|
CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) BOLUS/LOAD ORAL SOLUTION CUSTOM
|
Facility
|
OP
|
$37.76
|
|
|
Service Code
|
HCPCS J0706
|
| Hospital Charge Code |
301512
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.97 |
| Max. Negotiated Rate |
$33.98 |
| Rate for Payer: Aetna American Axle |
$24.54
|
| Rate for Payer: Aetna Commercial |
$32.10
|
| Rate for Payer: Aetna Medicare |
$18.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.54
|
| Rate for Payer: BCBS Complete |
$15.10
|
| Rate for Payer: Cash Price |
$30.21
|
| Rate for Payer: Cofinity Commercial |
$26.43
|
| Rate for Payer: Cofinity Commercial |
$32.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.21
|
| Rate for Payer: Healthscope Commercial |
$33.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.10
|
| Rate for Payer: PHP Commercial |
$32.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.54
|
| Rate for Payer: Priority Health SBD |
$23.79
|
| Rate for Payer: UMR Bronson Commercial |
$13.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.32
|
|
|
CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) MAINTENANCE INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$58.86
|
|
|
Service Code
|
HCPCS J0706
|
| Hospital Charge Code |
77412
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.78 |
| Max. Negotiated Rate |
$52.97 |
| Rate for Payer: Aetna American Axle |
$38.26
|
| Rate for Payer: Aetna American Axle |
$52.03
|
| Rate for Payer: Aetna American Axle |
$56.82
|
| Rate for Payer: Aetna American Axle |
$29.11
|
| Rate for Payer: Aetna American Axle |
$47.50
|
| Rate for Payer: Aetna Commercial |
$38.06
|
| Rate for Payer: Aetna Commercial |
$74.30
|
| Rate for Payer: Aetna Commercial |
$62.12
|
| Rate for Payer: Aetna Commercial |
$68.03
|
| Rate for Payer: Aetna Commercial |
$50.03
|
| Rate for Payer: Aetna Medicare |
$40.02
|
| Rate for Payer: Aetna Medicare |
$29.43
|
| Rate for Payer: Aetna Medicare |
$43.70
|
| Rate for Payer: Aetna Medicare |
$36.54
|
| Rate for Payer: Aetna Medicare |
$22.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.03
|
| Rate for Payer: BCBS Complete |
$34.96
|
| Rate for Payer: BCBS Complete |
$17.91
|
| Rate for Payer: BCBS Complete |
$32.02
|
| Rate for Payer: BCBS Complete |
$29.23
|
| Rate for Payer: BCBS Complete |
$23.54
|
| Rate for Payer: Cash Price |
$69.93
|
| Rate for Payer: Cash Price |
$35.82
|
| Rate for Payer: Cash Price |
$47.09
|
| Rate for Payer: Cash Price |
$64.03
|
| Rate for Payer: Cash Price |
$58.46
|
| Rate for Payer: Cofinity Commercial |
$61.19
|
| Rate for Payer: Cofinity Commercial |
$50.62
|
| Rate for Payer: Cofinity Commercial |
$68.83
|
| Rate for Payer: Cofinity Commercial |
$31.35
|
| Rate for Payer: Cofinity Commercial |
$62.85
|
| Rate for Payer: Cofinity Commercial |
$51.16
|
| Rate for Payer: Cofinity Commercial |
$56.03
|
| Rate for Payer: Cofinity Commercial |
$38.51
|
| Rate for Payer: Cofinity Commercial |
$41.20
|
| Rate for Payer: Cofinity Commercial |
$75.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.46
|
| Rate for Payer: Healthscope Commercial |
$40.30
|
| Rate for Payer: Healthscope Commercial |
$65.77
|
| Rate for Payer: Healthscope Commercial |
$78.67
|
| Rate for Payer: Healthscope Commercial |
$72.04
|
| Rate for Payer: Healthscope Commercial |
$52.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.30
|
| Rate for Payer: PHP Commercial |
$68.03
|
| Rate for Payer: PHP Commercial |
$62.12
|
| Rate for Payer: PHP Commercial |
$38.06
|
| Rate for Payer: PHP Commercial |
$50.03
|
| Rate for Payer: PHP Commercial |
$74.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.26
|
| Rate for Payer: Priority Health SBD |
$37.08
|
| Rate for Payer: Priority Health SBD |
$28.21
|
| Rate for Payer: Priority Health SBD |
$46.04
|
| Rate for Payer: Priority Health SBD |
$50.43
|
| Rate for Payer: Priority Health SBD |
$55.07
|
| Rate for Payer: UMR Bronson Commercial |
$32.34
|
| Rate for Payer: UMR Bronson Commercial |
$29.61
|
| Rate for Payer: UMR Bronson Commercial |
$21.78
|
| Rate for Payer: UMR Bronson Commercial |
$16.57
|
| Rate for Payer: UMR Bronson Commercial |
$27.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.81
|
|
|
CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) MAINTENANCE INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$80.04
|
|
|
Service Code
|
HCPCS J0706
|
| Hospital Charge Code |
77412
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.22 |
