|
VORINOSTAT 100 MG CAPSULE
|
Facility
|
IP
|
$55,535.52
|
|
|
Service Code
|
NDC 0006-0568-40
|
| Hospital Charge Code |
77539
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24,435.63 |
| Max. Negotiated Rate |
$49,981.97 |
| Rate for Payer: Aetna American Axle |
$36,098.09
|
| Rate for Payer: Aetna Commercial |
$47,205.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36,098.09
|
| Rate for Payer: Cash Price |
$44,428.42
|
| Rate for Payer: Cofinity Commercial |
$38,874.86
|
| Rate for Payer: Cofinity Commercial |
$47,760.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44,428.42
|
| Rate for Payer: Healthscope Commercial |
$49,981.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38,874.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41,651.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47,205.19
|
| Rate for Payer: PHP Commercial |
$47,205.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38,874.86
|
| Rate for Payer: Priority Health SBD |
$34,987.38
|
| Rate for Payer: UMR Bronson Commercial |
$24,435.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41,651.64
|
|
|
VORTIOXETINE 10 MG TABLET
|
Facility
|
IP
|
$1,684.98
|
|
|
Service Code
|
NDC 64764-730-30
|
| Hospital Charge Code |
168416
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$741.39 |
| Max. Negotiated Rate |
$1,516.48 |
| Rate for Payer: Aetna American Axle |
$1,095.24
|
| Rate for Payer: Aetna Commercial |
$1,432.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,095.24
|
| Rate for Payer: Cash Price |
$1,347.98
|
| Rate for Payer: Cofinity Commercial |
$1,179.49
|
| Rate for Payer: Cofinity Commercial |
$1,449.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,347.98
|
| Rate for Payer: Healthscope Commercial |
$1,516.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,179.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,263.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,432.23
|
| Rate for Payer: PHP Commercial |
$1,432.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,179.49
|
| Rate for Payer: Priority Health SBD |
$1,061.54
|
| Rate for Payer: UMR Bronson Commercial |
$741.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,263.74
|
|
|
VORTIOXETINE 20 MG TABLET
|
Facility
|
IP
|
$1,684.98
|
|
|
Service Code
|
NDC 64764-750-30
|
| Hospital Charge Code |
168417
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$741.39 |
| Max. Negotiated Rate |
$1,516.48 |
| Rate for Payer: Aetna American Axle |
$1,095.24
|
| Rate for Payer: Aetna Commercial |
$1,432.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,095.24
|
| Rate for Payer: Cash Price |
$1,347.98
|
| Rate for Payer: Cofinity Commercial |
$1,179.49
|
| Rate for Payer: Cofinity Commercial |
$1,449.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,347.98
|
| Rate for Payer: Healthscope Commercial |
$1,516.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,179.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,263.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,432.23
|
| Rate for Payer: PHP Commercial |
$1,432.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,179.49
|
| Rate for Payer: Priority Health SBD |
$1,061.54
|
| Rate for Payer: UMR Bronson Commercial |
$741.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,263.74
|
|
|
VULVECTOMY SIMPLE; PARTIAL
|
Facility
|
OP
|
$8,748.29
|
|
|
Service Code
|
CPT 56620
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$583.17 |
| Max. Negotiated Rate |
$8,748.29 |
| Rate for Payer: Aetna Medicare |
$2,890.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,473.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,473.69
|
| Rate for Payer: BCBS Complete |
$1,596.23
|
| Rate for Payer: BCBS MAPPO |
$2,778.95
|
| Rate for Payer: BCBS Trust/PPO |
$3,114.75
|
| Rate for Payer: BCN Medicare Advantage |
$2,778.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,778.95
|
| Rate for Payer: Mclaren Medicaid |
$1,520.09
|
| Rate for Payer: Mclaren Medicare |
$2,778.95
|
| Rate for Payer: Meridian Medicaid |
$1,596.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,917.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,195.79
|
| Rate for Payer: PACE Medicare |
$2,640.00
|
| Rate for Payer: PACE SWMI |
$2,778.95
|
| Rate for Payer: PHP Medicare Advantage |
$2,778.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,520.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,748.29
|
| Rate for Payer: Priority Health Medicare |
$2,778.95
|
| Rate for Payer: Priority Health Narrow Network |
$6,998.63
|
| Rate for Payer: Railroad Medicare Medicare |
$2,778.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$641.49
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,778.95
|
| Rate for Payer: UHC Exchange |
$583.17
|
| Rate for Payer: UHC Medicare Advantage |
$2,862.32
|
| Rate for Payer: VA VA |
$2,778.95
|
|
|
