|
CALCIUM GLUCONATE 2 GRAM/100 ML IN SODIUM CHLORIDE,ISO-OSM IV SOLUTION
|
Facility
|
OP
|
$74.32
|
|
|
Service Code
|
HCPCS J0613
|
| Hospital Charge Code |
190608
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.50 |
| Max. Negotiated Rate |
$66.89 |
| Rate for Payer: Aetna American Axle |
$48.31
|
| Rate for Payer: Aetna Commercial |
$63.17
|
| Rate for Payer: Aetna Medicare |
$37.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.31
|
| Rate for Payer: BCBS Complete |
$29.73
|
| Rate for Payer: Cash Price |
$59.46
|
| Rate for Payer: Cofinity Commercial |
$52.02
|
| Rate for Payer: Cofinity Commercial |
$63.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.46
|
| Rate for Payer: Healthscope Commercial |
$66.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.17
|
| Rate for Payer: PHP Commercial |
$63.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.31
|
| Rate for Payer: Priority Health SBD |
$46.82
|
| Rate for Payer: UMR Bronson Commercial |
$27.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.74
|
|
|
CALCIUM GLUCONATE 2 GRAM/100 ML IN SODIUM CHLORIDE,ISO-OSM IV SOLUTION
|
Facility
|
IP
|
$72.54
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
190608
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.92 |
| Max. Negotiated Rate |
$65.29 |
| Rate for Payer: Aetna American Axle |
$47.15
|
| Rate for Payer: Aetna American Axle |
$59.59
|
| Rate for Payer: Aetna Commercial |
$61.66
|
| Rate for Payer: Aetna Commercial |
$77.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.59
|
| Rate for Payer: Cash Price |
$58.03
|
| Rate for Payer: Cash Price |
$73.34
|
| Rate for Payer: Cofinity Commercial |
$78.84
|
| Rate for Payer: Cofinity Commercial |
$64.17
|
| Rate for Payer: Cofinity Commercial |
$50.78
|
| Rate for Payer: Cofinity Commercial |
$62.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.34
|
| Rate for Payer: Healthscope Commercial |
$65.29
|
| Rate for Payer: Healthscope Commercial |
$82.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.66
|
| Rate for Payer: PHP Commercial |
$77.92
|
| Rate for Payer: PHP Commercial |
$61.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.59
|
| Rate for Payer: Priority Health SBD |
$45.70
|
| Rate for Payer: Priority Health SBD |
$57.75
|
| Rate for Payer: UMR Bronson Commercial |
$31.92
|
| Rate for Payer: UMR Bronson Commercial |
$40.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.75
|
|
|
CALCIUM GLUCONATE (BULK) POWDER
|
Facility
|
OP
|
$366.00
|
|
|
Service Code
|
NDC 38779182608
|
| Hospital Charge Code |
1316
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.42 |
| Max. Negotiated Rate |
$329.40 |
| Rate for Payer: Aetna American Axle |
$237.90
|
| Rate for Payer: Aetna Commercial |
$311.10
|
| Rate for Payer: Aetna Medicare |
$183.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.90
|
| Rate for Payer: BCBS Complete |
$146.40
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cofinity Commercial |
$256.20
|
| Rate for Payer: Cofinity Commercial |
$314.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$256.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.80
|
| Rate for Payer: Healthscope Commercial |
$329.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.10
|
| Rate for Payer: PHP Commercial |
$311.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.90
|
| Rate for Payer: Priority Health SBD |
$230.58
|
| Rate for Payer: UMR Bronson Commercial |
$135.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.50
|
|
|
CALCIUM GLUCONATE (BULK) POWDER
|
Facility
|
IP
|
$3.75
|
|
|
Service Code
|
NDC 09900000980
|
| Hospital Charge Code |
1316
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$3.38 |
| Rate for Payer: Aetna American Axle |
$2.44
|
| Rate for Payer: Aetna Commercial |
$3.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.44
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cofinity Commercial |
$2.62
|
| Rate for Payer: Cofinity Commercial |
$3.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.00
|
| Rate for Payer: Healthscope Commercial |
$3.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.19
|
| Rate for Payer: PHP Commercial |
$3.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.44
|
| Rate for Payer: Priority Health SBD |
$2.36
|
| Rate for Payer: UMR Bronson Commercial |
$1.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.81
|
|
|
CALCIUM GLUCONATE (BULK) POWDER
|
Facility
|
OP
|
$3.75
|
|
|
Service Code
|
NDC 09900000980
|
| Hospital Charge Code |
1316
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$3.38 |
| Rate for Payer: Aetna American Axle |
$2.44
|
| Rate for Payer: Aetna Commercial |
$3.19
|
