|
SEVELAMER CARBONATE 2.4 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$61.42
|
|
|
Service Code
|
NDC 58468013102
|
| Hospital Charge Code |
99695
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.73 |
| Max. Negotiated Rate |
$55.28 |
| Rate for Payer: Aetna American Axle |
$39.92
|
| Rate for Payer: Aetna Commercial |
$52.21
|
| Rate for Payer: Aetna Medicare |
$30.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.92
|
| Rate for Payer: BCBS Complete |
$24.57
|
| Rate for Payer: Cash Price |
$49.14
|
| Rate for Payer: Cofinity Advantage |
$42.99
|
| Rate for Payer: Cofinity Commercial |
$52.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.14
|
| Rate for Payer: Healthscope Commercial |
$55.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.06
|
| Rate for Payer: PHP Commercial |
$52.21
|
| Rate for Payer: Priority Health SBD |
$38.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.92
|
| Rate for Payer: UHC Core |
$32.00
|
| Rate for Payer: UHC Exchange |
$24.14
|
| Rate for Payer: UMR Bronson Commercial |
$22.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.06
|
|
|
SEVELAMER CARBONATE 2.4 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$61.42
|
|
|
Service Code
|
NDC 58468013101
|
| Hospital Charge Code |
99695
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.73 |
| Max. Negotiated Rate |
$55.28 |
| Rate for Payer: Aetna American Axle |
$39.92
|
| Rate for Payer: Aetna Commercial |
$52.21
|
| Rate for Payer: Aetna Medicare |
$30.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.92
|
| Rate for Payer: BCBS Complete |
$24.57
|
| Rate for Payer: Cash Price |
$49.14
|
| Rate for Payer: Cofinity Advantage |
$42.99
|
| Rate for Payer: Cofinity Commercial |
$52.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.14
|
| Rate for Payer: Healthscope Commercial |
$55.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.06
|
| Rate for Payer: PHP Commercial |
$52.21
|
| Rate for Payer: Priority Health SBD |
$38.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.92
|
| Rate for Payer: UHC Core |
$32.00
|
| Rate for Payer: UHC Exchange |
$24.14
|
| Rate for Payer: UMR Bronson Commercial |
$22.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.06
|
|
|
SEVELAMER CARBONATE 800 MG TABLET
|
Facility
|
IP
|
$5,499.50
|
|
|
Service Code
|
NDC 58468013001
|
| Hospital Charge Code |
89201
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,419.78 |
| Max. Negotiated Rate |
$4,949.55 |
| Rate for Payer: Aetna American Axle |
$3,574.68
|
| Rate for Payer: Aetna Commercial |
$4,674.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,574.68
|
| Rate for Payer: Cash Price |
$4,399.60
|
| Rate for Payer: Cofinity Advantage |
$3,849.65
|
| Rate for Payer: Cofinity Commercial |
$4,729.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,399.60
|
| Rate for Payer: Healthscope Commercial |
$4,949.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,849.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,124.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,674.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,124.62
|
| Rate for Payer: PHP Commercial |
$4,674.57
|
| Rate for Payer: Priority Health SBD |
$3,464.68
|
| Rate for Payer: UMR Bronson Commercial |
$2,419.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,124.62
|
|
|
SEVELAMER CARBONATE 800 MG TABLET
|
Facility
|
IP
|
$258.24
|
|
|
Service Code
|
NDC 50268072015
|
| Hospital Charge Code |
89201
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.63 |
| Max. Negotiated Rate |
$232.42 |
| Rate for Payer: Aetna American Axle |
$167.86
|
| Rate for Payer: Aetna Commercial |
$219.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.86
|
| Rate for Payer: Cash Price |
$206.59
|
| Rate for Payer: Cofinity Advantage |
$180.77
|
| Rate for Payer: Cofinity Commercial |
$222.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.59
|
| Rate for Payer: Healthscope Commercial |
$232.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.68
|
| Rate for Payer: PHP Commercial |
$219.50
|
| Rate for Payer: Priority Health SBD |
$162.69
|
| Rate for Payer: UMR Bronson Commercial |
$113.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.68
|
|
|
SEVELAMER CARBONATE 800 MG TABLET
|
Facility
|
IP
|
$928.53
|
|
|
Service Code
|
NDC 65162005827
|
| Hospital Charge Code |
89201
