|
SODIUM POLYSTYRENE SULFONATE 15 GRAM-SORBITOL 20 GRAM/60 ML ORAL SUSP
|
Facility
|
IP
|
$76.59
|
|
|
Service Code
|
NDC 62559035601
|
| Hospital Charge Code |
179838
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.70 |
| Max. Negotiated Rate |
$68.93 |
| Rate for Payer: Aetna American Axle |
$49.78
|
| Rate for Payer: Aetna Commercial |
$65.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.78
|
| Rate for Payer: Cash Price |
$61.27
|
| Rate for Payer: Cofinity Advantage |
$53.61
|
| Rate for Payer: Cofinity Commercial |
$65.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.27
|
| Rate for Payer: Healthscope Commercial |
$68.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.44
|
| Rate for Payer: PHP Commercial |
$65.10
|
| Rate for Payer: Priority Health SBD |
$48.25
|
| Rate for Payer: UMR Bronson Commercial |
$33.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.44
|
|
|
SODIUM POLYSTYRENE SULFONATE 15 GRAM-SORBITOL 20 GRAM/60 ML ORAL SUSP
|
Facility
|
IP
|
$76.59
|
|
|
Service Code
|
NDC 62559035660
|
| Hospital Charge Code |
179838
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.70 |
| Max. Negotiated Rate |
$68.93 |
| Rate for Payer: Aetna American Axle |
$49.78
|
| Rate for Payer: Aetna Commercial |
$65.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.78
|
| Rate for Payer: Cash Price |
$61.27
|
| Rate for Payer: Cofinity Advantage |
$53.61
|
| Rate for Payer: Cofinity Commercial |
$65.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.27
|
| Rate for Payer: Healthscope Commercial |
$68.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.44
|
| Rate for Payer: PHP Commercial |
$65.10
|
| Rate for Payer: Priority Health SBD |
$48.25
|
| Rate for Payer: UMR Bronson Commercial |
$33.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.44
|
|
|
SODIUM POLYSTYRENE SULFONATE 30 GRAM-SORBITOL 40 GRAM/120 ML ENEMA
|
Facility
|
OP
|
$370.74
|
|
|
Service Code
|
NDC 46287000604
|
| Hospital Charge Code |
179841
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.17 |
| Max. Negotiated Rate |
$333.67 |
| Rate for Payer: Aetna American Axle |
$240.98
|
| Rate for Payer: Aetna Commercial |
$315.13
|
| Rate for Payer: Aetna Medicare |
$185.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.98
|
| Rate for Payer: BCBS Complete |
$148.30
|
| Rate for Payer: Cash Price |
$296.59
|
| Rate for Payer: Cofinity Advantage |
$259.52
|
| Rate for Payer: Cofinity Commercial |
$318.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.59
|
| Rate for Payer: Healthscope Commercial |
$333.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$259.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$296.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$278.06
|
| Rate for Payer: PHP Commercial |
$315.13
|
| Rate for Payer: Priority Health SBD |
$233.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$240.98
|
| Rate for Payer: UHC Core |
$193.16
|
| Rate for Payer: UHC Exchange |
$145.70
|
| Rate for Payer: UMR Bronson Commercial |
$137.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.06
|
|
|
SODIUM POLYSTYRENE SULFONATE 30 GRAM-SORBITOL 40 GRAM/120 ML ENEMA
|
Facility
|
IP
|
$370.74
|
|
|
Service Code
|
NDC 46287000604
|
| Hospital Charge Code |
179841
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.13 |
| Max. Negotiated Rate |
$333.67 |
| Rate for Payer: Aetna American Axle |
$240.98
|
| Rate for Payer: Aetna Commercial |
$315.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.98
|
| Rate for Payer: Cash Price |
$296.59
|
| Rate for Payer: Cofinity Advantage |
$259.52
|
| Rate for Payer: Cofinity Commercial |
$318.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.59
|
| Rate for Payer: Healthscope Commercial |
$333.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$259.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$278.06
|
| Rate for Payer: PHP Commercial |
$315.13
|
| Rate for Payer: Priority Health SBD |
$233.57
|
| Rate for Payer: UMR Bronson Commercial |
$163.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.06
|
|
|
SODIUM-POT-MAG-CAL-CHLOR-ACE-GLUCONATE 25 MEQ-40.6 MEQ-5 MEQ/20 ML IV
|
Facility
|
OP
|
$19.72
|
|
|
Service Code
|
NDC 00517312025
|
| Hospital Charge Code |
117109
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$17.75 |
| Rate for Payer: Aetna American Axle |
$12.82
|
| Rate for Payer: Aetna Commercial |
$16.76
|
| Rate for Payer: Aetna Medicare |
$9.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.82
|
