|
BRIMONIDINE 0.1 % EYE DROPS
|
Facility
|
IP
|
$632.59
|
|
|
Service Code
|
NDC 00023932105
|
| Hospital Charge Code |
70262
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$278.34 |
| Max. Negotiated Rate |
$569.33 |
| Rate for Payer: Aetna American Axle |
$411.18
|
| Rate for Payer: Aetna Commercial |
$537.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$411.18
|
| Rate for Payer: Cash Price |
$506.07
|
| Rate for Payer: Cofinity Commercial |
$442.81
|
| Rate for Payer: Cofinity Commercial |
$544.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$442.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$506.07
|
| Rate for Payer: Healthscope Commercial |
$569.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$442.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$474.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$537.70
|
| Rate for Payer: PHP Commercial |
$537.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$411.18
|
| Rate for Payer: Priority Health SBD |
$398.53
|
| Rate for Payer: UMR Bronson Commercial |
$278.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$474.44
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
IP
|
$8.77
|
|
|
Service Code
|
NDC 17478071510
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$7.89 |
| Rate for Payer: Aetna American Axle |
$5.70
|
| Rate for Payer: Aetna Commercial |
$7.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.70
|
| Rate for Payer: Cash Price |
$7.02
|
| Rate for Payer: Cofinity Commercial |
$6.14
|
| Rate for Payer: Cofinity Commercial |
$7.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.02
|
| Rate for Payer: Healthscope Commercial |
$7.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.45
|
| Rate for Payer: PHP Commercial |
$7.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.70
|
| Rate for Payer: Priority Health SBD |
$5.53
|
| Rate for Payer: UMR Bronson Commercial |
$3.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.58
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
IP
|
$10.29
|
|
|
Service Code
|
NDC 70069023101
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$9.26 |
| Rate for Payer: Aetna American Axle |
$6.69
|
| Rate for Payer: Aetna Commercial |
$8.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.69
|
| Rate for Payer: Cash Price |
$8.23
|
| Rate for Payer: Cofinity Commercial |
$7.20
|
| Rate for Payer: Cofinity Commercial |
$8.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.23
|
| Rate for Payer: Healthscope Commercial |
$9.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.75
|
| Rate for Payer: PHP Commercial |
$8.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.69
|
| Rate for Payer: Priority Health SBD |
$6.48
|
| Rate for Payer: UMR Bronson Commercial |
$4.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.72
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
OP
|
$50.99
|
|
|
Service Code
|
NDC 24208041105
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.87 |
| Max. Negotiated Rate |
$45.89 |
| Rate for Payer: Aetna American Axle |
$33.14
|
| Rate for Payer: Aetna Commercial |
$43.34
|
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.14
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: Cash Price |
$40.79
|
| Rate for Payer: Cofinity Commercial |
$35.69
|
| Rate for Payer: Cofinity Commercial |
$43.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.79
|
| Rate for Payer: Healthscope Commercial |
$45.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.34
|
| Rate for Payer: PHP Commercial |
$43.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.14
|
| Rate for Payer: Priority Health SBD |
$32.12
|
| Rate for Payer: UMR Bronson Commercial |
$18.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.24
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
OP
|
$10.29
|
|
|
Service Code
|
NDC 70069023101
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.81 |
| Max. Negotiated Rate |
$9.26 |
| Rate for Payer: Aetna American Axle |
$6.69
|
| Rate for Payer: Aetna Commercial |
$8.75
|
| Rate for Payer: Aetna Medicare |
$5.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.69
|
| Rate for Payer: BCBS Complete |
$4.12
|
| Rate for Payer: Cash Price |
$8.23
|
| Rate for Payer: Cofinity Commercial |
$7.20
|
| Rate for Payer: Cofinity Commercial |
$8.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.23
|
| Rate for Payer: Healthscope Commercial |
$9.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.75
|
| Rate for Payer: PHP Commercial |
$8.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.69
|
| Rate for Payer: Priority Health SBD |