| Rate for Payer: Aetna Medicare |
$1.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.44
|
| Rate for Payer: BCBS Complete |
$1.50
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cofinity Commercial |
$2.62
|
| Rate for Payer: Cofinity Commercial |
$3.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.00
|
| Rate for Payer: Healthscope Commercial |
$3.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.19
|
| Rate for Payer: PHP Commercial |
$3.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.44
|
| Rate for Payer: Priority Health SBD |
$2.36
|
| Rate for Payer: UMR Bronson Commercial |
$1.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.81
|
|
|
CALCIUM GLUCONATE (BULK) POWDER
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
NDC 38779182608
|
| Hospital Charge Code |
1316
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.04 |
| Max. Negotiated Rate |
$329.40 |
| Rate for Payer: Aetna American Axle |
$237.90
|
| Rate for Payer: Aetna Commercial |
$311.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.90
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cofinity Commercial |
$256.20
|
| Rate for Payer: Cofinity Commercial |
$314.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$256.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.80
|
| Rate for Payer: Healthscope Commercial |
$329.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.10
|
| Rate for Payer: PHP Commercial |
$311.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.90
|
| Rate for Payer: Priority Health SBD |
$230.58
|
| Rate for Payer: UMR Bronson Commercial |
$161.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.50
|
|
|
CALCIUM POLYCARBOPHIL 625 MG TABLET
|
Facility
|
OP
|
$112.10
|
|
|
Service Code
|
NDC 00904250091
|
| Hospital Charge Code |
11046
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.48 |
| Max. Negotiated Rate |
$100.89 |
| Rate for Payer: Aetna American Axle |
$72.86
|
| Rate for Payer: Aetna Commercial |
$95.28
|
| Rate for Payer: Aetna Medicare |
$56.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.86
|
| Rate for Payer: BCBS Complete |
$44.84
|
| Rate for Payer: Cash Price |
$89.68
|
| Rate for Payer: Cofinity Commercial |
$78.47
|
| Rate for Payer: Cofinity Commercial |
$96.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.68
|
| Rate for Payer: Healthscope Commercial |
$100.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.28
|
| Rate for Payer: PHP Commercial |
$95.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.86
|
| Rate for Payer: Priority Health SBD |
$70.62
|
| Rate for Payer: UMR Bronson Commercial |
$41.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.08
|
|
|
CALCIUM POLYCARBOPHIL 625 MG TABLET
|
Facility
|
IP
|
$120.56
|
|
|
Service Code
|
NDC 00536430611
|
| Hospital Charge Code |
11046
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.05 |
| Max. Negotiated Rate |
$108.50 |
| Rate for Payer: Aetna American Axle |
$78.36
|
| Rate for Payer: Aetna Commercial |
$102.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.36
|
| Rate for Payer: Cash Price |
$96.45
|
| Rate for Payer: Cofinity Commercial |
$103.68
|
| Rate for Payer: Cofinity Commercial |
$84.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$84.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.45
|
| Rate for Payer: Healthscope Commercial |
$108.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.48
|
| Rate for Payer: PHP Commercial |
$102.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.36
|
| Rate for Payer: Priority Health SBD |
$75.95
|
| Rate for Payer: UMR Bronson Commercial |
$53.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.42
|
|
|
CALCIUM POLYCARBOPHIL 625 MG TABLET
|
Facility
|
IP
|
$112.10
|
|
|
Service Code
|
NDC 00904250091
|
| Hospital Charge Code |
11046
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.32 |
| Max. Negotiated Rate |
$100.89 |
| Rate for Payer: Aetna American Axle |
$72.86
|
| Rate for Payer: Aetna Commercial |
$95.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.86
|
| Rate for Payer: Cash Price |
$89.68
|
| Rate for Payer: Cofinity Commercial |
$78.47
|
| Rate for Payer: Cofinity Commercial |
$96.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.68
|
| Rate for Payer: Healthscope Commercial |
$100.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.28
|
| Rate for Payer: PHP Commercial |
$95.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.86
|
| Rate for Payer: Priority Health SBD |
$70.62
|
| Rate for Payer: UMR Bronson Commercial |
$49.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.08
|
|
|
CALCIUM POLYCARBOPHIL 625 MG TABLET
|
Facility
|
OP
|
$120.56
|
|
|
