|
ATOVAQUONE 750 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$112.95
|
|
|
Service Code
|
NDC 00173054700
|
| Hospital Charge Code |
14953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.70 |
| Max. Negotiated Rate |
$101.66 |
| Rate for Payer: Aetna American Axle |
$73.42
|
| Rate for Payer: Aetna Commercial |
$96.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.42
|
| Rate for Payer: Cash Price |
$90.36
|
| Rate for Payer: Cofinity Commercial |
$79.06
|
| Rate for Payer: Cofinity Commercial |
$97.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.36
|
| Rate for Payer: Healthscope Commercial |
$101.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.01
|
| Rate for Payer: PHP Commercial |
$96.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.42
|
| Rate for Payer: Priority Health SBD |
$71.16
|
| Rate for Payer: UMR Bronson Commercial |
$49.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.71
|
|
|
ATOVAQUONE 750 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$1,220.69
|
|
|
Service Code
|
NDC 31722062921
|
| Hospital Charge Code |
14953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$537.10 |
| Max. Negotiated Rate |
$1,098.62 |
| Rate for Payer: Aetna American Axle |
$793.45
|
| Rate for Payer: Aetna Commercial |
$1,037.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$793.45
|
| Rate for Payer: Cash Price |
$976.55
|
| Rate for Payer: Cofinity Commercial |
$1,049.79
|
| Rate for Payer: Cofinity Commercial |
$854.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$854.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$976.55
|
| Rate for Payer: Healthscope Commercial |
$1,098.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$854.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$915.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,037.59
|
| Rate for Payer: PHP Commercial |
$1,037.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$793.45
|
| Rate for Payer: Priority Health SBD |
$769.03
|
| Rate for Payer: UMR Bronson Commercial |
$537.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$915.52
|
|
|
ATOVAQUONE 750 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$1,220.69
|
|
|
Service Code
|
NDC 31722062921
|
| Hospital Charge Code |
14953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$451.66 |
| Max. Negotiated Rate |
$1,098.62 |
| Rate for Payer: Aetna American Axle |
$793.45
|
| Rate for Payer: Aetna Commercial |
$1,037.59
|
| Rate for Payer: Aetna Medicare |
$610.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$793.45
|
| Rate for Payer: BCBS Complete |
$488.28
|
| Rate for Payer: Cash Price |
$976.55
|
| Rate for Payer: Cofinity Commercial |
$1,049.79
|
| Rate for Payer: Cofinity Commercial |
$854.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$854.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$976.55
|
| Rate for Payer: Healthscope Commercial |
$1,098.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$854.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$915.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,037.59
|
| Rate for Payer: PHP Commercial |
$1,037.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$793.45
|
| Rate for Payer: Priority Health SBD |
$769.03
|
| Rate for Payer: UMR Bronson Commercial |
$451.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$915.52
|
|
|
ATROPINE 0.1 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$36.23
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
730
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.41 |
| Max. Negotiated Rate |
$32.61 |
| Rate for Payer: Aetna American Axle |
$23.55
|
| Rate for Payer: Aetna American Axle |
$27.94
|
| Rate for Payer: Aetna American Axle |
$46.51
|
| Rate for Payer: Aetna American Axle |
$19.47
|
| Rate for Payer: Aetna American Axle |
$25.83
|
| Rate for Payer: Aetna Commercial |
$25.46
|
| Rate for Payer: Aetna Commercial |
$60.83
|
| Rate for Payer: Aetna Commercial |
$33.78
|
| Rate for Payer: Aetna Commercial |
$36.54
|
| Rate for Payer: Aetna Commercial |
$30.80
|
| Rate for Payer: Aetna Medicare |
$21.50
|
