|
THEOPHYLLINE ER 400 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$545.28
|
|
|
Service Code
|
NDC 29033000101
|
| Hospital Charge Code |
108325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$239.92 |
| Max. Negotiated Rate |
$490.75 |
| Rate for Payer: Aetna American Axle |
$354.43
|
| Rate for Payer: Aetna Commercial |
$463.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$354.43
|
| Rate for Payer: Cash Price |
$436.22
|
| Rate for Payer: Cofinity Advantage |
$381.70
|
| Rate for Payer: Cofinity Commercial |
$468.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.22
|
| Rate for Payer: Healthscope Commercial |
$490.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$381.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$408.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$408.96
|
| Rate for Payer: PHP Commercial |
$463.49
|
| Rate for Payer: Priority Health SBD |
$343.53
|
| Rate for Payer: UMR Bronson Commercial |
$239.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$408.96
|
|
|
THEOPHYLLINE ER 400 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$597.12
|
|
|
Service Code
|
NDC 68462038001
|
| Hospital Charge Code |
108325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$220.93 |
| Max. Negotiated Rate |
$537.41 |
| Rate for Payer: Aetna American Axle |
$388.13
|
| Rate for Payer: Aetna Commercial |
$507.55
|
| Rate for Payer: Aetna Medicare |
$298.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$388.13
|
| Rate for Payer: BCBS Complete |
$238.85
|
| Rate for Payer: Cash Price |
$477.70
|
| Rate for Payer: Cofinity Advantage |
$417.98
|
| Rate for Payer: Cofinity Commercial |
$513.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$477.70
|
| Rate for Payer: Healthscope Commercial |
$537.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$417.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$447.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$477.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$507.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$447.84
|
| Rate for Payer: PHP Commercial |
$507.55
|
| Rate for Payer: Priority Health SBD |
$376.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$388.13
|
| Rate for Payer: UHC Core |
$311.10
|
| Rate for Payer: UHC Exchange |
$234.67
|
| Rate for Payer: UMR Bronson Commercial |
$220.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$447.84
|
|
|
THEOPHYLLINE ER 400 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$463.68
|
|
|
Service Code
|
NDC 42858070101
|
| Hospital Charge Code |
108325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.56 |
| Max. Negotiated Rate |
$417.31 |
| Rate for Payer: Aetna American Axle |
$301.39
|
| Rate for Payer: Aetna Commercial |
$394.13
|
| Rate for Payer: Aetna Medicare |
$231.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.39
|
| Rate for Payer: BCBS Complete |
$185.47
|
| Rate for Payer: Cash Price |
$370.94
|
| Rate for Payer: Cofinity Advantage |
$324.58
|
| Rate for Payer: Cofinity Commercial |
$398.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.94
|
| Rate for Payer: Healthscope Commercial |
$417.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$324.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$347.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$370.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$394.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$347.76
|
| Rate for Payer: PHP Commercial |
$394.13
|
| Rate for Payer: Priority Health SBD |
$292.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$301.39
|
| Rate for Payer: UHC Core |
$241.58
|
| Rate for Payer: UHC Exchange |
$182.23
|
| Rate for Payer: UMR Bronson Commercial |
$171.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$347.76
|
|
|
THERAPEUTIC MULTIVITAMIN TABLET
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
NDC 00904053961
|
| Hospital Charge Code |
7857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.12 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna American Axle |
$96.20
|
| Rate for Payer: Aetna Commercial |
$125.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.20
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cofinity Advantage |
$103.60
|
| Rate for Payer: Cofinity Commercial |
