|
TREMELIMUMAB-ACTL 20 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$182,184.45
|
|
|
Service Code
|
HCPCS J9347
|
| Hospital Charge Code |
201908
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$75.52 |
| Max. Negotiated Rate |
$163,966.01 |
| Rate for Payer: Aetna American Axle |
$118,419.89
|
| Rate for Payer: Aetna Commercial |
$154,856.78
|
| Rate for Payer: Aetna Medicare |
$146.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118,419.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$176.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$176.12
|
| Rate for Payer: BCBS Complete |
$79.30
|
| Rate for Payer: BCBS MAPPO |
$140.90
|
| Rate for Payer: BCN Medicare Advantage |
$140.90
|
| Rate for Payer: Cash Price |
$145,747.56
|
| Rate for Payer: Cash Price |
$145,747.56
|
| Rate for Payer: Cofinity Commercial |
$127,529.12
|
| Rate for Payer: Cofinity Commercial |
$156,678.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$127,529.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145,747.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.90
|
| Rate for Payer: Healthscope Commercial |
$163,966.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127,529.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136,638.34
|
| Rate for Payer: Mclaren Medicaid |
$75.52
|
| Rate for Payer: Mclaren Medicare |
$140.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$147.94
|
| Rate for Payer: Meridian Medicaid |
$79.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$162.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154,856.78
|
| Rate for Payer: PACE Medicare |
$133.85
|
| Rate for Payer: PACE SWMI |
$140.90
|
| Rate for Payer: PHP Commercial |
$154,856.78
|
| Rate for Payer: PHP Medicare Advantage |
$140.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118,419.89
|
| Rate for Payer: Priority Health Medicare |
$140.90
|
| Rate for Payer: Priority Health SBD |
$114,776.20
|
| Rate for Payer: Railroad Medicare Medicare |
$140.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$396.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.90
|
| Rate for Payer: UHC Exchange |
$269.27
|
| Rate for Payer: UHC Medicare Advantage |
$140.90
|
| Rate for Payer: UHCCP Medicaid |
$75.52
|
| Rate for Payer: UMR Bronson Commercial |
$67,408.25
|
| Rate for Payer: VA VA |
$140.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136,638.34
|
|
|
TREPROSTINIL SODIUM 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$1,654.78
|
|
|
Service Code
|
HCPCS J3285
|
| Hospital Charge Code |
32931
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$728.10 |
| Max. Negotiated Rate |
$1,489.30 |
| Rate for Payer: Aetna American Axle |
$1,075.61
|
| Rate for Payer: Aetna American Axle |
$1,159.31
|
| Rate for Payer: Aetna Commercial |
$1,406.56
|
| Rate for Payer: Aetna Commercial |
$1,516.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,075.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,159.31
|
| Rate for Payer: Cash Price |
$1,323.82
|
| Rate for Payer: Cash Price |
$1,426.85
|
| Rate for Payer: Cofinity Commercial |
$1,533.86
|
| Rate for Payer: Cofinity Commercial |
$1,248.49
|
| Rate for Payer: Cofinity Commercial |
$1,158.35
|
| Rate for Payer: Cofinity Commercial |
$1,423.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,158.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,248.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,323.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,426.85
|
| Rate for Payer: Healthscope Commercial |
$1,489.30
|
| Rate for Payer: Healthscope Commercial |
$1,605.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,158.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,248.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,241.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,337.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,516.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,406.56
|
| Rate for Payer: PHP Commercial |
$1,516.03
|
| Rate for Payer: PHP Commercial |
$1,406.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,075.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,159.31
|
| Rate for Payer: Priority Health SBD |
$1,042.51
|
| Rate for Payer: Priority Health SBD |
$1,123.64
|
| Rate for Payer: UMR Bronson Commercial |
$728.10
|
| Rate for Payer: UMR Bronson Commercial |
$784.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,241.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,337.67
|
|
|
TREPROSTINIL SODIUM 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$1,783.56
|
|
|
Service Code
|
HCPCS J3285
|
| Hospital Charge Code |
32931
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.32 |
| Max. Negotiated Rate |
$1,605.20 |
| Rate for Payer: Aetna American Axle |
$1,159.31
|
| Rate for Payer: Aetna American Axle |
$1,075.61
|