| Rate for Payer: Aetna Medicare |
$18.11
|
| Rate for Payer: Aetna Medicare |
$35.78
|
| Rate for Payer: Aetna Medicare |
$19.87
|
| Rate for Payer: Aetna Medicare |
$14.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.94
|
| Rate for Payer: BCBS Complete |
$28.62
|
| Rate for Payer: BCBS Complete |
$11.98
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS Complete |
$15.90
|
| Rate for Payer: BCBS Complete |
$14.49
|
| Rate for Payer: Cash Price |
$57.25
|
| Rate for Payer: Cash Price |
$23.96
|
| Rate for Payer: Cash Price |
$28.98
|
| Rate for Payer: Cash Price |
$34.39
|
| Rate for Payer: Cash Price |
$31.79
|
| Rate for Payer: Cofinity Commercial |
$50.09
|
| Rate for Payer: Cofinity Commercial |
$31.16
|
| Rate for Payer: Cofinity Commercial |
$36.97
|
| Rate for Payer: Cofinity Commercial |
$20.96
|
| Rate for Payer: Cofinity Commercial |
$34.18
|
| Rate for Payer: Cofinity Commercial |
$27.82
|
| Rate for Payer: Cofinity Commercial |
$30.09
|
| Rate for Payer: Cofinity Commercial |
$25.76
|
| Rate for Payer: Cofinity Commercial |
$25.36
|
| Rate for Payer: Cofinity Commercial |
$61.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.79
|
| Rate for Payer: Healthscope Commercial |
$26.95
|
| Rate for Payer: Healthscope Commercial |
$35.77
|
| Rate for Payer: Healthscope Commercial |
$64.40
|
| Rate for Payer: Healthscope Commercial |
$38.69
|
| Rate for Payer: Healthscope Commercial |
$32.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.83
|
| Rate for Payer: PHP Commercial |
$36.54
|
| Rate for Payer: PHP Commercial |
$33.78
|
| Rate for Payer: PHP Commercial |
$25.46
|
| Rate for Payer: PHP Commercial |
$30.80
|
| Rate for Payer: PHP Commercial |
$60.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.55
|
| Rate for Payer: Priority Health SBD |
$22.82
|
| Rate for Payer: Priority Health SBD |
$18.87
|
| Rate for Payer: Priority Health SBD |
$25.04
|
| Rate for Payer: Priority Health SBD |
$27.08
|
| Rate for Payer: Priority Health SBD |
$45.08
|
| Rate for Payer: UMR Bronson Commercial |
$26.48
|
| Rate for Payer: UMR Bronson Commercial |
$15.91
|
| Rate for Payer: UMR Bronson Commercial |
$13.41
|
| Rate for Payer: UMR Bronson Commercial |
$11.08
|
| Rate for Payer: UMR Bronson Commercial |
$14.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.80
|
|
|
ATROPINE 0.1 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$42.99
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
730
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.92 |
| Max. Negotiated Rate |
$38.69 |
| Rate for Payer: Aetna American Axle |
$27.94
|
| Rate for Payer: Aetna American Axle |
$19.47
|
| Rate for Payer: Aetna American Axle |
$23.55
|
| Rate for Payer: Aetna American Axle |
$46.51
|
| Rate for Payer: Aetna American Axle |
$25.83
|
| Rate for Payer: Aetna Commercial |
$36.54
|
| Rate for Payer: Aetna Commercial |
$30.80
|
| Rate for Payer: Aetna Commercial |
$25.46
|
| Rate for Payer: Aetna Commercial |
$60.83
|
| Rate for Payer: Aetna Commercial |
$33.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.55
|
| Rate for Payer: Cash Price |
$34.39
|
| Rate for Payer: Cash Price |
$57.25
|
| Rate for Payer: Cash Price |
$28.98
|
| Rate for Payer: Cash Price |
$31.79
|
| Rate for Payer: Cash Price |
$23.96
|
| Rate for Payer: Cofinity Commercial |
$50.09
|
| Rate for Payer: Cofinity Commercial |
$20.96
|
| Rate for Payer: Cofinity Commercial |
$36.97
|
| Rate for Payer: Cofinity Commercial |
$30.09
|
| Rate for Payer: Cofinity Commercial |
$27.82
|
| Rate for Payer: Cofinity Commercial |
$25.36
|
| Rate for Payer: Cofinity Commercial |
$31.16
|
| Rate for Payer: Cofinity Commercial |
$34.18
|
| Rate for Payer: Cofinity Commercial |
$25.76
|
| Rate for Payer: Cofinity Commercial |
$61.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.79
|
| Rate for Payer: Healthscope Commercial |
$32.61
|
| Rate for Payer: Healthscope Commercial |
$38.69
|
| Rate for Payer: Healthscope Commercial |
$35.77
|
| Rate for Payer: Healthscope Commercial |
$64.40
|
| Rate for Payer: Healthscope Commercial |
$26.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.46