Service Code
|
NDC 00536430611
|
| Hospital Charge Code |
11046
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.61 |
| Max. Negotiated Rate |
$108.50 |
| Rate for Payer: Aetna American Axle |
$78.36
|
| Rate for Payer: Aetna Commercial |
$102.48
|
| Rate for Payer: Aetna Medicare |
$60.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.36
|
| Rate for Payer: BCBS Complete |
$48.22
|
| Rate for Payer: Cash Price |
$96.45
|
| Rate for Payer: Cofinity Commercial |
$103.68
|
| Rate for Payer: Cofinity Commercial |
$84.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$84.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.45
|
| Rate for Payer: Healthscope Commercial |
$108.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.48
|
| Rate for Payer: PHP Commercial |
$102.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.36
|
| Rate for Payer: Priority Health SBD |
$75.95
|
| Rate for Payer: UMR Bronson Commercial |
$44.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.42
|
|
|
CAMPHOR 4 %-METHYL SALICYLATE 30 %-MENTHOL 10 % TOPICAL CREAM
|
Facility
|
IP
|
$16.79
|
|
|
Service Code
|
NDC 96295013062
|
| Hospital Charge Code |
103884
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.39 |
| Max. Negotiated Rate |
$15.11 |
| Rate for Payer: Aetna American Axle |
$10.91
|
| Rate for Payer: Aetna Commercial |
$14.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.91
|
| Rate for Payer: Cash Price |
$13.43
|
| Rate for Payer: Cofinity Commercial |
$11.75
|
| Rate for Payer: Cofinity Commercial |
$14.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.43
|
| Rate for Payer: Healthscope Commercial |
$15.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.27
|
| Rate for Payer: PHP Commercial |
$14.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.91
|
| Rate for Payer: Priority Health SBD |
$10.58
|
| Rate for Payer: UMR Bronson Commercial |
$7.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.59
|
|
|
CAMPHOR 4 %-METHYL SALICYLATE 30 %-MENTHOL 10 % TOPICAL CREAM
|
Facility
|
OP
|
$16.79
|
|
|
Service Code
|
NDC 96295013062
|
| Hospital Charge Code |
103884
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.21 |
| Max. Negotiated Rate |
$15.11 |
| Rate for Payer: Aetna American Axle |
$10.91
|
| Rate for Payer: Aetna Commercial |
$14.27
|
| Rate for Payer: Aetna Medicare |
$8.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.91
|
| Rate for Payer: BCBS Complete |
$6.72
|
| Rate for Payer: Cash Price |
$13.43
|
| Rate for Payer: Cofinity Commercial |
$11.75
|
| Rate for Payer: Cofinity Commercial |
$14.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.43
|
| Rate for Payer: Healthscope Commercial |
$15.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.27
|
| Rate for Payer: PHP Commercial |
$14.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.91
|
| Rate for Payer: Priority Health SBD |
$10.58
|
| Rate for Payer: UMR Bronson Commercial |
$6.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.59
|
|
|
CAMPHOR-MENTHOL 0.5 %-0.5 % LOTION
|
Facility
|
OP
|
$17.99
|
|
|
Service Code
|
NDC 70000054601
|
| Hospital Charge Code |
23063
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.66 |
| Max. Negotiated Rate |
$16.19 |
| Rate for Payer: Aetna American Axle |
$11.69
|
| Rate for Payer: Aetna Commercial |
$15.29
|
| Rate for Payer: Aetna Medicare |
$8.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.69
|
| Rate for Payer: BCBS Complete |
$7.20
|
| Rate for Payer: Cash Price |
$14.39
|
| Rate for Payer: Cofinity Commercial |
$12.59
|
| Rate for Payer: Cofinity Commercial |
$15.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.39
|
| Rate for Payer: Healthscope Commercial |
$16.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.29
|
| Rate for Payer: PHP Commercial |
$15.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.69
|
| Rate for Payer: Priority Health SBD |
$11.33
|
| Rate for Payer: UMR Bronson Commercial |
$6.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.49
|
|
|
CAMPHOR-MENTHOL 0.5 %-0.5 % LOTION
|
Facility
|
IP
|
$17.99
|
|
|
Service Code
|
NDC 70000054601
|
| Hospital Charge Code |
23063
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$16.19 |
| Rate for Payer: Aetna American Axle |
$11.69
|
| Rate for Payer: Aetna Commercial |
$15.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.69
|
| Rate for Payer: Cash Price |
$14.39
|
| Rate for Payer: Cofinity Commercial |
$12.59
|
| Rate for Payer: Cofinity Commercial |
$15.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.39
|
| Rate for Payer: Healthscope Commercial |
$16.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.29
|
