|
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 |
$315.60
|
| 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 |
$315.60
|
| Rate for Payer: PHP Commercial |
$315.60
|
| 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
|
|
|
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 |
$336.28 |
| 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 |
$336.28
|
| 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
|
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 |
$97.52
|
| 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 |
$136.54
|
| Rate for Payer: Cofinity Commercial |
$167.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$136.54
|
| 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 |
$136.54
|
| 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
|
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 |
$201.30
|
| Rate for Payer: Aetna Commercial |
$263.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.30
|
| 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 |
$263.24
|
| Rate for Payer: PHP Commercial |
$263.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.30
|
| 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
|
$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 |
$315.60
|
| 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 |
$315.60
|
| Rate for Payer: PHP Commercial |
$315.60
|
| 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
|
|
|
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 |
$87.95
|
| Rate for Payer: Aetna Commercial |
$86.19
|
| Rate for Payer: Aetna Medicare |
$50.70
|
| Rate for Payer: Aetna Medicare |
$51.74
|
| 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: BCBS Trust/PPO |
$44.64
|
| Rate for Payer: BCBS Trust/PPO |
$44.64
|
| Rate for Payer: BCN Commercial |
$44.64
|
| Rate for Payer: BCN Commercial |
$44.64
|
| Rate for Payer: Cash Price |
$82.78
|
| Rate for Payer: Cash Price |
$82.78
|
| Rate for Payer: Cash Price |
$81.12
|
| Rate for Payer: Cash Price |
$81.12
|
| Rate for Payer: Cofinity Commercial |
$88.98
|
| Rate for Payer: Cofinity Commercial |
$70.98
|
| Rate for Payer: Cofinity Commercial |
$72.43
|
| 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 |
$82.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.12
|
| Rate for Payer: Healthscope Commercial |
$93.12
|
| Rate for Payer: Healthscope Commercial |
$91.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.05
|
| 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 |
$86.19
|
| Rate for Payer: PHP Commercial |
$87.95
|
| 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/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 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
|
IP
|
$166.85
|
|
|
Service Code
|
NDC 69315013701
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.41 |
| Max. Negotiated Rate |
$150.16 |
| Rate for Payer: Aetna American Axle |
$108.45
|
| Rate for Payer: Aetna Commercial |
$141.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.45
|
| 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 |
$73.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.14
|
|
|
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
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
|
OP
|
$331.35
|
|
|
Service Code
|
NDC 69097082707
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.60 |
| Max. Negotiated Rate |
$298.22 |
| Rate for Payer: Aetna American Axle |
$215.38
|
| Rate for Payer: Aetna Commercial |
$281.65
|
| Rate for Payer: Aetna Medicare |
$165.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.38
|
| Rate for Payer: BCBS Complete |
$132.54
|
| Rate for Payer: Cash Price |
$265.08
|
| Rate for Payer: Cofinity Commercial |
$231.94
|
| Rate for Payer: Cofinity Commercial |
$284.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$231.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.08
|
| Rate for Payer: Healthscope Commercial |
$298.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$231.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$281.65
|
| Rate for Payer: PHP Commercial |
$281.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.38
|
| Rate for Payer: Priority Health SBD |
$208.75
|
| Rate for Payer: UMR Bronson Commercial |
$122.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.51
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
|
IP
|
$331.35
|
|
|
Service Code
