|
POT BICARB 344 MG-SOD BICARB 1,050 MG-CITRIC ACID 1,000 MG EFFERV TAB
|
Facility
|
IP
|
$109.98
|
|
|
Service Code
|
NDC 16500004108
|
| Hospital Charge Code |
174294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.39 |
| Max. Negotiated Rate |
$98.98 |
| Rate for Payer: Aetna American Axle |
$71.49
|
| Rate for Payer: Aetna Commercial |
$93.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.49
|
| Rate for Payer: Cash Price |
$87.98
|
| Rate for Payer: Cofinity Commercial |
$76.99
|
| Rate for Payer: Cofinity Commercial |
$94.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.98
|
| Rate for Payer: Healthscope Commercial |
$98.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.48
|
| Rate for Payer: PHP Commercial |
$93.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.49
|
| Rate for Payer: Priority Health SBD |
$69.29
|
| Rate for Payer: UMR Bronson Commercial |
$48.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.48
|
|
|
POT BICARB 344 MG-SOD BICARB 1,050 MG-CITRIC ACID 1,000 MG EFFERV TAB
|
Facility
|
IP
|
$148.05
|
|
|
Service Code
|
NDC 16500056675
|
| Hospital Charge Code |
174294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.14 |
| Max. Negotiated Rate |
$133.24 |
| Rate for Payer: Aetna American Axle |
$96.23
|
| Rate for Payer: Aetna Commercial |
$125.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.23
|
| Rate for Payer: Cash Price |
$118.44
|
| Rate for Payer: Cofinity Commercial |
$103.64
|
| Rate for Payer: Cofinity Commercial |
$127.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.44
|
| Rate for Payer: Healthscope Commercial |
$133.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.84
|
| Rate for Payer: PHP Commercial |
$125.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.23
|
| Rate for Payer: Priority Health SBD |
$93.27
|
| Rate for Payer: UMR Bronson Commercial |
$65.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.04
|
|
|
POVIDONE (BULK) K-30 POWDER
|
Facility
|
IP
|
$630.00
|
|
|
Service Code
|
NDC 51552132305
|
| Hospital Charge Code |
23281
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$277.20 |
| Max. Negotiated Rate |
$567.00 |
| Rate for Payer: Aetna American Axle |
$409.50
|
| Rate for Payer: Aetna Commercial |
$535.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$409.50
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cofinity Commercial |
$441.00
|
| Rate for Payer: Cofinity Commercial |
$541.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$441.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$504.00
|
| Rate for Payer: Healthscope Commercial |
$567.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$441.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$472.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$535.50
|
| Rate for Payer: PHP Commercial |
$535.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$409.50
|
| Rate for Payer: Priority Health SBD |
$396.90
|
| Rate for Payer: UMR Bronson Commercial |
$277.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$472.50
|
|
|
POVIDONE (BULK) K-30 POWDER
|
Facility
|
OP
|
$630.00
|
|
|
Service Code
|
NDC 51552132305
|
| Hospital Charge Code |
23281
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$233.10 |
| Max. Negotiated Rate |
$567.00 |
| Rate for Payer: Aetna American Axle |
$409.50
|
| Rate for Payer: Aetna Commercial |
$535.50
|
| Rate for Payer: Aetna Medicare |
$315.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$409.50
|
| Rate for Payer: BCBS Complete |
$252.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cofinity Commercial |
$441.00
|
| Rate for Payer: Cofinity Commercial |
$541.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$441.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$504.00
|
| Rate for Payer: Healthscope Commercial |
$567.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$441.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$472.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$535.50
|
| Rate for Payer: PHP Commercial |
$535.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$409.50
|