$6.48
|
| Rate for Payer: UMR Bronson Commercial |
$3.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.72
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
IP
|
$20.65
|
|
|
Service Code
|
NDC 61314014305
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$18.59 |
| Rate for Payer: Aetna American Axle |
$13.42
|
| Rate for Payer: Aetna Commercial |
$17.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.42
|
| Rate for Payer: Cash Price |
$16.52
|
| Rate for Payer: Cofinity Commercial |
$14.46
|
| Rate for Payer: Cofinity Commercial |
$17.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.52
|
| Rate for Payer: Healthscope Commercial |
$18.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.55
|
| Rate for Payer: PHP Commercial |
$17.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.42
|
| Rate for Payer: Priority Health SBD |
$13.01
|
| Rate for Payer: UMR Bronson Commercial |
$9.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.49
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
OP
|
$8.77
|
|
|
Service Code
|
NDC 17478071510
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$7.89 |
| Rate for Payer: Aetna American Axle |
$5.70
|
| Rate for Payer: Aetna Commercial |
$7.45
|
| Rate for Payer: Aetna Medicare |
$4.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.70
|
| Rate for Payer: BCBS Complete |
$3.51
|
| Rate for Payer: Cash Price |
$7.02
|
| Rate for Payer: Cofinity Commercial |
$6.14
|
| Rate for Payer: Cofinity Commercial |
$7.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.02
|
| Rate for Payer: Healthscope Commercial |
$7.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.45
|
| Rate for Payer: PHP Commercial |
$7.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.70
|
| Rate for Payer: Priority Health SBD |
$5.53
|
| Rate for Payer: UMR Bronson Commercial |
$3.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.58
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
IP
|
$50.99
|
|
|
Service Code
|
NDC 24208041105
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$45.89 |
| Rate for Payer: Aetna American Axle |
$33.14
|
| Rate for Payer: Aetna Commercial |
$43.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.14
|
| Rate for Payer: Cash Price |
$40.79
|
| Rate for Payer: Cofinity Commercial |
$35.69
|
| Rate for Payer: Cofinity Commercial |
$43.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.79
|
| Rate for Payer: Healthscope Commercial |
$45.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.34
|
| Rate for Payer: PHP Commercial |
$43.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.14
|
| Rate for Payer: Priority Health SBD |
$32.12
|
| Rate for Payer: UMR Bronson Commercial |
$22.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.24
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
OP
|
$20.65
|
|
|
Service Code
|
NDC 61314014305
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$18.59 |
| Rate for Payer: Aetna American Axle |
$13.42
|
| Rate for Payer: Aetna Commercial |
$17.55
|
| Rate for Payer: Aetna Medicare |
$10.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.42
|
| Rate for Payer: BCBS Complete |
$8.26
|
| Rate for Payer: Cash Price |
$16.52
|
| Rate for Payer: Cofinity Commercial |
$14.46
|
| Rate for Payer: Cofinity Commercial |
$17.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.52
|
| Rate for Payer: Healthscope Commercial |
$18.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.55
|
| Rate for Payer: PHP Commercial |
$17.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.42
|
| Rate for Payer: Priority Health SBD |
$13.01
|
| Rate for Payer: UMR Bronson Commercial |
$7.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.49
|
|
|
BRINZOLAMIDE 1 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$1,114.61
|
|
|
Service Code
|
NDC 00065027510
|
| Hospital Charge Code |
22953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$412.41 |
| Max. Negotiated Rate |
$1,003.15 |
| Rate for Payer: Aetna American Axle |
$724.50
|
| Rate for Payer: Aetna Commercial |
$947.42
|
| Rate for Payer: Aetna Medicare |
$557.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$724.50
|
| Rate for Payer: BCBS Complete |
$445.84
|
| Rate for Payer: Cash Price |
$891.69
|
| Rate for Payer: Cofinity Commercial |
$780.23
|
| Rate for Payer: Cofinity Commercial |
$958.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$780.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$891.69
|
| Rate for Payer: Healthscope Commercial |
$1,003.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$780.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$835.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$947.42