|
NDC 69097082707
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.79 |
| Max. Negotiated Rate |
$298.22 |
| Rate for Payer: Aetna American Axle |
$215.38
|
| Rate for Payer: Aetna Commercial |
$281.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.38
|
| Rate for Payer: Cash Price |
$265.08
|
| Rate for Payer: Cofinity Commercial |
$231.94
|
| Rate for Payer: Cofinity Commercial |
$284.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$231.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.08
|
| Rate for Payer: Healthscope Commercial |
$298.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$231.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$281.65
|
| Rate for Payer: PHP Commercial |
$281.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.38
|
| Rate for Payer: Priority Health SBD |
$208.75
|
| Rate for Payer: UMR Bronson Commercial |
$145.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.51
|
|
|
BESIFLOXACIN 0.6 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$737.70
|
|
|
Service Code
|
NDC 24208044605
|
| Hospital Charge Code |
97934
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$272.95 |
| Max. Negotiated Rate |
$663.93 |
| Rate for Payer: Aetna American Axle |
$479.50
|
| Rate for Payer: Aetna Commercial |
$627.04
|
| Rate for Payer: Aetna Medicare |
$368.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$479.50
|
| Rate for Payer: BCBS Complete |
$295.08
|
| Rate for Payer: Cash Price |
$590.16
|
| Rate for Payer: Cofinity Commercial |
$516.39
|
| Rate for Payer: Cofinity Commercial |
$634.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$516.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$590.16
|
| Rate for Payer: Healthscope Commercial |
$663.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$516.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$553.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$627.04
|
| Rate for Payer: PHP Commercial |
$627.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$479.50
|
| Rate for Payer: Priority Health SBD |
$464.75
|
| Rate for Payer: UMR Bronson Commercial |
$272.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$553.28
|
|
|
BESIFLOXACIN 0.6 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$737.70
|
|
|
Service Code
|
NDC 24208044605
|
| Hospital Charge Code |
97934
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$324.59 |
| Max. Negotiated Rate |
$663.93 |
| Rate for Payer: Aetna American Axle |
$479.50
|
| Rate for Payer: Aetna Commercial |
$627.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$479.50
|
| Rate for Payer: Cash Price |
$590.16
|
| Rate for Payer: Cofinity Commercial |
$516.39
|
| Rate for Payer: Cofinity Commercial |
$634.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$516.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$590.16
|
| Rate for Payer: Healthscope Commercial |
$663.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$516.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$553.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$627.04
|
| Rate for Payer: PHP Commercial |
$627.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$479.50
|
| Rate for Payer: Priority Health SBD |
$464.75
|
| Rate for Payer: UMR Bronson Commercial |
$324.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$553.28
|
|
|
BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
OP
|
$189.22
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
9266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.93 |
| Max. Negotiated Rate |
$170.30 |
| Rate for Payer: Aetna American Axle |
$122.99
|
| Rate for Payer: Aetna American Axle |
$101.09
|
| Rate for Payer: Aetna American Axle |
$99.79
|
| Rate for Payer: Aetna American Axle |
$100.89
|
| Rate for Payer: Aetna Commercial |
$160.84
|
| Rate for Payer: Aetna Commercial |
$131.94
|
| Rate for Payer: Aetna Commercial |
$130.50
|
| Rate for Payer: Aetna Commercial |
$132.20
|
| Rate for Payer: Aetna Medicare |
$77.76
|
| Rate for Payer: Aetna Medicare |
$77.61
|
| Rate for Payer: Aetna Medicare |
$76.76
|
| Rate for Payer: Aetna Medicare |
$94.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.89
|
| Rate for Payer: BCBS Complete |
$62.21
|
| Rate for Payer: BCBS Complete |
$61.41
|
| Rate for Payer: BCBS Complete |
$75.69
|
| Rate for Payer: BCBS Complete |
$62.09
|
| Rate for Payer: BCBS Trust/PPO |