| Max. Negotiated Rate |
$72.04 |
| Rate for Payer: Aetna American Axle |
$52.03
|
| Rate for Payer: Aetna American Axle |
$29.11
|
| Rate for Payer: Aetna American Axle |
$38.26
|
| Rate for Payer: Aetna American Axle |
$56.82
|
| Rate for Payer: Aetna American Axle |
$47.50
|
| Rate for Payer: Aetna Commercial |
$68.03
|
| Rate for Payer: Aetna Commercial |
$50.03
|
| Rate for Payer: Aetna Commercial |
$38.06
|
| Rate for Payer: Aetna Commercial |
$74.30
|
| Rate for Payer: Aetna Commercial |
$62.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.26
|
| Rate for Payer: Cash Price |
$64.03
|
| Rate for Payer: Cash Price |
$69.93
|
| Rate for Payer: Cash Price |
$47.09
|
| Rate for Payer: Cash Price |
$58.46
|
| Rate for Payer: Cash Price |
$35.82
|
| Rate for Payer: Cofinity Commercial |
$61.19
|
| Rate for Payer: Cofinity Commercial |
$31.35
|
| Rate for Payer: Cofinity Commercial |
$68.83
|
| Rate for Payer: Cofinity Commercial |
$56.03
|
| Rate for Payer: Cofinity Commercial |
$51.16
|
| Rate for Payer: Cofinity Commercial |
$41.20
|
| Rate for Payer: Cofinity Commercial |
$50.62
|
| Rate for Payer: Cofinity Commercial |
$62.85
|
| Rate for Payer: Cofinity Commercial |
$38.51
|
| Rate for Payer: Cofinity Commercial |
$75.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.46
|
| Rate for Payer: Healthscope Commercial |
$52.97
|
| Rate for Payer: Healthscope Commercial |
$72.04
|
| Rate for Payer: Healthscope Commercial |
$65.77
|
| Rate for Payer: Healthscope Commercial |
$78.67
|
| Rate for Payer: Healthscope Commercial |
$40.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.06
|
| Rate for Payer: PHP Commercial |
$38.06
|
| Rate for Payer: PHP Commercial |
$74.30
|
| Rate for Payer: PHP Commercial |
$62.12
|
| Rate for Payer: PHP Commercial |
$68.03
|
| Rate for Payer: PHP Commercial |
$50.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.11
|
| Rate for Payer: Priority Health SBD |
$55.07
|
| Rate for Payer: Priority Health SBD |
$46.04
|
| Rate for Payer: Priority Health SBD |
$37.08
|
| Rate for Payer: Priority Health SBD |
$28.21
|
| Rate for Payer: Priority Health SBD |
$50.43
|
| Rate for Payer: UMR Bronson Commercial |
$19.70
|
| Rate for Payer: UMR Bronson Commercial |
$25.90
|
| Rate for Payer: UMR Bronson Commercial |
$35.22
|
| Rate for Payer: UMR Bronson Commercial |
$38.46
|
| Rate for Payer: UMR Bronson Commercial |
$32.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.03
|
|
|
CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) MAINTENANCE ORAL SOLUTION
|
Facility
|
IP
|
$37.76
|
|
|
Service Code
|
HCPCS J0706
|
| Hospital Charge Code |
77411
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$33.98 |
| Rate for Payer: Aetna American Axle |
$24.54
|
| Rate for Payer: Aetna Commercial |
$32.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.54
|
| Rate for Payer: Cash Price |
$30.21
|
| Rate for Payer: Cofinity Commercial |
$26.43
|
| Rate for Payer: Cofinity Commercial |
$32.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.21
|
| Rate for Payer: Healthscope Commercial |
$33.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.10
|
| Rate for Payer: PHP Commercial |
$32.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.54
|
| Rate for Payer: Priority Health SBD |
$23.79
|
| Rate for Payer: UMR Bronson Commercial |
$16.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.32
|
|
|
CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) MAINTENANCE ORAL SOLUTION
|
Facility
|
OP
|
$37.76
|
|
|
Service Code
|
HCPCS J0706
|
| Hospital Charge Code |
77411
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.97 |
| Max. Negotiated Rate |
$33.98 |
| Rate for Payer: Aetna American Axle |
$24.54
|
| Rate for Payer: Aetna Commercial |
$32.10
|
| Rate for Payer: Aetna Medicare |
$18.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.54
|
| Rate for Payer: BCBS Complete |
$15.10
|
| Rate for Payer: Cash Price |
$30.21
|
| Rate for Payer: Cofinity Commercial |
$26.43
|
| Rate for Payer: Cofinity Commercial |
$32.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.21
|
| Rate for Payer: Healthscope Commercial |
$33.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.10
|
| Rate for Payer: PHP Commercial |
$32.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.54
|
| Rate for Payer: Priority Health SBD |
$23.79
|
| Rate for Payer: UMR Bronson Commercial |
$13.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.32
|
|
|