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$408.55 |
| Max. Negotiated Rate |
$835.68 |
| Rate for Payer: Aetna American Axle |
$603.54
|
| Rate for Payer: Aetna Commercial |
$789.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$603.54
|
| Rate for Payer: Cash Price |
$742.82
|
| Rate for Payer: Cofinity Advantage |
$649.97
|
| Rate for Payer: Cofinity Commercial |
$798.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$742.82
|
| Rate for Payer: Healthscope Commercial |
$835.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$649.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$696.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$789.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$696.40
|
| Rate for Payer: PHP Commercial |
$789.25
|
| Rate for Payer: Priority Health SBD |
$584.97
|
| Rate for Payer: UMR Bronson Commercial |
$408.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$696.40
|
|
|
SEVELAMER CARBONATE 800 MG TABLET
|
Facility
|
OP
|
$5.17
|
|
|
Service Code
|
NDC 50268072011
|
| Hospital Charge Code |
89201
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$4.65 |
| Rate for Payer: Aetna American Axle |
$3.36
|
| Rate for Payer: Aetna Commercial |
$4.39
|
| Rate for Payer: Aetna Medicare |
$2.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.36
|
| Rate for Payer: BCBS Complete |
$2.07
|
| Rate for Payer: Cash Price |
$4.14
|
| Rate for Payer: Cofinity Advantage |
$3.62
|
| Rate for Payer: Cofinity Commercial |
$4.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.14
|
| Rate for Payer: Healthscope Commercial |
$4.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.88
|
| Rate for Payer: PHP Commercial |
$4.39
|
| Rate for Payer: Priority Health SBD |
$3.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.36
|
| Rate for Payer: UHC Core |
$2.69
|
| Rate for Payer: UHC Exchange |
$2.03
|
| Rate for Payer: UMR Bronson Commercial |
$1.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.88
|
|
|
SEVELAMER CARBONATE 800 MG TABLET
|
Facility
|
OP
|
$5,499.50
|
|
|
Service Code
|
NDC 58468013001
|
| Hospital Charge Code |
89201
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,034.82 |
| Max. Negotiated Rate |
$4,949.55 |
| Rate for Payer: Aetna American Axle |
$3,574.68
|
| Rate for Payer: Aetna Commercial |
$4,674.57
|
| Rate for Payer: Aetna Medicare |
$2,749.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,574.68
|
| Rate for Payer: BCBS Complete |
$2,199.80
|
| Rate for Payer: Cash Price |
$4,399.60
|
| Rate for Payer: Cofinity Advantage |
$3,849.65
|
| Rate for Payer: Cofinity Commercial |
$4,729.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,399.60
|
| Rate for Payer: Healthscope Commercial |
$4,949.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,849.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,124.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,399.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,674.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,124.62
|
| Rate for Payer: PHP Commercial |
$4,674.57
|
| Rate for Payer: Priority Health SBD |
$3,464.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,574.68
|
| Rate for Payer: UHC Core |
$2,865.24
|
| Rate for Payer: UHC Exchange |
$2,161.30
|
| Rate for Payer: UMR Bronson Commercial |
$2,034.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,124.62
|
|
|
SEVELAMER CARBONATE 800 MG TABLET
|
Facility
|
OP
|
$928.53
|
|
|
Service Code
|
NDC 65162005827
|
| Hospital Charge Code |
89201
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$343.56 |
| Max. Negotiated Rate |
$835.68 |
| Rate for Payer: Aetna American Axle |
$603.54
|
| Rate for Payer: Aetna Commercial |
$789.25
|
| Rate for Payer: Aetna Medicare |
$464.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$603.54
|
| Rate for Payer: BCBS Complete |
$371.41
|
| Rate for Payer: Cash Price |
$742.82
|
| Rate for Payer: Cofinity Advantage |
$649.97
|
| Rate for Payer: Cofinity Commercial |
$798.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$742.82
|
| Rate for Payer: Healthscope Commercial |
$835.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$649.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$696.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$742.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$789.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$696.40