|
| Rate for Payer: PHP Commercial |
$25.46
|
| Rate for Payer: PHP Commercial |
$60.83
|
| Rate for Payer: PHP Commercial |
$33.78
|
| Rate for Payer: PHP Commercial |
$36.54
|
| Rate for Payer: PHP Commercial |
$30.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.47
|
| Rate for Payer: Priority Health SBD |
$45.08
|
| Rate for Payer: Priority Health SBD |
$25.04
|
| Rate for Payer: Priority Health SBD |
$22.82
|
| Rate for Payer: Priority Health SBD |
$18.87
|
| Rate for Payer: Priority Health SBD |
$27.08
|
| Rate for Payer: UMR Bronson Commercial |
$13.18
|
| Rate for Payer: UMR Bronson Commercial |
$15.94
|
| Rate for Payer: UMR Bronson Commercial |
$18.92
|
| Rate for Payer: UMR Bronson Commercial |
$31.49
|
| Rate for Payer: UMR Bronson Commercial |
$17.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.24
|
|
|
ATROPINE 0.1 MG/ML SYRINGE (CODE)
|
Facility
|
IP
|
$29.95
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
163701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.18 |
| Max. Negotiated Rate |
$26.95 |
| Rate for Payer: Aetna American Axle |
$19.47
|
| Rate for Payer: Aetna American Axle |
$25.83
|
| Rate for Payer: Aetna American Axle |
$46.51
|
| Rate for Payer: Aetna Commercial |
$33.78
|
| Rate for Payer: Aetna Commercial |
$25.46
|
| Rate for Payer: Aetna Commercial |
$60.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.83
|
| Rate for Payer: Cash Price |
$57.25
|
| Rate for Payer: Cash Price |
$31.79
|
| Rate for Payer: Cash Price |
$23.96
|
| Rate for Payer: Cofinity Commercial |
$25.76
|
| Rate for Payer: Cofinity Commercial |
$34.18
|
| Rate for Payer: Cofinity Commercial |
$27.82
|
| Rate for Payer: Cofinity Commercial |
$61.54
|
| Rate for Payer: Cofinity Commercial |
$50.09
|
| Rate for Payer: Cofinity Commercial |
$20.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.79
|
| Rate for Payer: Healthscope Commercial |
$35.77
|
| Rate for Payer: Healthscope Commercial |
$26.95
|
| Rate for Payer: Healthscope Commercial |
$64.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.78
|
| Rate for Payer: PHP Commercial |
$60.83
|
| Rate for Payer: PHP Commercial |
$33.78
|
| Rate for Payer: PHP Commercial |
$25.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.47
|
| Rate for Payer: Priority Health SBD |
$45.08
|
| Rate for Payer: Priority Health SBD |
$25.04
|
| Rate for Payer: Priority Health SBD |
$18.87
|
| Rate for Payer: UMR Bronson Commercial |
$13.18
|
| Rate for Payer: UMR Bronson Commercial |
$31.49
|
| Rate for Payer: UMR Bronson Commercial |
$17.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.80
|
|
|
ATROPINE 0.1 MG/ML SYRINGE (CODE)
|
Facility
|
OP
|
$71.56
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
163701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.48 |
| Max. Negotiated Rate |
$64.40 |
| Rate for Payer: Aetna American Axle |
$46.51
|
| Rate for Payer: Aetna American Axle |
$19.47
|
| Rate for Payer: Aetna American Axle |
$25.83
|
| Rate for Payer: Aetna Commercial |
$60.83
|
| Rate for Payer: Aetna Commercial |
$33.78
|
| Rate for Payer: Aetna Commercial |
$25.46
|
| Rate for Payer: Aetna Medicare |
$35.78
|
| Rate for Payer: Aetna Medicare |
$19.87
|
| Rate for Payer: Aetna Medicare |
$14.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.47
|
| Rate for Payer: BCBS Complete |
$11.98
|
| Rate for Payer: BCBS Complete |
$15.90
|
| Rate for Payer: BCBS Complete |
$28.62
|
| Rate for Payer: Cash Price |
$57.25
|
| Rate for Payer: Cash Price |
$31.79
|
| Rate for Payer: Cash Price |
$23.96
|
| Rate for Payer: Cofinity Commercial |
$34.18
|
| Rate for Payer: Cofinity Commercial |
$20.96
|
| Rate for Payer: Cofinity Commercial |
$25.76
|
| Rate for Payer: Cofinity Commercial |
$61.54
|
| Rate for Payer: Cofinity Commercial |
$50.09
|
| Rate for Payer: Cofinity Commercial |
$27.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.25
|
| Rate for Payer: Healthscope Commercial |
$26.95
|
| Rate for Payer: Healthscope Commercial |
$35.77
|
| Rate for Payer: Healthscope Commercial |
$64.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.83
|