| Rate for Payer: Priority Health SBD |
$396.90
|
| Rate for Payer: UMR Bronson Commercial |
$233.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$472.50
|
|
|
POVIDONE-IODINE 0.3 % VAGINAL SOLUTION
|
Facility
|
IP
|
$16.03
|
|
|
Service Code
|
NDC 41608008743
|
| Hospital Charge Code |
12799
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.05 |
| Max. Negotiated Rate |
$14.43 |
| Rate for Payer: Aetna American Axle |
$10.42
|
| Rate for Payer: Aetna Commercial |
$13.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.42
|
| Rate for Payer: Cash Price |
$12.82
|
| Rate for Payer: Cofinity Commercial |
$11.22
|
| Rate for Payer: Cofinity Commercial |
$13.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.82
|
| Rate for Payer: Healthscope Commercial |
$14.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.63
|
| Rate for Payer: PHP Commercial |
$13.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.42
|
| Rate for Payer: Priority Health SBD |
$10.10
|
| Rate for Payer: UMR Bronson Commercial |
$7.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.02
|
|
|
POVIDONE-IODINE 0.3 % VAGINAL SOLUTION
|
Facility
|
OP
|
$16.03
|
|
|
Service Code
|
NDC 41608008743
|
| Hospital Charge Code |
12799
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.93 |
| Max. Negotiated Rate |
$14.43 |
| Rate for Payer: Aetna American Axle |
$10.42
|
| Rate for Payer: Aetna Commercial |
$13.63
|
| Rate for Payer: Aetna Medicare |
$8.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.42
|
| Rate for Payer: BCBS Complete |
$6.41
|
| Rate for Payer: Cash Price |
$12.82
|
| Rate for Payer: Cofinity Commercial |
$11.22
|
| Rate for Payer: Cofinity Commercial |
$13.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.82
|
| Rate for Payer: Healthscope Commercial |
$14.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.63
|
| Rate for Payer: PHP Commercial |
$13.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.42
|
| Rate for Payer: Priority Health SBD |
$10.10
|
| Rate for Payer: UMR Bronson Commercial |
$5.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.02
|
|
|
POVIDONE-IODINE 10 % TOPICAL SOLUTION
|
Facility
|
IP
|
$14.94
|
|
|
Service Code
|
NDC 52380190508
|
| Hospital Charge Code |
6458
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$13.45 |
| Rate for Payer: Aetna American Axle |
$9.71
|
| Rate for Payer: Aetna Commercial |
$12.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.71
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: Cofinity Commercial |
$10.46
|
| Rate for Payer: Cofinity Commercial |
$12.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.95
|
| Rate for Payer: Healthscope Commercial |
$13.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.70
|
| Rate for Payer: PHP Commercial |
$12.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
| Rate for Payer: Priority Health SBD |
$9.41
|
| Rate for Payer: UMR Bronson Commercial |
$6.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.20
|
|
|
POVIDONE-IODINE 10 % TOPICAL SOLUTION
|
Facility
|
OP
|
$21.29
|
|
|
Service Code
|
NDC 00395232516
|
| Hospital Charge Code |
6458
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.88 |
| Max. Negotiated Rate |
$19.16 |
| Rate for Payer: Aetna American Axle |
$13.84
|
| Rate for Payer: Aetna Commercial |
$18.10
|
| Rate for Payer: Aetna Medicare |
$10.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.84
|
| Rate for Payer: BCBS Complete |
$8.52
|
| Rate for Payer: Cash Price |
$17.03
|
| Rate for Payer: Cofinity Commercial |
$14.90
|
| Rate for Payer: Cofinity Commercial |
$18.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.03
|
| Rate for Payer: Healthscope Commercial |
$19.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.10
|
| Rate for Payer: PHP Commercial |
$18.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.84
|
| Rate for Payer: Priority Health SBD |
$13.41
|
| Rate for Payer: UMR Bronson Commercial |
$7.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.97
|
|
|
POVIDONE-IODINE 10 % TOPICAL SOLUTION
|
Facility
|
OP
|
$13.81
|
|
|
Service Code
|
NDC 00904110309
|
| Hospital Charge Code |
