|
ALLOPURINOL 100 MG TABLET
|
Facility
|
OP
|
$2.73
|
|
|
Service Code
|
NDC 51079020501
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Aetna American Axle |
$1.77
|
| Rate for Payer: Aetna Commercial |
$2.32
|
| Rate for Payer: Aetna Medicare |
$1.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.77
|
| Rate for Payer: BCBS Complete |
$1.09
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$1.91
|
| Rate for Payer: Cofinity Commercial |
$2.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Healthscope Commercial |
$2.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.32
|
| Rate for Payer: PHP Commercial |
$2.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.77
|
| Rate for Payer: Priority Health SBD |
$1.72
|
| Rate for Payer: UMR Bronson Commercial |
$1.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.05
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
IP
|
$272.65
|
|
|
Service Code
|
NDC 51079020520
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.97 |
| Max. Negotiated Rate |
$245.38 |
| Rate for Payer: Aetna American Axle |
$177.22
|
| Rate for Payer: Aetna Commercial |
$231.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.22
|
| Rate for Payer: Cash Price |
$218.12
|
| Rate for Payer: Cofinity Commercial |
$190.86
|
| Rate for Payer: Cofinity Commercial |
$234.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.12
|
| Rate for Payer: Healthscope Commercial |
$245.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.75
|
| Rate for Payer: PHP Commercial |
$231.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.22
|
| Rate for Payer: Priority Health SBD |
$171.77
|
| Rate for Payer: UMR Bronson Commercial |
$119.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.49
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
OP
|
$451.20
|
|
|
Service Code
|
NDC 00904704161
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.94 |
| Max. Negotiated Rate |
$406.08 |
| Rate for Payer: Aetna American Axle |
$293.28
|
| Rate for Payer: Aetna Commercial |
$383.52
|
| Rate for Payer: Aetna Medicare |
$225.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.28
|
| Rate for Payer: BCBS Complete |
$180.48
|
| Rate for Payer: Cash Price |
$360.96
|
| Rate for Payer: Cofinity Commercial |
$315.84
|
| Rate for Payer: Cofinity Commercial |
$388.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$315.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.96
|
| Rate for Payer: Healthscope Commercial |
$406.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$315.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$338.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$383.52
|
| Rate for Payer: PHP Commercial |
$383.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.28
|
| Rate for Payer: Priority Health SBD |
$284.26
|
| Rate for Payer: UMR Bronson Commercial |
$166.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$338.40
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
IP
|
$246.75
|
|
|
Service Code
|
NDC 23155069301
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.57 |
| Max. Negotiated Rate |
$222.08 |
| Rate for Payer: Aetna American Axle |
$160.39
|
| Rate for Payer: Aetna Commercial |
$209.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.39
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cofinity Commercial |
$172.72
|
| Rate for Payer: Cofinity Commercial |
$212.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.40
|
| Rate for Payer: Healthscope Commercial |
$222.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.74
|
| Rate for Payer: PHP Commercial |
$209.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.39
|
| Rate for Payer: Priority Health SBD |
$155.45
|
| Rate for Payer: UMR Bronson Commercial |
$108.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.06
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
IP
|
$277.40
|
|
|
Service Code
|
NDC 00603211521
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.06 |
| Max. Negotiated Rate |
$249.66 |
| Rate for Payer: Aetna American Axle |
$180.31
|
| Rate for Payer: Aetna Commercial |
$235.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.31
|
| Rate for Payer: Cash Price |
$221.92
|
| Rate for Payer: Cofinity Commercial |
$194.18
|
| Rate for Payer: Cofinity Commercial |
$238.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$194.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.92
|
| Rate for Payer: Healthscope Commercial |
$249.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.79
|
| Rate for Payer: PHP Commercial |