| Rate for Payer: BCBS Complete |
$7.89
|
| Rate for Payer: Cash Price |
$15.78
|
| Rate for Payer: Cofinity Advantage |
$13.80
|
| Rate for Payer: Cofinity Commercial |
$16.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.78
|
| Rate for Payer: Healthscope Commercial |
$17.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.79
|
| Rate for Payer: PHP Commercial |
$16.76
|
| Rate for Payer: Priority Health SBD |
$12.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.82
|
| Rate for Payer: UHC Core |
$10.27
|
| Rate for Payer: UHC Exchange |
$7.75
|
| Rate for Payer: UMR Bronson Commercial |
$7.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.79
|
|
|
SODIUM-POT-MAG-CAL-CHLOR-ACE-GLUCONATE 25 MEQ-40.6 MEQ-5 MEQ/20 ML IV
|
Facility
|
OP
|
$19.72
|
|
|
Service Code
|
NDC 517312025
|
| Hospital Charge Code |
117109
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$17.75 |
| Rate for Payer: Aetna American Axle |
$12.82
|
| Rate for Payer: Aetna Commercial |
$16.76
|
| Rate for Payer: Aetna Medicare |
$9.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.82
|
| Rate for Payer: BCBS Complete |
$7.89
|
| Rate for Payer: Cash Price |
$15.78
|
| Rate for Payer: Cofinity Advantage |
$13.80
|
| Rate for Payer: Cofinity Commercial |
$16.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.78
|
| Rate for Payer: Healthscope Commercial |
$17.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.79
|
| Rate for Payer: PHP Commercial |
$16.76
|
| Rate for Payer: Priority Health SBD |
$12.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.82
|
| Rate for Payer: UHC Core |
$10.27
|
| Rate for Payer: UHC Exchange |
$7.75
|
| Rate for Payer: UMR Bronson Commercial |
$7.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.79
|
|
|
SODIUM-POT-MAG-CAL-CHLOR-ACE-GLUCONATE 25 MEQ-40.6 MEQ-5 MEQ/20 ML IV
|
Facility
|
IP
|
$19.72
|
|
|
Service Code
|
NDC 00517312025
|
| Hospital Charge Code |
117109
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$17.75 |
| Rate for Payer: Aetna American Axle |
$12.82
|
| Rate for Payer: Aetna Commercial |
$16.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.82
|
| Rate for Payer: Cash Price |
$15.78
|
| Rate for Payer: Cofinity Advantage |
$13.80
|
| Rate for Payer: Cofinity Commercial |
$16.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.78
|
| Rate for Payer: Healthscope Commercial |
$17.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.79
|
| Rate for Payer: PHP Commercial |
$16.76
|
| Rate for Payer: Priority Health SBD |
$12.42
|
| Rate for Payer: UMR Bronson Commercial |
$8.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.79
|
|
|
SODIUM TETRADECYL SULFATE 3 % (30 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$257.28
|
|
|
Service Code
|
NDC 67457016302
|
| Hospital Charge Code |
41793
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$113.20 |
| Max. Negotiated Rate |
$231.55 |
| Rate for Payer: Aetna American Axle |
$167.23
|
| Rate for Payer: Aetna Commercial |
$218.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.23
|
| Rate for Payer: Cash Price |
$205.82
|
| Rate for Payer: Cofinity Advantage |
$180.10
|
| Rate for Payer: Cofinity Commercial |
$221.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.82
|
| Rate for Payer: Healthscope Commercial |
$231.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.96
|
| Rate for Payer: PHP Commercial |
$218.69
|
| Rate for Payer: Priority Health SBD |
$162.09
|
| Rate for Payer: UMR Bronson Commercial |
$113.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.96
|
|
|
SODIUM TETRADECYL SULFATE 3 % (30 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$257.28
|
|
|
Service Code
|
NDC 67457016302
|
| Hospital Charge Code |
41793
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$95.19 |
| Max. Negotiated Rate |
$231.55 |
| Rate for Payer: Aetna American Axle |
$167.23
|
| Rate for Payer: Aetna Commercial |
$218.69
|
| Rate for Payer: Aetna Medicare |
$128.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.23
|
| Rate for Payer: BCBS Complete |
$102.91
|
| Rate for Payer: Cash Price |
$205.82
|
| Rate for Payer: Cofinity Advantage |
$180.10
|
| Rate for Payer: Cofinity Commercial |
$221.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.82
|
| Rate for Payer: Healthscope Commercial |
$231.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$205.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.96
|
| Rate for Payer: PHP Commercial |
$218.69
|
| Rate for Payer: Priority Health SBD |