| Rate for Payer: PHP Commercial |
$15.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.69
|
| Rate for Payer: Priority Health SBD |
$11.33
|
| Rate for Payer: UMR Bronson Commercial |
$7.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.49
|
|
|
CAMPHOR-MENTHOL 0.5 %-0.5 % LOTION
|
Facility
|
IP
|
$18.99
|
|
|
Service Code
|
NDC 00536126812
|
| Hospital Charge Code |
23063
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$17.09 |
| Rate for Payer: Aetna American Axle |
$12.34
|
| Rate for Payer: Aetna Commercial |
$16.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.34
|
| Rate for Payer: Cash Price |
$15.19
|
| Rate for Payer: Cofinity Commercial |
$13.29
|
| Rate for Payer: Cofinity Commercial |
$16.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.19
|
| Rate for Payer: Healthscope Commercial |
$17.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.14
|
| Rate for Payer: PHP Commercial |
$16.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.34
|
| Rate for Payer: Priority Health SBD |
$11.96
|
| Rate for Payer: UMR Bronson Commercial |
$8.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.24
|
|
|
CAMPHOR-MENTHOL 0.5 %-0.5 % LOTION
|
Facility
|
OP
|
$18.99
|
|
|
Service Code
|
NDC 00536126812
|
| Hospital Charge Code |
23063
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.03 |
| Max. Negotiated Rate |
$17.09 |
| Rate for Payer: Aetna American Axle |
$12.34
|
| Rate for Payer: Aetna Commercial |
$16.14
|
| Rate for Payer: Aetna Medicare |
$9.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.34
|
| Rate for Payer: BCBS Complete |
$7.60
|
| Rate for Payer: Cash Price |
$15.19
|
| Rate for Payer: Cofinity Commercial |
$13.29
|
| Rate for Payer: Cofinity Commercial |
$16.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.19
|
| Rate for Payer: Healthscope Commercial |
$17.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.14
|
| Rate for Payer: PHP Commercial |
$16.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.34
|
| Rate for Payer: Priority Health SBD |
$11.96
|
| Rate for Payer: UMR Bronson Commercial |
$7.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.24
|
|
|
CANDIDA ALBICANS SKIN TEST FDA STANDARD INTRADERMAL
|
Facility
|
OP
|
$977.25
|
|
|
Service Code
|
NDC 59584013801
|
| Hospital Charge Code |
115385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$361.58 |
| Max. Negotiated Rate |
$879.52 |
| Rate for Payer: Aetna American Axle |
$635.21
|
| Rate for Payer: Aetna Commercial |
$830.66
|
| Rate for Payer: Aetna Medicare |
$488.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$635.21
|
| Rate for Payer: BCBS Complete |
$390.90
|
| Rate for Payer: Cash Price |
$781.80
|
| Rate for Payer: Cofinity Commercial |
$684.08
|
| Rate for Payer: Cofinity Commercial |
$840.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$684.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$781.80
|
| Rate for Payer: Healthscope Commercial |
$879.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$684.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$732.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$830.66
|
| Rate for Payer: PHP Commercial |
$830.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$635.21
|
| Rate for Payer: Priority Health SBD |
$615.67
|
| Rate for Payer: UMR Bronson Commercial |
$361.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$732.94
|
|
|
CANDIDA ALBICANS SKIN TEST FDA STANDARD INTRADERMAL
|
Facility
|
IP
|
$977.25
|
|
|
Service Code
|
NDC 59584013801
|
| Hospital Charge Code |
115385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$429.99 |
| Max. Negotiated Rate |
$879.52 |
| Rate for Payer: Aetna American Axle |
$635.21
|
| Rate for Payer: Aetna Commercial |
$830.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$635.21
|
| Rate for Payer: Cash Price |
$781.80
|
| Rate for Payer: Cofinity Commercial |
$684.08
|
| Rate for Payer: Cofinity Commercial |
$840.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$684.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$781.80
|
| Rate for Payer: Healthscope Commercial |
$879.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$684.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$732.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$830.66
|
| Rate for Payer: PHP Commercial |
$830.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$635.21
|
| Rate for Payer: Priority Health SBD |
$615.67
|
| Rate for Payer: UMR Bronson Commercial |
$429.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$732.94
|
|
|
CANGRELOR 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3,117.50
|
|
|
Service Code
|
HCPCS C9460
|
| Hospital Charge Code |