| Rate for Payer: PHP Commercial |
$25.46
|
| Rate for Payer: PHP Commercial |
$33.78
|
| Rate for Payer: PHP Commercial |
$60.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.47
|
| Rate for Payer: Priority Health SBD |
$25.04
|
| Rate for Payer: Priority Health SBD |
$18.87
|
| Rate for Payer: Priority Health SBD |
$45.08
|
| Rate for Payer: UMR Bronson Commercial |
$26.48
|
| Rate for Payer: UMR Bronson Commercial |
$11.08
|
| Rate for Payer: UMR Bronson Commercial |
$14.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.67
|
|
|
ATROPINE 0.4 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$35.25
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
731
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.04 |
| Max. Negotiated Rate |
$31.73 |
| Rate for Payer: Aetna American Axle |
$22.91
|
| Rate for Payer: Aetna American Axle |
$80.07
|
| Rate for Payer: Aetna American Axle |
$21.70
|
| Rate for Payer: Aetna Commercial |
$29.96
|
| Rate for Payer: Aetna Commercial |
$28.37
|
| Rate for Payer: Aetna Commercial |
$104.70
|
| Rate for Payer: Aetna Medicare |
$17.62
|
| Rate for Payer: Aetna Medicare |
$16.69
|
| Rate for Payer: Aetna Medicare |
$61.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.07
|
| Rate for Payer: BCBS Complete |
$49.27
|
| Rate for Payer: BCBS Complete |
$13.35
|
| Rate for Payer: BCBS Complete |
$14.10
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cash Price |
$98.54
|
| Rate for Payer: Cofinity Commercial |
$28.71
|
| Rate for Payer: Cofinity Commercial |
$105.93
|
| Rate for Payer: Cofinity Commercial |
$86.23
|
| Rate for Payer: Cofinity Commercial |
$30.32
|
| Rate for Payer: Cofinity Commercial |
$24.68
|
| Rate for Payer: Cofinity Commercial |
$23.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.20
|
| Rate for Payer: Healthscope Commercial |
$110.86
|
| Rate for Payer: Healthscope Commercial |
$30.04
|
| Rate for Payer: Healthscope Commercial |
$31.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.96
|
| Rate for Payer: PHP Commercial |
$104.70
|
| Rate for Payer: PHP Commercial |
$28.37
|
| Rate for Payer: PHP Commercial |
$29.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.07
|
| Rate for Payer: Priority Health SBD |
$21.03
|
| Rate for Payer: Priority Health SBD |
$77.60
|
| Rate for Payer: Priority Health SBD |
$22.21
|
| Rate for Payer: UMR Bronson Commercial |
$13.04
|
| Rate for Payer: UMR Bronson Commercial |
$45.58
|
| Rate for Payer: UMR Bronson Commercial |
$12.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.44
|
|
|
ATROPINE 0.4 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$33.38
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
731
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.69 |
| Max. Negotiated Rate |
$30.04 |
| Rate for Payer: Aetna American Axle |
$21.70
|
| Rate for Payer: Aetna American Axle |
$22.91
|
| Rate for Payer: Aetna Commercial |
$28.37
|
| Rate for Payer: Aetna Commercial |
$29.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.91
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cofinity Commercial |
$30.32
|
| Rate for Payer: Cofinity Commercial |
$24.68
|
| Rate for Payer: Cofinity Commercial |
$23.37
|
| Rate for Payer: Cofinity Commercial |
$28.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.20
|
| Rate for Payer: Healthscope Commercial |
$30.04
|
| Rate for Payer: Healthscope Commercial |
$31.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.37
|
| Rate for Payer: PHP Commercial |
$29.96
|
| Rate for Payer: PHP Commercial |
$28.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.91
|
| Rate for Payer: Priority Health SBD |
$21.03
|
| Rate for Payer: Priority Health SBD |
$22.21
|
| Rate for Payer: UMR Bronson Commercial |
$14.69
|
| Rate for Payer: UMR Bronson Commercial |
$15.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.44
|
|
|
ATROPINE 0.4 MG/ML INJECTION SOLUTION WRAPPER
|
Facility
|
IP
|
$35.25
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
301845
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.51 |
| Max. Negotiated Rate |
$31.73 |
| Rate for Payer: Aetna American Axle |