|
| Rate for Payer: PHP Commercial |
$789.25
|
| Rate for Payer: Priority Health SBD |
$584.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$603.54
|
| Rate for Payer: UHC Core |
$483.76
|
| Rate for Payer: UHC Exchange |
$364.91
|
| Rate for Payer: UMR Bronson Commercial |
$343.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$696.40
|
|
|
SEVELAMER CARBONATE 800 MG TABLET
|
Facility
|
IP
|
$232.32
|
|
|
Service Code
|
NDC 00904670706
|
| Hospital Charge Code |
89201
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.22 |
| Max. Negotiated Rate |
$209.09 |
| Rate for Payer: Aetna American Axle |
$151.01
|
| Rate for Payer: Aetna Commercial |
$197.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.01
|
| Rate for Payer: Cash Price |
$185.86
|
| Rate for Payer: Cofinity Advantage |
$162.62
|
| Rate for Payer: Cofinity Commercial |
$199.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.86
|
| Rate for Payer: Healthscope Commercial |
$209.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.24
|
| Rate for Payer: PHP Commercial |
$197.47
|
| Rate for Payer: Priority Health SBD |
$146.36
|
| Rate for Payer: UMR Bronson Commercial |
$102.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.24
|
|
|
SEVELAMER CARBONATE 800 MG TABLET
|
Facility
|
IP
|
$5.17
|
|
|
Service Code
|
NDC 50268072011
|
| Hospital Charge Code |
89201
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.27 |
| Max. Negotiated Rate |
$4.65 |
| Rate for Payer: Aetna American Axle |
$3.36
|
| Rate for Payer: Aetna Commercial |
$4.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.36
|
| Rate for Payer: Cash Price |
$4.14
|
| Rate for Payer: Cofinity Advantage |
$3.62
|
| Rate for Payer: Cofinity Commercial |
$4.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.14
|
| Rate for Payer: Healthscope Commercial |
$4.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.88
|
| Rate for Payer: PHP Commercial |
$4.39
|
| Rate for Payer: Priority Health SBD |
$3.26
|
| Rate for Payer: UMR Bronson Commercial |
$2.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.88
|
|
|
SEVELAMER CARBONATE 800 MG TABLET
|
Facility
|
OP
|
$258.24
|
|
|
Service Code
|
NDC 50268072015
|
| Hospital Charge Code |
89201
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.55 |
| Max. Negotiated Rate |
$232.42 |
| Rate for Payer: Aetna American Axle |
$167.86
|
| Rate for Payer: Aetna Commercial |
$219.50
|
| Rate for Payer: Aetna Medicare |
$129.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.86
|
| Rate for Payer: BCBS Complete |
$103.30
|
| Rate for Payer: Cash Price |
$206.59
|
| Rate for Payer: Cofinity Advantage |
$180.77
|
| Rate for Payer: Cofinity Commercial |
$222.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.59
|
| Rate for Payer: Healthscope Commercial |
$232.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$206.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.68
|
| Rate for Payer: PHP Commercial |
$219.50
|
| Rate for Payer: Priority Health SBD |
$162.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.86
|
| Rate for Payer: UHC Core |
$134.54
|
| Rate for Payer: UHC Exchange |
$101.49
|
| Rate for Payer: UMR Bronson Commercial |
$95.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.68
|
|
|
SEVELAMER CARBONATE 800 MG TABLET
|
Facility
|
OP
|
$232.32
|
|
|
Service Code
|
NDC 00904670706
|
| Hospital Charge Code |
89201
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.96 |
| Max. Negotiated Rate |
$209.09 |
| Rate for Payer: Aetna American Axle |
$151.01
|
| Rate for Payer: Aetna Commercial |
$197.47
|
| Rate for Payer: Aetna Medicare |
$116.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.01
|
| Rate for Payer: BCBS Complete |
$92.93
|
| Rate for Payer: Cash Price |
$185.86
|
| Rate for Payer: Cofinity Advantage |
$162.62
|
| Rate for Payer: Cofinity Commercial |
$199.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.86
|
| Rate for Payer: Healthscope Commercial |
$209.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$185.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.24
|
| Rate for Payer: PHP Commercial |
$197.47
|
| Rate for Payer: Priority Health SBD |
$146.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.01
|
| Rate for Payer: UHC Core |
$121.04
|
| Rate for Payer: UHC Exchange |
$91.30
|
| Rate for Payer: UMR Bronson Commercial |