CAFFEINE-SODIUM BENZOATE 250 MG/ML(125 MG/ML CAFFEINE) INJECTION SOLN
|
Facility
|
IP
|
$124.20
|
|
|
Service Code
|
NDC 00517250210
|
| Hospital Charge Code |
1262
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$54.65 |
| Max. Negotiated Rate |
$111.78 |
| Rate for Payer: Aetna American Axle |
$80.73
|
| Rate for Payer: Aetna Commercial |
$105.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.73
|
| Rate for Payer: Cash Price |
$99.36
|
| Rate for Payer: Cofinity Commercial |
$106.81
|
| Rate for Payer: Cofinity Commercial |
$86.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.36
|
| Rate for Payer: Healthscope Commercial |
$111.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.57
|
| Rate for Payer: PHP Commercial |
$105.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.73
|
| Rate for Payer: Priority Health SBD |
$78.25
|
| Rate for Payer: UMR Bronson Commercial |
$54.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.15
|
|
|
CAFFEINE-SODIUM BENZOATE 250 MG/ML(125 MG/ML CAFFEINE) INJECTION SOLN
|
Facility
|
OP
|
$124.20
|
|
|
Service Code
|
NDC 00517250201
|
| Hospital Charge Code |
1262
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.95 |
| Max. Negotiated Rate |
$111.78 |
| Rate for Payer: Aetna American Axle |
$80.73
|
| Rate for Payer: Aetna Commercial |
$105.57
|
| Rate for Payer: Aetna Medicare |
$62.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.73
|
| Rate for Payer: BCBS Complete |
$49.68
|
| Rate for Payer: Cash Price |
$99.36
|
| Rate for Payer: Cofinity Commercial |
$106.81
|
| Rate for Payer: Cofinity Commercial |
$86.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.36
|
| Rate for Payer: Healthscope Commercial |
$111.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.57
|
| Rate for Payer: PHP Commercial |
$105.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.73
|
| Rate for Payer: Priority Health SBD |
$78.25
|
| Rate for Payer: UMR Bronson Commercial |
$45.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.15
|
|
|
CAFFEINE-SODIUM BENZOATE 250 MG/ML(125 MG/ML CAFFEINE) INJECTION SOLN
|
Facility
|
IP
|
$124.20
|
|
|
Service Code
|
NDC 00517250201
|
| Hospital Charge Code |
1262
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$54.65 |
| Max. Negotiated Rate |
$111.78 |
| Rate for Payer: Aetna American Axle |
$80.73
|
| Rate for Payer: Aetna Commercial |
$105.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.73
|
| Rate for Payer: Cash Price |
$99.36
|
| Rate for Payer: Cofinity Commercial |
$106.81
|
| Rate for Payer: Cofinity Commercial |
$86.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.36
|
| Rate for Payer: Healthscope Commercial |
$111.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.57
|
| Rate for Payer: PHP Commercial |
$105.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.73
|
| Rate for Payer: Priority Health SBD |
$78.25
|
| Rate for Payer: UMR Bronson Commercial |
$54.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.15
|
|
|
CAFFEINE-SODIUM BENZOATE 250 MG/ML(125 MG/ML CAFFEINE) INJECTION SOLN
|
Facility
|
OP
|
$124.20
|
|
|
Service Code
|
NDC 00517250210
|
| Hospital Charge Code |
1262
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.95 |
| Max. Negotiated Rate |
$111.78 |
| Rate for Payer: Aetna American Axle |
$80.73
|
| Rate for Payer: Aetna Commercial |
$105.57
|
| Rate for Payer: Aetna Medicare |
$62.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.73
|
| Rate for Payer: BCBS Complete |
$49.68
|
| Rate for Payer: Cash Price |
$99.36
|
| Rate for Payer: Cofinity Commercial |
$106.81
|
| Rate for Payer: Cofinity Commercial |
$86.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.36
|
| Rate for Payer: Healthscope Commercial |
$111.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.57
|
| Rate for Payer: PHP Commercial |
$105.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.73
|
| Rate for Payer: Priority Health SBD |
$78.25
|
| Rate for Payer: UMR Bronson Commercial |
$45.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.15
|
|
|
CALAMINE 8 %-ZINC OXIDE 8 % LOTION
|
Facility
|
OP
|
$8.50
|
|
|
Service Code
|
NDC 00904253321
|
| Hospital Charge Code |
78879
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna American Axle |
$5.53
|
| Rate for Payer: Aetna Commercial |
$7.22
|
| Rate for Payer: Aetna Medicare |
$4.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.53
|
| Rate for Payer: BCBS Complete |
$3.40
|
| Rate for Payer: Cash Price |
