
$504.74
|
| Rate for Payer: Cofinity Advantage |
$441.65
|
| Rate for Payer: Cofinity Commercial |
$542.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$504.74
|
| Rate for Payer: Healthscope Commercial |
$567.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$441.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$473.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$536.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$473.20
|
| Rate for Payer: PHP Commercial |
$536.29
|
| Rate for Payer: Priority Health SBD |
$397.49
|
| Rate for Payer: UMR Bronson Commercial |
$277.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$473.20
|
|
|
ABACAVIR 300 MG TABLET
|
Facility
|
IP
|
$694.09
|
|
|
Service Code
|
NDC 68084002121
|
| Hospital Charge Code |
24438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$305.40 |
| Max. Negotiated Rate |
$624.68 |
| Rate for Payer: Aetna American Axle |
$451.16
|
| Rate for Payer: Aetna Commercial |
$589.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$451.16
|
| Rate for Payer: Cash Price |
$555.27
|
| Rate for Payer: Cofinity Advantage |
$485.86
|
| Rate for Payer: Cofinity Commercial |
$596.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$555.27
|
| Rate for Payer: Healthscope Commercial |
$624.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$485.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$520.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$589.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$520.57
|
| Rate for Payer: PHP Commercial |
$589.98
|
| Rate for Payer: Priority Health SBD |
$437.28
|
| Rate for Payer: UMR Bronson Commercial |
$305.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$520.57
|
|
|
ABACAVIR 300 MG TABLET
|
Facility
|
IP
|
$1,310.54
|
|
|
Service Code
|
NDC 00904687406
|
| Hospital Charge Code |
24438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$576.64 |
| Max. Negotiated Rate |
$1,179.49 |
| Rate for Payer: Aetna American Axle |
$851.85
|
| Rate for Payer: Aetna Commercial |
$1,113.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$851.85
|
| Rate for Payer: Cash Price |
$1,048.43
|
| Rate for Payer: Cofinity Advantage |
$917.38
|
| Rate for Payer: Cofinity Commercial |
$1,127.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,048.43
|
| Rate for Payer: Healthscope Commercial |
$1,179.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$917.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$982.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,113.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$982.90
|
| Rate for Payer: PHP Commercial |
$1,113.96
|
| Rate for Payer: Priority Health SBD |
$825.64
|
| Rate for Payer: UMR Bronson Commercial |
$576.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$982.90
|
|
|
ABACAVIR 300 MG TABLET
|
Facility
|
OP
|
$23.14
|
|
|
Service Code
|
NDC 68084002111
|
| Hospital Charge Code |
24438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.56 |
| Max. Negotiated Rate |
$20.83 |
| Rate for Payer: Aetna American Axle |
$15.04
|
| Rate for Payer: Aetna Commercial |
$19.67
|
| Rate for Payer: Aetna Medicare |
$11.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.04
|
| Rate for Payer: BCBS Complete |
$9.26
|
| Rate for Payer: Cash Price |
$18.51
|
| Rate for Payer: Cofinity Advantage |
$16.20
|
| Rate for Payer: Cofinity Commercial |
$19.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.51
|
| Rate for Payer: Healthscope Commercial |
$20.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.36
|
| Rate for Payer: PHP Commercial |
$19.67
|
| Rate for Payer: Priority Health SBD |
$14.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.04
|
| Rate for Payer: UHC Core |
$12.06
|
| Rate for Payer: UHC Exchange |
$9.09
|
| Rate for Payer: UMR Bronson Commercial |
$8.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.36
|
|
|
ABACAVIR 300 MG TABLET
|
Facility
|
IP
|
$516.15
|
|
|
Service Code
|
NDC 31722055760
|
| Hospital Charge Code |
24438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$227.11 |
| Max. Negotiated Rate |
$464.54 |
| Rate for Payer: Aetna American Axle |
$335.50
|
| Rate for Payer: Aetna Commercial |
$438.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$335.50
|
| Rate for Payer: Cash Price |
$412.92
|
| Rate for Payer: Cofinity Advantage |
$361.31
|
| Rate for Payer: Cofinity Commercial |
$443.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$412.92
|
| Rate for Payer: Healthscope Commercial |
