|
BENZOCAINE 20 % MUCOSAL GEL
|
Facility
|
OP
|
$26.98
|
|
|
Service Code
|
NDC 00573022567
|
| Hospital Charge Code |
19691
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.98 |
| Max. Negotiated Rate |
$24.28 |
| Rate for Payer: Aetna American Axle |
$17.54
|
| Rate for Payer: Aetna Commercial |
$22.93
|
| Rate for Payer: Aetna Medicare |
$13.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.54
|
| Rate for Payer: BCBS Complete |
$10.79
|
| Rate for Payer: Cash Price |
$21.58
|
| Rate for Payer: Cofinity Commercial |
$18.89
|
| Rate for Payer: Cofinity Commercial |
$23.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.58
|
| Rate for Payer: Healthscope Commercial |
$24.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.93
|
| Rate for Payer: PHP Commercial |
$22.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.54
|
| Rate for Payer: Priority Health SBD |
$17.00
|
| Rate for Payer: UMR Bronson Commercial |
$9.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.23
|
|
|
BENZOCAINE 20 % MUCOSAL GEL
|
Facility
|
IP
|
$26.98
|
|
|
Service Code
|
NDC 00573022567
|
| Hospital Charge Code |
19691
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.87 |
| Max. Negotiated Rate |
$24.28 |
| Rate for Payer: Aetna American Axle |
$17.54
|
| Rate for Payer: Aetna Commercial |
$22.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.54
|
| Rate for Payer: Cash Price |
$21.58
|
| Rate for Payer: Cofinity Commercial |
$18.89
|
| Rate for Payer: Cofinity Commercial |
$23.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.58
|
| Rate for Payer: Healthscope Commercial |
$24.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.93
|
| Rate for Payer: PHP Commercial |
$22.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.54
|
| Rate for Payer: Priority Health SBD |
$17.00
|
| Rate for Payer: UMR Bronson Commercial |
$11.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.23
|
|
|
BENZOCAINE 20 % MUCOSAL SPRAY
|
Facility
|
OP
|
$37.17
|
|
|
Service Code
|
NDC 00283061043
|
| Hospital Charge Code |
27666
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.75 |
| Max. Negotiated Rate |
$33.45 |
| Rate for Payer: Aetna American Axle |
$24.16
|
| Rate for Payer: Aetna Commercial |
$31.59
|
| Rate for Payer: Aetna Medicare |
$18.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.16
|
| Rate for Payer: BCBS Complete |
$14.87
|
| Rate for Payer: Cash Price |
$29.74
|
| Rate for Payer: Cofinity Commercial |
$26.02
|
| Rate for Payer: Cofinity Commercial |
$31.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.74
|
| Rate for Payer: Healthscope Commercial |
$33.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.59
|
| Rate for Payer: PHP Commercial |
$31.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.16
|
| Rate for Payer: Priority Health SBD |
$23.42
|
| Rate for Payer: UMR Bronson Commercial |
$13.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.88
|
|
|
BENZOCAINE 20 % MUCOSAL SPRAY
|
Facility
|
IP
|
$34.86
|
|
|
Service Code
|
NDC 00283061026
|
| Hospital Charge Code |
27666
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.34 |
| Max. Negotiated Rate |
$31.37 |
| Rate for Payer: Aetna American Axle |
$22.66
|
| Rate for Payer: Aetna Commercial |
$29.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.66
|
| Rate for Payer: Cash Price |
$27.89
|
| Rate for Payer: Cofinity Commercial |
$24.40
|
| Rate for Payer: Cofinity Commercial |
$29.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.89
|
| Rate for Payer: Healthscope Commercial |
$31.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.63
|
| Rate for Payer: PHP Commercial |
$29.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.66
|
| Rate for Payer: Priority Health SBD |
$21.96
|
| Rate for Payer: UMR Bronson Commercial |
$15.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.14
|
|
|
BENZOCAINE 20 % MUCOSAL SPRAY
|
Facility
|
IP
|
$37.17
|
|
|
Service Code
|
NDC 00283061043
|
| Hospital Charge Code |
27666
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.35 |
| Max. Negotiated Rate |
$33.45 |
| Rate for Payer: Aetna American Axle |
$24.16
|
| Rate for Payer: Aetna Commercial |
$31.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.16
|
| Rate for Payer: Cash Price |
$29.74
|
| Rate for Payer: Cofinity Commercial |
$26.02
|
| Rate for Payer: Cofinity Commercial |
$31.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.74
|