$19.93
|
| Rate for Payer: BCBS Trust/PPO |
$19.93
|
| Rate for Payer: BCBS Trust/PPO |
$19.93
|
| Rate for Payer: BCBS Trust/PPO |
$19.93
|
| Rate for Payer: BCN Commercial |
$19.93
|
| Rate for Payer: BCN Commercial |
$19.93
|
| Rate for Payer: BCN Commercial |
$19.93
|
| Rate for Payer: BCN Commercial |
$19.93
|
| Rate for Payer: Cash Price |
$124.18
|
| Rate for Payer: Cash Price |
$151.38
|
| Rate for Payer: Cash Price |
$124.42
|
| Rate for Payer: Cash Price |
$124.18
|
| Rate for Payer: Cash Price |
$122.82
|
| Rate for Payer: Cash Price |
$122.82
|
| Rate for Payer: Cash Price |
$124.42
|
| Rate for Payer: Cash Price |
$151.38
|
| Rate for Payer: Cofinity Commercial |
$162.73
|
| Rate for Payer: Cofinity Commercial |
$133.49
|
| Rate for Payer: Cofinity Commercial |
$107.47
|
| Rate for Payer: Cofinity Commercial |
$132.04
|
| Rate for Payer: Cofinity Commercial |
$108.65
|
| Rate for Payer: Cofinity Commercial |
$108.87
|
| Rate for Payer: Cofinity Commercial |
$133.76
|
| Rate for Payer: Cofinity Commercial |
$132.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.82
|
| Rate for Payer: Healthscope Commercial |
$138.18
|
| Rate for Payer: Healthscope Commercial |
$170.30
|
| Rate for Payer: Healthscope Commercial |
$139.98
|
| Rate for Payer: Healthscope Commercial |
$139.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.50
|
| Rate for Payer: PHP Commercial |
$160.84
|
| Rate for Payer: PHP Commercial |
$131.94
|
| Rate for Payer: PHP Commercial |
$130.50
|
| Rate for Payer: PHP Commercial |
$132.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.09
|
| Rate for Payer: Priority Health SBD |
$96.72
|
| Rate for Payer: Priority Health SBD |
$97.98
|
| Rate for Payer: Priority Health SBD |
$97.79
|
| Rate for Payer: Priority Health SBD |
$119.21
|
| Rate for Payer: UMR Bronson Commercial |
$56.81
|
| Rate for Payer: UMR Bronson Commercial |
$57.55
|
| Rate for Payer: UMR Bronson Commercial |
$70.01
|
| Rate for Payer: UMR Bronson Commercial |
$57.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.92
|
|
|
BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
IP
|
$155.53
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
9266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.43 |
| Max. Negotiated Rate |
$139.98 |
| Rate for Payer: Aetna American Axle |
$101.09
|
| Rate for Payer: Aetna American Axle |
$100.89
|
| Rate for Payer: Aetna American Axle |
$99.79
|
| Rate for Payer: Aetna American Axle |
$122.99
|
| Rate for Payer: Aetna Commercial |
$132.20
|
| Rate for Payer: Aetna Commercial |
$160.84
|
| Rate for Payer: Aetna Commercial |
$131.94
|
| Rate for Payer: Aetna Commercial |
$130.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.09
|
| Rate for Payer: Cash Price |
$124.18
|
| Rate for Payer: Cash Price |
$124.42
|
| Rate for Payer: Cash Price |
$122.82
|
| Rate for Payer: Cash Price |
$151.38
|
| Rate for Payer: Cofinity Commercial |
$107.47
|
| Rate for Payer: Cofinity Commercial |
$162.73
|
| Rate for Payer: Cofinity Commercial |
$132.45
|
| Rate for Payer: Cofinity Commercial |
$108.87
|
| Rate for Payer: Cofinity Commercial |
$108.65
|
| Rate for Payer: Cofinity Commercial |
$133.49
|
| Rate for Payer: Cofinity Commercial |
$133.76
|
| Rate for Payer: Cofinity Commercial |
$132.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.18
|
| Rate for Payer: Healthscope Commercial |
$139.98
|
| Rate for Payer: Healthscope Commercial |
$138.18
|
| Rate for Payer: Healthscope Commercial |
$139.70
|
| Rate for Payer: Healthscope Commercial |
$170.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.20
|
| Rate for Payer: PHP Commercial |
$132.20
|
| Rate for Payer: PHP Commercial |
$160.84
|
| Rate for Payer: PHP Commercial |
$130.50
|
| Rate for Payer: PHP Commercial |
$131.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.79
|
| Rate for Payer: Priority Health SBD |
$119.21
|
| Rate for Payer: Priority Health SBD |
$96.72
|
| Rate for Payer: Priority Health SBD |
$97.79
|
| Rate for Payer: Priority Health SBD |
$97.98
|
| Rate for Payer: UMR Bronson Commercial |
$68.43
|
| Rate for Payer: UMR Bronson Commercial |
$83.26
|
| Rate for Payer: UMR Bronson Commercial |
$68.30
|
| Rate for Payer: UMR Bronson Commercial |
$67.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.65
|
|
|
BETAXOLOL 0.25 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$1,067.36
|
|