174562
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,371.70 |
| Max. Negotiated Rate |
$2,805.75 |
| Rate for Payer: Aetna American Axle |
$2,026.38
|
| Rate for Payer: Aetna Commercial |
$2,649.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,026.38
|
| Rate for Payer: Cash Price |
$2,494.00
|
| Rate for Payer: Cofinity Commercial |
$2,182.25
|
| Rate for Payer: Cofinity Commercial |
$2,681.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,182.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,494.00
|
| Rate for Payer: Healthscope Commercial |
$2,805.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,182.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,338.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,649.88
|
| Rate for Payer: PHP Commercial |
$2,649.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,026.38
|
| Rate for Payer: Priority Health SBD |
$1,964.03
|
| Rate for Payer: UMR Bronson Commercial |
$1,371.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,338.12
|
|
|
CANGRELOR 50 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,117.50
|
|
|
Service Code
|
HCPCS C9460
|
| Hospital Charge Code |
174562
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.71 |
| Max. Negotiated Rate |
$2,805.75 |
| Rate for Payer: Aetna American Axle |
$2,026.38
|
| Rate for Payer: Aetna Commercial |
$2,649.88
|
| Rate for Payer: Aetna Medicare |
$20.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,026.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.98
|
| Rate for Payer: BCBS Complete |
$11.24
|
| Rate for Payer: BCBS MAPPO |
$19.98
|
| Rate for Payer: BCN Medicare Advantage |
$19.98
|
| Rate for Payer: Cash Price |
$2,494.00
|
| Rate for Payer: Cash Price |
$2,494.00
|
| Rate for Payer: Cofinity Commercial |
$2,681.05
|
| Rate for Payer: Cofinity Commercial |
$2,182.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,182.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,494.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.98
|
| Rate for Payer: Healthscope Commercial |
$2,805.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,182.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,338.12
|
| Rate for Payer: Mclaren Medicaid |
$10.71
|
| Rate for Payer: Mclaren Medicare |
$19.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.98
|
| Rate for Payer: Meridian Medicaid |
$11.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,649.88
|
| Rate for Payer: PACE Medicare |
$18.98
|
| Rate for Payer: PACE SWMI |
$19.98
|
| Rate for Payer: PHP Commercial |
$2,649.88
|
| Rate for Payer: PHP Medicare Advantage |
$19.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,026.38
|
| Rate for Payer: Priority Health Medicare |
$19.98
|
| Rate for Payer: Priority Health SBD |
$1,964.03
|
| Rate for Payer: Railroad Medicare Medicare |
$19.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.98
|
| Rate for Payer: UHC Exchange |
$38.18
|
| Rate for Payer: UHC Medicare Advantage |
$19.98
|
| Rate for Payer: UHCCP Medicaid |
$10.71
|
| Rate for Payer: UMR Bronson Commercial |
$1,153.47
|
| Rate for Payer: VA VA |
$19.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,338.12
|
|
|
CANNABIDIOL 100 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$6,049.50
|
|
|
Service Code
|
NDC 70127010001
|
| Hospital Charge Code |
188582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,661.78 |
| Max. Negotiated Rate |
$5,444.55 |
| Rate for Payer: Aetna American Axle |
$3,932.18
|
| Rate for Payer: Aetna Commercial |
$5,142.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,932.18
|
| Rate for Payer: Cash Price |
$4,839.60
|
| Rate for Payer: Cofinity Commercial |
$4,234.65
|
| Rate for Payer: Cofinity Commercial |
$5,202.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,234.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,839.60
|
| Rate for Payer: Healthscope Commercial |
$5,444.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,234.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,537.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,142.07
|
| Rate for Payer: PHP Commercial |
$5,142.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,932.18
|
| Rate for Payer: Priority Health SBD |
$3,811.18
|
| Rate for Payer: UMR Bronson Commercial |
$2,661.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,537.12
|
|
|
CANNABIDIOL 100 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$6,049.50
|
|
|
Service Code
|
NDC 70127010010
|
| Hospital Charge Code |
188582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,238.32 |
| Max. Negotiated Rate |
$5,444.55 |
| Rate for Payer: Aetna American Axle |
$3,932.18
|