|
| Rate for Payer: PHP Commercial |
$947.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$724.50
|
| Rate for Payer: Priority Health SBD |
$702.20
|
| Rate for Payer: UMR Bronson Commercial |
$412.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$835.96
|
|
|
BRINZOLAMIDE 1 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$1,114.61
|
|
|
Service Code
|
NDC 00065027510
|
| Hospital Charge Code |
22953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$490.43 |
| Max. Negotiated Rate |
$1,003.15 |
| Rate for Payer: Aetna American Axle |
$724.50
|
| Rate for Payer: Aetna Commercial |
$947.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$724.50
|
| Rate for Payer: Cash Price |
$891.69
|
| Rate for Payer: Cofinity Commercial |
$780.23
|
| Rate for Payer: Cofinity Commercial |
$958.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$780.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$891.69
|
| Rate for Payer: Healthscope Commercial |
$1,003.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$780.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$835.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$947.42
|
| Rate for Payer: PHP Commercial |
$947.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$724.50
|
| Rate for Payer: Priority Health SBD |
$702.20
|
| Rate for Payer: UMR Bronson Commercial |
$490.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$835.96
|
|
|
BRIVARACETAM 100 MG TABLET
|
Facility
|
IP
|
$5,068.49
|
|
|
Service Code
|
NDC 50474077066
|
| Hospital Charge Code |
178919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,230.14 |
| Max. Negotiated Rate |
$4,561.64 |
| Rate for Payer: Aetna American Axle |
$3,294.52
|
| Rate for Payer: Aetna Commercial |
$4,308.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,294.52
|
| Rate for Payer: Cash Price |
$4,054.79
|
| Rate for Payer: Cofinity Commercial |
$3,547.94
|
| Rate for Payer: Cofinity Commercial |
$4,358.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,547.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,054.79
|
| Rate for Payer: Healthscope Commercial |
$4,561.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,547.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,801.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,308.22
|
| Rate for Payer: PHP Commercial |
$4,308.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,294.52
|
| Rate for Payer: Priority Health SBD |
$3,193.15
|
| Rate for Payer: UMR Bronson Commercial |
$2,230.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,801.37
|
|
|
BRIVARACETAM 100 MG TABLET
|
Facility
|
OP
|
$5,068.49
|
|
|
Service Code
|
NDC 50474077066
|
| Hospital Charge Code |
178919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,875.34 |
| Max. Negotiated Rate |
$4,561.64 |
| Rate for Payer: Aetna American Axle |
$3,294.52
|
| Rate for Payer: Aetna Commercial |
$4,308.22
|
| Rate for Payer: Aetna Medicare |
$2,534.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,294.52
|
| Rate for Payer: BCBS Complete |
$2,027.40
|
| Rate for Payer: Cash Price |
$4,054.79
|
| Rate for Payer: Cofinity Commercial |
$3,547.94
|
| Rate for Payer: Cofinity Commercial |
$4,358.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,547.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,054.79
|
| Rate for Payer: Healthscope Commercial |
$4,561.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,547.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,801.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,308.22
|
| Rate for Payer: PHP Commercial |
$4,308.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,294.52
|
| Rate for Payer: Priority Health SBD |
$3,193.15
|
| Rate for Payer: UMR Bronson Commercial |
$1,875.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,801.37
|
|
|
BROMOCRIPTINE 2.5 MG TABLET
|
Facility
|
IP
|
$202.76
|
|
|
Service Code
|
NDC 00574010603
|
| Hospital Charge Code |
9297
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.21 |
| Max. Negotiated Rate |
$182.48 |
| Rate for Payer: Aetna American Axle |
$131.79
|
| Rate for Payer: Aetna Commercial |
$172.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.79
|
| Rate for Payer: Cash Price |
$162.21
|
| Rate for Payer: Cofinity Commercial |
$141.93
|
| Rate for Payer: Cofinity Commercial |
$174.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$141.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.21
|
| Rate for Payer: Healthscope Commercial |