| Rate for Payer: Aetna Commercial |
$1,406.56
|
| Rate for Payer: Aetna Commercial |
$1,516.03
|
| Rate for Payer: Aetna Medicare |
$56.90
|
| Rate for Payer: Aetna Medicare |
$56.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,159.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,075.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.39
|
| Rate for Payer: BCBS Complete |
$30.79
|
| Rate for Payer: BCBS Complete |
$30.79
|
| Rate for Payer: BCBS MAPPO |
$54.71
|
| Rate for Payer: BCBS MAPPO |
$54.71
|
| Rate for Payer: BCN Medicare Advantage |
$54.71
|
| Rate for Payer: BCN Medicare Advantage |
$54.71
|
| Rate for Payer: Cash Price |
$1,323.82
|
| Rate for Payer: Cash Price |
$1,426.85
|
| Rate for Payer: Cash Price |
$1,426.85
|
| Rate for Payer: Cash Price |
$1,323.82
|
| Rate for Payer: Cofinity Commercial |
$1,158.35
|
| Rate for Payer: Cofinity Commercial |
$1,423.11
|
| Rate for Payer: Cofinity Commercial |
$1,248.49
|
| Rate for Payer: Cofinity Commercial |
$1,533.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,158.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,248.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,426.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,323.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.71
|
| Rate for Payer: Healthscope Commercial |
$1,605.20
|
| Rate for Payer: Healthscope Commercial |
$1,489.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,248.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,158.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,241.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,337.67
|
| Rate for Payer: Mclaren Medicaid |
$29.32
|
| Rate for Payer: Mclaren Medicaid |
$29.32
|
| Rate for Payer: Mclaren Medicare |
$54.71
|
| Rate for Payer: Mclaren Medicare |
$54.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.45
|
| Rate for Payer: Meridian Medicaid |
$30.79
|
| Rate for Payer: Meridian Medicaid |
$30.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,516.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,406.56
|
| Rate for Payer: PACE Medicare |
$51.97
|
| Rate for Payer: PACE Medicare |
$51.97
|
| Rate for Payer: PACE SWMI |
$54.71
|
| Rate for Payer: PACE SWMI |
$54.71
|
| Rate for Payer: PHP Commercial |
$1,406.56
|
| Rate for Payer: PHP Commercial |
$1,516.03
|
| Rate for Payer: PHP Medicare Advantage |
$54.71
|
| Rate for Payer: PHP Medicare Advantage |
$54.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,075.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,159.31
|
| Rate for Payer: Priority Health Medicare |
$54.71
|
| Rate for Payer: Priority Health Medicare |
$54.71
|
| Rate for Payer: Priority Health SBD |
$1,042.51
|
| Rate for Payer: Priority Health SBD |
$1,123.64
|
| Rate for Payer: Railroad Medicare Medicare |
$54.71
|
| Rate for Payer: Railroad Medicare Medicare |
$54.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.71
|
| Rate for Payer: UHC Exchange |
$104.56
|
| Rate for Payer: UHC Exchange |
$104.56
|
| Rate for Payer: UHC Medicare Advantage |
$54.71
|
| Rate for Payer: UHC Medicare Advantage |
$54.71
|
| Rate for Payer: UHCCP Medicaid |
$29.32
|
| Rate for Payer: UHCCP Medicaid |
$29.32
|
| Rate for Payer: UMR Bronson Commercial |
$612.27
|
| Rate for Payer: UMR Bronson Commercial |
$659.92
|
| Rate for Payer: VA VA |
$54.71
|
| Rate for Payer: VA VA |
$54.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,337.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,241.09
|
|
|
TREPROSTINIL SODIUM 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$20,691.48
|
|
|
Service Code
|
HCPCS J3285
|
| Hospital Charge Code |
32933
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,104.25 |
| Max. Negotiated Rate |
$18,622.33 |
| Rate for Payer: Aetna American Axle |
$13,449.46
|
| Rate for Payer: Aetna Commercial |
$17,587.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,449.46
|
| Rate for Payer: Cash Price |
$16,553.18
|
| Rate for Payer: Cofinity Commercial |
$14,484.04
|
| Rate for Payer: Cofinity Commercial |
$17,794.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$14,484.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,553.18
|
| Rate for Payer: Healthscope Commercial |
$18,622.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14,484.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15,518.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17,587.76
|
| Rate for Payer: PHP Commercial |
$17,587.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,449.46
|
| Rate for Payer: Priority Health SBD |
$13,035.63
|
| Rate for Payer: UMR Bronson Commercial |
$9,104.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15,518.61
|
|
|
TREPROSTINIL SODIUM 5 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$20,691.48
|
|
|
Service Code
|
HCPCS J3285
|
| Hospital Charge Code |
32933