6458
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.11 |
| Max. Negotiated Rate |
$12.43 |
| Rate for Payer: Aetna American Axle |
$8.98
|
| Rate for Payer: Aetna Commercial |
$11.74
|
| Rate for Payer: Aetna Medicare |
$6.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.98
|
| Rate for Payer: BCBS Complete |
$5.52
|
| Rate for Payer: Cash Price |
$11.05
|
| Rate for Payer: Cofinity Commercial |
$11.88
|
| Rate for Payer: Cofinity Commercial |
$9.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.05
|
| Rate for Payer: Healthscope Commercial |
$12.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.74
|
| Rate for Payer: PHP Commercial |
$11.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.98
|
| Rate for Payer: Priority Health SBD |
$8.70
|
| Rate for Payer: UMR Bronson Commercial |
$5.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.36
|
|
|
POVIDONE-IODINE 10 % TOPICAL SOLUTION
|
Facility
|
IP
|
$21.29
|
|
|
Service Code
|
NDC 00395232516
|
| Hospital Charge Code |
6458
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.37 |
| Max. Negotiated Rate |
$19.16 |
| Rate for Payer: Aetna American Axle |
$13.84
|
| Rate for Payer: Aetna Commercial |
$18.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.84
|
| Rate for Payer: Cash Price |
$17.03
|
| Rate for Payer: Cofinity Commercial |
$14.90
|
| Rate for Payer: Cofinity Commercial |
$18.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.03
|
| Rate for Payer: Healthscope Commercial |
$19.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.10
|
| Rate for Payer: PHP Commercial |
$18.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.84
|
| Rate for Payer: Priority Health SBD |
$13.41
|
| Rate for Payer: UMR Bronson Commercial |
$9.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.97
|
|
|
POVIDONE-IODINE 10 % TOPICAL SOLUTION
|
Facility
|
IP
|
$13.81
|
|
|
Service Code
|
NDC 00904110309
|
| Hospital Charge Code |
6458
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.08 |
| Max. Negotiated Rate |
$12.43 |
| Rate for Payer: Aetna American Axle |
$8.98
|
| Rate for Payer: Aetna Commercial |
$11.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.98
|
| Rate for Payer: Cash Price |
$11.05
|
| Rate for Payer: Cofinity Commercial |
$11.88
|
| Rate for Payer: Cofinity Commercial |
$9.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.05
|
| Rate for Payer: Healthscope Commercial |
$12.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.74
|
| Rate for Payer: PHP Commercial |
$11.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.98
|
| Rate for Payer: Priority Health SBD |
$8.70
|
| Rate for Payer: UMR Bronson Commercial |
$6.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.36
|
|
|
POVIDONE-IODINE 10 % TOPICAL SOLUTION
|
Facility
|
OP
|
$14.94
|
|
|
Service Code
|
NDC 52380190508
|
| Hospital Charge Code |
6458
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$13.45 |
| Rate for Payer: Aetna American Axle |
$9.71
|
| Rate for Payer: Aetna Commercial |
$12.70
|
| Rate for Payer: Aetna Medicare |
$7.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.71
|
| Rate for Payer: BCBS Complete |
$5.98
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: Cofinity Commercial |
$10.46
|
| Rate for Payer: Cofinity Commercial |
$12.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.95
|
| Rate for Payer: Healthscope Commercial |
$13.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.70
|
| Rate for Payer: PHP Commercial |
$12.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
| Rate for Payer: Priority Health SBD |
$9.41
|
| Rate for Payer: UMR Bronson Commercial |
$5.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.20
|
|
|
POVIDONE-IODINE 10 % TOPICAL SOLUTION
|
Facility
|
IP
|
$13.87
|
|
|
Service Code
|
NDC 67618015009
|
| Hospital Charge Code |
6458
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$12.48 |
| Rate for Payer: Aetna American Axle |
$9.02
|
| Rate for Payer: Aetna Commercial |
$11.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.02
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$11.93
|