$6.80
|
| Rate for Payer: Cofinity Commercial |
$5.95
|
| Rate for Payer: Cofinity Commercial |
$7.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.80
|
| Rate for Payer: Healthscope Commercial |
$7.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.22
|
| Rate for Payer: PHP Commercial |
$7.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.53
|
| Rate for Payer: Priority Health SBD |
$5.36
|
| Rate for Payer: UMR Bronson Commercial |
$3.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.38
|
|
|
CALAMINE 8 %-ZINC OXIDE 8 % LOTION
|
Facility
|
IP
|
$8.50
|
|
|
Service Code
|
NDC 00904253321
|
| Hospital Charge Code |
78879
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna American Axle |
$5.53
|
| Rate for Payer: Aetna Commercial |
$7.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.53
|
| Rate for Payer: Cash Price |
$6.80
|
| Rate for Payer: Cofinity Commercial |
$5.95
|
| Rate for Payer: Cofinity Commercial |
$7.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.80
|
| Rate for Payer: Healthscope Commercial |
$7.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.22
|
| Rate for Payer: PHP Commercial |
$7.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.53
|
| Rate for Payer: Priority Health SBD |
$5.36
|
| Rate for Payer: UMR Bronson Commercial |
$3.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.38
|
|
|
CALAMINE 8 %-ZINC OXIDE 8 % LOTION
|
Facility
|
IP
|
$14.34
|
|
|
Service Code
|
NDC 00395041396
|
| Hospital Charge Code |
78879
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.31 |
| Max. Negotiated Rate |
$12.91 |
| Rate for Payer: Aetna American Axle |
$9.32
|
| Rate for Payer: Aetna Commercial |
$12.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.32
|
| Rate for Payer: Cash Price |
$11.47
|
| Rate for Payer: Cofinity Commercial |
$10.04
|
| Rate for Payer: Cofinity Commercial |
$12.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.47
|
| Rate for Payer: Healthscope Commercial |
$12.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.19
|
| Rate for Payer: PHP Commercial |
$12.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.32
|
| Rate for Payer: Priority Health SBD |
$9.03
|
| Rate for Payer: UMR Bronson Commercial |
$6.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.76
|
|
|
CALAMINE 8 %-ZINC OXIDE 8 % LOTION
|
Facility
|
OP
|
$14.34
|
|
|
Service Code
|
NDC 00395041396
|
| Hospital Charge Code |
78879
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.31 |
| Max. Negotiated Rate |
$12.91 |
| Rate for Payer: Aetna American Axle |
$9.32
|
| Rate for Payer: Aetna Commercial |
$12.19
|
| Rate for Payer: Aetna Medicare |
$7.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.32
|
| Rate for Payer: BCBS Complete |
$5.74
|
| Rate for Payer: Cash Price |
$11.47
|
| Rate for Payer: Cofinity Commercial |
$10.04
|
| Rate for Payer: Cofinity Commercial |
$12.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.47
|
| Rate for Payer: Healthscope Commercial |
$12.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.19
|
| Rate for Payer: PHP Commercial |
$12.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.32
|
| Rate for Payer: Priority Health SBD |
$9.03
|
| Rate for Payer: UMR Bronson Commercial |
$5.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.76
|
|
|
CALASPARGASE PEGOL-MKNL 750 UNIT/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$130,372.23
|
|
|
Service Code
|
HCPCS J9118
|
| Hospital Charge Code |
191705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57,363.78 |
| Max. Negotiated Rate |
$117,335.01 |
| Rate for Payer: Aetna American Axle |
$84,741.95
|
| Rate for Payer: Aetna Commercial |
$110,816.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84,741.95
|
| Rate for Payer: Cash Price |
$104,297.78
|
| Rate for Payer: Cofinity Commercial |
$112,120.12
|
| Rate for Payer: Cofinity Commercial |
$91,260.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$91,260.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104,297.78
|
| Rate for Payer: Healthscope Commercial |
$117,335.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91,260.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97,779.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110,816.40
|
| Rate for Payer: PHP Commercial |
$110,816.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84,741.95
|
| Rate for Payer: Priority Health SBD |
$82,134.50
|
| Rate for Payer: UMR Bronson Commercial |