WARFARIN 1 MG TABLET
|
Facility
|
IP
|
$3.62
|
|
|
Service Code
|
NDC 0832-1211-89
|
| Hospital Charge Code |
11664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$3.26 |
| Rate for Payer: Aetna American Axle |
$2.35
|
| Rate for Payer: Aetna Commercial |
$3.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.35
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: Cofinity Commercial |
$2.53
|
| Rate for Payer: Cofinity Commercial |
$3.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.90
|
| Rate for Payer: Healthscope Commercial |
$3.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.08
|
| Rate for Payer: PHP Commercial |
$3.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.53
|
| Rate for Payer: Priority Health SBD |
$2.28
|
| Rate for Payer: UMR Bronson Commercial |
$1.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.72
|
|
|
WARFARIN 1 MG TABLET
|
Facility
|
IP
|
$354.85
|
|
|
Service Code
|
NDC 65162-761-10
|
| Hospital Charge Code |
11664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.13 |
| Max. Negotiated Rate |
$319.36 |
| Rate for Payer: Aetna American Axle |
$230.65
|
| Rate for Payer: Aetna Commercial |
$301.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.65
|
| Rate for Payer: Cash Price |
$283.88
|
| Rate for Payer: Cofinity Commercial |
$248.40
|
| Rate for Payer: Cofinity Commercial |
$305.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.88
|
| Rate for Payer: Healthscope Commercial |
$319.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$301.62
|
| Rate for Payer: PHP Commercial |
$301.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.40
|
| Rate for Payer: Priority Health SBD |
$223.56
|
| Rate for Payer: UMR Bronson Commercial |
$156.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.14
|
|
|
WARFARIN 1 MG TABLET
|
Facility
|
IP
|
$272.60
|
|
|
Service Code
|
NDC 0832-1211-00
|
| Hospital Charge Code |
11664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.94 |
| Max. Negotiated Rate |
$245.34 |
| Rate for Payer: Aetna American Axle |
$177.19
|
| Rate for Payer: Aetna Commercial |
$231.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.19
|
| Rate for Payer: Cash Price |
$218.08
|
| Rate for Payer: Cofinity Commercial |
$190.82
|
| Rate for Payer: Cofinity Commercial |
$234.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.08
|
| Rate for Payer: Healthscope Commercial |
$245.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$231.71
|
| Rate for Payer: PHP Commercial |
$231.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.82
|
| Rate for Payer: Priority Health SBD |
$171.74
|
| Rate for Payer: UMR Bronson Commercial |
$119.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.45
|
|
|
WARFARIN 1 MG TABLET
|
Facility
|
IP
|
$361.90
|
|
|
Service Code
|
NDC 0832-1211-01
|
| Hospital Charge Code |
11664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.24 |
| Max. Negotiated Rate |
$325.71 |
| Rate for Payer: Aetna American Axle |
$235.24
|
| Rate for Payer: Aetna Commercial |
$307.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.24
|
| Rate for Payer: Cash Price |
$289.52
|
| Rate for Payer: Cofinity Commercial |
$253.33
|
| Rate for Payer: Cofinity Commercial |
$311.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.52
|
| Rate for Payer: Healthscope Commercial |
$325.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$253.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$307.62
|
| Rate for Payer: PHP Commercial |
$307.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.33
|
| Rate for Payer: Priority Health SBD |
$228.00
|
| Rate for Payer: UMR Bronson Commercial |
$159.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.42
|
|
|
WARFARIN 2.5 MG TABLET
|
Facility
|
IP
|
$219.45
|
|
|
Service Code
|
NDC 68084-027-01
|
| Hospital Charge Code |
8750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.56 |
| Max. Negotiated Rate |
$197.50 |
| Rate for Payer: Aetna American Axle |
$142.64
|
| Rate for Payer: Aetna Commercial |
$186.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.64
|
| Rate for Payer: Cash Price |
$175.56
|
| Rate for Payer: Cofinity Commercial |
$153.62
|
| Rate for Payer: Cofinity Commercial |
$188.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.56
|
| Rate for Payer: Healthscope Commercial |
$197.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$153.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$186.53
|
| Rate for Payer: PHP Commercial |
$186.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.62
|
| Rate for Payer: Priority Health SBD |
$138.25
|
| Rate for Payer: UMR Bronson Commercial |
$96.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.59
|
|
|
WARFARIN 2.5 MG TABLET
|
Facility
|
IP
|
$219.45
|
|
|
Service Code
|
NDC 68084-027-11
|
| Hospital Charge Code |
8750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.56 |