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.32 |
| Max. Negotiated Rate |
$18,622.33 |
| Rate for Payer: Aetna American Axle |
$13,449.46
|
| Rate for Payer: Aetna Commercial |
$17,587.76
|
| Rate for Payer: Aetna Medicare |
$56.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,449.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.39
|
| Rate for Payer: BCBS Complete |
$30.79
|
| Rate for Payer: BCBS MAPPO |
$54.71
|
| Rate for Payer: BCN Medicare Advantage |
$54.71
|
| Rate for Payer: Cash Price |
$16,553.18
|
| Rate for Payer: Cash Price |
$16,553.18
|
| Rate for Payer: Cofinity Commercial |
$17,794.67
|
| Rate for Payer: Cofinity Commercial |
$14,484.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$14,484.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,553.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.71
|
| Rate for Payer: Healthscope Commercial |
$18,622.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14,484.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15,518.61
|
| Rate for Payer: Mclaren Medicaid |
$29.32
|
| Rate for Payer: Mclaren Medicare |
$54.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.45
|
| Rate for Payer: Meridian Medicaid |
$30.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17,587.76
|
| Rate for Payer: PACE Medicare |
$51.97
|
| Rate for Payer: PACE SWMI |
$54.71
|
| Rate for Payer: PHP Commercial |
$17,587.76
|
| Rate for Payer: PHP Medicare Advantage |
$54.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,449.46
|
| Rate for Payer: Priority Health Medicare |
$54.71
|
| Rate for Payer: Priority Health SBD |
$13,035.63
|
| Rate for Payer: Railroad Medicare Medicare |
$54.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.71
|
| Rate for Payer: UHC Exchange |
$104.56
|
| Rate for Payer: UHC Medicare Advantage |
$54.71
|
| Rate for Payer: UHCCP Medicaid |
$29.32
|
| Rate for Payer: UMR Bronson Commercial |
$7,655.85
|
| Rate for Payer: VA VA |
$54.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15,518.61
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE
|
Facility
|
IP
|
$3,029.97
|
|
|
Service Code
|
NDC 68084007521
|
| Hospital Charge Code |
16005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,333.19 |
| Max. Negotiated Rate |
$2,726.97 |
| Rate for Payer: Aetna American Axle |
$1,969.48
|
| Rate for Payer: Aetna Commercial |
$2,575.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,969.48
|
| Rate for Payer: Cash Price |
$2,423.98
|
| Rate for Payer: Cofinity Commercial |
$2,120.98
|
| Rate for Payer: Cofinity Commercial |
$2,605.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,120.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,423.98
|
| Rate for Payer: Healthscope Commercial |
$2,726.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,120.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,272.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,575.47
|
| Rate for Payer: PHP Commercial |
$2,575.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,969.48
|
| Rate for Payer: Priority Health SBD |
$1,908.88
|
| Rate for Payer: UMR Bronson Commercial |
$1,333.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,272.48
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE
|
Facility
|
IP
|
$9,453.13
|
|
|
Service Code
|
NDC 10370026801
|
| Hospital Charge Code |
16005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,159.38 |
| Max. Negotiated Rate |
$8,507.82 |
| Rate for Payer: Aetna American Axle |
$6,144.53
|
| Rate for Payer: Aetna Commercial |
$8,035.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,144.53
|
| Rate for Payer: Cash Price |
$7,562.50
|
| Rate for Payer: Cofinity Commercial |
$6,617.19
|
| Rate for Payer: Cofinity Commercial |
$8,129.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,617.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,562.50
|
| Rate for Payer: Healthscope Commercial |
$8,507.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,617.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,089.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,035.16
|
| Rate for Payer: PHP Commercial |
$8,035.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,144.53
|
| Rate for Payer: Priority Health SBD |
$5,955.47
|
| Rate for Payer: UMR Bronson Commercial |
$4,159.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,089.85
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
NDC 68084007511
|
| Hospital Charge Code |
16005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.44 |
| Max. Negotiated Rate |
$90.90 |
| Rate for Payer: Aetna American Axle |
$65.65
|
| Rate for Payer: Aetna Commercial |
$85.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.65
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cofinity Commercial |
$70.70
|
| Rate for Payer: Cofinity Commercial |
$86.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.80