$235.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.31
|
| Rate for Payer: Priority Health SBD |
$174.76
|
| Rate for Payer: UMR Bronson Commercial |
$122.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.05
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
OP
|
$3.65
|
|
|
Service Code
|
NDC 62584098811
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$3.28 |
| Rate for Payer: Aetna American Axle |
$2.37
|
| Rate for Payer: Aetna Commercial |
$3.10
|
| Rate for Payer: Aetna Medicare |
$1.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.37
|
| Rate for Payer: BCBS Complete |
$1.46
|
| Rate for Payer: Cash Price |
$2.92
|
| Rate for Payer: Cofinity Commercial |
$2.56
|
| Rate for Payer: Cofinity Commercial |
$3.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.92
|
| Rate for Payer: Healthscope Commercial |
$3.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.10
|
| Rate for Payer: PHP Commercial |
$3.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.37
|
| Rate for Payer: Priority Health SBD |
$2.30
|
| Rate for Payer: UMR Bronson Commercial |
$1.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.74
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
IP
|
$3.65
|
|
|
Service Code
|
NDC 62584098811
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$3.28 |
| Rate for Payer: Aetna American Axle |
$2.37
|
| Rate for Payer: Aetna Commercial |
$3.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.37
|
| Rate for Payer: Cash Price |
$2.92
|
| Rate for Payer: Cofinity Commercial |
$2.56
|
| Rate for Payer: Cofinity Commercial |
$3.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.92
|
| Rate for Payer: Healthscope Commercial |
$3.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.10
|
| Rate for Payer: PHP Commercial |
$3.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.37
|
| Rate for Payer: Priority Health SBD |
$2.30
|
| Rate for Payer: UMR Bronson Commercial |
$1.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.74
|
|
|
ALLOPURINOL 300 MG TABLET
|
Facility
|
IP
|
$2.41
|
|
|
Service Code
|
NDC 62584071311
|
| Hospital Charge Code |
311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$2.17 |
| Rate for Payer: Aetna American Axle |
$1.57
|
| Rate for Payer: Aetna Commercial |
$2.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.57
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Cofinity Commercial |
$1.69
|
| Rate for Payer: Cofinity Commercial |
$2.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.93
|
| Rate for Payer: Healthscope Commercial |
$2.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.05
|
| Rate for Payer: PHP Commercial |
$2.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.57
|
| Rate for Payer: Priority Health SBD |
$1.52
|
| Rate for Payer: UMR Bronson Commercial |
$1.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.81
|
|
|
ALLOPURINOL 300 MG TABLET
|
Facility
|
IP
|
$337.25
|
|
|
Service Code
|
NDC 00904657261
|
| Hospital Charge Code |
311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.39 |
| Max. Negotiated Rate |
$303.52 |
| Rate for Payer: Aetna American Axle |
$219.21
|
| Rate for Payer: Aetna Commercial |
$286.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.21
|
| Rate for Payer: Cash Price |
$269.80
|
| Rate for Payer: Cofinity Commercial |
$236.08
|
| Rate for Payer: Cofinity Commercial |
$290.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$236.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.80
|
| Rate for Payer: Healthscope Commercial |
$303.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$236.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.66
|
| Rate for Payer: PHP Commercial |
$286.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.21
|
| Rate for Payer: Priority Health SBD |
$212.47
|
| Rate for Payer: UMR Bronson Commercial |
$148.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.94
|
|
|
ALLOPURINOL 300 MG TABLET
|
Facility
|
OP
|
$281.28
|
|
|
Service Code
|
NDC 51079020620
|
| Hospital Charge Code |
311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.07 |
| Max. Negotiated Rate |
$253.15 |
| Rate for Payer: Aetna American Axle |
$182.83
|
| Rate for Payer: Aetna Commercial |
$239.09
|
| Rate for Payer: Aetna Medicare |
$140.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.83
|
| Rate for Payer: BCBS Complete |
$112.51
|
| Rate for Payer: Cash Price |
$225.02
|
| Rate for Payer: Cofinity Commercial |
$196.90
|
| Rate for Payer: Cofinity Commercial |
$241.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.02
|