$127.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.40
|
| Rate for Payer: Healthscope Commercial |
$133.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.00
|
| Rate for Payer: PHP Commercial |
$125.80
|
| Rate for Payer: Priority Health SBD |
$93.24
|
| Rate for Payer: UMR Bronson Commercial |
$65.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.00
|
|
|
THERAPEUTIC MULTIVITAMIN TABLET
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
NDC 00904053961
|
| Hospital Charge Code |
7857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.76 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna American Axle |
$96.20
|
| Rate for Payer: Aetna Commercial |
$125.80
|
| Rate for Payer: Aetna Medicare |
$74.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.20
|
| Rate for Payer: BCBS Complete |
$59.20
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cofinity Advantage |
$103.60
|
| Rate for Payer: Cofinity Commercial |
$127.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.40
|
| Rate for Payer: Healthscope Commercial |
$133.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$118.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.00
|
| Rate for Payer: PHP Commercial |
$125.80
|
| Rate for Payer: Priority Health SBD |
$93.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.20
|
| Rate for Payer: UHC Core |
$77.11
|
| Rate for Payer: UHC Exchange |
$58.16
|
| Rate for Payer: UMR Bronson Commercial |
$54.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.00
|
|
|
THERMAGE
|
Professional
|
Both
|
$1,051.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$420.40 |
| Max. Negotiated Rate |
$788.25 |
| Rate for Payer: Aetna Medicare |
$525.50
|
| Rate for Payer: BCBS Complete |
$420.40
|
| Rate for Payer: Cash Price |
$840.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$788.25
|
| Rate for Payer: UMR Bronson Commercial |
$483.46
|
|
|
THERMAGE ABDOMEN - ENTIRE
|
Professional
|
Both
|
$3,257.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,302.80 |
| Max. Negotiated Rate |
$2,442.75 |
| Rate for Payer: Aetna Medicare |
$1,628.50
|
| Rate for Payer: BCBS Complete |
$1,302.80
|
| Rate for Payer: Cash Price |
$2,605.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,442.75
|
| Rate for Payer: UMR Bronson Commercial |
$1,498.22
|
|
|
THERMAGE ABDOMEN - LOWER
|
Professional
|
Both
|
$2,101.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$840.40 |
| Max. Negotiated Rate |
$1,575.75 |
| Rate for Payer: Aetna Medicare |
$1,050.50
|
| Rate for Payer: BCBS Complete |
$840.40
|
| Rate for Payer: Cash Price |
$1,680.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,575.75
|
| Rate for Payer: UMR Bronson Commercial |
$966.46
|
|
|
THERMAGE ARMS - 1 ARM
|
Professional
|
Both
|
$1,261.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$504.40 |
| Max. Negotiated Rate |
$945.75 |
| Rate for Payer: Aetna Medicare |
$630.50
|
| Rate for Payer: BCBS Complete |
$504.40
|
| Rate for Payer: Cash Price |
$1,008.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$945.75
|
| Rate for Payer: UMR Bronson Commercial |
$580.06
|
|
|
THERMAGE ARMS - BILATERAL
|
Professional
|
Both
|
$2,206.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$882.40 |
| Max. Negotiated Rate |
$1,654.50 |
| Rate for Payer: Aetna Medicare |
$1,103.00
|
| Rate for Payer: BCBS Complete |
$882.40
|
| Rate for Payer: Cash Price |
$1,764.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,654.50
|
| Rate for Payer: UMR Bronson Commercial |
$1,014.76
|
|
|
THERMAGE EYES
|
Professional
|
Both
|
$998.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$399.20 |
| Max. Negotiated Rate |
$748.50 |
| Rate for Payer: Aetna Medicare |
$499.00
|
| Rate for Payer: BCBS Complete |
$399.20
|
| Rate for Payer: Cash Price |
$798.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$748.50
|
| Rate for Payer: UMR Bronson Commercial |
$459.08
|
|
|
THERMAGE FACE
|
Professional
|
Both
|
$2,101.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$840.40 |
| Max. Negotiated Rate |
$1,575.75 |
| Rate for Payer: Aetna Medicare |
$1,050.50
|
| Rate for Payer: BCBS Complete |
$840.40
|
| Rate for Payer: Cash Price |
$1,680.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,575.75
|
| Rate for Payer: UMR Bronson Commercial |
$966.46
|
|
|
THERMAGE FACE & EYES
|
Professional