|
| Rate for Payer: Healthscope Commercial |
$90.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.85
|
| Rate for Payer: PHP Commercial |
$85.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.65
|
| Rate for Payer: Priority Health SBD |
$63.63
|
| Rate for Payer: UMR Bronson Commercial |
$44.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.75
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE
|
Facility
|
OP
|
$3,659.67
|
|
|
Service Code
|
NDC 68462079201
|
| Hospital Charge Code |
16005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,354.08 |
| Max. Negotiated Rate |
$3,293.70 |
| Rate for Payer: Aetna American Axle |
$2,378.79
|
| Rate for Payer: Aetna Commercial |
$3,110.72
|
| Rate for Payer: Aetna Medicare |
$1,829.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,378.79
|
| Rate for Payer: BCBS Complete |
$1,463.87
|
| Rate for Payer: Cash Price |
$2,927.74
|
| Rate for Payer: Cofinity Commercial |
$2,561.77
|
| Rate for Payer: Cofinity Commercial |
$3,147.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,561.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,927.74
|
| Rate for Payer: Healthscope Commercial |
$3,293.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,561.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,744.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,110.72
|
| Rate for Payer: PHP Commercial |
$3,110.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,378.79
|
| Rate for Payer: Priority Health SBD |
$2,305.59
|
| Rate for Payer: UMR Bronson Commercial |
$1,354.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,744.75
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE
|
Facility
|
IP
|
$9,254.07
|
|
|
Service Code
|
NDC 00555080802
|
| Hospital Charge Code |
16005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,071.79 |
| Max. Negotiated Rate |
$8,328.66 |
| Rate for Payer: Aetna American Axle |
$6,015.15
|
| Rate for Payer: Aetna Commercial |
$7,865.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,015.15
|
| Rate for Payer: Cash Price |
$7,403.26
|
| Rate for Payer: Cofinity Commercial |
$6,477.85
|
| Rate for Payer: Cofinity Commercial |
$7,958.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,477.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,403.26
|
| Rate for Payer: Healthscope Commercial |
$8,328.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,477.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,940.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,865.96
|
| Rate for Payer: PHP Commercial |
$7,865.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,015.15
|
| Rate for Payer: Priority Health SBD |
$5,830.06
|
| Rate for Payer: UMR Bronson Commercial |
$4,071.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,940.55
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
NDC 68084007511
|
| Hospital Charge Code |
16005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.37 |
| Max. Negotiated Rate |
$90.90 |
| Rate for Payer: Aetna American Axle |
$65.65
|
| Rate for Payer: Aetna Commercial |
$85.85
|
| Rate for Payer: Aetna Medicare |
$50.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.65
|
| Rate for Payer: BCBS Complete |
$40.40
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cofinity Commercial |
$70.70
|
| Rate for Payer: Cofinity Commercial |
$86.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.80
|
| Rate for Payer: Healthscope Commercial |
$90.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.85
|
| Rate for Payer: PHP Commercial |
$85.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.65
|
| Rate for Payer: Priority Health SBD |
$63.63
|
| Rate for Payer: UMR Bronson Commercial |
$37.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.75
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE
|
Facility
|
IP
|
$3,659.67
|
|
|
Service Code
|
NDC 68462079201
|
| Hospital Charge Code |
16005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,610.25 |
| Max. Negotiated Rate |
$3,293.70 |
| Rate for Payer: Aetna American Axle |
$2,378.79
|
| Rate for Payer: Aetna Commercial |
$3,110.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,378.79
|
| Rate for Payer: Cash Price |
$2,927.74
|
| Rate for Payer: Cofinity Commercial |
$2,561.77
|
| Rate for Payer: Cofinity Commercial |
$3,147.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,561.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,927.74
|
| Rate for Payer: Healthscope Commercial |
$3,293.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,561.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,744.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,110.72
|
| Rate for Payer: PHP Commercial |
$3,110.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,378.79
|
| Rate for Payer: Priority Health SBD |
$2,305.59
|