| Rate for Payer: Healthscope Commercial |
$33.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.59
|
| Rate for Payer: PHP Commercial |
$31.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.16
|
| Rate for Payer: Priority Health SBD |
$23.42
|
| Rate for Payer: UMR Bronson Commercial |
$16.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.88
|
|
|
BENZOCAINE 20 % MUCOSAL SPRAY
|
Facility
|
OP
|
$34.86
|
|
|
Service Code
|
NDC 00283061026
|
| Hospital Charge Code |
27666
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$31.37 |
| Rate for Payer: Aetna American Axle |
$22.66
|
| Rate for Payer: Aetna Commercial |
$29.63
|
| Rate for Payer: Aetna Medicare |
$17.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.66
|
| Rate for Payer: BCBS Complete |
$13.94
|
| Rate for Payer: Cash Price |
$27.89
|
| Rate for Payer: Cofinity Commercial |
$24.40
|
| Rate for Payer: Cofinity Commercial |
$29.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.89
|
| Rate for Payer: Healthscope Commercial |
$31.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.63
|
| Rate for Payer: PHP Commercial |
$29.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.66
|
| Rate for Payer: Priority Health SBD |
$21.96
|
| Rate for Payer: UMR Bronson Commercial |
$12.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.14
|
|
|
BENZOIN (BULK) TOPICAL TINCTURE
|
Facility
|
IP
|
$30.87
|
|
|
Service Code
|
NDC 00395024792
|
| Hospital Charge Code |
165061
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.58 |
| Max. Negotiated Rate |
$27.78 |
| Rate for Payer: Aetna American Axle |
$20.07
|
| Rate for Payer: Aetna Commercial |
$26.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.07
|
| Rate for Payer: Cash Price |
$24.70
|
| Rate for Payer: Cofinity Commercial |
$21.61
|
| Rate for Payer: Cofinity Commercial |
$26.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.70
|
| Rate for Payer: Healthscope Commercial |
$27.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.24
|
| Rate for Payer: PHP Commercial |
$26.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.07
|
| Rate for Payer: Priority Health SBD |
$19.45
|
| Rate for Payer: UMR Bronson Commercial |
$13.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.15
|
|
|
BENZOIN (BULK) TOPICAL TINCTURE
|
Facility
|
OP
|
$30.87
|
|
|
Service Code
|
NDC 00395024792
|
| Hospital Charge Code |
165061
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.42 |
| Max. Negotiated Rate |
$27.78 |
| Rate for Payer: Aetna American Axle |
$20.07
|
| Rate for Payer: Aetna Commercial |
$26.24
|
| Rate for Payer: Aetna Medicare |
$15.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.07
|
| Rate for Payer: BCBS Complete |
$12.35
|
| Rate for Payer: Cash Price |
$24.70
|
| Rate for Payer: Cofinity Commercial |
$21.61
|
| Rate for Payer: Cofinity Commercial |
$26.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.70
|
| Rate for Payer: Healthscope Commercial |
$27.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.24
|
| Rate for Payer: PHP Commercial |
$26.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.07
|
| Rate for Payer: Priority Health SBD |
$19.45
|
| Rate for Payer: UMR Bronson Commercial |
$11.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.15
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
IP
|
$264.10
|
|
|
Service Code
|
NDC 62332042631
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.20 |
| Max. Negotiated Rate |
$237.69 |
| Rate for Payer: Aetna American Axle |
$171.66
|
| Rate for Payer: Aetna Commercial |
$224.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.66
|
| Rate for Payer: Cash Price |
$211.28
|
| Rate for Payer: Cofinity Commercial |
$184.87
|
| Rate for Payer: Cofinity Commercial |
$227.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$184.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.28
|
| Rate for Payer: Healthscope Commercial |
$237.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$184.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.49
|
| Rate for Payer: PHP Commercial |
$224.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.66
|
| Rate for Payer: Priority Health SBD |
$166.38
|
| Rate for Payer: UMR Bronson Commercial |
$116.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.07
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
IP
|
$195.05
|
|
|
Service Code
|
NDC 42806071401
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$175.54 |