| Rate for Payer: Healthscope Commercial |
$253.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.09
|
| Rate for Payer: PHP Commercial |
$239.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.83
|
| Rate for Payer: Priority Health SBD |
$177.21
|
| Rate for Payer: UMR Bronson Commercial |
$104.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.96
|
|
|
ALLOPURINOL 300 MG TABLET
|
Facility
|
OP
|
$2.82
|
|
|
Service Code
|
NDC 51079020601
|
| Hospital Charge Code |
311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Aetna American Axle |
$1.83
|
| Rate for Payer: Aetna Commercial |
$2.40
|
| Rate for Payer: Aetna Medicare |
$1.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.83
|
| Rate for Payer: BCBS Complete |
$1.13
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cofinity Commercial |
$1.97
|
| Rate for Payer: Cofinity Commercial |
$2.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.26
|
| Rate for Payer: Healthscope Commercial |
$2.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.40
|
| Rate for Payer: PHP Commercial |
$2.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.83
|
| Rate for Payer: Priority Health SBD |
$1.78
|
| Rate for Payer: UMR Bronson Commercial |
$1.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.12
|
|
|
ALLOPURINOL 300 MG TABLET
|
Facility
|
IP
|
$2.82
|
|
|
Service Code
|
NDC 51079020601
|
| Hospital Charge Code |
311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Aetna American Axle |
$1.83
|
| Rate for Payer: Aetna Commercial |
$2.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.83
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cofinity Commercial |
$1.97
|
| Rate for Payer: Cofinity Commercial |
$2.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.26
|
| Rate for Payer: Healthscope Commercial |
$2.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.40
|
| Rate for Payer: PHP Commercial |
$2.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.83
|
| Rate for Payer: Priority Health SBD |
$1.78
|
| Rate for Payer: UMR Bronson Commercial |
$1.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.12
|
|
|
ALLOPURINOL 300 MG TABLET
|
Facility
|
IP
|
$281.28
|
|
|
Service Code
|
NDC 51079020620
|
| Hospital Charge Code |
311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.76 |
| Max. Negotiated Rate |
$253.15 |
| Rate for Payer: Aetna American Axle |
$182.83
|
| Rate for Payer: Aetna Commercial |
$239.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.83
|
| Rate for Payer: Cash Price |
$225.02
|
| Rate for Payer: Cofinity Commercial |
$196.90
|
| Rate for Payer: Cofinity Commercial |
$241.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.02
|
| Rate for Payer: Healthscope Commercial |
$253.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.09
|
| Rate for Payer: PHP Commercial |
$239.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.83
|
| Rate for Payer: Priority Health SBD |
$177.21
|
| Rate for Payer: UMR Bronson Commercial |
$123.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.96
|
|
|
ALLOPURINOL 300 MG TABLET
|
Facility
|
IP
|
$449.35
|
|
|
Service Code
|
NDC 63739079610
|
| Hospital Charge Code |
311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$197.71 |
| Max. Negotiated Rate |
$404.42 |
| Rate for Payer: Aetna American Axle |
$292.08
|
| Rate for Payer: Aetna Commercial |
$381.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.08
|
| Rate for Payer: Cash Price |
$359.48
|
| Rate for Payer: Cofinity Commercial |
$314.54
|
| Rate for Payer: Cofinity Commercial |
$386.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$314.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.48
|
| Rate for Payer: Healthscope Commercial |
$404.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$314.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.95
|
| Rate for Payer: PHP Commercial |
$381.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.08
|
| Rate for Payer: Priority Health SBD |
$283.09
|
| Rate for Payer: UMR Bronson Commercial |
$197.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.01
|
|
|
ALLOPURINOL 300 MG TABLET
|
Facility
|
OP
|
$2.41
|
|
|
Service Code
|
NDC 62584071311
|
| Hospital Charge Code |
311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$2.17 |
| Rate for Payer: Aetna American Axle |
$1.57
|
| Rate for Payer: Aetna Commercial |
$2.05
|
| Rate for Payer: Aetna Medicare |
$1.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.57
|
| Rate for Payer: BCBS Complete |
$0.96
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Cofinity Commercial |
$1.69