$22.91
|
| Rate for Payer: Aetna Commercial |
$29.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.91
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cofinity Commercial |
$24.68
|
| Rate for Payer: Cofinity Commercial |
$30.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.20
|
| Rate for Payer: Healthscope Commercial |
$31.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.96
|
| Rate for Payer: PHP Commercial |
$29.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.91
|
| Rate for Payer: Priority Health SBD |
$22.21
|
| Rate for Payer: UMR Bronson Commercial |
$15.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.44
|
|
|
ATROPINE 0.4 MG/ML INJECTION SOLUTION WRAPPER
|
Facility
|
OP
|
$123.18
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
301845
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.58 |
| Max. Negotiated Rate |
$110.86 |
| Rate for Payer: Aetna American Axle |
$80.07
|
| Rate for Payer: Aetna American Axle |
$22.91
|
| Rate for Payer: Aetna Commercial |
$104.70
|
| Rate for Payer: Aetna Commercial |
$29.96
|
| Rate for Payer: Aetna Medicare |
$61.59
|
| Rate for Payer: Aetna Medicare |
$17.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.91
|
| Rate for Payer: BCBS Complete |
$49.27
|
| Rate for Payer: BCBS Complete |
$14.10
|
| Rate for Payer: Cash Price |
$98.54
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cofinity Commercial |
$86.23
|
| Rate for Payer: Cofinity Commercial |
$105.93
|
| Rate for Payer: Cofinity Commercial |
$30.32
|
| Rate for Payer: Cofinity Commercial |
$24.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.54
|
| Rate for Payer: Healthscope Commercial |
$110.86
|
| Rate for Payer: Healthscope Commercial |
$31.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.70
|
| Rate for Payer: PHP Commercial |
$29.96
|
| Rate for Payer: PHP Commercial |
$104.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.91
|
| Rate for Payer: Priority Health SBD |
$22.21
|
| Rate for Payer: Priority Health SBD |
$77.60
|
| Rate for Payer: UMR Bronson Commercial |
$45.58
|
| Rate for Payer: UMR Bronson Commercial |
$13.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.44
|
|
|
ATROPINE 1 % EYE DROPS
|
Facility
|
OP
|
$122.08
|
|
|
Service Code
|
NDC 17478021505
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.17 |
| Max. Negotiated Rate |
$109.87 |
| Rate for Payer: Aetna American Axle |
$79.35
|
| Rate for Payer: Aetna Commercial |
$103.77
|
| Rate for Payer: Aetna Medicare |
$61.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.35
|
| Rate for Payer: BCBS Complete |
$48.83
|
| Rate for Payer: Cash Price |
$97.66
|
| Rate for Payer: Cofinity Commercial |
$104.99
|
| Rate for Payer: Cofinity Commercial |
$85.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.66
|
| Rate for Payer: Healthscope Commercial |
$109.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.77
|
| Rate for Payer: PHP Commercial |
$103.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.35
|
| Rate for Payer: Priority Health SBD |
$76.91
|
| Rate for Payer: UMR Bronson Commercial |
$45.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.56
|
|
|
ATROPINE 1 % EYE DROPS
|
Facility
|
IP
|
$153.23
|
|
|
Service Code
|
NDC 60219174903
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.42 |
| Max. Negotiated Rate |
$137.91 |
| Rate for Payer: Aetna American Axle |
$99.60
|
| Rate for Payer: Aetna Commercial |
$130.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.60
|
| Rate for Payer: Cash Price |
$122.58
|
| Rate for Payer: Cofinity Commercial |
$107.26
|
| Rate for Payer: Cofinity Commercial |
$131.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.58
|
| Rate for Payer: Healthscope Commercial |
$137.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.25
|
| Rate for Payer: PHP Commercial |
$130.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.60
|
| Rate for Payer: Priority Health SBD |
$96.53
|
| Rate for Payer: UMR Bronson Commercial |
$67.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.92
|
|
|
ATROPINE 1 % EYE DROPS
|
Facility
|
OP
|
$153.23
|
|
|
Service Code