| Rate for Payer: Aetna American Axle |
$126.78
|
| Rate for Payer: Aetna Commercial |
$165.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.78
|
| Rate for Payer: Cash Price |
$156.04
|
| Rate for Payer: Cofinity Commercial |
$136.53
|
| Rate for Payer: Cofinity Commercial |
$167.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$136.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.04
|
| Rate for Payer: Healthscope Commercial |
$175.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.79
|
| Rate for Payer: PHP Commercial |
$165.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.78
|
| Rate for Payer: Priority Health SBD |
$122.88
|
| Rate for Payer: UMR Bronson Commercial |
$85.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.29
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
OP
|
$195.05
|
|
|
Service Code
|
NDC 42806071401
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.17 |
| Max. Negotiated Rate |
$175.54 |
| Rate for Payer: Aetna American Axle |
$126.78
|
| Rate for Payer: Aetna Commercial |
$165.79
|
| Rate for Payer: Aetna Medicare |
$97.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.78
|
| Rate for Payer: BCBS Complete |
$78.02
|
| Rate for Payer: Cash Price |
$156.04
|
| Rate for Payer: Cofinity Commercial |
$136.53
|
| Rate for Payer: Cofinity Commercial |
$167.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$136.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.04
|
| Rate for Payer: Healthscope Commercial |
$175.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.79
|
| Rate for Payer: PHP Commercial |
$165.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.78
|
| Rate for Payer: Priority Health SBD |
$122.88
|
| Rate for Payer: UMR Bronson Commercial |
$72.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.29
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
OP
|
$309.70
|
|
|
Service Code
|
NDC 00904715361
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.59 |
| Max. Negotiated Rate |
$278.73 |
| Rate for Payer: Aetna American Axle |
$201.31
|
| Rate for Payer: Aetna Commercial |
$263.25
|
| Rate for Payer: Aetna Medicare |
$154.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.31
|
| Rate for Payer: BCBS Complete |
$123.88
|
| Rate for Payer: Cash Price |
$247.76
|
| Rate for Payer: Cofinity Commercial |
$216.79
|
| Rate for Payer: Cofinity Commercial |
$266.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$216.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.76
|
| Rate for Payer: Healthscope Commercial |
$278.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.25
|
| Rate for Payer: PHP Commercial |
$263.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.31
|
| Rate for Payer: Priority Health SBD |
$195.11
|
| Rate for Payer: UMR Bronson Commercial |
$114.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.28
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
OP
|
$371.30
|
|
|
Service Code
|
NDC 67877057301
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.38 |
| Max. Negotiated Rate |
$334.17 |
| Rate for Payer: Aetna American Axle |
$241.34
|
| Rate for Payer: Aetna Commercial |
$315.61
|
| Rate for Payer: Aetna Medicare |
$185.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.34
|
| Rate for Payer: BCBS Complete |
$148.52
|
| Rate for Payer: Cash Price |
$297.04
|
| Rate for Payer: Cofinity Commercial |
$259.91
|
| Rate for Payer: Cofinity Commercial |
$319.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$259.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.04
|
| Rate for Payer: Healthscope Commercial |
$334.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$259.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.61
|
| Rate for Payer: PHP Commercial |
$315.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.34
|
| Rate for Payer: Priority Health SBD |
$233.92
|
| Rate for Payer: UMR Bronson Commercial |
$137.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.48
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
OP
|
$373.65
|
|
|
Service Code
|
NDC 64380071206
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.25 |
| Max. Negotiated Rate |
$336.29 |
| Rate for Payer: Aetna American Axle |
$242.87
|
| Rate for Payer: Aetna Commercial |
$317.60
|
| Rate for Payer: Aetna Medicare |
$186.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.87
|
| Rate for Payer: BCBS Complete |