$162.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.23
|
| Rate for Payer: UHC Core |
$134.04
|
| Rate for Payer: UHC Exchange |
$101.11
|
| Rate for Payer: UMR Bronson Commercial |
$95.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.96
|
|
|
SODIUM TETRADECYL SULFATE 3 % (30 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$257.28
|
|
|
Service Code
|
NDC 67457016300
|
| Hospital Charge Code |
41793
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$113.20 |
| Max. Negotiated Rate |
$231.55 |
| Rate for Payer: Aetna American Axle |
$167.23
|
| Rate for Payer: Aetna Commercial |
$218.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.23
|
| Rate for Payer: Cash Price |
$205.82
|
| Rate for Payer: Cofinity Advantage |
$180.10
|
| Rate for Payer: Cofinity Commercial |
$221.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.82
|
| Rate for Payer: Healthscope Commercial |
$231.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.96
|
| Rate for Payer: PHP Commercial |
$218.69
|
| Rate for Payer: Priority Health SBD |
$162.09
|
| Rate for Payer: UMR Bronson Commercial |
$113.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.96
|
|
|
SODIUM TETRADECYL SULFATE 3 % (30 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$257.28
|
|
|
Service Code
|
NDC 67457016300
|
| Hospital Charge Code |
41793
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$95.19 |
| Max. Negotiated Rate |
$231.55 |
| Rate for Payer: Aetna American Axle |
$167.23
|
| Rate for Payer: Aetna Commercial |
$218.69
|
| Rate for Payer: Aetna Medicare |
$128.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.23
|
| Rate for Payer: BCBS Complete |
$102.91
|
| Rate for Payer: Cash Price |
$205.82
|
| Rate for Payer: Cofinity Advantage |
$180.10
|
| Rate for Payer: Cofinity Commercial |
$221.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.82
|
| Rate for Payer: Healthscope Commercial |
$231.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$205.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.96
|
| Rate for Payer: PHP Commercial |
$218.69
|
| Rate for Payer: Priority Health SBD |
$162.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.23
|
| Rate for Payer: UHC Core |
$134.04
|
| Rate for Payer: UHC Exchange |
$101.11
|
| Rate for Payer: UMR Bronson Commercial |
$95.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.96
|
|
|
SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$351.45
|
|
|
Service Code
|
HCPCS J0209
|
| Hospital Charge Code |
7364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$316.31 |
| Rate for Payer: Aetna American Axle |
$228.44
|
| Rate for Payer: Aetna Commercial |
$298.73
|
| Rate for Payer: Aetna Medicare |
$0.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.10
|
| Rate for Payer: BCBS Complete |
$0.48
|
| Rate for Payer: BCBS MAPPO |
$0.88
|
| Rate for Payer: BCBS Trust/PPO |
$1.97
|
| Rate for Payer: BCN Commercial |
$1.97
|
| Rate for Payer: BCN Medicare Advantage |
$0.88
|
| Rate for Payer: Cash Price |
$281.16
|
| Rate for Payer: Cash Price |
$281.16
|
| Rate for Payer: Cofinity Advantage |
$246.01
|
| Rate for Payer: Cofinity Commercial |
$302.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.88
|
| Rate for Payer: Healthscope Commercial |
$316.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$246.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.59
|
| Rate for Payer: Mclaren Medicaid |
$0.88
|
| Rate for Payer: Mclaren Medicare |
$0.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.92
|
| Rate for Payer: Meridian Medicaid |
$0.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.73
|
| Rate for Payer: Nomi Health Commercial |
$2.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$263.59
|
| Rate for Payer: PACE Medicare |
$0.84
|
| Rate for Payer: PACE SWMI |
$0.88
|
| Rate for Payer: PHP Commercial |
$298.73
|
| Rate for Payer: PHP Medicare Advantage |
$0.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2.77
|
| Rate for Payer: Priority Health Medicare |
$0.88
|
| Rate for Payer: Priority Health SBD |
$221.41
|
| Rate for Payer: Priority Health Tiered Network |
$2.22
|
| Rate for Payer: Railroad Medicare Medicare |
$0.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.45
|
| Rate for Payer: UHC Core |
$1.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.88
|
| Rate for Payer: UHC Exchange |
$1.45
|
| Rate for Payer: UHC Medicaid |
$0.46
|
| Rate for Payer: UHCCP Medicaid |
$0.46
|