$57,363.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97,779.17
|
|
|
CALASPARGASE PEGOL-MKNL 750 UNIT/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$130,372.23
|
|
|
Service Code
|
HCPCS J9118
|
| Hospital Charge Code |
191705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.99 |
| Max. Negotiated Rate |
$117,335.01 |
| Rate for Payer: Aetna American Axle |
$84,741.95
|
| Rate for Payer: Aetna Commercial |
$110,816.40
|
| Rate for Payer: Aetna Medicare |
$85.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84,741.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$102.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$102.60
|
| Rate for Payer: BCBS Complete |
$46.19
|
| Rate for Payer: BCBS MAPPO |
$82.08
|
| Rate for Payer: BCN Medicare Advantage |
$82.08
|
| Rate for Payer: Cash Price |
$104,297.78
|
| Rate for Payer: Cash Price |
$104,297.78
|
| Rate for Payer: Cofinity Commercial |
$91,260.56
|
| Rate for Payer: Cofinity Commercial |
$112,120.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$91,260.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104,297.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.08
|
| Rate for Payer: Healthscope Commercial |
$117,335.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91,260.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97,779.17
|
| Rate for Payer: Mclaren Medicaid |
$43.99
|
| Rate for Payer: Mclaren Medicare |
$82.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.18
|
| Rate for Payer: Meridian Medicaid |
$46.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110,816.40
|
| Rate for Payer: PACE Medicare |
$77.98
|
| Rate for Payer: PACE SWMI |
$82.08
|
| Rate for Payer: PHP Commercial |
$110,816.40
|
| Rate for Payer: PHP Medicare Advantage |
$82.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84,741.95
|
| Rate for Payer: Priority Health Medicare |
$82.08
|
| Rate for Payer: Priority Health SBD |
$82,134.50
|
| Rate for Payer: Railroad Medicare Medicare |
$82.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.08
|
| Rate for Payer: UHC Exchange |
$156.86
|
| Rate for Payer: UHC Medicare Advantage |
$82.08
|
| Rate for Payer: UHCCP Medicaid |
$43.99
|
| Rate for Payer: UMR Bronson Commercial |
$48,237.73
|
| Rate for Payer: VA VA |
$82.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97,779.17
|
|
|
CALCIPOTRIENE 0.005 % TOPICAL CREAM
|
Facility
|
OP
|
$254.31
|
|
|
Service Code
|
NDC 66993087761
|
| Hospital Charge Code |
16034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.09 |
| Max. Negotiated Rate |
$228.88 |
| Rate for Payer: Aetna American Axle |
$165.30
|
| Rate for Payer: Aetna Commercial |
$216.16
|
| Rate for Payer: Aetna Medicare |
$127.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.30
|
| Rate for Payer: BCBS Complete |
$101.72
|
| Rate for Payer: Cash Price |
$203.45
|
| Rate for Payer: Cofinity Commercial |
$178.02
|
| Rate for Payer: Cofinity Commercial |
$218.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.45
|
| Rate for Payer: Healthscope Commercial |
$228.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.16
|
| Rate for Payer: PHP Commercial |
$216.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.30
|
| Rate for Payer: Priority Health SBD |
$160.22
|
| Rate for Payer: UMR Bronson Commercial |
$94.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.73
|
|
|
CALCIPOTRIENE 0.005 % TOPICAL CREAM
|
Facility
|
IP
|
$254.31
|
|
|
Service Code
|
NDC 66993087761
|
| Hospital Charge Code |
16034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.90 |
| Max. Negotiated Rate |
$228.88 |
| Rate for Payer: Aetna American Axle |
$165.30
|
| Rate for Payer: Aetna Commercial |
$216.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.30
|
| Rate for Payer: Cash Price |
$203.45
|
| Rate for Payer: Cofinity Commercial |
$178.02
|
| Rate for Payer: Cofinity Commercial |
$218.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.45
|
| Rate for Payer: Healthscope Commercial |
$228.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.16
|
| Rate for Payer: PHP Commercial |
$216.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.30
|
| Rate for Payer: Priority Health SBD |
$160.22
|
| Rate for Payer: UMR Bronson Commercial |
$111.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.73
|
|
|
CALCIPOTRIENE 0.005 % TOPICAL CREAM
|
Facility
|
OP
|
$1,150.59
|
|
|
Service Code
|
NDC 00781711735
|
| Hospital Charge Code |