$182.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$141.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.35
|
| Rate for Payer: PHP Commercial |
$172.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.79
|
| Rate for Payer: Priority Health SBD |
$127.74
|
| Rate for Payer: UMR Bronson Commercial |
$89.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.07
|
|
|
BROMOCRIPTINE 2.5 MG TABLET
|
Facility
|
IP
|
$613.92
|
|
|
Service Code
|
NDC 00574010601
|
| Hospital Charge Code |
9297
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$270.12 |
| Max. Negotiated Rate |
$552.53 |
| Rate for Payer: Aetna American Axle |
$399.05
|
| Rate for Payer: Aetna Commercial |
$521.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$399.05
|
| Rate for Payer: Cash Price |
$491.14
|
| Rate for Payer: Cofinity Commercial |
$429.74
|
| Rate for Payer: Cofinity Commercial |
$527.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$429.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$491.14
|
| Rate for Payer: Healthscope Commercial |
$552.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$429.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$460.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$521.83
|
| Rate for Payer: PHP Commercial |
$521.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.05
|
| Rate for Payer: Priority Health SBD |
$386.77
|
| Rate for Payer: UMR Bronson Commercial |
$270.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$460.44
|
|
|
BROMOCRIPTINE 2.5 MG TABLET
|
Facility
|
OP
|
$202.76
|
|
|
Service Code
|
NDC 00574010603
|
| Hospital Charge Code |
9297
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.02 |
| Max. Negotiated Rate |
$182.48 |
| Rate for Payer: Aetna American Axle |
$131.79
|
| Rate for Payer: Aetna Commercial |
$172.35
|
| Rate for Payer: Aetna Medicare |
$101.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.79
|
| Rate for Payer: BCBS Complete |
$81.10
|
| Rate for Payer: Cash Price |
$162.21
|
| Rate for Payer: Cofinity Commercial |
$141.93
|
| Rate for Payer: Cofinity Commercial |
$174.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$141.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.21
|
| Rate for Payer: Healthscope Commercial |
$182.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$141.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.35
|
| Rate for Payer: PHP Commercial |
$172.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.79
|
| Rate for Payer: Priority Health SBD |
$127.74
|
| Rate for Payer: UMR Bronson Commercial |
$75.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.07
|
|
|
BROMOCRIPTINE 2.5 MG TABLET
|
Facility
|
OP
|
$613.92
|
|
|
Service Code
|
NDC 00574010601
|
| Hospital Charge Code |
9297
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$227.15 |
| Max. Negotiated Rate |
$552.53 |
| Rate for Payer: Aetna American Axle |
$399.05
|
| Rate for Payer: Aetna Commercial |
$521.83
|
| Rate for Payer: Aetna Medicare |
$306.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$399.05
|
| Rate for Payer: BCBS Complete |
$245.57
|
| Rate for Payer: Cash Price |
$491.14
|
| Rate for Payer: Cofinity Commercial |
$429.74
|
| Rate for Payer: Cofinity Commercial |
$527.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$429.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$491.14
|
| Rate for Payer: Healthscope Commercial |
$552.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$429.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$460.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$521.83
|
| Rate for Payer: PHP Commercial |
$521.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.05
|
| Rate for Payer: Priority Health SBD |
$386.77
|
| Rate for Payer: UMR Bronson Commercial |
$227.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$460.44
|
|
|
BROMOCRIPTINE 5 MG CAPSULE
|
Facility
|
OP
|
$1,211.01
|
|
|
Service Code
|
NDC 63304015801
|
| Hospital Charge Code |
9296
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$448.07 |
| Max. Negotiated Rate |
$1,089.91 |
| Rate for Payer: Aetna American Axle |
$787.16
|
| Rate for Payer: Aetna Commercial |
$1,029.36
|
| Rate for Payer: Aetna Medicare |
$605.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$787.16
|
| Rate for Payer: BCBS Complete |
$484.40
|
| Rate for Payer: Cash Price |
$968.81
|
| Rate for Payer: Cofinity Commercial |
$1,041.47
|
| Rate for Payer: Cofinity Commercial |
$847.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$847.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$968.81
|
| Rate for Payer: Healthscope Commercial |