|
Both
|
$2,837.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,134.80 |
| Max. Negotiated Rate |
$2,127.75 |
| Rate for Payer: Aetna Medicare |
$1,418.50
|
| Rate for Payer: BCBS Complete |
$1,134.80
|
| Rate for Payer: Cash Price |
$2,269.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,127.75
|
| Rate for Payer: UMR Bronson Commercial |
$1,305.02
|
|
|
THERMAGE FACE & NECK
|
Professional
|
Both
|
$2,942.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,176.80 |
| Max. Negotiated Rate |
$2,206.50 |
| Rate for Payer: Aetna Medicare |
$1,471.00
|
| Rate for Payer: BCBS Complete |
$1,176.80
|
| Rate for Payer: Cash Price |
$2,353.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,206.50
|
| Rate for Payer: UMR Bronson Commercial |
$1,353.32
|
|
|
THERMAGE FACE, NECK, & EYES
|
Professional
|
Both
|
$3,677.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,470.80 |
| Max. Negotiated Rate |
$2,757.75 |
| Rate for Payer: Aetna Medicare |
$1,838.50
|
| Rate for Payer: BCBS Complete |
$1,470.80
|
| Rate for Payer: Cash Price |
$2,941.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,757.75
|
| Rate for Payer: UMR Bronson Commercial |
$1,691.42
|
|
|
THERMAGE KNEES - BILATERAL
|
Professional
|
Both
|
$1,261.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$504.40 |
| Max. Negotiated Rate |
$945.75 |
| Rate for Payer: Aetna Medicare |
$630.50
|
| Rate for Payer: BCBS Complete |
$504.40
|
| Rate for Payer: Cash Price |
$1,008.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$945.75
|
| Rate for Payer: UMR Bronson Commercial |
$580.06
|
|
|
THERMAGE NECK
|
Professional
|
Both
|
$1,261.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$504.40 |
| Max. Negotiated Rate |
$945.75 |
| Rate for Payer: Aetna Medicare |
$630.50
|
| Rate for Payer: BCBS Complete |
$504.40
|
| Rate for Payer: Cash Price |
$1,008.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$945.75
|
| Rate for Payer: UMR Bronson Commercial |
$580.06
|
|
|
THERMAGE THIGH - 1 THIGH
|
Professional
|
Both
|
$1,996.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$798.40 |
| Max. Negotiated Rate |
$1,497.00 |
| Rate for Payer: Aetna Medicare |
$998.00
|
| Rate for Payer: BCBS Complete |
$798.40
|
| Rate for Payer: Cash Price |
$1,596.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,497.00
|
| Rate for Payer: UMR Bronson Commercial |
$918.16
|
|
|
THERMAGE THIGH - BILATERAL
|
Professional
|
Both
|
$3,257.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,302.80 |
| Max. Negotiated Rate |
$2,442.75 |
| Rate for Payer: Aetna Medicare |
$1,628.50
|
| Rate for Payer: BCBS Complete |
$1,302.80
|
| Rate for Payer: Cash Price |
$2,605.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,442.75
|
| Rate for Payer: UMR Bronson Commercial |
$1,498.22
|
|
|
THERMAL DESTRUCTION OF INTRAOSSEOUS BASIVERTEBRAL NERVE, INCLUDING ALL IMAGING GUIDANCE; FIRST 2 VERTEBRAL BODIES, LUMBAR OR SACRAL
|
Facility
|
OP
|
$41,369.85
|
|
|
Service Code
|
CPT 64628
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,690.48 |
| Max. Negotiated Rate |
$41,369.85 |
| Rate for Payer: Aetna Medicare |
$13,304.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,990.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,990.64
|
| Rate for Payer: BCBS Complete |
$7,025.65
|
| Rate for Payer: BCBS MAPPO |
$12,792.51
|
| Rate for Payer: BCBS Trust/PPO |
$18,737.24
|
| Rate for Payer: BCN Commercial |
$18,737.24
|
| Rate for Payer: BCN Medicare Advantage |
$12,792.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,792.51
|
| Rate for Payer: Mclaren Medicaid |
$12,792.51
|
| Rate for Payer: Mclaren Medicare |
$12,792.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,432.14
|
| Rate for Payer: Meridian Medicaid |
$13,432.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,711.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,071.76
|
| Rate for Payer: Nomi Health Commercial |
$38,377.53
|
| Rate for Payer: PACE Medicare |
$12,152.88
|
| Rate for Payer: PACE SWMI |
$12,792.51
|
| Rate for Payer: PHP Medicare Advantage |
$12,792.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,690.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$41,369.85
|
| Rate for Payer: Priority Health Medicare |
$12,792.51
|
| Rate for Payer: Priority Health Tiered Network |
$33,095.88