|
| Rate for Payer: Cofinity Commercial |
$2.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.93
|
| Rate for Payer: Healthscope Commercial |
$2.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.05
|
| Rate for Payer: PHP Commercial |
$2.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.57
|
| Rate for Payer: Priority Health SBD |
$1.52
|
| Rate for Payer: UMR Bronson Commercial |
$0.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.81
|
|
|
ALLOPURINOL 300 MG TABLET
|
Facility
|
OP
|
$337.25
|
|
|
Service Code
|
NDC 00904657261
|
| Hospital Charge Code |
311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.78 |
| Max. Negotiated Rate |
$303.52 |
| Rate for Payer: Aetna American Axle |
$219.21
|
| Rate for Payer: Aetna Commercial |
$286.66
|
| Rate for Payer: Aetna Medicare |
$168.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.21
|
| Rate for Payer: BCBS Complete |
$134.90
|
| Rate for Payer: Cash Price |
$269.80
|
| Rate for Payer: Cofinity Commercial |
$236.08
|
| Rate for Payer: Cofinity Commercial |
$290.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$236.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.80
|
| Rate for Payer: Healthscope Commercial |
$303.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$236.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.66
|
| Rate for Payer: PHP Commercial |
$286.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.21
|
| Rate for Payer: Priority Health SBD |
$212.47
|
| Rate for Payer: UMR Bronson Commercial |
$124.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.94
|
|
|
ALLOPURINOL 300 MG TABLET
|
Facility
|
IP
|
$240.96
|
|
|
Service Code
|
NDC 62584071301
|
| Hospital Charge Code |
311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.02 |
| Max. Negotiated Rate |
$216.86 |
| Rate for Payer: Aetna American Axle |
$156.62
|
| Rate for Payer: Aetna Commercial |
$204.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.62
|
| Rate for Payer: Cash Price |
$192.77
|
| Rate for Payer: Cofinity Commercial |
$168.67
|
| Rate for Payer: Cofinity Commercial |
$207.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$168.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.77
|
| Rate for Payer: Healthscope Commercial |
$216.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$168.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.82
|
| Rate for Payer: PHP Commercial |
$204.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.62
|
| Rate for Payer: Priority Health SBD |
$151.80
|
| Rate for Payer: UMR Bronson Commercial |
$106.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.72
|
|
|
ALLOPURINOL 300 MG TABLET
|
Facility
|
OP
|
$449.35
|
|
|
Service Code
|
NDC 63739079610
|
| Hospital Charge Code |
311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.26 |
| Max. Negotiated Rate |
$404.42 |
| Rate for Payer: Aetna American Axle |
$292.08
|
| Rate for Payer: Aetna Commercial |
$381.95
|
| Rate for Payer: Aetna Medicare |
$224.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.08
|
| Rate for Payer: BCBS Complete |
$179.74
|
| Rate for Payer: Cash Price |
$359.48
|
| Rate for Payer: Cofinity Commercial |
$314.54
|
| Rate for Payer: Cofinity Commercial |
$386.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$314.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.48
|
| Rate for Payer: Healthscope Commercial |
$404.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$314.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.95
|
| Rate for Payer: PHP Commercial |
$381.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.08
|
| Rate for Payer: Priority Health SBD |
$283.09
|
| Rate for Payer: UMR Bronson Commercial |
$166.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.01
|
|
|
ALLOPURINOL 300 MG TABLET
|
Facility
|
OP
|
$240.96
|
|
|
Service Code
|
NDC 62584071301
|
| Hospital Charge Code |
311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.16 |
| Max. Negotiated Rate |
$216.86 |
| Rate for Payer: Aetna American Axle |
$156.62
|
| Rate for Payer: Aetna Commercial |
$204.82
|
| Rate for Payer: Aetna Medicare |
$120.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.62
|
| Rate for Payer: BCBS Complete |
$96.38
|
| Rate for Payer: Cash Price |
$192.77
|
| Rate for Payer: Cofinity Commercial |
$168.67
|
| Rate for Payer: Cofinity Commercial |
$207.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$168.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.77
|
| Rate for Payer: Healthscope Commercial |
$216.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$168.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.82