$1,089.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$847.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$908.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,029.36
|
| Rate for Payer: PHP Commercial |
$1,029.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$787.16
|
| Rate for Payer: Priority Health SBD |
$762.94
|
| Rate for Payer: UMR Bronson Commercial |
$448.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$908.26
|
|
|
BROMOCRIPTINE 5 MG CAPSULE
|
Facility
|
IP
|
$2,562.99
|
|
|
Service Code
|
NDC 00378709601
|
| Hospital Charge Code |
9296
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,127.72 |
| Max. Negotiated Rate |
$2,306.69 |
| Rate for Payer: Aetna American Axle |
$1,665.94
|
| Rate for Payer: Aetna Commercial |
$2,178.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,665.94
|
| Rate for Payer: Cash Price |
$2,050.39
|
| Rate for Payer: Cofinity Commercial |
$1,794.09
|
| Rate for Payer: Cofinity Commercial |
$2,204.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,794.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,050.39
|
| Rate for Payer: Healthscope Commercial |
$2,306.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,794.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,922.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,178.54
|
| Rate for Payer: PHP Commercial |
$2,178.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,665.94
|
| Rate for Payer: Priority Health SBD |
$1,614.68
|
| Rate for Payer: UMR Bronson Commercial |
$1,127.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,922.24
|
|
|
BROMOCRIPTINE 5 MG CAPSULE
|
Facility
|
IP
|
$1,211.01
|
|
|
Service Code
|
NDC 63304015801
|
| Hospital Charge Code |
9296
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$532.84 |
| Max. Negotiated Rate |
$1,089.91 |
| Rate for Payer: Aetna American Axle |
$787.16
|
| Rate for Payer: Aetna Commercial |
$1,029.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$787.16
|
| Rate for Payer: Cash Price |
$968.81
|
| Rate for Payer: Cofinity Commercial |
$1,041.47
|
| Rate for Payer: Cofinity Commercial |
$847.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$847.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$968.81
|
| Rate for Payer: Healthscope Commercial |
$1,089.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$847.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$908.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,029.36
|
| Rate for Payer: PHP Commercial |
$1,029.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$787.16
|
| Rate for Payer: Priority Health SBD |
$762.94
|
| Rate for Payer: UMR Bronson Commercial |
$532.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$908.26
|
|
|
BROMOCRIPTINE 5 MG CAPSULE
|
Facility
|
OP
|
$2,562.99
|
|
|
Service Code
|
NDC 00378709601
|
| Hospital Charge Code |
9296
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$948.31 |
| Max. Negotiated Rate |
$2,306.69 |
| Rate for Payer: Aetna American Axle |
$1,665.94
|
| Rate for Payer: Aetna Commercial |
$2,178.54
|
| Rate for Payer: Aetna Medicare |
$1,281.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,665.94
|
| Rate for Payer: BCBS Complete |
$1,025.20
|
| Rate for Payer: Cash Price |
$2,050.39
|
| Rate for Payer: Cofinity Commercial |
$1,794.09
|
| Rate for Payer: Cofinity Commercial |
$2,204.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,794.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,050.39
|
| Rate for Payer: Healthscope Commercial |
$2,306.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,794.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,922.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,178.54
|
| Rate for Payer: PHP Commercial |
$2,178.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,665.94
|
| Rate for Payer: Priority Health SBD |
$1,614.68
|
| Rate for Payer: UMR Bronson Commercial |
$948.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,922.24
|
|
|
BROMOCRIPTINE 5 MG CAPSULE
|
Facility
|
IP
|
$469.53
|
|
|
Service Code
|
NDC 68382011006
|
| Hospital Charge Code |
9296
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$206.59 |
| Max. Negotiated Rate |
$422.58 |
| Rate for Payer: Aetna American Axle |
$305.19
|
| Rate for Payer: Aetna Commercial |
$399.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.19
|
| Rate for Payer: Cash Price |
$375.62
|
| Rate for Payer: Cofinity Commercial |
$328.67
|
| Rate for Payer: Cofinity Commercial |
$403.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$328.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$375.62
|
| Rate for Payer: Healthscope Commercial |