|
| Rate for Payer: Railroad Medicare Medicare |
$12,792.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,792.51
|
| Rate for Payer: UHC Medicaid |
$6,690.48
|
| Rate for Payer: UHCCP Medicaid |
$6,690.48
|
| Rate for Payer: VA VA |
$12,792.51
|
|
|
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$27.12
|
|
|
Service Code
|
HCPCS J3411
|
| Hospital Charge Code |
7876
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$24.41 |
| Rate for Payer: Aetna American Axle |
$17.63
|
| Rate for Payer: Aetna American Axle |
$12.88
|
| Rate for Payer: Aetna American Axle |
$13.29
|
| Rate for Payer: Aetna American Axle |
$15.21
|
| Rate for Payer: Aetna Commercial |
$23.05
|
| Rate for Payer: Aetna Commercial |
$19.89
|
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: Aetna Commercial |
$17.37
|
| Rate for Payer: Aetna Medicare |
$11.70
|
| Rate for Payer: Aetna Medicare |
$10.22
|
| Rate for Payer: Aetna Medicare |
$13.56
|
| Rate for Payer: Aetna Medicare |
$9.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.21
|
| Rate for Payer: BCBS Complete |
$7.93
|
| Rate for Payer: BCBS Complete |
$8.18
|
| Rate for Payer: BCBS Complete |
$9.36
|
| Rate for Payer: BCBS Complete |
$10.85
|
| Rate for Payer: BCBS Trust/PPO |
$5.86
|
| Rate for Payer: BCBS Trust/PPO |
$5.86
|
| Rate for Payer: BCBS Trust/PPO |
$5.86
|
| Rate for Payer: BCBS Trust/PPO |
$5.86
|
| Rate for Payer: BCN Commercial |
$5.86
|
| Rate for Payer: BCN Commercial |
$5.86
|
| Rate for Payer: BCN Commercial |
$5.86
|
| Rate for Payer: BCN Commercial |
$5.86
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cash Price |
$21.70
|
| Rate for Payer: Cash Price |
$15.86
|
| Rate for Payer: Cash Price |
$21.70
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cash Price |
$16.35
|
| Rate for Payer: Cash Price |
$16.35
|
| Rate for Payer: Cash Price |
$15.86
|
| Rate for Payer: Cofinity Advantage |
$18.98
|
| Rate for Payer: Cofinity Advantage |
$16.38
|
| Rate for Payer: Cofinity Advantage |
$14.31
|
| Rate for Payer: Cofinity Advantage |
$13.87
|
| Rate for Payer: Cofinity Commercial |
$17.58
|
| Rate for Payer: Cofinity Commercial |
$20.12
|
| Rate for Payer: Cofinity Commercial |
$23.32
|
| Rate for Payer: Cofinity Commercial |
$17.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.86
|
| Rate for Payer: Healthscope Commercial |
$21.06
|
| Rate for Payer: Healthscope Commercial |
$17.84
|
| Rate for Payer: Healthscope Commercial |
$18.40
|
| Rate for Payer: Healthscope Commercial |
$24.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.34
|
| Rate for Payer: PHP Commercial |
$16.85
|
| Rate for Payer: PHP Commercial |
$19.89
|
| Rate for Payer: PHP Commercial |
$23.05
|
| Rate for Payer: PHP Commercial |
$17.37
|
| Rate for Payer: Priority Health SBD |
$14.74
|
| Rate for Payer: Priority Health SBD |
$12.49
|
| Rate for Payer: Priority Health SBD |
$12.88
|
| Rate for Payer: Priority Health SBD |
$17.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.99
|
| Rate for Payer: UHC Core |
$2.99
|
| Rate for Payer: UHC Core |
$2.99
|
| Rate for Payer: UHC Core |
$2.99
|
| Rate for Payer: UHC Core |
$2.99
|
| Rate for Payer: UHC Exchange |
$2.99
|
| Rate for Payer: UHC Exchange |
$2.99
|
| Rate for Payer: UHC Exchange |
$2.99
|
| Rate for Payer: UHC Exchange |
$2.99
|
| Rate for Payer: UMR Bronson Commercial |
$10.03
|
| Rate for Payer: UMR Bronson Commercial |
$7.33
|
| Rate for Payer: UMR Bronson Commercial |
$7.56
|
| Rate for Payer: UMR Bronson Commercial |
$8.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.34
|
|
|
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$23.40
|
|
|
Service Code
|
HCPCS J3411
|
| Hospital Charge Code |
7876
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$21.06 |
| Rate for Payer: Aetna American Axle |
$15.21
|
| Rate for Payer: Aetna American Axle |
$13.29
|
| Rate for Payer: Aetna American Axle |
$17.63
|
| Rate for Payer: Aetna American Axle |
$12.88
|
| Rate for Payer: Aetna Commercial |
$23.05
|
| Rate for Payer: Aetna Commercial |
$19.89
|
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: Aetna Commercial |
$17.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.88
|
| Rate for Payer: Cash Price |
$15.86
|
| Rate for Payer: Cash Price |
$21.70
|
| Rate for Payer: Cash Price |
$16.35