16034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$425.72 |
| Max. Negotiated Rate |
$1,035.53 |
| Rate for Payer: Aetna American Axle |
$747.88
|
| Rate for Payer: Aetna Commercial |
$978.00
|
| Rate for Payer: Aetna Medicare |
$575.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$747.88
|
| Rate for Payer: BCBS Complete |
$460.24
|
| Rate for Payer: Cash Price |
$920.47
|
| Rate for Payer: Cofinity Commercial |
$805.41
|
| Rate for Payer: Cofinity Commercial |
$989.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$805.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$920.47
|
| Rate for Payer: Healthscope Commercial |
$1,035.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$805.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$862.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$978.00
|
| Rate for Payer: PHP Commercial |
$978.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$747.88
|
| Rate for Payer: Priority Health SBD |
$724.87
|
| Rate for Payer: UMR Bronson Commercial |
$425.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$862.94
|
|
|
CALCIPOTRIENE 0.005 % TOPICAL CREAM
|
Facility
|
IP
|
$683.76
|
|
|
Service Code
|
NDC 68462050165
|
| Hospital Charge Code |
16034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$300.85 |
| Max. Negotiated Rate |
$615.38 |
| Rate for Payer: Aetna American Axle |
$444.44
|
| Rate for Payer: Aetna Commercial |
$581.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$444.44
|
| Rate for Payer: Cash Price |
$547.01
|
| Rate for Payer: Cofinity Commercial |
$478.63
|
| Rate for Payer: Cofinity Commercial |
$588.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$478.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$547.01
|
| Rate for Payer: Healthscope Commercial |
$615.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$478.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$512.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$581.20
|
| Rate for Payer: PHP Commercial |
$581.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$444.44
|
| Rate for Payer: Priority Health SBD |
$430.77
|
| Rate for Payer: UMR Bronson Commercial |
$300.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$512.82
|
|
|
CALCIPOTRIENE 0.005 % TOPICAL CREAM
|
Facility
|
IP
|
$1,150.59
|
|
|
Service Code
|
NDC 00781711735
|
| Hospital Charge Code |
16034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$506.26 |
| Max. Negotiated Rate |
$1,035.53 |
| Rate for Payer: Aetna American Axle |
$747.88
|
| Rate for Payer: Aetna Commercial |
$978.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$747.88
|
| Rate for Payer: Cash Price |
$920.47
|
| Rate for Payer: Cofinity Commercial |
$805.41
|
| Rate for Payer: Cofinity Commercial |
$989.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$805.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$920.47
|
| Rate for Payer: Healthscope Commercial |
$1,035.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$805.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$862.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$978.00
|
| Rate for Payer: PHP Commercial |
$978.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$747.88
|
| Rate for Payer: Priority Health SBD |
$724.87
|
| Rate for Payer: UMR Bronson Commercial |
$506.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$862.94
|
|
|
CALCIPOTRIENE 0.005 % TOPICAL CREAM
|
Facility
|
OP
|
$683.76
|
|
|
Service Code
|
NDC 68462050165
|
| Hospital Charge Code |
16034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$252.99 |
| Max. Negotiated Rate |
$615.38 |
| Rate for Payer: Aetna American Axle |
$444.44
|
| Rate for Payer: Aetna Commercial |
$581.20
|
| Rate for Payer: Aetna Medicare |
$341.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$444.44
|
| Rate for Payer: BCBS Complete |
$273.50
|
| Rate for Payer: Cash Price |
$547.01
|
| Rate for Payer: Cofinity Commercial |
$478.63
|
| Rate for Payer: Cofinity Commercial |
$588.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$478.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$547.01
|
| Rate for Payer: Healthscope Commercial |
$615.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$478.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$512.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$581.20
|
| Rate for Payer: PHP Commercial |
$581.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$444.44
|
| Rate for Payer: Priority Health SBD |