$464.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$361.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$387.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$438.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$387.11
|
| Rate for Payer: PHP Commercial |
$438.73
|
| Rate for Payer: Priority Health SBD |
$325.17
|
| Rate for Payer: UMR Bronson Commercial |
$227.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$387.11
|
|
|
ABACAVIR 300 MG TABLET
|
Facility
|
OP
|
$630.93
|
|
|
Service Code
|
NDC 00904687404
|
| Hospital Charge Code |
24438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$233.44 |
| Max. Negotiated Rate |
$567.84 |
| Rate for Payer: Aetna American Axle |
$410.10
|
| Rate for Payer: Aetna Commercial |
$536.29
|
| Rate for Payer: Aetna Medicare |
$315.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$410.10
|
| Rate for Payer: BCBS Complete |
$252.37
|
| Rate for Payer: Cash Price |
$504.74
|
| Rate for Payer: Cofinity Advantage |
$441.65
|
| Rate for Payer: Cofinity Commercial |
$542.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$504.74
|
| Rate for Payer: Healthscope Commercial |
$567.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$441.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$473.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$504.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$536.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$473.20
|
| Rate for Payer: PHP Commercial |
$536.29
|
| Rate for Payer: Priority Health SBD |
$397.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$410.10
|
| Rate for Payer: UHC Core |
$328.71
|
| Rate for Payer: UHC Exchange |
$247.96
|
| Rate for Payer: UMR Bronson Commercial |
$233.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$473.20
|
|
|
ABACAVIR 600 MG-LAMIVUDINE 300 MG TABLET
|
Facility
|
OP
|
$4,659.90
|
|
|
Service Code
|
NDC 49702020613
|
| Hospital Charge Code |
39301
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,724.16 |
| Max. Negotiated Rate |
$4,193.91 |
| Rate for Payer: Aetna American Axle |
$3,028.93
|
| Rate for Payer: Aetna Commercial |
$3,960.91
|
| Rate for Payer: Aetna Medicare |
$2,329.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,028.93
|
| Rate for Payer: BCBS Complete |
$1,863.96
|
| Rate for Payer: Cash Price |
$3,727.92
|
| Rate for Payer: Cofinity Advantage |
$3,261.93
|
| Rate for Payer: Cofinity Commercial |
$4,007.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,727.92
|
| Rate for Payer: Healthscope Commercial |
$4,193.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,261.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,494.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,727.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,960.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,494.93
|
| Rate for Payer: PHP Commercial |
$3,960.91
|
| Rate for Payer: Priority Health SBD |
$2,935.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,028.93
|
| Rate for Payer: UHC Core |
$2,427.81
|
| Rate for Payer: UHC Exchange |
$1,831.34
|
| Rate for Payer: UMR Bronson Commercial |
$1,724.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,494.93
|
|
|
ABACAVIR 600 MG-LAMIVUDINE 300 MG TABLET
|
Facility
|
IP
|
$262.37
|
|
|
Service Code
|
NDC 69097036202
|
| Hospital Charge Code |
39301
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.44 |
| Max. Negotiated Rate |
$236.13 |
| Rate for Payer: Aetna American Axle |
$170.54
|
| Rate for Payer: Aetna Commercial |
$223.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.54
|
| Rate for Payer: Cash Price |
$209.90
|
| Rate for Payer: Cofinity Advantage |
$183.66
|
| Rate for Payer: Cofinity Commercial |
$225.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.90
|
| Rate for Payer: Healthscope Commercial |
$236.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.78
|
| Rate for Payer: PHP Commercial |
$223.01
|
| Rate for Payer: Priority Health SBD |
$165.29
|
| Rate for Payer: UMR Bronson Commercial |
$115.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.78
|
|
|
ABACAVIR 600 MG-LAMIVUDINE 300 MG TABLET
|
Facility
|
IP
|
$340.66
|
|
|
Service Code
|
NDC 68180028806
|
| Hospital Charge Code |
39301
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.89 |
| Max. Negotiated Rate |
$306.59 |
| Rate for Payer: Aetna American Axle |
$221.43
|
| Rate for Payer: Aetna Commercial |
$289.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.43
|
| Rate for Payer: Cash Price |
$272.53
|
| Rate for Payer: Cofinity Advantage |
$238.46
|
| Rate for Payer: Cofinity Commercial |