| Max. Negotiated Rate |
$197.50 |
| Rate for Payer: Aetna American Axle |
$142.64
|
| Rate for Payer: Aetna Commercial |
$186.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.64
|
| Rate for Payer: Cash Price |
$175.56
|
| Rate for Payer: Cofinity Commercial |
$153.62
|
| Rate for Payer: Cofinity Commercial |
$188.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.56
|
| Rate for Payer: Healthscope Commercial |
$197.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$153.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$186.53
|
| Rate for Payer: PHP Commercial |
$186.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.62
|
| Rate for Payer: Priority Health SBD |
$138.25
|
| Rate for Payer: UMR Bronson Commercial |
$96.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.59
|
|
|
WARFARIN 2.5 MG TABLET
|
Facility
|
IP
|
$220.90
|
|
|
Service Code
|
NDC 0093-1714-01
|
| Hospital Charge Code |
8750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.20 |
| Max. Negotiated Rate |
$198.81 |
| Rate for Payer: Aetna American Axle |
$143.58
|
| Rate for Payer: Aetna Commercial |
$187.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.58
|
| Rate for Payer: Cash Price |
$176.72
|
| Rate for Payer: Cofinity Commercial |
$154.63
|
| Rate for Payer: Cofinity Commercial |
$189.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.72
|
| Rate for Payer: Healthscope Commercial |
$198.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.76
|
| Rate for Payer: PHP Commercial |
$187.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.63
|
| Rate for Payer: Priority Health SBD |
$139.17
|
| Rate for Payer: UMR Bronson Commercial |
$97.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.68
|
|
|
WARFARIN 2.5 MG TABLET
|
Facility
|
IP
|
$3.62
|
|
|
Service Code
|
NDC 0832-1213-89
|
| Hospital Charge Code |
8750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$3.26 |
| Rate for Payer: Aetna American Axle |
$2.35
|
| Rate for Payer: Aetna Commercial |
$3.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.35
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: Cofinity Commercial |
$2.53
|
| Rate for Payer: Cofinity Commercial |
$3.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.90
|
| Rate for Payer: Healthscope Commercial |
$3.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.08
|
| Rate for Payer: PHP Commercial |
$3.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.53
|
| Rate for Payer: Priority Health SBD |
$2.28
|
| Rate for Payer: UMR Bronson Commercial |
$1.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.72
|
|
|
WARFARIN 2.5 MG TABLET
|
Facility
|
IP
|
$361.90
|
|
|
Service Code
|
NDC 0832-1213-01
|
| Hospital Charge Code |
8750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.24 |
| Max. Negotiated Rate |
$325.71 |
| Rate for Payer: Aetna American Axle |
$235.24
|
| Rate for Payer: Aetna Commercial |
$307.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.24
|
| Rate for Payer: Cash Price |
$289.52
|
| Rate for Payer: Cofinity Commercial |
$253.33
|
| Rate for Payer: Cofinity Commercial |
$311.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.52
|
| Rate for Payer: Healthscope Commercial |
$325.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$253.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$307.62
|
| Rate for Payer: PHP Commercial |
$307.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.33
|
| Rate for Payer: Priority Health SBD |
$228.00
|
| Rate for Payer: UMR Bronson Commercial |
$159.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.42
|
|
|
WARFARIN 2 MG TABLET
|
Facility
|
IP
|
$286.90
|
|
|
Service Code
|
NDC 51672-4028-1
|
| Hospital Charge Code |
8749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.24 |
| Max. Negotiated Rate |
$258.21 |
| Rate for Payer: Aetna American Axle |
$186.48
|
| Rate for Payer: Aetna Commercial |
$243.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.48
|
| Rate for Payer: Cash Price |
$229.52
|
| Rate for Payer: Cofinity Commercial |
$200.83
|
| Rate for Payer: Cofinity Commercial |
$246.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.52
|
| Rate for Payer: Healthscope Commercial |
$258.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$243.86
|
| Rate for Payer: PHP Commercial |
$243.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.83
|
| Rate for Payer: Priority Health SBD |
$180.75
|
| Rate for Payer: UMR Bronson Commercial |
$126.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.18
|
|
|
WARFARIN 2 MG TABLET
|
Facility
|
IP
|
$237.50
|
|
|
Service Code
|
NDC 62584-984-01
|
| Hospital Charge Code |
8749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.50 |
| Max. Negotiated Rate |
$213.75 |
| Rate for Payer: Aetna American Axle |
$154.38
|
| Rate for Payer: Aetna Commercial |
$201.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.38