|
Service Code
|
NDC 00065024610
|
| Hospital Charge Code |
19703
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$469.64 |
| Max. Negotiated Rate |
$960.62 |
| Rate for Payer: Aetna American Axle |
$693.78
|
| Rate for Payer: Aetna Commercial |
$907.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$693.78
|
| Rate for Payer: Cash Price |
$853.89
|
| Rate for Payer: Cofinity Commercial |
$747.15
|
| Rate for Payer: Cofinity Commercial |
$917.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$747.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$853.89
|
| Rate for Payer: Healthscope Commercial |
$960.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$747.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$800.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$907.26
|
| Rate for Payer: PHP Commercial |
$907.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$693.78
|
| Rate for Payer: Priority Health SBD |
$672.44
|
| Rate for Payer: UMR Bronson Commercial |
$469.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$800.52
|
|
|
BETAXOLOL 0.25 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$1,201.38
|
|
|
Service Code
|
NDC 00078072910
|
| Hospital Charge Code |
19703
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$528.61 |
| Max. Negotiated Rate |
$1,081.24 |
| Rate for Payer: Aetna American Axle |
$780.90
|
| Rate for Payer: Aetna Commercial |
$1,021.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$780.90
|
| Rate for Payer: Cash Price |
$961.10
|
| Rate for Payer: Cofinity Commercial |
$1,033.19
|
| Rate for Payer: Cofinity Commercial |
$840.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$840.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$961.10
|
| Rate for Payer: Healthscope Commercial |
$1,081.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$840.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$901.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,021.17
|
| Rate for Payer: PHP Commercial |
$1,021.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$780.90
|
| Rate for Payer: Priority Health SBD |
$756.87
|
| Rate for Payer: UMR Bronson Commercial |
$528.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$901.04
|
|
|
BETAXOLOL 0.25 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$1,201.38
|
|
|
Service Code
|
NDC 00078072910
|
| Hospital Charge Code |
19703
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$444.51 |
| Max. Negotiated Rate |
$1,081.24 |
| Rate for Payer: Aetna American Axle |
$780.90
|
| Rate for Payer: Aetna Commercial |
$1,021.17
|
| Rate for Payer: Aetna Medicare |
$600.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$780.90
|
| Rate for Payer: BCBS Complete |
$480.55
|
| Rate for Payer: Cash Price |
$961.10
|
| Rate for Payer: Cofinity Commercial |
$1,033.19
|
| Rate for Payer: Cofinity Commercial |
$840.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$840.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$961.10
|
| Rate for Payer: Healthscope Commercial |
$1,081.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$840.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$901.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,021.17
|
| Rate for Payer: PHP Commercial |
$1,021.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$780.90
|
| Rate for Payer: Priority Health SBD |
$756.87
|
| Rate for Payer: UMR Bronson Commercial |
$444.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$901.04
|
|
|
BETAXOLOL 0.25 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$1,067.36
|
|
|
Service Code
|
NDC 00065024610
|
| Hospital Charge Code |
19703
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$394.92 |
| Max. Negotiated Rate |
$960.62 |
| Rate for Payer: Aetna American Axle |
$693.78
|
| Rate for Payer: Aetna Commercial |
$907.26
|
| Rate for Payer: Aetna Medicare |
$533.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$693.78
|
| Rate for Payer: BCBS Complete |
$426.94
|
| Rate for Payer: Cash Price |
$853.89
|
| Rate for Payer: Cofinity Commercial |
$747.15
|
| Rate for Payer: Cofinity Commercial |
$917.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$747.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$853.89
|
| Rate for Payer: Healthscope Commercial |
$960.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$747.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$800.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$907.26