| Rate for Payer: Cofinity Commercial |
$9.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.10
|
| Rate for Payer: Healthscope Commercial |
$12.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.79
|
| Rate for Payer: PHP Commercial |
$11.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.02
|
| Rate for Payer: Priority Health SBD |
$8.74
|
| Rate for Payer: UMR Bronson Commercial |
$6.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.40
|
|
|
POVIDONE-IODINE 10 % TOPICAL SOLUTION
|
Facility
|
OP
|
$13.87
|
|
|
Service Code
|
NDC 67618015009
|
| Hospital Charge Code |
6458
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.13 |
| Max. Negotiated Rate |
$12.48 |
| Rate for Payer: Aetna American Axle |
$9.02
|
| Rate for Payer: Aetna Commercial |
$11.79
|
| Rate for Payer: Aetna Medicare |
$6.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.02
|
| Rate for Payer: BCBS Complete |
$5.55
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$11.93
|
| Rate for Payer: Cofinity Commercial |
$9.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.10
|
| Rate for Payer: Healthscope Commercial |
$12.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.79
|
| Rate for Payer: PHP Commercial |
$11.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.02
|
| Rate for Payer: Priority Health SBD |
$8.74
|
| Rate for Payer: UMR Bronson Commercial |
$5.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.40
|
|
|
POVIDONE-IODINE 5 % EYE SOLUTION
|
Facility
|
OP
|
$3.54
|
|
|
Service Code
|
NDC 09900000395
|
| Hospital Charge Code |
19791
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$3.19 |
| Rate for Payer: Aetna American Axle |
$2.30
|
| Rate for Payer: Aetna Commercial |
$3.01
|
| Rate for Payer: Aetna Medicare |
$1.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.30
|
| Rate for Payer: BCBS Complete |
$1.42
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Cofinity Commercial |
$3.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.83
|
| Rate for Payer: Healthscope Commercial |
$3.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.01
|
| Rate for Payer: PHP Commercial |
$3.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.30
|
| Rate for Payer: Priority Health SBD |
$2.23
|
| Rate for Payer: UMR Bronson Commercial |
$1.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.66
|
|
|
POVIDONE-IODINE 5 % EYE SOLUTION
|
Facility
|
IP
|
$33.39
|
|
|
Service Code
|
NDC 00065041130
|
| Hospital Charge Code |
19791
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.69 |
| Max. Negotiated Rate |
$30.05 |
| Rate for Payer: Aetna American Axle |
$21.70
|
| Rate for Payer: Aetna Commercial |
$28.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.70
|
| Rate for Payer: Cash Price |
$26.71
|
| Rate for Payer: Cofinity Commercial |
$23.37
|
| Rate for Payer: Cofinity Commercial |
$28.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.71
|
| Rate for Payer: Healthscope Commercial |
$30.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.38
|
| Rate for Payer: PHP Commercial |
$28.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.70
|
| Rate for Payer: Priority Health SBD |
$21.04
|
| Rate for Payer: UMR Bronson Commercial |
$14.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.04
|
|
|
POVIDONE-IODINE 5 % EYE SOLUTION
|
Facility
|
IP
|
$3.54
|
|
|
Service Code
|
NDC 09900000395
|
| Hospital Charge Code |
19791
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$3.19 |
| Rate for Payer: Aetna American Axle |
$2.30
|
| Rate for Payer: Aetna Commercial |
$3.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.30
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Cofinity Commercial |
$3.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.83
|
| Rate for Payer: Healthscope Commercial |
$3.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.01
|
| Rate for Payer: PHP Commercial |
$3.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.30
|
| Rate for Payer: Priority Health SBD |
$2.23
|
| Rate for Payer: UMR Bronson Commercial |
$1.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.66
|
|
|