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: Cofinity Commercial |
$166.25
|
| Rate for Payer: Cofinity Commercial |
$204.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.00
|
| Rate for Payer: Healthscope Commercial |
$213.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$166.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$201.88
|
| Rate for Payer: PHP Commercial |
$201.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.25
|
| Rate for Payer: Priority Health SBD |
$149.62
|
| Rate for Payer: UMR Bronson Commercial |
$104.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.12
|
|
|
WARFARIN 2 MG TABLET
|
Facility
|
IP
|
$237.50
|
|
|
Service Code
|
NDC 62584-984-11
|
| Hospital Charge Code |
8749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.50 |
| Max. Negotiated Rate |
$213.75 |
| Rate for Payer: Aetna American Axle |
$154.38
|
| Rate for Payer: Aetna Commercial |
$201.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.38
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: Cofinity Commercial |
$166.25
|
| Rate for Payer: Cofinity Commercial |
$204.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.00
|
| Rate for Payer: Healthscope Commercial |
$213.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$166.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$201.88
|
| Rate for Payer: PHP Commercial |
$201.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.25
|
| Rate for Payer: Priority Health SBD |
$149.62
|
| Rate for Payer: UMR Bronson Commercial |
$104.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.12
|
|
|
WARFARIN 5 MG TABLET
|
Facility
|
IP
|
$2.28
|
|
|
Service Code
|
NDC 62584-994-11
|
| Hospital Charge Code |
8751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$2.05 |
| Rate for Payer: Aetna American Axle |
$1.48
|
| Rate for Payer: Aetna Commercial |
$1.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.48
|
| Rate for Payer: Cash Price |
$1.82
|
| Rate for Payer: Cofinity Commercial |
$1.60
|
| Rate for Payer: Cofinity Commercial |
$1.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.82
|
| Rate for Payer: Healthscope Commercial |
$2.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.94
|
| Rate for Payer: PHP Commercial |
$1.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.60
|
| Rate for Payer: Priority Health SBD |
$1.44
|
| Rate for Payer: UMR Bronson Commercial |
$1.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.71
|
|
|
WARFARIN 5 MG TABLET
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
NDC 62584-994-01
|
| Hospital Charge Code |
8751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.32 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Aetna American Axle |
$148.20
|
| Rate for Payer: Aetna Commercial |
$193.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.20
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cofinity Commercial |
$159.60
|
| Rate for Payer: Cofinity Commercial |
$196.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.40
|
| Rate for Payer: Healthscope Commercial |
$205.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$159.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$193.80
|
| Rate for Payer: PHP Commercial |
$193.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.60
|
| Rate for Payer: Priority Health SBD |
$143.64
|
| Rate for Payer: UMR Bronson Commercial |
$100.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.00
|
|
|
WATER FOR INJECTION, BACTERIOSTATIC INJECTION SOLUTION
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
NDC 0409-3977-03
|
| Hospital Charge Code |
864
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.16 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Aetna American Axle |
$25.35
|
| Rate for Payer: Aetna Commercial |
$33.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.35
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cofinity Commercial |
$27.30
|
| Rate for Payer: Cofinity Commercial |
$33.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.20
|
| Rate for Payer: Healthscope Commercial |
$35.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.15
|
| Rate for Payer: PHP Commercial |
$33.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health SBD |
$24.57
|
| Rate for Payer: UMR Bronson Commercial |
$17.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.25
|
|
|
WATER FOR INJECTION, BACTERIOSTATIC INJECTION SOLUTION
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
NDC 0409-3977-03
|
| Hospital Charge Code |
864
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.43 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Aetna American Axle |
$25.35
|
| Rate for Payer: Aetna Commercial |
$33.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.35
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cofinity Commercial |
$27.30
|