| Rate for Payer: UMR Bronson Commercial |
$130.04
|
| Rate for Payer: VA VA |
$0.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.59
|
|
|
SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$351.45
|
|
|
Service Code
|
HCPCS J0209
|
| Hospital Charge Code |
7364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$154.64 |
| Max. Negotiated Rate |
$316.31 |
| Rate for Payer: Aetna American Axle |
$228.44
|
| Rate for Payer: Aetna Commercial |
$298.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.44
|
| Rate for Payer: Cash Price |
$281.16
|
| Rate for Payer: Cofinity Advantage |
$246.01
|
| Rate for Payer: Cofinity Commercial |
$302.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.16
|
| Rate for Payer: Healthscope Commercial |
$316.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$246.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$263.59
|
| Rate for Payer: PHP Commercial |
$298.73
|
| Rate for Payer: Priority Health SBD |
$221.41
|
| Rate for Payer: UMR Bronson Commercial |
$154.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.59
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$1,313.02
|
|
|
Service Code
|
NDC 00310111030
|
| Hospital Charge Code |
188049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$485.82 |
| Max. Negotiated Rate |
$1,181.72 |
| Rate for Payer: Aetna American Axle |
$853.46
|
| Rate for Payer: Aetna Commercial |
$1,116.07
|
| Rate for Payer: Aetna Medicare |
$656.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$853.46
|
| Rate for Payer: BCBS Complete |
$525.21
|
| Rate for Payer: Cash Price |
$1,050.42
|
| Rate for Payer: Cofinity Advantage |
$919.11
|
| Rate for Payer: Cofinity Commercial |
$1,129.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,050.42
|
| Rate for Payer: Healthscope Commercial |
$1,181.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$919.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$984.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,050.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,116.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$984.76
|
| Rate for Payer: PHP Commercial |
$1,116.07
|
| Rate for Payer: Priority Health SBD |
$827.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$853.46
|
| Rate for Payer: UHC Core |
$684.08
|
| Rate for Payer: UHC Exchange |
$516.02
|
| Rate for Payer: UMR Bronson Commercial |
$485.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$984.76
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$1,313.02
|
|
|
Service Code
|
NDC 00310111030
|
| Hospital Charge Code |
188049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$577.73 |
| Max. Negotiated Rate |
$1,181.72 |
| Rate for Payer: Aetna American Axle |
$853.46
|
| Rate for Payer: Aetna Commercial |
$1,116.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$853.46
|
| Rate for Payer: Cash Price |
$1,050.42
|
| Rate for Payer: Cofinity Advantage |
$919.11
|
| Rate for Payer: Cofinity Commercial |
$1,129.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,050.42
|
| Rate for Payer: Healthscope Commercial |
$1,181.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$919.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$984.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,116.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$984.76
|
| Rate for Payer: PHP Commercial |
$1,116.07
|
| Rate for Payer: Priority Health SBD |
$827.20
|
| Rate for Payer: UMR Bronson Commercial |
$577.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$984.76
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$43.77
|
|
|
Service Code
|
NDC 00310111001
|
| Hospital Charge Code |
188049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.26 |
| Max. Negotiated Rate |
$39.39 |
| Rate for Payer: Aetna American Axle |
$28.45
|
| Rate for Payer: Aetna Commercial |
$37.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.45
|
| Rate for Payer: Cash Price |
$35.02
|
| Rate for Payer: Cofinity Advantage |
$30.64
|
| Rate for Payer: Cofinity Commercial |
$37.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.02
|
| Rate for Payer: Healthscope Commercial |
$39.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.83
|
| Rate for Payer: PHP Commercial |
$37.20
|
| Rate for Payer: Priority Health SBD |
$27.58
|
| Rate for Payer: UMR Bronson Commercial |
$19.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.83
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$43.77
|
|
|
Service Code
|
NDC 00310111001