POVIDONE-IODINE 5 % EYE SOLUTION
|
Facility
|
OP
|
$33.39
|
|
|
Service Code
|
NDC 00065041130
|
| Hospital Charge Code |
19791
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.35 |
| Max. Negotiated Rate |
$30.05 |
| Rate for Payer: Aetna American Axle |
$21.70
|
| Rate for Payer: Aetna Commercial |
$28.38
|
| Rate for Payer: Aetna Medicare |
$16.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.70
|
| Rate for Payer: BCBS Complete |
$13.36
|
| Rate for Payer: Cash Price |
$26.71
|
| Rate for Payer: Cofinity Commercial |
$23.37
|
| Rate for Payer: Cofinity Commercial |
$28.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.71
|
| Rate for Payer: Healthscope Commercial |
$30.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.38
|
| Rate for Payer: PHP Commercial |
$28.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.70
|
| Rate for Payer: Priority Health SBD |
$21.04
|
| Rate for Payer: UMR Bronson Commercial |
$12.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.04
|
|
|
PR 1 STAGE PROX PENILE/PENOSCROTAL HYPOSPADIAS RPR
|
Professional
|
Both
|
$2,098.00
|
|
|
Service Code
|
HCPCS 54332
|
| Min. Negotiated Rate |
$645.39 |
| Max. Negotiated Rate |
$2,967.99 |
| Rate for Payer: Aetna Commercial |
$1,292.63
|
| Rate for Payer: Aetna Medicare |
$1,003.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,292.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,389.10
|
| Rate for Payer: BCBS Complete |
$677.66
|
| Rate for Payer: BCBS MAPPO |
$964.65
|
| Rate for Payer: BCBS Trust/PPO |
$2,967.99
|
| Rate for Payer: BCN Commercial |
$1,452.84
|
| Rate for Payer: BCN Medicare Advantage |
$964.65
|
| Rate for Payer: Cash Price |
$1,678.40
|
| Rate for Payer: Cash Price |
$1,678.40
|
| Rate for Payer: Cofinity Commercial |
$1,389.10
|
| Rate for Payer: Cofinity Commercial |
$1,292.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$964.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,012.88
|
| Rate for Payer: Meridian Medicaid |
$677.66
|
| Rate for Payer: Nomi Health Commercial |
$1,157.58
|
| Rate for Payer: PACE SWMI |
$964.65
|
| Rate for Payer: PHP Commercial |
$1,350.51
|
| Rate for Payer: PHP Medicare Advantage |
$964.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$645.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,363.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,602.59
|
| Rate for Payer: Priority Health Medicare |
$964.65
|
| Rate for Payer: Priority Health Narrow Network |
$1,602.59
|
| Rate for Payer: Priority Health SBD |
$1,602.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$964.65
|
| Rate for Payer: UHC Medicare Advantage |
$964.65
|
| Rate for Payer: UHCCP Medicaid |
$645.39
|
| Rate for Payer: UMR Bronson Commercial |
$965.08
|
|
|
PR 1 STG DSTL HYPOSPADIAS RPR URTP SKN FLAPS
|
Professional
|
Both
|
$1,774.00
|
|
|
Service Code
|
HCPCS 54326
|
| Min. Negotiated Rate |
$602.36 |
| Max. Negotiated Rate |
$2,714.41 |
| Rate for Payer: Aetna Commercial |
$1,205.73
|
| Rate for Payer: Aetna Medicare |
$935.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,205.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,295.71
|
| Rate for Payer: BCBS Complete |
$632.48
|
| Rate for Payer: BCBS MAPPO |
$899.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,714.41
|
| Rate for Payer: BCN Commercial |
$1,356.57
|
| Rate for Payer: BCN Medicare Advantage |
$899.80
|
| Rate for Payer: Cash Price |
$1,419.20
|
| Rate for Payer: Cash Price |
$1,419.20
|
| Rate for Payer: Cofinity Commercial |
$1,205.73
|
| Rate for Payer: Cofinity Commercial |
$1,295.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$899.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$944.79
|
| Rate for Payer: Meridian Medicaid |
$632.48
|
| Rate for Payer: Nomi Health Commercial |
$1,079.76
|
| Rate for Payer: PACE SWMI |
$899.80
|
| Rate for Payer: PHP Commercial |
$1,259.72
|
| Rate for Payer: PHP Medicare Advantage |
$899.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$602.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,153.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,496.61
|