|
NDC 60219174903
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.70 |
| Max. Negotiated Rate |
$137.91 |
| Rate for Payer: Aetna American Axle |
$99.60
|
| Rate for Payer: Aetna Commercial |
$130.25
|
| Rate for Payer: Aetna Medicare |
$76.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.60
|
| Rate for Payer: BCBS Complete |
$61.29
|
| Rate for Payer: Cash Price |
$122.58
|
| Rate for Payer: Cofinity Commercial |
$107.26
|
| Rate for Payer: Cofinity Commercial |
$131.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.58
|
| Rate for Payer: Healthscope Commercial |
$137.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.25
|
| Rate for Payer: PHP Commercial |
$130.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.60
|
| Rate for Payer: Priority Health SBD |
$96.53
|
| Rate for Payer: UMR Bronson Commercial |
$56.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.92
|
|
|
ATROPINE 1 % EYE DROPS
|
Facility
|
IP
|
$97.65
|
|
|
Service Code
|
NDC 17478021502
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.97 |
| Max. Negotiated Rate |
$87.89 |
| Rate for Payer: Aetna American Axle |
$63.47
|
| Rate for Payer: Aetna Commercial |
$83.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.47
|
| Rate for Payer: Cash Price |
$78.12
|
| Rate for Payer: Cofinity Commercial |
$68.36
|
| Rate for Payer: Cofinity Commercial |
$83.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$68.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.12
|
| Rate for Payer: Healthscope Commercial |
$87.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.00
|
| Rate for Payer: PHP Commercial |
$83.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.47
|
| Rate for Payer: Priority Health SBD |
$61.52
|
| Rate for Payer: UMR Bronson Commercial |
$42.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.24
|
|
|
ATROPINE 1 % EYE DROPS
|
Facility
|
OP
|
$97.65
|
|
|
Service Code
|
NDC 17478021502
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.13 |
| Max. Negotiated Rate |
$87.89 |
| Rate for Payer: Aetna American Axle |
$63.47
|
| Rate for Payer: Aetna Commercial |
$83.00
|
| Rate for Payer: Aetna Medicare |
$48.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.47
|
| Rate for Payer: BCBS Complete |
$39.06
|
| Rate for Payer: Cash Price |
$78.12
|
| Rate for Payer: Cofinity Commercial |
$68.36
|
| Rate for Payer: Cofinity Commercial |
$83.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$68.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.12
|
| Rate for Payer: Healthscope Commercial |
$87.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.00
|
| Rate for Payer: PHP Commercial |
$83.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.47
|
| Rate for Payer: Priority Health SBD |
$61.52
|
| Rate for Payer: UMR Bronson Commercial |
$36.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.24
|
|
|
ATROPINE 1 % EYE DROPS
|
Facility
|
OP
|
$125.62
|
|
|
Service Code
|
NDC 60219174802
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.48 |
| Max. Negotiated Rate |
$113.06 |
| Rate for Payer: Aetna American Axle |
$81.65
|
| Rate for Payer: Aetna Commercial |
$106.78
|
| Rate for Payer: Aetna Medicare |
$62.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.65
|
| Rate for Payer: BCBS Complete |
$50.25
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cofinity Commercial |
$108.03
|
| Rate for Payer: Cofinity Commercial |
$87.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.50
|
| Rate for Payer: Healthscope Commercial |
$113.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.78
|
| Rate for Payer: PHP Commercial |
$106.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.65
|
| Rate for Payer: Priority Health SBD |
$79.14
|
| Rate for Payer: UMR Bronson Commercial |
$46.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.22
|
|
|
ATROPINE 1 % EYE DROPS
|
Facility
|
IP
|
$125.62
|
|
|
Service Code
|
NDC 60219174802
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.27 |
| Max. Negotiated Rate |
$113.06 |
| Rate for Payer: Aetna American Axle |
$81.65
|
| Rate for Payer: Aetna Commercial |