$422.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$328.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$352.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.10
|
| Rate for Payer: PHP Commercial |
$399.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.19
|
| Rate for Payer: Priority Health SBD |
$295.80
|
| Rate for Payer: UMR Bronson Commercial |
$206.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$352.15
|
|
|
BROMOCRIPTINE 5 MG CAPSULE
|
Facility
|
OP
|
$469.53
|
|
|
Service Code
|
NDC 68382011006
|
| Hospital Charge Code |
9296
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.73 |
| Max. Negotiated Rate |
$422.58 |
| Rate for Payer: Aetna American Axle |
$305.19
|
| Rate for Payer: Aetna Commercial |
$399.10
|
| Rate for Payer: Aetna Medicare |
$234.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.19
|
| Rate for Payer: BCBS Complete |
$187.81
|
| Rate for Payer: Cash Price |
$375.62
|
| Rate for Payer: Cofinity Commercial |
$328.67
|
| Rate for Payer: Cofinity Commercial |
$403.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$328.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$375.62
|
| Rate for Payer: Healthscope Commercial |
$422.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$328.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$352.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.10
|
| Rate for Payer: PHP Commercial |
$399.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.19
|
| Rate for Payer: Priority Health SBD |
$295.80
|
| Rate for Payer: UMR Bronson Commercial |
$173.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$352.15
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; DIAGNOSTIC, WITH CELL WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$4,734.21
|
|
|
Service Code
|
CPT 31622
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$901.47 |
| Max. Negotiated Rate |
$4,734.21 |
| Rate for Payer: Aetna Medicare |
$1,749.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,102.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,102.30
|
| Rate for Payer: BCBS Complete |
$946.54
|
| Rate for Payer: BCBS MAPPO |
$1,681.84
|
| Rate for Payer: BCN Medicare Advantage |
$1,681.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,681.84
|
| Rate for Payer: Mclaren Medicaid |
$901.47
|
| Rate for Payer: Mclaren Medicare |
$1,681.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,765.93
|
| Rate for Payer: Meridian Medicaid |
$946.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,934.12
|
| Rate for Payer: PACE Medicare |
$1,597.75
|
| Rate for Payer: PACE SWMI |
$1,681.84
|
| Rate for Payer: PHP Medicare Advantage |
$1,681.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$901.47
|
| Rate for Payer: Priority Health Medicare |
$1,681.84
|
| Rate for Payer: Railroad Medicare Medicare |
$1,681.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,734.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,681.84
|
| Rate for Payer: UHC Exchange |
$3,214.16
|
| Rate for Payer: UHC Medicare Advantage |
$1,681.84
|
| Rate for Payer: UHCCP Medicaid |
$901.47
|
| Rate for Payer: VA VA |
$1,681.84
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH BRONCHIAL ALVEOLAR LAVAGE
|
Facility
|
OP
|
$4,734.21
|
|
|
Service Code
|
CPT 31624
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$901.47 |
| Max. Negotiated Rate |
$4,734.21 |
| Rate for Payer: Aetna Medicare |
$1,749.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,102.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,102.30
|
| Rate for Payer: BCBS Complete |
$946.54
|
| Rate for Payer: BCBS MAPPO |
$1,681.84
|
| Rate for Payer: BCN Medicare Advantage |
$1,681.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,681.84
|
| Rate for Payer: Mclaren Medicaid |
$901.47
|
| Rate for Payer: Mclaren Medicare |
$1,681.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,765.93
|
| Rate for Payer: Meridian Medicaid |
$946.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,934.12
|
| Rate for Payer: PACE Medicare |
$1,597.75
|
| Rate for Payer: PACE SWMI |
$1,681.84
|
| Rate for Payer: PHP Medicare Advantage |
$1,681.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$901.47
|
| Rate for Payer: Priority Health Medicare |
$1,681.84
|
| Rate for Payer: Railroad Medicare Medicare |
$1,681.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,734.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,681.84
|
| Rate for Payer: UHC Exchange |
$3,214.16
|
| Rate for Payer: UHC Medicare Advantage |
$1,681.84
|
| Rate for Payer: UHCCP Medicaid |
$901.47
|
| Rate for Payer: VA VA |
$1,681.84
|
|