$292.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.53
|
| Rate for Payer: Healthscope Commercial |
$306.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$238.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$255.50
|
| Rate for Payer: PHP Commercial |
$289.56
|
| Rate for Payer: Priority Health SBD |
$214.62
|
| Rate for Payer: UMR Bronson Commercial |
$149.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.50
|
|
|
ABACAVIR 600 MG-LAMIVUDINE 300 MG TABLET
|
Facility
|
OP
|
$340.66
|
|
|
Service Code
|
NDC 68180028806
|
| Hospital Charge Code |
39301
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.04 |
| Max. Negotiated Rate |
$306.59 |
| Rate for Payer: Aetna American Axle |
$221.43
|
| Rate for Payer: Aetna Commercial |
$289.56
|
| Rate for Payer: Aetna Medicare |
$170.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.43
|
| Rate for Payer: BCBS Complete |
$136.26
|
| Rate for Payer: Cash Price |
$272.53
|
| Rate for Payer: Cofinity Advantage |
$238.46
|
| Rate for Payer: Cofinity Commercial |
$292.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.53
|
| Rate for Payer: Healthscope Commercial |
$306.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$238.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$255.50
|
| Rate for Payer: PHP Commercial |
$289.56
|
| Rate for Payer: Priority Health SBD |
$214.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.43
|
| Rate for Payer: UHC Core |
$177.48
|
| Rate for Payer: UHC Exchange |
$133.88
|
| Rate for Payer: UMR Bronson Commercial |
$126.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.50
|
|
|
ABACAVIR 600 MG-LAMIVUDINE 300 MG TABLET
|
Facility
|
OP
|
$262.37
|
|
|
Service Code
|
NDC 69097036202
|
| Hospital Charge Code |
39301
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.08 |
| Max. Negotiated Rate |
$236.13 |
| Rate for Payer: Aetna American Axle |
$170.54
|
| Rate for Payer: Aetna Commercial |
$223.01
|
| Rate for Payer: Aetna Medicare |
$131.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.54
|
| Rate for Payer: BCBS Complete |
$104.95
|
| Rate for Payer: Cash Price |
$209.90
|
| Rate for Payer: Cofinity Advantage |
$183.66
|
| Rate for Payer: Cofinity Commercial |
$225.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.90
|
| Rate for Payer: Healthscope Commercial |
$236.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$209.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.78
|
| Rate for Payer: PHP Commercial |
$223.01
|
| Rate for Payer: Priority Health SBD |
$165.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.54
|
| Rate for Payer: UHC Core |
$136.69
|
| Rate for Payer: UHC Exchange |
$103.11
|
| Rate for Payer: UMR Bronson Commercial |
$97.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.78
|
|
|
ABACAVIR 600 MG-LAMIVUDINE 300 MG TABLET
|
Facility
|
IP
|
$4,659.90
|
|
|
Service Code
|
NDC 49702020613
|
| Hospital Charge Code |
39301
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,050.36 |
| Max. Negotiated Rate |
$4,193.91 |
| Rate for Payer: Aetna American Axle |
$3,028.93
|
| Rate for Payer: Aetna Commercial |
$3,960.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,028.93
|
| Rate for Payer: Cash Price |
$3,727.92
|
| Rate for Payer: Cofinity Advantage |
$3,261.93
|
| Rate for Payer: Cofinity Commercial |
$4,007.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,727.92
|
| Rate for Payer: Healthscope Commercial |
$4,193.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,261.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,494.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,960.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,494.93
|
| Rate for Payer: PHP Commercial |
$3,960.91
|
| Rate for Payer: Priority Health SBD |
$2,935.74
|
| Rate for Payer: UMR Bronson Commercial |
$2,050.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,494.93
|
|
|
ABATACEPT (WITH MALTOSE) 250 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,151.36
|
|
|
Service Code
|
HCPCS J0129
|
| Hospital Charge Code |
70287
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$946.60 |
| Max. Negotiated Rate |
$1,936.22 |
| Rate for Payer: Aetna American Axle |
$1,398.38
|
| Rate for Payer: Aetna American Axle |
$3,253.41
|
| Rate for Payer: Aetna Commercial |
$1,828.66
|
| Rate for Payer: Aetna Commercial |
$4,254.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,398.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,253.41
|
| Rate for Payer: Cash Price |
$1,721.09
|
| Rate for Payer: Cash Price |
$4,004.20
|
| Rate for Payer: Cofinity Advantage |