|
| Rate for Payer: PHP Commercial |
$204.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.62
|
| Rate for Payer: Priority Health SBD |
$151.80
|
| Rate for Payer: UMR Bronson Commercial |
$89.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.72
|
|
|
ALLOPURINOL 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$5,151.40
|
|
|
Service Code
|
HCPCS J0206
|
| Hospital Charge Code |
25408
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,266.62 |
| Max. Negotiated Rate |
$4,636.26 |
| Rate for Payer: Aetna American Axle |
$3,732.79
|
| Rate for Payer: Aetna Commercial |
$4,378.69
|
| Rate for Payer: Aetna Commercial |
$3,688.16
|
| Rate for Payer: Aetna Commercial |
$4,881.34
|
| Rate for Payer: Aetna American Axle |
$3,348.41
|
| Rate for Payer: Aetna American Axle |
$2,820.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,732.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,348.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,820.36
|
| Rate for Payer: Cash Price |
$4,594.20
|
| Rate for Payer: Cash Price |
$4,121.12
|
| Rate for Payer: Cash Price |
$3,471.21
|
| Rate for Payer: Cofinity Commercial |
$3,731.55
|
| Rate for Payer: Cofinity Commercial |
$3,037.31
|
| Rate for Payer: Cofinity Commercial |
$3,605.98
|
| Rate for Payer: Cofinity Commercial |
$4,430.20
|
| Rate for Payer: Cofinity Commercial |
$4,019.92
|
| Rate for Payer: Cofinity Commercial |
$4,938.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,037.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,019.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,605.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,121.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,594.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,471.21
|
| Rate for Payer: Healthscope Commercial |
$5,168.48
|
| Rate for Payer: Healthscope Commercial |
$3,905.11
|
| Rate for Payer: Healthscope Commercial |
$4,636.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,605.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,037.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,019.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,307.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,254.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,863.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,688.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,378.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,881.34
|
| Rate for Payer: PHP Commercial |
$3,688.16
|
| Rate for Payer: PHP Commercial |
$4,881.34
|
| Rate for Payer: PHP Commercial |
$4,378.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,348.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,820.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,732.79
|
| Rate for Payer: Priority Health SBD |
$3,245.38
|
| Rate for Payer: Priority Health SBD |
$2,733.58
|
| Rate for Payer: Priority Health SBD |
$3,617.93
|
| Rate for Payer: UMR Bronson Commercial |
$2,526.81
|
| Rate for Payer: UMR Bronson Commercial |
$2,266.62
|
| Rate for Payer: UMR Bronson Commercial |
$1,909.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,254.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,307.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,863.55
|
|
|
ALLOPURINOL 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$4,339.01
|
|
|
Service Code
|
HCPCS J0206
|
| Hospital Charge Code |
25408
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$3,905.11 |
| Rate for Payer: Cofinity Commercial |
$4,938.76
|
| Rate for Payer: Cofinity Commercial |
$3,731.55
|
| Rate for Payer: Cofinity Commercial |
$3,037.31
|
| Rate for Payer: Cofinity Commercial |
$4,430.20
|
| Rate for Payer: Cofinity Commercial |
$3,605.98
|
| Rate for Payer: Cofinity Commercial |
$4,019.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,019.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,605.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,037.31
|
| Rate for Payer: UHCCP Medicaid |
$2.36
|
| Rate for Payer: UHCCP Medicaid |
$2.36
|
| Rate for Payer: UHCCP Medicaid |
$2.36
|
| Rate for Payer: UMR Bronson Commercial |
$1,906.02
|
| Rate for Payer: UMR Bronson Commercial |
$1,605.43
|
| Rate for Payer: UMR Bronson Commercial |
$2,124.82
|
| Rate for Payer: VA VA |
$4.40
|
| Rate for Payer: VA VA |
$4.40
|
| Rate for Payer: VA VA |
$4.40
|
| Rate for Payer: Aetna American Axle |
$2,820.36
|
| Rate for Payer: Aetna American Axle |
$3,348.41
|
| Rate for Payer: Aetna American Axle |
$3,732.79
|