$85.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.24
|
|
|
SEVELAMER CARBONATE 800 MG TABLET
|
Facility
|
OP
|
$2,051.57
|
|
|
Service Code
|
NDC 00955105027
|
| Hospital Charge Code |
89201
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$759.08 |
| Max. Negotiated Rate |
$1,846.41 |
| Rate for Payer: Aetna American Axle |
$1,333.52
|
| Rate for Payer: Aetna Commercial |
$1,743.83
|
| Rate for Payer: Aetna Medicare |
$1,025.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,333.52
|
| Rate for Payer: BCBS Complete |
$820.63
|
| Rate for Payer: Cash Price |
$1,641.26
|
| Rate for Payer: Cofinity Advantage |
$1,436.10
|
| Rate for Payer: Cofinity Commercial |
$1,764.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,641.26
|
| Rate for Payer: Healthscope Commercial |
$1,846.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,436.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,538.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,641.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,743.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,538.68
|
| Rate for Payer: PHP Commercial |
$1,743.83
|
| Rate for Payer: Priority Health SBD |
$1,292.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,333.52
|
| Rate for Payer: UHC Core |
$1,068.87
|
| Rate for Payer: UHC Exchange |
$806.27
|
| Rate for Payer: UMR Bronson Commercial |
$759.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,538.68
|
|
|
SEVELAMER CARBONATE 800 MG TABLET
|
Facility
|
IP
|
$715.64
|
|
|
Service Code
|
NDC 65862092127
|
| Hospital Charge Code |
89201
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$314.88 |
| Max. Negotiated Rate |
$644.08 |
| Rate for Payer: Aetna American Axle |
$465.17
|
| Rate for Payer: Aetna Commercial |
$608.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$465.17
|
| Rate for Payer: Cash Price |
$572.51
|
| Rate for Payer: Cofinity Advantage |
$500.95
|
| Rate for Payer: Cofinity Commercial |
$615.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$572.51
|
| Rate for Payer: Healthscope Commercial |
$644.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$500.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$536.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$608.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$536.73
|
| Rate for Payer: PHP Commercial |
$608.29
|
| Rate for Payer: Priority Health SBD |
$450.85
|
| Rate for Payer: UMR Bronson Commercial |
$314.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$536.73
|
|
|
SEVELAMER CARBONATE 800 MG TABLET
|
Facility
|
IP
|
$2,051.57
|
|
|
Service Code
|
NDC 00955105027
|
| Hospital Charge Code |
89201
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$902.69 |
| Max. Negotiated Rate |
$1,846.41 |
| Rate for Payer: Aetna American Axle |
$1,333.52
|
| Rate for Payer: Aetna Commercial |
$1,743.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,333.52
|
| Rate for Payer: Cash Price |
$1,641.26
|
| Rate for Payer: Cofinity Advantage |
$1,436.10
|
| Rate for Payer: Cofinity Commercial |
$1,764.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,641.26
|
| Rate for Payer: Healthscope Commercial |
$1,846.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,436.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,538.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,743.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,538.68
|
| Rate for Payer: PHP Commercial |
$1,743.83
|
| Rate for Payer: Priority Health SBD |
$1,292.49
|
| Rate for Payer: UMR Bronson Commercial |
$902.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,538.68
|
|
|
SEVELAMER CARBONATE 800 MG TABLET
|
Facility
|
OP
|
$715.64
|
|
|
Service Code
|
NDC 65862092127
|
| Hospital Charge Code |
89201
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$264.79 |
| Max. Negotiated Rate |
$644.08 |
| Rate for Payer: Aetna American Axle |
$465.17
|
| Rate for Payer: Aetna Commercial |
$608.29
|
| Rate for Payer: Aetna Medicare |
$357.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$465.17
|
| Rate for Payer: BCBS Complete |
$286.26
|
| Rate for Payer: Cash Price |
$572.51
|
| Rate for Payer: Cofinity Advantage |
$500.95
|
| Rate for Payer: Cofinity Commercial |
$615.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$572.51
|
| Rate for Payer: Healthscope Commercial |