|
| Hospital Charge Code |
188049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.19 |
| Max. Negotiated Rate |
$39.39 |
| Rate for Payer: Aetna American Axle |
$28.45
|
| Rate for Payer: Aetna Commercial |
$37.20
|
| Rate for Payer: Aetna Medicare |
$21.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.45
|
| Rate for Payer: BCBS Complete |
$17.51
|
| Rate for Payer: Cash Price |
$35.02
|
| Rate for Payer: Cofinity Advantage |
$30.64
|
| Rate for Payer: Cofinity Commercial |
$37.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.02
|
| Rate for Payer: Healthscope Commercial |
$39.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.83
|
| Rate for Payer: PHP Commercial |
$37.20
|
| Rate for Payer: Priority Health SBD |
$27.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.45
|
| Rate for Payer: UHC Core |
$22.80
|
| Rate for Payer: UHC Exchange |
$17.20
|
| Rate for Payer: UMR Bronson Commercial |
$16.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.83
|
|
|
SOFT TISSUE PROCEDURES WITH CC
|
Facility
|
IP
|
$37,550.22
|
|
|
Service Code
|
MSDRG 501
|
| Min. Negotiated Rate |
$14,451.21 |
| Max. Negotiated Rate |
$37,550.22 |
| Rate for Payer: Aetna Medicare |
$15,820.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,014.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,014.75
|
| Rate for Payer: BCBS MAPPO |
$15,211.80
|
| Rate for Payer: BCBS Trust/PPO |
$37,550.22
|
| Rate for Payer: BCN Commercial |
$37,550.22
|
| Rate for Payer: BCN Medicare Advantage |
$15,211.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,211.80
|
| Rate for Payer: Mclaren Medicare |
$15,211.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,972.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,493.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$16,732.98
|
| Rate for Payer: Nomi Health Commercial |
$22,550.49
|
| Rate for Payer: PACE Medicare |
$14,451.21
|
| Rate for Payer: PACE SWMI |
$15,211.80
|
| Rate for Payer: PHP Medicare Advantage |
$15,211.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$28,183.11
|
| Rate for Payer: Priority Health Medicare |
$15,211.80
|
| Rate for Payer: Priority Health Tiered Network |
$22,546.49
|
| Rate for Payer: Railroad Medicare Medicare |
$15,211.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28,494.03
|
| Rate for Payer: UHC Core |
$23,838.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,211.80
|
| Rate for Payer: UHC Exchange |
$19,468.59
|
| Rate for Payer: VA VA |
$15,211.80
|
|
|
SOFT TISSUE PROCEDURES WITH MCC
|
Facility
|
IP
|
$91,000.07
|
|
|
Service Code
|
MSDRG 500
|
| Min. Negotiated Rate |
$25,706.26 |
| Max. Negotiated Rate |
$91,000.07 |
| Rate for Payer: Aetna Medicare |
$28,141.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33,824.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33,824.03
|
| Rate for Payer: BCBS MAPPO |
$27,059.22
|
| Rate for Payer: BCBS Trust/PPO |
$91,000.07
|
| Rate for Payer: BCN Commercial |
$91,000.07
|
| Rate for Payer: BCN Medicare Advantage |
$27,059.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27,059.22
|
| Rate for Payer: Mclaren Medicare |
$27,059.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28,412.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31,118.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$29,765.14
|
| Rate for Payer: Nomi Health Commercial |
$40,825.92
|
| Rate for Payer: PACE Medicare |
$25,706.26
|
| Rate for Payer: PACE SWMI |
$27,059.22
|
| Rate for Payer: PHP Medicare Advantage |
$27,059.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$51,023.35
|
| Rate for Payer: Priority Health Medicare |
$27,059.22
|
| Rate for Payer: Priority Health Tiered Network |
$40,818.67
|
| Rate for Payer: Railroad Medicare Medicare |
$27,059.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51,586.24
|
| Rate for Payer: UHC Core |
$43,158.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27,059.22
|
| Rate for Payer: UHC Exchange |
$35,246.38
|
| Rate for Payer: VA VA |
$27,059.22
|
|
|
SOFT TISSUE PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$31,678.45
|
|
|
Service Code
|
MSDRG 502
|
| Min. Negotiated Rate |
$11,255.91 |
| Max. Negotiated Rate |
$31,678.45 |
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,938.17
|
| Rate for Payer: UHC Core |
$18,354.04
|
| Rate for Payer: Priority Health Tiered Network |
$17,359.03
|
| Rate for Payer: Railroad Medicare Medicare |
$11,848.33
|
| Rate for Payer: Aetna Medicare |