| Rate for Payer: Aetna Commercial |
$4,881.34
|
| Rate for Payer: Aetna Commercial |
$3,688.16
|
| Rate for Payer: Aetna Commercial |
$4,378.69
|
| Rate for Payer: Aetna Medicare |
$4.58
|
| Rate for Payer: Aetna Medicare |
$4.58
|
| Rate for Payer: Aetna Medicare |
$4.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,348.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,820.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,732.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.50
|
| Rate for Payer: BCBS Complete |
$2.48
|
| Rate for Payer: BCBS Complete |
$2.48
|
| Rate for Payer: BCBS Complete |
$2.48
|
| Rate for Payer: BCBS MAPPO |
$4.40
|
| Rate for Payer: BCBS MAPPO |
$4.40
|
| Rate for Payer: BCBS MAPPO |
$4.40
|
| Rate for Payer: BCBS Trust/PPO |
$13.47
|
| Rate for Payer: BCBS Trust/PPO |
$13.47
|
| Rate for Payer: BCBS Trust/PPO |
$13.47
|
| Rate for Payer: BCN Commercial |
$13.47
|
| Rate for Payer: BCN Commercial |
$13.47
|
| Rate for Payer: BCN Commercial |
$13.47
|
| Rate for Payer: BCN Medicare Advantage |
$4.40
|
| Rate for Payer: BCN Medicare Advantage |
$4.40
|
| Rate for Payer: BCN Medicare Advantage |
$4.40
|
| Rate for Payer: Cash Price |
$4,594.20
|
| Rate for Payer: Cash Price |
$3,471.21
|
| Rate for Payer: Cash Price |
$3,471.21
|
| Rate for Payer: Cash Price |
$4,594.20
|
| Rate for Payer: Cash Price |
$4,121.12
|
| Rate for Payer: Cash Price |
$4,121.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,471.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,121.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,594.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.40
|
| Rate for Payer: Healthscope Commercial |
$3,905.11
|
| Rate for Payer: Healthscope Commercial |
$5,168.48
|
| Rate for Payer: Healthscope Commercial |
$4,636.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,019.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,605.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,037.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,307.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,863.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,254.26
|
| Rate for Payer: Mclaren Medicaid |
$2.36
|
| Rate for Payer: Mclaren Medicaid |
$2.36
|
| Rate for Payer: Mclaren Medicaid |
$2.36
|
| Rate for Payer: Mclaren Medicare |
$4.40
|
| Rate for Payer: Mclaren Medicare |
$4.40
|
| Rate for Payer: Mclaren Medicare |
$4.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.62
|
| Rate for Payer: Meridian Medicaid |
$2.48
|
| Rate for Payer: Meridian Medicaid |
$2.48
|
| Rate for Payer: Meridian Medicaid |
$2.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,881.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,688.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,378.69
|
| Rate for Payer: Nomi Health Commercial |
$13.20
|
| Rate for Payer: Nomi Health Commercial |
$13.20
|
| Rate for Payer: Nomi Health Commercial |
$13.20
|
| Rate for Payer: PACE Medicare |
$4.18
|
| Rate for Payer: PACE Medicare |
$4.18
|
| Rate for Payer: PACE Medicare |
$4.18
|
| Rate for Payer: PACE SWMI |
$4.40
|
| Rate for Payer: PACE SWMI |
$4.40
|
| Rate for Payer: PACE SWMI |
$4.40
|
| Rate for Payer: PHP Commercial |
$4,378.69
|
| Rate for Payer: PHP Commercial |
$3,688.16
|
| Rate for Payer: PHP Commercial |
$4,881.34
|
| Rate for Payer: PHP Medicare Advantage |
$4.40
|
| Rate for Payer: PHP Medicare Advantage |
$4.40
|
| Rate for Payer: PHP Medicare Advantage |
$4.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,732.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,348.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,820.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.40
|
| Rate for Payer: Priority Health Medicare |
$4.40
|
| Rate for Payer: Priority Health Medicare |
$4.40
|
| Rate for Payer: Priority Health Medicare |
$4.40
|
| Rate for Payer: Priority Health Narrow Network |
$11.52
|
| Rate for Payer: Priority Health Narrow Network |
$11.52
|
| Rate for Payer: Priority Health Narrow Network |
$11.52
|
| Rate for Payer: Priority Health SBD |
$2,733.58
|
| Rate for Payer: Priority Health SBD |
$3,245.38
|
| Rate for Payer: Priority Health SBD |
$3,617.93
|
| Rate for Payer: Railroad Medicare Medicare |
$4.40
|
| Rate for Payer: Railroad Medicare Medicare |
$4.40
|
| Rate for Payer: Railroad Medicare Medicare |
$4.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.40
|
| Rate for Payer: UHC Exchange |
$8.41
|
| Rate for Payer: UHC Exchange |
$8.41
|
| Rate for Payer: UHC Exchange |
$8.41
|
| Rate for Payer: UHC Medicare Advantage |