| Rate for Payer: Priority Health Medicare |
$899.80
|
| Rate for Payer: Priority Health Narrow Network |
$1,496.61
|
| Rate for Payer: Priority Health SBD |
$1,496.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$899.80
|
| Rate for Payer: UHC Medicare Advantage |
$899.80
|
| Rate for Payer: UHCCP Medicaid |
$602.36
|
| Rate for Payer: UMR Bronson Commercial |
$816.04
|
|
|
PR 1 STG DSTL HYPOSPADIAS RPR W/SMPL MEATAL ADVMNT
|
Professional
|
Both
|
$5,000.00
|
|
|
Service Code
|
HCPCS 54322
|
| Min. Negotiated Rate |
$362.41 |
| Max. Negotiated Rate |
$3,250.00 |
| Rate for Payer: Aetna Commercial |
$1,000.38
|
| Rate for Payer: Aetna Medicare |
$776.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,000.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,075.03
|
| Rate for Payer: BCBS Complete |
$525.13
|
| Rate for Payer: BCBS MAPPO |
$746.55
|
| Rate for Payer: BCBS Trust/PPO |
$362.41
|
| Rate for Payer: BCN Commercial |
$1,126.40
|
| Rate for Payer: BCN Medicare Advantage |
$746.55
|
| Rate for Payer: Cash Price |
$4,000.00
|
| Rate for Payer: Cash Price |
$4,000.00
|
| Rate for Payer: Cofinity Commercial |
$1,000.38
|
| Rate for Payer: Cofinity Commercial |
$1,075.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$746.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$783.88
|
| Rate for Payer: Meridian Medicaid |
$525.13
|
| Rate for Payer: Nomi Health Commercial |
$895.86
|
| Rate for Payer: PACE SWMI |
$746.55
|
| Rate for Payer: PHP Commercial |
$1,045.17
|
| Rate for Payer: PHP Medicare Advantage |
$746.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$500.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,250.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,242.02
|
| Rate for Payer: Priority Health Medicare |
$746.55
|
| Rate for Payer: Priority Health Narrow Network |
$1,242.02
|
| Rate for Payer: Priority Health SBD |
$1,242.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$746.55
|
| Rate for Payer: UHC Medicare Advantage |
$746.55
|
| Rate for Payer: UHCCP Medicaid |
$500.12
|
| Rate for Payer: UMR Bronson Commercial |
$2,300.00
|
|
|
PR 1 STG DSTL HYPOSPADIAS RPR W/URTP SKIN FLAPS
|
Professional
|
Both
|
$2,012.00
|
|
|
Service Code
|
HCPCS 54324
|
| Min. Negotiated Rate |
$517.21 |
| Max. Negotiated Rate |
$1,537.09 |
| Rate for Payer: Aetna Commercial |
$1,238.98
|
| Rate for Payer: Aetna Medicare |
$961.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,238.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,331.44
|
| Rate for Payer: BCBS Complete |
$649.71
|
| Rate for Payer: BCBS MAPPO |
$924.61
|
| Rate for Payer: BCBS Trust/PPO |
$517.21
|
| Rate for Payer: BCN Commercial |
$1,393.22
|
| Rate for Payer: BCN Medicare Advantage |
$924.61
|
| Rate for Payer: Cash Price |
$1,609.60
|
| Rate for Payer: Cash Price |
$1,609.60
|
| Rate for Payer: Cofinity Commercial |
$1,238.98
|
| Rate for Payer: Cofinity Commercial |
$1,331.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$924.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$970.84
|
| Rate for Payer: Meridian Medicaid |
$649.71
|
| Rate for Payer: Nomi Health Commercial |
$1,109.53
|
| Rate for Payer: PACE SWMI |
$924.61
|
| Rate for Payer: PHP Commercial |
$1,294.45
|
| Rate for Payer: PHP Medicare Advantage |
$924.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$618.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,307.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,537.09
|
| Rate for Payer: Priority Health Medicare |
$924.61
|
| Rate for Payer: Priority Health Narrow Network |
$1,537.09
|
| Rate for Payer: Priority Health SBD |
$1,537.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$924.61
|
| Rate for Payer: UHC Medicare Advantage |
$924.61
|
| Rate for Payer: UHCCP Medicaid |
$618.77
|
| Rate for Payer: UMR Bronson Commercial |
$925.52
|
|
|
PR 1ST HOSP/BIRTHING CENTER CARE PER DAY NML NB
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS 99460
|
| Min. Negotiated Rate |
$58.36 |
| Max. Negotiated Rate |
$190.72 |
| Rate for Payer: Aetna Commercial |
$117.08
|
| Rate for Payer: Aetna Medicare |