$149.46
|
| Rate for Payer: Cash Price |
$298.92
|
| Rate for Payer: Cofinity Commercial |
$261.56
|
| Rate for Payer: Cofinity Commercial |
$321.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$261.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.92
|
| Rate for Payer: Healthscope Commercial |
$336.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$261.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.60
|
| Rate for Payer: PHP Commercial |
$317.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.87
|
| Rate for Payer: Priority Health SBD |
$235.40
|
| Rate for Payer: UMR Bronson Commercial |
$138.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.24
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
OP
|
$264.10
|
|
|
Service Code
|
NDC 62332042631
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.72 |
| Max. Negotiated Rate |
$237.69 |
| Rate for Payer: Aetna American Axle |
$171.66
|
| Rate for Payer: Aetna Commercial |
$224.49
|
| Rate for Payer: Aetna Medicare |
$132.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.66
|
| Rate for Payer: BCBS Complete |
$105.64
|
| Rate for Payer: Cash Price |
$211.28
|
| Rate for Payer: Cofinity Commercial |
$184.87
|
| Rate for Payer: Cofinity Commercial |
$227.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$184.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.28
|
| Rate for Payer: Healthscope Commercial |
$237.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$184.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.49
|
| Rate for Payer: PHP Commercial |
$224.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.66
|
| Rate for Payer: Priority Health SBD |
$166.38
|
| Rate for Payer: UMR Bronson Commercial |
$97.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.07
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
IP
|
$309.70
|
|
|
Service Code
|
NDC 00904715361
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.27 |
| Max. Negotiated Rate |
$278.73 |
| Rate for Payer: Aetna American Axle |
$201.31
|
| Rate for Payer: Aetna Commercial |
$263.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.31
|
| Rate for Payer: Cash Price |
$247.76
|
| Rate for Payer: Cofinity Commercial |
$216.79
|
| Rate for Payer: Cofinity Commercial |
$266.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$216.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.76
|
| Rate for Payer: Healthscope Commercial |
$278.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.25
|
| Rate for Payer: PHP Commercial |
$263.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.31
|
| Rate for Payer: Priority Health SBD |
$195.11
|
| Rate for Payer: UMR Bronson Commercial |
$136.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.28
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
OP
|
$425.35
|
|
|
Service Code
|
NDC 00904656460
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.38 |
| Max. Negotiated Rate |
$382.81 |
| Rate for Payer: Aetna American Axle |
$276.48
|
| Rate for Payer: Aetna Commercial |
$361.55
|
| Rate for Payer: Aetna Medicare |
$212.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.48
|
| Rate for Payer: BCBS Complete |
$170.14
|
| Rate for Payer: Cash Price |
$340.28
|
| Rate for Payer: Cofinity Commercial |
$297.75
|
| Rate for Payer: Cofinity Commercial |
$365.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$297.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.28
|
| Rate for Payer: Healthscope Commercial |
$382.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$297.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$319.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.55
|
| Rate for Payer: PHP Commercial |
$361.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.48
|
| Rate for Payer: Priority Health SBD |
$267.97
|
| Rate for Payer: UMR Bronson Commercial |
$157.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$319.01
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
IP
|
$425.35
|
|
|
Service Code
|
NDC 00904656460
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$187.15 |
| Max. Negotiated Rate |
$382.81 |
| Rate for Payer: Aetna American Axle |
$276.48
|
| Rate for Payer: Aetna Commercial |
$361.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.48
|
| Rate for Payer: Cash Price |
$340.28
|
| Rate for Payer: Cofinity Commercial |
$297.75
|
| Rate for Payer: Cofinity Commercial |