$4.40
|
| Rate for Payer: UHC Medicare Advantage |
$4.40
|
| Rate for Payer: UHC Medicare Advantage |
$4.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,254.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,307.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,863.55
|
|
|
ALOE VERA-COLLAGEN TOPICAL FOAM
|
Facility
|
IP
|
$28.09
|
|
|
Service Code
|
NDC 68455010841
|
| Hospital Charge Code |
108259
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.36 |
| Max. Negotiated Rate |
$25.28 |
| Rate for Payer: Aetna American Axle |
$18.26
|
| Rate for Payer: Aetna Commercial |
$23.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.26
|
| Rate for Payer: Cash Price |
$22.47
|
| Rate for Payer: Cofinity Commercial |
$19.66
|
| Rate for Payer: Cofinity Commercial |
$24.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.47
|
| Rate for Payer: Healthscope Commercial |
$25.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.88
|
| Rate for Payer: PHP Commercial |
$23.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.26
|
| Rate for Payer: Priority Health SBD |
$17.70
|
| Rate for Payer: UMR Bronson Commercial |
$12.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.07
|
|
|
ALOE VERA-COLLAGEN TOPICAL FOAM
|
Facility
|
OP
|
$28.09
|
|
|
Service Code
|
NDC 68455010841
|
| Hospital Charge Code |
108259
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.39 |
| Max. Negotiated Rate |
$25.28 |
| Rate for Payer: Aetna American Axle |
$18.26
|
| Rate for Payer: Aetna Commercial |
$23.88
|
| Rate for Payer: Aetna Medicare |
$14.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.26
|
| Rate for Payer: BCBS Complete |
$11.24
|
| Rate for Payer: Cash Price |
$22.47
|
| Rate for Payer: Cofinity Commercial |
$19.66
|
| Rate for Payer: Cofinity Commercial |
$24.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.47
|
| Rate for Payer: Healthscope Commercial |
$25.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.88
|
| Rate for Payer: PHP Commercial |
$23.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.26
|
| Rate for Payer: Priority Health SBD |
$17.70
|
| Rate for Payer: UMR Bronson Commercial |
$10.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.07
|
|
|
ALOSETRON 1 MG TABLET
|
Facility
|
IP
|
$1,066.71
|
|
|
Service Code
|
NDC 65162024903
|
| Hospital Charge Code |
27127
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$469.35 |
| Max. Negotiated Rate |
$960.04 |
| Rate for Payer: UMR Bronson Commercial |
$469.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$800.03
|
| Rate for Payer: Aetna American Axle |
$693.36
|
| Rate for Payer: Aetna Commercial |
$906.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$693.36
|
| Rate for Payer: Cash Price |
$853.37
|
| Rate for Payer: Cofinity Commercial |
$746.70
|
| Rate for Payer: Cofinity Commercial |
$917.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$746.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$853.37
|
| Rate for Payer: Healthscope Commercial |
$960.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$746.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$800.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$906.70
|
| Rate for Payer: PHP Commercial |
$906.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$693.36
|
| Rate for Payer: Priority Health SBD |
$672.03
|
|
|
ALOSETRON 1 MG TABLET
|
Facility
|
OP
|
$1,066.71
|
|
|
Service Code
|
NDC 65162024903
|
| Hospital Charge Code |
27127
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$394.68 |
| Max. Negotiated Rate |
$960.04 |
| Rate for Payer: Aetna American Axle |
$693.36
|
| Rate for Payer: Aetna Commercial |
$906.70
|
| Rate for Payer: Aetna Medicare |
$533.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$693.36
|
| Rate for Payer: BCBS Complete |
$426.68
|
| Rate for Payer: Cash Price |
$853.37
|
| Rate for Payer: Cofinity Commercial |
$746.70
|
| Rate for Payer: Cofinity Commercial |
$917.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$746.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$853.37
|
| Rate for Payer: Healthscope Commercial |
$960.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$746.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$800.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$906.70
|
| Rate for Payer: PHP Commercial |
$906.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$693.36
|
| Rate for Payer: Priority Health SBD |
$672.03
|
| Rate for Payer: UMR Bronson Commercial |
$394.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$800.03
|
|