$3,503.68
|
| Rate for Payer: Cofinity Advantage |
$1,505.95
|
| Rate for Payer: Cofinity Commercial |
$4,304.52
|
| Rate for Payer: Cofinity Commercial |
$1,850.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,721.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,004.20
|
| Rate for Payer: Healthscope Commercial |
$1,936.22
|
| Rate for Payer: Healthscope Commercial |
$4,504.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,503.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,505.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,613.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,753.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,828.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,254.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,613.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,753.94
|
| Rate for Payer: PHP Commercial |
$1,828.66
|
| Rate for Payer: PHP Commercial |
$4,254.46
|
| Rate for Payer: Priority Health SBD |
$3,153.31
|
| Rate for Payer: Priority Health SBD |
$1,355.36
|
| Rate for Payer: UMR Bronson Commercial |
$946.60
|
| Rate for Payer: UMR Bronson Commercial |
$2,202.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,613.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,753.94
|
|
|
ABATACEPT (WITH MALTOSE) 250 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$5,005.25
|
|
|
Service Code
|
HCPCS J0129
|
| Hospital Charge Code |
70287
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.39 |
| Max. Negotiated Rate |
$4,504.73 |
| Rate for Payer: Aetna American Axle |
$3,253.41
|
| Rate for Payer: Aetna American Axle |
$1,398.38
|
| Rate for Payer: Aetna Commercial |
$1,828.66
|
| Rate for Payer: Aetna Commercial |
$4,254.46
|
| Rate for Payer: Aetna Medicare |
$46.51
|
| Rate for Payer: Aetna Medicare |
$46.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,398.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,253.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.90
|
| Rate for Payer: BCBS Complete |
$24.56
|
| Rate for Payer: BCBS Complete |
$24.56
|
| Rate for Payer: BCBS MAPPO |
$44.72
|
| Rate for Payer: BCBS MAPPO |
$44.72
|
| Rate for Payer: BCBS Trust/PPO |
$186.28
|
| Rate for Payer: BCBS Trust/PPO |
$186.28
|
| Rate for Payer: BCN Commercial |
$186.28
|
| Rate for Payer: BCN Commercial |
$186.28
|
| Rate for Payer: BCN Medicare Advantage |
$44.72
|
| Rate for Payer: BCN Medicare Advantage |
$44.72
|
| Rate for Payer: Cash Price |
$1,721.09
|
| Rate for Payer: Cash Price |
$4,004.20
|
| Rate for Payer: Cash Price |
$4,004.20
|
| Rate for Payer: Cash Price |
$1,721.09
|
| Rate for Payer: Cofinity Advantage |
$3,503.68
|
| Rate for Payer: Cofinity Advantage |
$1,505.95
|
| Rate for Payer: Cofinity Commercial |
$1,850.17
|
| Rate for Payer: Cofinity Commercial |
$4,304.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,721.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,004.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.72
|
| Rate for Payer: Healthscope Commercial |
$1,936.22
|
| Rate for Payer: Healthscope Commercial |
$4,504.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,503.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,505.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,613.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,753.94
|
| Rate for Payer: Mclaren Medicaid |
$44.72
|
| Rate for Payer: Mclaren Medicaid |
$44.72
|
| Rate for Payer: Mclaren Medicare |
$44.72
|
| Rate for Payer: Mclaren Medicare |
$44.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.96
|
| Rate for Payer: Meridian Medicaid |
$46.96
|
| Rate for Payer: Meridian Medicaid |
$46.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$49.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$49.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,828.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,254.46
|
| Rate for Payer: Nomi Health Commercial |
$134.16
|
| Rate for Payer: Nomi Health Commercial |
$134.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,753.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,613.52
|
| Rate for Payer: PACE Medicare |
$42.48
|
| Rate for Payer: PACE Medicare |
$42.48
|
| Rate for Payer: PACE SWMI |
$44.72
|
| Rate for Payer: PACE SWMI |
$44.72
|
| Rate for Payer: PHP Commercial |
$1,828.66
|
| Rate for Payer: PHP Commercial |
$4,254.46
|
| Rate for Payer: PHP Medicare Advantage |
$44.72
|
| Rate for Payer: PHP Medicare Advantage |
$44.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$139.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$139.11