$365.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$297.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.28
|
| Rate for Payer: Healthscope Commercial |
$382.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$297.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$319.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.55
|
| Rate for Payer: PHP Commercial |
$361.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.48
|
| Rate for Payer: Priority Health SBD |
$267.97
|
| Rate for Payer: UMR Bronson Commercial |
$187.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$319.01
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
IP
|
$373.65
|
|
|
Service Code
|
NDC 64380071206
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.41 |
| Max. Negotiated Rate |
$336.29 |
| Rate for Payer: Aetna American Axle |
$242.87
|
| Rate for Payer: Aetna Commercial |
$317.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.87
|
| Rate for Payer: Cash Price |
$298.92
|
| Rate for Payer: Cofinity Commercial |
$261.56
|
| Rate for Payer: Cofinity Commercial |
$321.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$261.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.92
|
| Rate for Payer: Healthscope Commercial |
$336.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$261.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.60
|
| Rate for Payer: PHP Commercial |
$317.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.87
|
| Rate for Payer: Priority Health SBD |
$235.40
|
| Rate for Payer: UMR Bronson Commercial |
$164.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.24
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
IP
|
$371.30
|
|
|
Service Code
|
NDC 67877057301
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.37 |
| Max. Negotiated Rate |
$334.17 |
| Rate for Payer: Aetna American Axle |
$241.34
|
| Rate for Payer: Aetna Commercial |
$315.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.34
|
| Rate for Payer: Cash Price |
$297.04
|
| Rate for Payer: Cofinity Commercial |
$259.91
|
| Rate for Payer: Cofinity Commercial |
$319.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$259.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.04
|
| Rate for Payer: Healthscope Commercial |
$334.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$259.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.61
|
| Rate for Payer: PHP Commercial |
$315.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.34
|
| Rate for Payer: Priority Health SBD |
$233.92
|
| Rate for Payer: UMR Bronson Commercial |
$163.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.48
|
|
|
BENZTROPINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$101.40
|
|
|
Service Code
|
HCPCS J0515
|
| Hospital Charge Code |
9259
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.62 |
| Max. Negotiated Rate |
$91.26 |
| Rate for Payer: Aetna American Axle |
$65.91
|
| Rate for Payer: Aetna American Axle |
$67.26
|
| Rate for Payer: Aetna Commercial |
$86.19
|
| Rate for Payer: Aetna Commercial |
$87.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.26
|
| Rate for Payer: Cash Price |
$81.12
|
| Rate for Payer: Cash Price |
$82.78
|
| Rate for Payer: Cofinity Commercial |
$88.98
|
| Rate for Payer: Cofinity Commercial |
$72.43
|
| Rate for Payer: Cofinity Commercial |
$70.98
|
| Rate for Payer: Cofinity Commercial |
$87.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$72.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.78
|
| Rate for Payer: Healthscope Commercial |
$91.26
|
| Rate for Payer: Healthscope Commercial |
$93.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.19
|
| Rate for Payer: PHP Commercial |
$87.95
|
| Rate for Payer: PHP Commercial |
$86.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.26
|
| Rate for Payer: Priority Health SBD |
$63.88
|
| Rate for Payer: Priority Health SBD |
$65.19
|
| Rate for Payer: UMR Bronson Commercial |
$44.62
|
| Rate for Payer: UMR Bronson Commercial |
$45.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.60
|
|
|
BENZTROPINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$101.40
|
|
|
Service Code
|
HCPCS J0515
|
| Hospital Charge Code |
9259
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.52 |
| Max. Negotiated Rate |
$91.26 |
| Rate for Payer: Aetna American Axle |
$65.91
|
| Rate for Payer: Aetna American Axle |
$67.26
|
| Rate for Payer: Aetna Commercial |