$430.77
|
| Rate for Payer: UMR Bronson Commercial |
$252.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$512.82
|
|
|
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY
|
Facility
|
OP
|
$243.71
|
|
|
Service Code
|
NDC 60505082306
|
| Hospital Charge Code |
15738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.17 |
| Max. Negotiated Rate |
$219.34 |
| Rate for Payer: Aetna American Axle |
$158.41
|
| Rate for Payer: Aetna Commercial |
$207.15
|
| Rate for Payer: Aetna Medicare |
$121.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.41
|
| Rate for Payer: BCBS Complete |
$97.48
|
| Rate for Payer: Cash Price |
$194.97
|
| Rate for Payer: Cofinity Commercial |
$170.60
|
| Rate for Payer: Cofinity Commercial |
$209.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$170.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.97
|
| Rate for Payer: Healthscope Commercial |
$219.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$170.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.15
|
| Rate for Payer: PHP Commercial |
$207.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.41
|
| Rate for Payer: Priority Health SBD |
$153.54
|
| Rate for Payer: UMR Bronson Commercial |
$90.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.78
|
|
|
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY
|
Facility
|
IP
|
$137.24
|
|
|
Service Code
|
NDC 49884016111
|
| Hospital Charge Code |
15738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.39 |
| Max. Negotiated Rate |
$123.52 |
| Rate for Payer: Aetna American Axle |
$89.21
|
| Rate for Payer: Aetna Commercial |
$116.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.21
|
| Rate for Payer: Cash Price |
$109.79
|
| Rate for Payer: Cofinity Commercial |
$118.03
|
| Rate for Payer: Cofinity Commercial |
$96.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$96.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.79
|
| Rate for Payer: Healthscope Commercial |
$123.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.65
|
| Rate for Payer: PHP Commercial |
$116.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.21
|
| Rate for Payer: Priority Health SBD |
$86.46
|
| Rate for Payer: UMR Bronson Commercial |
$60.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.93
|
|
|
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY
|
Facility
|
OP
|
$137.24
|
|
|
Service Code
|
NDC 49884016111
|
| Hospital Charge Code |
15738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.78 |
| Max. Negotiated Rate |
$123.52 |
| Rate for Payer: Aetna American Axle |
$89.21
|
| Rate for Payer: Aetna Commercial |
$116.65
|
| Rate for Payer: Aetna Medicare |
$68.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.21
|
| Rate for Payer: BCBS Complete |
$54.90
|
| Rate for Payer: Cash Price |
$109.79
|
| Rate for Payer: Cofinity Commercial |
$118.03
|
| Rate for Payer: Cofinity Commercial |
$96.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$96.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.79
|
| Rate for Payer: Healthscope Commercial |
$123.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.65
|
| Rate for Payer: PHP Commercial |
$116.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.21
|
| Rate for Payer: Priority Health SBD |
$86.46
|
| Rate for Payer: UMR Bronson Commercial |
$50.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.93
|
|
|
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY
|
Facility
|
IP
|
$243.71
|
|
|
Service Code
|
NDC 60505082306
|
| Hospital Charge Code |
15738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.23 |
| Max. Negotiated Rate |
$219.34 |
| Rate for Payer: Aetna American Axle |
$158.41
|
| Rate for Payer: Aetna Commercial |
$207.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.41
|
| Rate for Payer: Cash Price |
$194.97
|
| Rate for Payer: Cofinity Commercial |
$170.60
|
| Rate for Payer: Cofinity Commercial |
$209.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$170.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.97
|
| Rate for Payer: Healthscope Commercial |
$219.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$170.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.15
|
| Rate for Payer: PHP Commercial |
$207.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.41
|
| Rate for Payer: Priority Health SBD |
$153.54
|
| Rate for Payer: UMR Bronson Commercial |
$107.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.78
|
|