|
| Rate for Payer: PHP Commercial |
$907.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$693.78
|
| Rate for Payer: Priority Health SBD |
$672.44
|
| Rate for Payer: UMR Bronson Commercial |
$394.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$800.52
|
|
|
BETAXOLOL 0.5 % EYE DROPS
|
Facility
|
IP
|
$165.90
|
|
|
Service Code
|
NDC 61314024501
|
| Hospital Charge Code |
9268
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.00 |
| Max. Negotiated Rate |
$149.31 |
| Rate for Payer: Aetna American Axle |
$107.84
|
| Rate for Payer: Aetna Commercial |
$141.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.84
|
| Rate for Payer: Cash Price |
$132.72
|
| Rate for Payer: Cofinity Commercial |
$116.13
|
| Rate for Payer: Cofinity Commercial |
$142.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$116.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.72
|
| Rate for Payer: Healthscope Commercial |
$149.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.02
|
| Rate for Payer: PHP Commercial |
$141.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.84
|
| Rate for Payer: Priority Health SBD |
$104.52
|
| Rate for Payer: UMR Bronson Commercial |
$73.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.42
|
|
|
BETAXOLOL 0.5 % EYE DROPS
|
Facility
|
OP
|
$165.90
|
|
|
Service Code
|
NDC 61314024501
|
| Hospital Charge Code |
9268
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.38 |
| Max. Negotiated Rate |
$149.31 |
| Rate for Payer: Aetna American Axle |
$107.84
|
| Rate for Payer: Aetna Commercial |
$141.02
|
| Rate for Payer: Aetna Medicare |
$82.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.84
|
| Rate for Payer: BCBS Complete |
$66.36
|
| Rate for Payer: Cash Price |
$132.72
|
| Rate for Payer: Cofinity Commercial |
$116.13
|
| Rate for Payer: Cofinity Commercial |
$142.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$116.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.72
|
| Rate for Payer: Healthscope Commercial |
$149.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.02
|
| Rate for Payer: PHP Commercial |
$141.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.84
|
| Rate for Payer: Priority Health SBD |
$104.52
|
| Rate for Payer: UMR Bronson Commercial |
$61.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.42
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET
|
Facility
|
OP
|
$3.16
|
|
|
Service Code
|
NDC 00832051189
|
| Hospital Charge Code |
1043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$2.84 |
| Rate for Payer: Aetna American Axle |
$2.05
|
| Rate for Payer: Aetna Commercial |
$2.69
|
| Rate for Payer: Aetna Medicare |
$1.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.05
|
| Rate for Payer: BCBS Complete |
$1.26
|
| Rate for Payer: Cash Price |
$2.53
|
| Rate for Payer: Cofinity Commercial |
$2.21
|
| Rate for Payer: Cofinity Commercial |
$2.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.53
|
| Rate for Payer: Healthscope Commercial |
$2.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.69
|
| Rate for Payer: PHP Commercial |
$2.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.05
|
| Rate for Payer: Priority Health SBD |
$1.99
|
| Rate for Payer: UMR Bronson Commercial |
$1.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.37
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET
|
Facility
|
IP
|
$193.80
|
|
|
Service Code
|
NDC 00832051100
|
| Hospital Charge Code |
1043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.27 |
| Max. Negotiated Rate |
$174.42 |
| Rate for Payer: Aetna American Axle |
$125.97
|
| Rate for Payer: Aetna Commercial |
$164.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.97
|
| Rate for Payer: Cash Price |
$155.04
|
| Rate for Payer: Cofinity Commercial |
$135.66
|
| Rate for Payer: Cofinity Commercial |
$166.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$135.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.04
|
| Rate for Payer: Healthscope Commercial |
$174.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.73
|
| Rate for Payer: PHP Commercial |
$164.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.97
|
| Rate for Payer: Priority Health SBD |
$122.09
|
| Rate for Payer: UMR Bronson Commercial |
$85.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.35
|
|