$644.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$500.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$536.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$572.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$608.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$536.73
|
| Rate for Payer: PHP Commercial |
$608.29
|
| Rate for Payer: Priority Health SBD |
$450.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$465.17
|
| Rate for Payer: UHC Core |
$372.85
|
| Rate for Payer: UHC Exchange |
$281.25
|
| Rate for Payer: UMR Bronson Commercial |
$264.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$536.73
|
|
|
SEVOFLURANE 99.97 % INHALATION LIQUID
|
Facility
|
IP
|
$223.13
|
|
|
Service Code
|
NDC 10019065164
|
| Hospital Charge Code |
15119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.18 |
| Max. Negotiated Rate |
$200.82 |
| Rate for Payer: Aetna American Axle |
$145.03
|
| Rate for Payer: Aetna Commercial |
$189.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.03
|
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: Cofinity Advantage |
$156.19
|
| Rate for Payer: Cofinity Commercial |
$191.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.50
|
| Rate for Payer: Healthscope Commercial |
$200.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$167.35
|
| Rate for Payer: PHP Commercial |
$189.66
|
| Rate for Payer: Priority Health SBD |
$140.57
|
| Rate for Payer: UMR Bronson Commercial |
$98.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.35
|
|
|
SEVOFLURANE 99.97 % INHALATION LIQUID
|
Facility
|
OP
|
$214.38
|
|
|
Service Code
|
NDC 00074445651
|
| Hospital Charge Code |
15119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.32 |
| Max. Negotiated Rate |
$192.94 |
| Rate for Payer: Aetna American Axle |
$139.35
|
| Rate for Payer: Aetna Commercial |
$182.22
|
| Rate for Payer: Aetna Medicare |
$107.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.35
|
| Rate for Payer: BCBS Complete |
$85.75
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: Cofinity Advantage |
$150.07
|
| Rate for Payer: Cofinity Commercial |
$184.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.50
|
| Rate for Payer: Healthscope Commercial |
$192.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$150.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$160.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$171.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$160.78
|
| Rate for Payer: PHP Commercial |
$182.22
|
| Rate for Payer: Priority Health SBD |
$135.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.35
|
| Rate for Payer: UHC Core |
$111.69
|
| Rate for Payer: UHC Exchange |
$84.25
|
| Rate for Payer: UMR Bronson Commercial |
$79.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$160.78
|
|
|
SEVOFLURANE 99.97 % INHALATION LIQUID
|
Facility
|
OP
|
$223.13
|
|
|
Service Code
|
NDC 10019065164
|
| Hospital Charge Code |
15119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.56 |
| Max. Negotiated Rate |
$200.82 |
| Rate for Payer: Aetna American Axle |
$145.03
|
| Rate for Payer: Aetna Commercial |
$189.66
|
| Rate for Payer: Aetna Medicare |
$111.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.03
|
| Rate for Payer: BCBS Complete |
$89.25
|
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: Cofinity Advantage |
$156.19
|
| Rate for Payer: Cofinity Commercial |
$191.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.50
|
| Rate for Payer: Healthscope Commercial |
$200.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$178.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$167.35
|
| Rate for Payer: PHP Commercial |
$189.66
|
| Rate for Payer: Priority Health SBD |
$140.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.03
|
| Rate for Payer: UHC Core |
$116.25
|
| Rate for Payer: UHC Exchange |
$87.69
|
| Rate for Payer: UMR Bronson Commercial |
$82.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.35
|
|
|
SEVOFLURANE 99.97 % INHALATION LIQUID
|
Facility
|
IP
|
$214.38
|
|
|
Service Code
|
NDC 00074445604
|
| Hospital Charge Code |
15119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.33 |
| Max. Negotiated Rate |
$192.94 |
| Rate for Payer: Aetna American Axle |
$139.35
|
| Rate for Payer: Aetna Commercial |
$182.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.35