$12,322.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,810.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,810.41
|
| Rate for Payer: BCBS MAPPO |
$11,848.33
|
| Rate for Payer: BCBS Trust/PPO |
$31,678.45
|
| Rate for Payer: BCN Commercial |
$31,678.45
|
| Rate for Payer: BCN Medicare Advantage |
$11,848.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,848.33
|
| Rate for Payer: Mclaren Medicare |
$11,848.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,440.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,625.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,033.16
|
| Rate for Payer: Nomi Health Commercial |
$17,362.11
|
| Rate for Payer: PACE Medicare |
$11,255.91
|
| Rate for Payer: PACE SWMI |
$11,848.33
|
| Rate for Payer: PHP Medicare Advantage |
$11,848.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21,698.79
|
| Rate for Payer: Priority Health Medicare |
$11,848.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,848.33
|
| Rate for Payer: UHC Exchange |
$14,989.29
|
| Rate for Payer: VA VA |
$11,848.33
|
|
|
SOMATROPIN 0.2 MG/0.25 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$115.52
|
|
|
Service Code
|
HCPCS J2941
|
| Hospital Charge Code |
26404
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.83 |
| Max. Negotiated Rate |
$103.97 |
| Rate for Payer: Aetna American Axle |
$75.09
|
| Rate for Payer: Aetna American Axle |
$525.58
|
| Rate for Payer: Aetna Commercial |
$98.19
|
| Rate for Payer: Aetna Commercial |
$687.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$525.58
|
| Rate for Payer: Cash Price |
$92.42
|
| Rate for Payer: Cash Price |
$646.86
|
| Rate for Payer: Cofinity Advantage |
$566.01
|
| Rate for Payer: Cofinity Advantage |
$80.86
|
| Rate for Payer: Cofinity Commercial |
$695.38
|
| Rate for Payer: Cofinity Commercial |
$99.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$646.86
|
| Rate for Payer: Healthscope Commercial |
$103.97
|
| Rate for Payer: Healthscope Commercial |
$727.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$566.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$606.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$687.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$606.43
|
| Rate for Payer: PHP Commercial |
$98.19
|
| Rate for Payer: PHP Commercial |
$687.29
|
| Rate for Payer: Priority Health SBD |
$509.41
|
| Rate for Payer: Priority Health SBD |
$72.78
|
| Rate for Payer: UMR Bronson Commercial |
$50.83
|
| Rate for Payer: UMR Bronson Commercial |
$355.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$606.43
|
|
|
SOMATROPIN 0.2 MG/0.25 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$115.52
|
|
|
Service Code
|
HCPCS J2941
|
| Hospital Charge Code |
26404
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.74 |
| Max. Negotiated Rate |
$272.09 |
| Rate for Payer: Aetna American Axle |
$75.09
|
| Rate for Payer: Aetna American Axle |
$525.58
|
| Rate for Payer: Aetna Commercial |
$98.19
|
| Rate for Payer: Aetna Commercial |
$687.29
|
| Rate for Payer: Aetna Medicare |
$57.76
|
| Rate for Payer: Aetna Medicare |
$404.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$525.58
|
| Rate for Payer: BCBS Complete |
$323.43
|
| Rate for Payer: BCBS Complete |
$46.21
|
| Rate for Payer: Cash Price |
$92.42
|
| Rate for Payer: Cash Price |
$92.42
|
| Rate for Payer: Cash Price |
$646.86
|
| Rate for Payer: Cash Price |
$646.86
|
| Rate for Payer: Cofinity Advantage |
$566.01
|
| Rate for Payer: Cofinity Advantage |
$80.86
|
| Rate for Payer: Cofinity Commercial |
$99.35
|
| Rate for Payer: Cofinity Commercial |
$695.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$646.86
|
| Rate for Payer: Healthscope Commercial |
$103.97
|
| Rate for Payer: Healthscope Commercial |
$727.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$566.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$606.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$646.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$687.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$606.43
|
| Rate for Payer: PHP Commercial |
$687.29
|
| Rate for Payer: PHP Commercial |
$98.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$164.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$164.78
|
| Rate for Payer: Priority Health SBD |
$72.78
|
| Rate for Payer: Priority Health SBD |
$509.41
|
| Rate for Payer: Priority Health Tiered Network |
$131.82
|
| Rate for Payer: Priority Health Tiered Network |