| Rate for Payer: UMR Bronson Commercial |
$1,610.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,744.75
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE
|
Facility
|
OP
|
$9,254.07
|
|
|
Service Code
|
NDC 00555080802
|
| Hospital Charge Code |
16005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,424.01 |
| Max. Negotiated Rate |
$8,328.66 |
| Rate for Payer: Aetna American Axle |
$6,015.15
|
| Rate for Payer: Aetna Commercial |
$7,865.96
|
| Rate for Payer: Aetna Medicare |
$4,627.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,015.15
|
| Rate for Payer: BCBS Complete |
$3,701.63
|
| Rate for Payer: Cash Price |
$7,403.26
|
| Rate for Payer: Cofinity Commercial |
$6,477.85
|
| Rate for Payer: Cofinity Commercial |
$7,958.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,477.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,403.26
|
| Rate for Payer: Healthscope Commercial |
$8,328.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,477.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,940.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,865.96
|
| Rate for Payer: PHP Commercial |
$7,865.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,015.15
|
| Rate for Payer: Priority Health SBD |
$5,830.06
|
| Rate for Payer: UMR Bronson Commercial |
$3,424.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,940.55
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE
|
Facility
|
OP
|
$3,029.97
|
|
|
Service Code
|
NDC 68084007521
|
| Hospital Charge Code |
16005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,121.09 |
| Max. Negotiated Rate |
$2,726.97 |
| Rate for Payer: Aetna American Axle |
$1,969.48
|
| Rate for Payer: Aetna Commercial |
$2,575.47
|
| Rate for Payer: Aetna Medicare |
$1,514.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,969.48
|
| Rate for Payer: BCBS Complete |
$1,211.99
|
| Rate for Payer: Cash Price |
$2,423.98
|
| Rate for Payer: Cofinity Commercial |
$2,120.98
|
| Rate for Payer: Cofinity Commercial |
$2,605.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,120.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,423.98
|
| Rate for Payer: Healthscope Commercial |
$2,726.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,120.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,272.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,575.47
|
| Rate for Payer: PHP Commercial |
$2,575.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,969.48
|
| Rate for Payer: Priority Health SBD |
$1,908.88
|
| Rate for Payer: UMR Bronson Commercial |
$1,121.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,272.48
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE
|
Facility
|
OP
|
$9,453.13
|
|
|
Service Code
|
NDC 10370026801
|
| Hospital Charge Code |
16005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,497.66 |
| Max. Negotiated Rate |
$8,507.82 |
| Rate for Payer: Aetna American Axle |
$6,144.53
|
| Rate for Payer: Aetna Commercial |
$8,035.16
|
| Rate for Payer: Aetna Medicare |
$4,726.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,144.53
|
| Rate for Payer: BCBS Complete |
$3,781.25
|
| Rate for Payer: Cash Price |
$7,562.50
|
| Rate for Payer: Cofinity Commercial |
$6,617.19
|
| Rate for Payer: Cofinity Commercial |
$8,129.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,617.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,562.50
|
| Rate for Payer: Healthscope Commercial |
$8,507.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,617.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,089.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,035.16
|
| Rate for Payer: PHP Commercial |
$8,035.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,144.53
|
| Rate for Payer: Priority Health SBD |
$5,955.47
|
| Rate for Payer: UMR Bronson Commercial |
$3,497.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,089.85
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL OINTMENT
|
Facility
|
OP
|
$21.20
|
|
|
Service Code
|
NDC 45802005435
|
| Hospital Charge Code |
8117
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.84 |
| Max. Negotiated Rate |
$19.08 |
| Rate for Payer: Aetna American Axle |
$13.78
|
| Rate for Payer: Aetna Commercial |
$18.02
|
| Rate for Payer: Aetna Medicare |
$10.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.78
|
| Rate for Payer: BCBS Complete |
$8.48
|
| Rate for Payer: Cash Price |
$16.96
|
| Rate for Payer: Cofinity Commercial |
$14.84
|
| Rate for Payer: Cofinity Commercial |
$18.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.96
|
| Rate for Payer: Healthscope Commercial |
$19.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.02
|
| Rate for Payer: PHP Commercial |
$18.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.78
|
| Rate for Payer: Priority Health SBD |
$13.36
|
| Rate for Payer: UMR Bronson Commercial |