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: Cofinity Advantage |
$150.07
|
| Rate for Payer: Cofinity Commercial |
$184.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.50
|
| Rate for Payer: Healthscope Commercial |
$192.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$150.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$160.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$160.78
|
| Rate for Payer: PHP Commercial |
$182.22
|
| Rate for Payer: Priority Health SBD |
$135.06
|
| Rate for Payer: UMR Bronson Commercial |
$94.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$160.78
|
|
|
SEVOFLURANE 99.97 % INHALATION LIQUID
|
Facility
|
OP
|
$214.38
|
|
|
Service Code
|
NDC 00074445604
|
| Hospital Charge Code |
15119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.32 |
| Max. Negotiated Rate |
$192.94 |
| Rate for Payer: Aetna American Axle |
$139.35
|
| Rate for Payer: Aetna Commercial |
$182.22
|
| Rate for Payer: Aetna Medicare |
$107.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.35
|
| Rate for Payer: BCBS Complete |
$85.75
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: Cofinity Advantage |
$150.07
|
| Rate for Payer: Cofinity Commercial |
$184.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.50
|
| Rate for Payer: Healthscope Commercial |
$192.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$150.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$160.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$171.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$160.78
|
| Rate for Payer: PHP Commercial |
$182.22
|
| Rate for Payer: Priority Health SBD |
$135.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.35
|
| Rate for Payer: UHC Core |
$111.69
|
| Rate for Payer: UHC Exchange |
$84.25
|
| Rate for Payer: UMR Bronson Commercial |
$79.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$160.78
|
|
|
SEVOFLURANE 99.97 % INHALATION LIQUID
|
Facility
|
IP
|
$214.38
|
|
|
Service Code
|
NDC 00074445651
|
| Hospital Charge Code |
15119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.33 |
| Max. Negotiated Rate |
$192.94 |
| Rate for Payer: Aetna American Axle |
$139.35
|
| Rate for Payer: Aetna Commercial |
$182.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.35
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: Cofinity Advantage |
$150.07
|
| Rate for Payer: Cofinity Commercial |
$184.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.50
|
| Rate for Payer: Healthscope Commercial |
$192.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$150.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$160.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$160.78
|
| Rate for Payer: PHP Commercial |
$182.22
|
| Rate for Payer: Priority Health SBD |
$135.06
|
| Rate for Payer: UMR Bronson Commercial |
$94.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$160.78
|
|
|
SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; LESION DIAMETER 0.6 TO 1.0 CM
|
Facility
|
OP
|
$646.50
|
|
|
Service Code
|
CPT 11311
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$112.00
|
| Rate for Payer: BCN Commercial |
$112.00
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Mclaren Medicaid |
$199.91
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$209.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.50
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
SHOULDER AND ELBOW JOINT REPLACEMENT
|
Facility
|
IP
|
$10,719.10
|
|
|
Service Code
|
APR-DRG 3221
|
| Min. Negotiated Rate |
$10,208.66 |
| Max. Negotiated Rate |
$10,719.10 |
| Rate for Payer: BCBS Complete |
$10,719.10
|
| Rate for Payer: Mclaren Medicaid |
$10,208.66
|
| Rate for Payer: Meridian Medicaid |
$10,719.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,208.66
|
| Rate for Payer: UHC Medicaid |
$10,208.66
|
| Rate for Payer: UHCCP Medicaid |
$10,208.66
|
|
|
SHOULDER AND ELBOW JOINT REPLACEMENT
|
Facility
|
IP
|
$13,268.72
|
|
|
Service Code
|
APR-DRG 3222
|
| Min. Negotiated Rate |
$12,636.88 |
| Max. Negotiated Rate |
$13,268.72 |
| Rate for Payer: BCBS Complete |
$13,268.72
|
| Rate for Payer: Mclaren Medicaid |
$12,636.88
|
| Rate for Payer: Meridian Medicaid |
$13,268.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,636.88
|
| Rate for Payer: UHC Medicaid |
$12,636.88
|
| Rate for Payer: UHCCP Medicaid |
$12,636.88
|
|