$106.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.65
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cofinity Commercial |
$108.03
|
| Rate for Payer: Cofinity Commercial |
$87.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.50
|
| Rate for Payer: Healthscope Commercial |
$113.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.78
|
| Rate for Payer: PHP Commercial |
$106.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.65
|
| Rate for Payer: Priority Health SBD |
$79.14
|
| Rate for Payer: UMR Bronson Commercial |
$55.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.22
|
|
|
ATROPINE 1 % EYE DROPS
|
Facility
|
IP
|
$122.08
|
|
|
Service Code
|
NDC 17478021505
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.72 |
| Max. Negotiated Rate |
$109.87 |
| Rate for Payer: Aetna American Axle |
$79.35
|
| Rate for Payer: Aetna Commercial |
$103.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.35
|
| Rate for Payer: Cash Price |
$97.66
|
| Rate for Payer: Cofinity Commercial |
$104.99
|
| Rate for Payer: Cofinity Commercial |
$85.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.66
|
| Rate for Payer: Healthscope Commercial |
$109.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.77
|
| Rate for Payer: PHP Commercial |
$103.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.35
|
| Rate for Payer: Priority Health SBD |
$76.91
|
| Rate for Payer: UMR Bronson Commercial |
$53.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.56
|
|
|
ATROPINE 1 % EYE OINTMENT
|
Facility
|
IP
|
$56.98
|
|
|
Service Code
|
NDC 24208082555
|
| Hospital Charge Code |
735
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.07 |
| Max. Negotiated Rate |
$51.28 |
| Rate for Payer: Aetna American Axle |
$37.04
|
| Rate for Payer: Aetna Commercial |
$48.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.04
|
| Rate for Payer: Cash Price |
$45.58
|
| Rate for Payer: Cofinity Commercial |
$39.89
|
| Rate for Payer: Cofinity Commercial |
$49.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.58
|
| Rate for Payer: Healthscope Commercial |
$51.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.43
|
| Rate for Payer: PHP Commercial |
$48.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.04
|
| Rate for Payer: Priority Health SBD |
$35.90
|
| Rate for Payer: UMR Bronson Commercial |
$25.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.73
|
|
|
ATROPINE 1 % EYE OINTMENT
|
Facility
|
OP
|
$56.98
|
|
|
Service Code
|
NDC 24208082555
|
| Hospital Charge Code |
735
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.08 |
| Max. Negotiated Rate |
$51.28 |
| Rate for Payer: Aetna American Axle |
$37.04
|
| Rate for Payer: Aetna Commercial |
$48.43
|
| Rate for Payer: Aetna Medicare |
$28.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.04
|
| Rate for Payer: BCBS Complete |
$22.79
|
| Rate for Payer: Cash Price |
$45.58
|
| Rate for Payer: Cofinity Commercial |
$39.89
|
| Rate for Payer: Cofinity Commercial |
$49.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.58
|
| Rate for Payer: Healthscope Commercial |
$51.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.43
|
| Rate for Payer: PHP Commercial |
$48.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.04
|
| Rate for Payer: Priority Health SBD |
$35.90
|
| Rate for Payer: UMR Bronson Commercial |
$21.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.73
|
|
|
ATROPINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$30.29
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
734
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.33 |
| Max. Negotiated Rate |
$27.26 |
| Rate for Payer: Aetna American Axle |
$19.69
|
| Rate for Payer: Aetna Commercial |
$25.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.69
|
| Rate for Payer: Cash Price |
$24.23
|
| Rate for Payer: Cofinity Commercial |
$21.20
|
| Rate for Payer: Cofinity Commercial |
$26.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.23
|
| Rate for Payer: Healthscope Commercial |
$27.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.75
|
| Rate for Payer: PHP Commercial |