$131.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.09
|
| Rate for Payer: UHC Core |
$272.09
|
| Rate for Payer: UHC Core |
$272.09
|
| Rate for Payer: UHC Exchange |
$272.09
|
| Rate for Payer: UHC Exchange |
$272.09
|
| Rate for Payer: UMR Bronson Commercial |
$42.74
|
| Rate for Payer: UMR Bronson Commercial |
$299.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$606.43
|
|
|
SOMATROPIN 0.4 MG/0.25 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$1,617.30
|
|
|
Service Code
|
HCPCS J2941
|
| Hospital Charge Code |
26405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$711.61 |
| Max. Negotiated Rate |
$1,455.57 |
| Rate for Payer: Aetna American Axle |
$1,051.24
|
| Rate for Payer: Aetna Commercial |
$1,374.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,051.24
|
| Rate for Payer: Cash Price |
$1,293.84
|
| Rate for Payer: Cofinity Advantage |
$1,132.11
|
| Rate for Payer: Cofinity Commercial |
$1,390.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,293.84
|
| Rate for Payer: Healthscope Commercial |
$1,455.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,132.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,212.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,374.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,212.97
|
| Rate for Payer: PHP Commercial |
$1,374.70
|
| Rate for Payer: Priority Health SBD |
$1,018.90
|
| Rate for Payer: UMR Bronson Commercial |
$711.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,212.97
|
|
|
SOMATROPIN 0.4 MG/0.25 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$1,617.30
|
|
|
Service Code
|
HCPCS J2941
|
| Hospital Charge Code |
26405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$131.82 |
| Max. Negotiated Rate |
$1,455.57 |
| Rate for Payer: Aetna American Axle |
$1,051.24
|
| Rate for Payer: Aetna Commercial |
$1,374.70
|
| Rate for Payer: Aetna Medicare |
$808.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,051.24
|
| Rate for Payer: BCBS Complete |
$646.92
|
| Rate for Payer: Cash Price |
$1,293.84
|
| Rate for Payer: Cash Price |
$1,293.84
|
| Rate for Payer: Cofinity Advantage |
$1,132.11
|
| Rate for Payer: Cofinity Commercial |
$1,390.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,293.84
|
| Rate for Payer: Healthscope Commercial |
$1,455.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,132.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,212.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,293.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,374.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,212.97
|
| Rate for Payer: PHP Commercial |
$1,374.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$164.78
|
| Rate for Payer: Priority Health SBD |
$1,018.90
|
| Rate for Payer: Priority Health Tiered Network |
$131.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.09
|
| Rate for Payer: UHC Core |
$272.09
|
| Rate for Payer: UHC Exchange |
$272.09
|
| Rate for Payer: UMR Bronson Commercial |
$598.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,212.97
|
|
|
SORAFENIB 200 MG TABLET
|
Facility
|
OP
|
$41,326.64
|
|
|
Service Code
|
NDC 00378120178
|
| Hospital Charge Code |
43675
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15,290.86 |
| Max. Negotiated Rate |
$37,193.98 |
| Rate for Payer: Aetna American Axle |
$26,862.32
|
| Rate for Payer: Aetna Commercial |
$35,127.64
|
| Rate for Payer: Aetna Medicare |
$20,663.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26,862.32
|
| Rate for Payer: BCBS Complete |
$16,530.66
|
| Rate for Payer: Cash Price |
$33,061.31
|
| Rate for Payer: Cofinity Advantage |
$28,928.65
|
| Rate for Payer: Cofinity Commercial |
$35,540.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33,061.31
|
| Rate for Payer: Healthscope Commercial |
$37,193.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28,928.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30,994.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33,061.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35,127.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30,994.98
|
| Rate for Payer: PHP Commercial |
$35,127.64
|
| Rate for Payer: Priority Health SBD |
$26,035.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,862.32
|
| Rate for Payer: UHC Core |
$21,531.18
|
| Rate for Payer: UHC Exchange |
$16,241.37
|
| Rate for Payer: UMR Bronson Commercial |
$15,290.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30,994.98
|
|