$86.19
|
| Rate for Payer: Aetna Commercial |
$87.95
|
| Rate for Payer: Aetna Medicare |
$50.70
|
| Rate for Payer: Aetna Medicare |
$51.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.26
|
| Rate for Payer: BCBS Complete |
$41.39
|
| Rate for Payer: BCBS Complete |
$40.56
|
| Rate for Payer: Cash Price |
$81.12
|
| Rate for Payer: Cash Price |
$82.78
|
| Rate for Payer: Cofinity Commercial |
$87.20
|
| Rate for Payer: Cofinity Commercial |
$70.98
|
| Rate for Payer: Cofinity Commercial |
$72.43
|
| Rate for Payer: Cofinity Commercial |
$88.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$72.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.78
|
| Rate for Payer: Healthscope Commercial |
$93.12
|
| Rate for Payer: Healthscope Commercial |
$91.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.95
|
| Rate for Payer: PHP Commercial |
$87.95
|
| Rate for Payer: PHP Commercial |
$86.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.26
|
| Rate for Payer: Priority Health SBD |
$65.19
|
| Rate for Payer: Priority Health SBD |
$63.88
|
| Rate for Payer: UMR Bronson Commercial |
$37.52
|
| Rate for Payer: UMR Bronson Commercial |
$38.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.05
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
|
OP
|
$166.85
|
|
|
Service Code
|
NDC 69315013701
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.73 |
| Max. Negotiated Rate |
$150.16 |
| Rate for Payer: Aetna American Axle |
$108.45
|
| Rate for Payer: Aetna Commercial |
$141.82
|
| Rate for Payer: Aetna Medicare |
$83.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.45
|
| Rate for Payer: BCBS Complete |
$66.74
|
| Rate for Payer: Cash Price |
$133.48
|
| Rate for Payer: Cofinity Commercial |
$116.80
|
| Rate for Payer: Cofinity Commercial |
$143.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$116.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.48
|
| Rate for Payer: Healthscope Commercial |
$150.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.82
|
| Rate for Payer: PHP Commercial |
$141.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.45
|
| Rate for Payer: Priority Health SBD |
$105.12
|
| Rate for Payer: UMR Bronson Commercial |
$61.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.14
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
|
IP
|
$357.20
|
|
|
Service Code
|
NDC 00603243421
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.17 |
| Max. Negotiated Rate |
$321.48 |
| Rate for Payer: Aetna American Axle |
$232.18
|
| Rate for Payer: Aetna Commercial |
$303.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.18
|
| Rate for Payer: Cash Price |
$285.76
|
| Rate for Payer: Cofinity Commercial |
$250.04
|
| Rate for Payer: Cofinity Commercial |
$307.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$250.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.76
|
| Rate for Payer: Healthscope Commercial |
$321.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$250.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.62
|
| Rate for Payer: PHP Commercial |
$303.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.18
|
| Rate for Payer: Priority Health SBD |
$225.04
|
| Rate for Payer: UMR Bronson Commercial |
$157.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.90
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
|
OP
|
$357.20
|
|
|
Service Code
|
NDC 00603243421
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.16 |
| Max. Negotiated Rate |
$321.48 |
| Rate for Payer: Aetna American Axle |
$232.18
|
| Rate for Payer: Aetna Commercial |
$303.62
|
| Rate for Payer: Aetna Medicare |
$178.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.18
|
| Rate for Payer: BCBS Complete |
$142.88
|
| Rate for Payer: Cash Price |
$285.76
|
| Rate for Payer: Cofinity Commercial |
$250.04
|
| Rate for Payer: Cofinity Commercial |
$307.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$250.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.76
|
| Rate for Payer: Healthscope Commercial |
$321.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$250.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.62
|
| Rate for Payer: PHP Commercial |
$303.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.18
|
| Rate for Payer: Priority Health SBD |
$225.04
|
| Rate for Payer: UMR Bronson Commercial |
$132.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.90
|
|