$25.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.69
|
| Rate for Payer: Priority Health SBD |
$19.08
|
| Rate for Payer: UMR Bronson Commercial |
$13.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.72
|
|
|
ATROPINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$30.29
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
734
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.21 |
| Max. Negotiated Rate |
$27.26 |
| Rate for Payer: Aetna American Axle |
$19.69
|
| Rate for Payer: Aetna Commercial |
$25.75
|
| Rate for Payer: Aetna Medicare |
$15.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.69
|
| Rate for Payer: BCBS Complete |
$12.12
|
| Rate for Payer: Cash Price |
$24.23
|
| Rate for Payer: Cofinity Commercial |
$21.20
|
| Rate for Payer: Cofinity Commercial |
$26.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.23
|
| Rate for Payer: Healthscope Commercial |
$27.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.75
|
| Rate for Payer: PHP Commercial |
$25.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.69
|
| Rate for Payer: Priority Health SBD |
$19.08
|
| Rate for Payer: UMR Bronson Commercial |
$11.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.72
|
|
|
ATROPINE 1 MG/ML INJECTION SOLUTION WRAPPER
|
Facility
|
IP
|
$30.29
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
301597
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.33 |
| Max. Negotiated Rate |
$27.26 |
| Rate for Payer: Aetna American Axle |
$19.69
|
| Rate for Payer: Aetna American Axle |
$28.84
|
| Rate for Payer: Aetna Commercial |
$25.75
|
| Rate for Payer: Aetna Commercial |
$37.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.84
|
| Rate for Payer: Cash Price |
$24.23
|
| Rate for Payer: Cash Price |
$35.50
|
| Rate for Payer: Cofinity Commercial |
$38.16
|
| Rate for Payer: Cofinity Commercial |
$31.06
|
| Rate for Payer: Cofinity Commercial |
$21.20
|
| Rate for Payer: Cofinity Commercial |
$26.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.50
|
| Rate for Payer: Healthscope Commercial |
$27.26
|
| Rate for Payer: Healthscope Commercial |
$39.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.75
|
| Rate for Payer: PHP Commercial |
$37.71
|
| Rate for Payer: PHP Commercial |
$25.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.84
|
| Rate for Payer: Priority Health SBD |
$19.08
|
| Rate for Payer: Priority Health SBD |
$27.95
|
| Rate for Payer: UMR Bronson Commercial |
$13.33
|
| Rate for Payer: UMR Bronson Commercial |
$19.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.28
|
|
|
ATROPINE 1 MG/ML INJECTION SOLUTION WRAPPER
|
Facility
|
OP
|
$30.29
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
301597
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.21 |
| Max. Negotiated Rate |
$27.26 |
| Rate for Payer: Aetna American Axle |
$19.69
|
| Rate for Payer: Aetna American Axle |
$28.84
|
| Rate for Payer: Aetna Commercial |
$25.75
|
| Rate for Payer: Aetna Commercial |
$37.71
|
| Rate for Payer: Aetna Medicare |
$15.14
|
| Rate for Payer: Aetna Medicare |
$22.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.84
|
| Rate for Payer: BCBS Complete |
$17.75
|
| Rate for Payer: BCBS Complete |
$12.12
|
| Rate for Payer: Cash Price |
$24.23
|
| Rate for Payer: Cash Price |
$35.50
|
| Rate for Payer: Cofinity Commercial |
$26.05
|
| Rate for Payer: Cofinity Commercial |
$21.20
|
| Rate for Payer: Cofinity Commercial |
$31.06
|
| Rate for Payer: Cofinity Commercial |
$38.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.50
|
| Rate for Payer: Healthscope Commercial |
$39.93
|
| Rate for Payer: Healthscope Commercial |
$27.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.71
|
| Rate for Payer: PHP Commercial |
$37.71
|
| Rate for Payer: PHP Commercial |
$25.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.84
|
| Rate for Payer: Priority Health SBD |
$27.95
|
| Rate for Payer: Priority Health SBD |
$19.08
|
| Rate for Payer: UMR Bronson Commercial |
$11.21
|
| Rate for Payer: UMR Bronson Commercial |
$16.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.72
|
|