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cofinity Advantage |
$14.31
|
| Rate for Payer: Cofinity Advantage |
$13.87
|
| Rate for Payer: Cofinity Advantage |
$16.38
|
| Rate for Payer: Cofinity Advantage |
$18.98
|
| Rate for Payer: Cofinity Commercial |
$20.12
|
| Rate for Payer: Cofinity Commercial |
$17.05
|
| Rate for Payer: Cofinity Commercial |
$17.58
|
| Rate for Payer: Cofinity Commercial |
$23.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.35
|
| Rate for Payer: Healthscope Commercial |
$18.40
|
| Rate for Payer: Healthscope Commercial |
$24.41
|
| Rate for Payer: Healthscope Commercial |
$21.06
|
| Rate for Payer: Healthscope Commercial |
$17.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.87
|
| Rate for Payer: PHP Commercial |
$16.85
|
| Rate for Payer: PHP Commercial |
$19.89
|
| Rate for Payer: PHP Commercial |
$17.37
|
| Rate for Payer: PHP Commercial |
$23.05
|
| Rate for Payer: Priority Health SBD |
$17.09
|
| Rate for Payer: Priority Health SBD |
$12.49
|
| Rate for Payer: Priority Health SBD |
$14.74
|
| Rate for Payer: Priority Health SBD |
$12.88
|
| Rate for Payer: UMR Bronson Commercial |
$8.99
|
| Rate for Payer: UMR Bronson Commercial |
$10.30
|
| Rate for Payer: UMR Bronson Commercial |
$8.72
|
| Rate for Payer: UMR Bronson Commercial |
$11.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.34
|
|
|
THIAMINE HCL (VITAMIN B1) 100 MG TABLET
|
Facility
|
OP
|
$105.75
|
|
|
Service Code
|
NDC 79854020010
|
| Hospital Charge Code |
7877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.13 |
| Max. Negotiated Rate |
$95.17 |
| Rate for Payer: Aetna American Axle |
$68.74
|
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Aetna Medicare |
$52.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.74
|
| Rate for Payer: BCBS Complete |
$42.30
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cofinity Advantage |
$74.03
|
| Rate for Payer: Cofinity Commercial |
$90.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.60
|
| Rate for Payer: Healthscope Commercial |
$95.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.31
|
| Rate for Payer: PHP Commercial |
$89.89
|
| Rate for Payer: Priority Health SBD |
$66.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.74
|
| Rate for Payer: UHC Core |
$55.10
|
| Rate for Payer: UHC Exchange |
$41.56
|
| Rate for Payer: UMR Bronson Commercial |
$39.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.31
|
|
|
THIAMINE HCL (VITAMIN B1) 100 MG TABLET
|
Facility
|
IP
|
$105.75
|
|
|
Service Code
|
NDC 79854020010
|
| Hospital Charge Code |
7877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.53 |
| Max. Negotiated Rate |
$95.17 |
| Rate for Payer: Aetna American Axle |
$68.74
|
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.74
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cofinity Advantage |
$74.03
|
| Rate for Payer: Cofinity Commercial |
$90.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.60
|
| Rate for Payer: Healthscope Commercial |
$95.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.31
|
| Rate for Payer: PHP Commercial |
$89.89
|
| Rate for Payer: Priority Health SBD |
$66.62
|
| Rate for Payer: UMR Bronson Commercial |
$46.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.31
|
|
|
THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET
|
Facility
|
OP
|
$3.88
|
|
|
Service Code
|
NDC 77333093425
|
| Hospital Charge Code |
119871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$3.49 |
| Rate for Payer: Aetna American Axle |
$2.52
|
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Aetna Medicare |
$1.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.52
|
| Rate for Payer: BCBS Complete |
$1.55
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cofinity Advantage |
$2.72
|
| Rate for Payer: Cofinity Commercial |
$3.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.10
|
| Rate for Payer: Healthscope Commercial |
$3.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.91
|
| Rate for Payer: PHP Commercial |
$3.30
|
| Rate for Payer: Priority Health SBD |
$2.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.52
|
| Rate for Payer: UHC Core |
$2.02
|
| Rate for Payer: UHC Exchange |
$1.52
|
| Rate for Payer: UMR Bronson Commercial |
$1.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.91
|
|