| Rate for Payer: Cofinity Commercial |
$33.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.20
|
| Rate for Payer: Healthscope Commercial |
$35.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.15
|
| Rate for Payer: PHP Commercial |
$33.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health SBD |
$24.57
|
| Rate for Payer: UMR Bronson Commercial |
$14.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.25
|
|
|
WATER FOR INJECTION, BACTERIOSTATIC INJECTION SOLUTION
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
NDC 0409-3977-01
|
| Hospital Charge Code |
864
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.43 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Aetna American Axle |
$25.35
|
| Rate for Payer: Aetna Commercial |
$33.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.35
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cofinity Commercial |
$27.30
|
| Rate for Payer: Cofinity Commercial |
$33.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.20
|
| Rate for Payer: Healthscope Commercial |
$35.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.15
|
| Rate for Payer: PHP Commercial |
$33.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health SBD |
$24.57
|
| Rate for Payer: UMR Bronson Commercial |
$14.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.25
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$14.79
|
|
|
Service Code
|
NDC 0409-4887-20
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.47 |
| Max. Negotiated Rate |
$13.31 |
| Rate for Payer: Aetna American Axle |
$9.61
|
| Rate for Payer: Aetna Commercial |
$12.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.61
|
| Rate for Payer: BCBS Complete |
$5.92
|
| Rate for Payer: Cash Price |
$11.83
|
| Rate for Payer: Cofinity Commercial |
$10.35
|
| Rate for Payer: Cofinity Commercial |
$12.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.83
|
| Rate for Payer: Healthscope Commercial |
$13.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.57
|
| Rate for Payer: PHP Commercial |
$12.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.35
|
| Rate for Payer: Priority Health SBD |
$9.32
|
| Rate for Payer: UMR Bronson Commercial |
$5.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.09
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$26.83
|
|
|
Service Code
|
NDC 0409-4887-50
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$24.15 |
| Rate for Payer: Aetna American Axle |
$17.44
|
| Rate for Payer: Aetna Commercial |
$22.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.44
|
| Rate for Payer: BCBS Complete |
$10.73
|
| Rate for Payer: Cash Price |
$21.46
|
| Rate for Payer: Cofinity Commercial |
$18.78
|
| Rate for Payer: Cofinity Commercial |
$23.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.46
|
| Rate for Payer: Healthscope Commercial |
$24.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.81
|
| Rate for Payer: PHP Commercial |
$22.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.78
|
| Rate for Payer: Priority Health SBD |
$16.90
|
| Rate for Payer: UMR Bronson Commercial |
$9.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.12
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$14.79
|
|
|
Service Code
|
NDC 0409-4887-23
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$13.31 |
| Rate for Payer: Aetna American Axle |
$9.61
|
| Rate for Payer: Aetna Commercial |
$12.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.61
|
| Rate for Payer: Cash Price |
$11.83
|
| Rate for Payer: Cofinity Commercial |
$10.35
|
| Rate for Payer: Cofinity Commercial |
$12.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.83
|
| Rate for Payer: Healthscope Commercial |
$13.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.57
|
| Rate for Payer: PHP Commercial |
$12.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.35
|
| Rate for Payer: Priority Health SBD |
$9.32
|
| Rate for Payer: UMR Bronson Commercial |
$6.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.09
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$14.79
|
|
|
Service Code
|
NDC 0409-4887-20
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$13.31 |
| Rate for Payer: Aetna American Axle |
$9.61
|
| Rate for Payer: Aetna Commercial |
$12.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.61
|
| Rate for Payer: Cash Price |
$11.83
|
| Rate for Payer: Cofinity Commercial |
$10.35
|
| Rate for Payer: Cofinity Commercial |
$12.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.83
|
| Rate for Payer: Healthscope Commercial |
$13.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.57
|
| Rate for Payer: PHP Commercial |
$12.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.35
|
| Rate for Payer: Priority Health SBD |
$9.32
|
| Rate for Payer: UMR Bronson Commercial |
$6.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.09
|
|