$90.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.81
|
| Rate for Payer: BCBS Complete |
$61.28
|
| Rate for Payer: BCBS MAPPO |
$87.37
|
| Rate for Payer: BCBS Trust/PPO |
$190.72
|
| Rate for Payer: BCN Commercial |
$133.89
|
| Rate for Payer: BCN Medicare Advantage |
$87.37
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cofinity Commercial |
$117.08
|
| Rate for Payer: Cofinity Commercial |
$125.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.74
|
| Rate for Payer: Meridian Medicaid |
$61.28
|
| Rate for Payer: Nomi Health Commercial |
$104.84
|
| Rate for Payer: PACE SWMI |
$87.37
|
| Rate for Payer: PHP Commercial |
$122.32
|
| Rate for Payer: PHP Medicare Advantage |
$87.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$123.40
|
| Rate for Payer: Priority Health Medicare |
$87.37
|
| Rate for Payer: Priority Health Narrow Network |
$123.40
|
| Rate for Payer: Priority Health SBD |
$123.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.37
|
| Rate for Payer: UHC Medicare Advantage |
$87.37
|
| Rate for Payer: UHCCP Medicaid |
$58.36
|
| Rate for Payer: UMR Bronson Commercial |
$72.68
|
|
|
PR 1ST HOSP/BIRTHING CENTER NB ADMIT & DSCHG SM DAT
|
Professional
|
Both
|
$172.00
|
|
|
Service Code
|
HCPCS 99463
|
| Min. Negotiated Rate |
$68.37 |
| Max. Negotiated Rate |
$1,537.35 |
| Rate for Payer: Aetna Commercial |
$136.79
|
| Rate for Payer: Aetna Medicare |
$106.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.00
|
| Rate for Payer: BCBS Complete |
$71.79
|
| Rate for Payer: BCBS MAPPO |
$102.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,537.35
|
| Rate for Payer: BCN Commercial |
$157.35
|
| Rate for Payer: BCN Medicare Advantage |
$102.08
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Cofinity Commercial |
$136.79
|
| Rate for Payer: Cofinity Commercial |
$147.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.18
|
| Rate for Payer: Meridian Medicaid |
$71.79
|
| Rate for Payer: Nomi Health Commercial |
$122.50
|
| Rate for Payer: PACE SWMI |
$102.08
|
| Rate for Payer: PHP Commercial |
$142.91
|
| Rate for Payer: PHP Medicare Advantage |
$102.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.03
|
| Rate for Payer: Priority Health Medicare |
$102.08
|
| Rate for Payer: Priority Health Narrow Network |
$144.03
|
| Rate for Payer: Priority Health SBD |
$144.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.08
|
| Rate for Payer: UHC Medicare Advantage |
$102.08
|
| Rate for Payer: UHCCP Medicaid |
$68.37
|
| Rate for Payer: UMR Bronson Commercial |
$79.12
|
|
|
PR 1ST HOSPITAL IP/OBS CARE HIGH MDM 75 MINUTES
|
Professional
|
Both
|
$353.00
|
|
|
Service Code
|
HCPCS 99223
|
| Min. Negotiated Rate |
$110.12 |
| Max. Negotiated Rate |
$1,363.01 |
| Rate for Payer: Aetna Commercial |
$220.83
|
| Rate for Payer: Aetna Medicare |
$171.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.31
|
| Rate for Payer: BCBS Complete |
$115.63
|
| Rate for Payer: BCBS MAPPO |
$164.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,363.01
|
| Rate for Payer: BCN Commercial |
$183.78
|
| Rate for Payer: BCN Medicare Advantage |
$164.80
|
| Rate for Payer: Cash Price |
$282.40
|
| Rate for Payer: Cash Price |
$282.40
|
| Rate for Payer: Cofinity Commercial |
$220.83
|
| Rate for Payer: Cofinity Commercial |
$237.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$164.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$173.04
|
| Rate for Payer: Meridian Medicaid |
$115.63
|
| Rate for Payer: Nomi Health Commercial |
$197.76
|
| Rate for Payer: PACE SWMI |
$164.80
|
| Rate for Payer: PHP Commercial |
$230.72
|
| Rate for Payer: PHP Medicare Advantage |
$164.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$230.64
|
| Rate for Payer: Priority Health Medicare |
$164.80
|
| Rate for Payer: Priority Health Narrow Network |
$230.64
|
| Rate for Payer: Priority Health SBD |
$230.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$164.80
|
| Rate for Payer: UHC Medicare Advantage |
$164.80
|
| Rate for Payer: UHCCP Medicaid |
$110.12
|
| Rate for Payer: UMR Bronson Commercial |
$162.38
|
|