|
| Rate for Payer: Priority Health Medicare |
$44.72
|
| Rate for Payer: Priority Health Medicare |
$44.72
|
| Rate for Payer: Priority Health SBD |
$1,355.36
|
| Rate for Payer: Priority Health SBD |
$3,153.31
|
| Rate for Payer: Priority Health Tiered Network |
$111.29
|
| Rate for Payer: Priority Health Tiered Network |
$111.29
|
| Rate for Payer: Railroad Medicare Medicare |
$44.72
|
| Rate for Payer: Railroad Medicare Medicare |
$44.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.87
|
| Rate for Payer: UHC Core |
$73.87
|
| Rate for Payer: UHC Core |
$73.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$44.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$44.72
|
| Rate for Payer: UHC Exchange |
$73.87
|
| Rate for Payer: UHC Exchange |
$73.87
|
| Rate for Payer: UHC Medicaid |
$23.39
|
| Rate for Payer: UHC Medicaid |
$23.39
|
| Rate for Payer: UHCCP Medicaid |
$23.39
|
| Rate for Payer: UHCCP Medicaid |
$23.39
|
| Rate for Payer: UMR Bronson Commercial |
$796.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,851.94
|
| Rate for Payer: VA VA |
$44.72
|
| Rate for Payer: VA VA |
$44.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,753.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,613.52
|
|
|
ABDHR GEL TOPICAL SYRINGE
|
Facility
|
OP
|
$11.70
|
|
|
Service Code
|
NDC 09900000392
|
| Hospital Charge Code |
151065
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.33 |
| Max. Negotiated Rate |
$10.53 |
| Rate for Payer: Aetna American Axle |
$7.61
|
| Rate for Payer: Aetna Commercial |
$9.95
|
| Rate for Payer: Aetna Medicare |
$5.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.61
|
| Rate for Payer: BCBS Complete |
$4.68
|
| Rate for Payer: Cash Price |
$9.36
|
| Rate for Payer: Cofinity Advantage |
$8.19
|
| Rate for Payer: Cofinity Commercial |
$10.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.36
|
| Rate for Payer: Healthscope Commercial |
$10.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.78
|
| Rate for Payer: PHP Commercial |
$9.95
|
| Rate for Payer: Priority Health SBD |
$7.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.61
|
| Rate for Payer: UHC Core |
$6.10
|
| Rate for Payer: UHC Exchange |
$4.60
|
| Rate for Payer: UMR Bronson Commercial |
$4.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.78
|
|
|
ABDHR GEL TOPICAL SYRINGE
|
Facility
|
IP
|
$11.70
|
|
|
Service Code
|
NDC 09900000392
|
| Hospital Charge Code |
151065
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.15 |
| Max. Negotiated Rate |
$10.53 |
| Rate for Payer: Aetna American Axle |
$7.61
|
| Rate for Payer: Aetna Commercial |
$9.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.61
|
| Rate for Payer: Cash Price |
$9.36
|
| Rate for Payer: Cofinity Advantage |
$8.19
|
| Rate for Payer: Cofinity Commercial |
$10.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.36
|
| Rate for Payer: Healthscope Commercial |
$10.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.78
|
| Rate for Payer: PHP Commercial |
$9.95
|
| Rate for Payer: Priority Health SBD |
$7.37
|
| Rate for Payer: UMR Bronson Commercial |
$5.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.78
|
|
|
ABDOMINAL PAIN
|
Facility
|
IP
|
$4,990.30
|
|
|
Service Code
|
APR-DRG 2512
|
| Min. Negotiated Rate |
$4,752.67 |
| Max. Negotiated Rate |
$4,990.30 |
| Rate for Payer: BCBS Complete |
$4,990.30
|
| Rate for Payer: Mclaren Medicaid |
$4,752.67
|
| Rate for Payer: Meridian Medicaid |
$4,990.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,752.67
|
| Rate for Payer: UHC Medicaid |
$4,752.67
|
| Rate for Payer: UHCCP Medicaid |
$4,752.67
|
|
|
ABDOMINAL PAIN
|
Facility
|
IP
|
$4,170.69
|
|
|
Service Code
|
APR-DRG 2511
|
| Min. Negotiated Rate |
$3,972.09 |
| Max. Negotiated Rate |
$4,170.69 |
| Rate for Payer: BCBS Complete |
$4,170.69
|
| Rate for Payer: Mclaren Medicaid |
$3,972.09
|
| Rate for Payer: Meridian Medicaid |
$4,170.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,972.09
|
| Rate for Payer: UHC Medicaid |
$3,972.09
|
| Rate for Payer: UHCCP Medicaid |
$3,972.09
|
|
|
ABDOMINAL PAIN
|
Facility
|
IP
|
$6,175.53
|
|
|
Service Code
|
APR-DRG 2513
|
| Min. Negotiated Rate |
$5,881.45 |
| Max. Negotiated Rate |
$6,175.53 |
| Rate for Payer: BCBS Complete |
$6,175.53
|
| Rate for Payer: Mclaren Medicaid |
$5,881.45
|
| Rate for Payer: Meridian Medicaid |
$6,175.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,881.45
|
| Rate for Payer: UHC Medicaid |
$5,881.45
|
| Rate for Payer: UHCCP Medicaid |
$5,881.45
|
|