| Rate for Payer: Aetna Commercial |
$5,142.07
|
| Rate for Payer: Aetna Medicare |
$3,024.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,932.18
|
| Rate for Payer: BCBS Complete |
$2,419.80
|
| Rate for Payer: Cash Price |
$4,839.60
|
| Rate for Payer: Cofinity Commercial |
$4,234.65
|
| Rate for Payer: Cofinity Commercial |
$5,202.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,234.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,839.60
|
| Rate for Payer: Healthscope Commercial |
$5,444.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,234.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,537.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,142.07
|
| Rate for Payer: PHP Commercial |
$5,142.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,932.18
|
| Rate for Payer: Priority Health SBD |
$3,811.18
|
| Rate for Payer: UMR Bronson Commercial |
$2,238.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,537.12
|
|
|
CANNABIDIOL 100 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$6,049.50
|
|
|
Service Code
|
NDC 70127010010
|
| Hospital Charge Code |
188582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,661.78 |
| Max. Negotiated Rate |
$5,444.55 |
| Rate for Payer: Aetna American Axle |
$3,932.18
|
| Rate for Payer: Aetna Commercial |
$5,142.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,932.18
|
| Rate for Payer: Cash Price |
$4,839.60
|
| Rate for Payer: Cofinity Commercial |
$4,234.65
|
| Rate for Payer: Cofinity Commercial |
$5,202.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,234.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,839.60
|
| Rate for Payer: Healthscope Commercial |
$5,444.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,234.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,537.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,142.07
|
| Rate for Payer: PHP Commercial |
$5,142.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,932.18
|
| Rate for Payer: Priority Health SBD |
$3,811.18
|
| Rate for Payer: UMR Bronson Commercial |
$2,661.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,537.12
|
|
|
CANNABIDIOL 100 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$6,049.50
|
|
|
Service Code
|
NDC 70127010001
|
| Hospital Charge Code |
188582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,238.32 |
| Max. Negotiated Rate |
$5,444.55 |
| Rate for Payer: Aetna American Axle |
$3,932.18
|
| Rate for Payer: Aetna Commercial |
$5,142.07
|
| Rate for Payer: Aetna Medicare |
$3,024.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,932.18
|
| Rate for Payer: BCBS Complete |
$2,419.80
|
| Rate for Payer: Cash Price |
$4,839.60
|
| Rate for Payer: Cofinity Commercial |
$4,234.65
|
| Rate for Payer: Cofinity Commercial |
$5,202.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,234.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,839.60
|
| Rate for Payer: Healthscope Commercial |
$5,444.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,234.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,537.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,142.07
|
| Rate for Payer: PHP Commercial |
$5,142.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,932.18
|
| Rate for Payer: Priority Health SBD |
$3,811.18
|
| Rate for Payer: UMR Bronson Commercial |
$2,238.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,537.12
|
|
|
CAPLACIZUMAB-YHDP 11 MG INJECTION KIT
|
Facility
|
OP
|
$21,429.20
|
|
|
Service Code
|
HCPCS C9047
|
| Hospital Charge Code |
189691
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,928.80 |
| Max. Negotiated Rate |
$19,286.28 |
| Rate for Payer: Aetna American Axle |
$13,928.98
|
| Rate for Payer: Aetna Commercial |
$18,214.82
|
| Rate for Payer: Aetna Medicare |
$10,714.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,928.98
|
| Rate for Payer: BCBS Complete |
$8,571.68
|
| Rate for Payer: Cash Price |
$17,143.36
|
| Rate for Payer: Cofinity Commercial |
$15,000.44
|
| Rate for Payer: Cofinity Commercial |
$18,429.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$15,000.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,143.36
|
| Rate for Payer: Healthscope Commercial |
$19,286.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15,000.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16,071.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,214.82
|
| Rate for Payer: PHP Commercial |
$18,214.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,928.98
|
| Rate for Payer: Priority Health SBD |
$13,500.40
|
| Rate for Payer: UMR Bronson Commercial |
$7,928.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16,071.90
|
|