$7.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.90
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL OINTMENT
|
Facility
|
IP
|
$21.20
|
|
|
Service Code
|
NDC 45802005435
|
| Hospital Charge Code |
8117
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.33 |
| Max. Negotiated Rate |
$19.08 |
| Rate for Payer: Aetna American Axle |
$13.78
|
| Rate for Payer: Aetna Commercial |
$18.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.78
|
| Rate for Payer: Cash Price |
$16.96
|
| Rate for Payer: Cofinity Commercial |
$14.84
|
| Rate for Payer: Cofinity Commercial |
$18.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.96
|
| Rate for Payer: Healthscope Commercial |
$19.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.02
|
| Rate for Payer: PHP Commercial |
$18.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.78
|
| Rate for Payer: Priority Health SBD |
$13.36
|
| Rate for Payer: UMR Bronson Commercial |
$9.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.90
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % DENTAL PASTE
|
Facility
|
OP
|
$87.47
|
|
|
Service Code
|
NDC 64980032005
|
| Hospital Charge Code |
8121
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.36 |
| Max. Negotiated Rate |
$78.72 |
| Rate for Payer: Aetna American Axle |
$56.86
|
| Rate for Payer: Aetna Commercial |
$74.35
|
| Rate for Payer: Aetna Medicare |
$43.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.86
|
| Rate for Payer: BCBS Complete |
$34.99
|
| Rate for Payer: Cash Price |
$69.98
|
| Rate for Payer: Cofinity Commercial |
$61.23
|
| Rate for Payer: Cofinity Commercial |
$75.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.98
|
| Rate for Payer: Healthscope Commercial |
$78.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.35
|
| Rate for Payer: PHP Commercial |
$74.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.86
|
| Rate for Payer: Priority Health SBD |
$55.11
|
| Rate for Payer: UMR Bronson Commercial |
$32.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.60
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % DENTAL PASTE
|
Facility
|
OP
|
$207.59
|
|
|
Service Code
|
NDC 51672126705
|
| Hospital Charge Code |
8121
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.81 |
| Max. Negotiated Rate |
$186.83 |
| Rate for Payer: Aetna American Axle |
$134.93
|
| Rate for Payer: Aetna Commercial |
$176.45
|
| Rate for Payer: Aetna Medicare |
$103.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.93
|
| Rate for Payer: BCBS Complete |
$83.04
|
| Rate for Payer: Cash Price |
$166.07
|
| Rate for Payer: Cofinity Commercial |
$145.31
|
| Rate for Payer: Cofinity Commercial |
$178.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$145.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.07
|
| Rate for Payer: Healthscope Commercial |
$186.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$145.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.45
|
| Rate for Payer: PHP Commercial |
$176.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.93
|
| Rate for Payer: Priority Health SBD |
$130.78
|
| Rate for Payer: UMR Bronson Commercial |
$76.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.69
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % DENTAL PASTE
|
Facility
|
OP
|
$209.86
|
|
|
Service Code
|
NDC 00713065540
|
| Hospital Charge Code |
8121
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.65 |
| Max. Negotiated Rate |
$188.87 |
| Rate for Payer: Aetna American Axle |
$136.41
|
| Rate for Payer: Aetna Commercial |
$178.38
|
| Rate for Payer: Aetna Medicare |
$104.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.41
|
| Rate for Payer: BCBS Complete |
$83.94
|
| Rate for Payer: Cash Price |
$167.89
|
| Rate for Payer: Cofinity Commercial |
$146.90
|
| Rate for Payer: Cofinity Commercial |
$180.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$146.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.89
|
| Rate for Payer: Healthscope Commercial |
$188.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.38
|
| Rate for Payer: PHP Commercial |
$178.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.41
|
| Rate for Payer: Priority Health SBD |
$132.21
|
| Rate for Payer: UMR Bronson Commercial |
$77.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.40
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % DENTAL PASTE
|
Facility
|
IP
|
$209.86
|
|
|
Service Code
|
NDC 00713065540
|
| Hospital Charge Code |
8121
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.34 |
| Max. Negotiated Rate |
$188.87 |
| Rate for Payer: Aetna American Axle |
$136.41
|
| Rate for Payer: Aetna Commercial |
$178.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.41
|
| Rate for Payer: Cash Price |
$167.89
|
| Rate for Payer: Cofinity Commercial |
$146.90
|
| Rate for Payer: Cofinity Commercial |
$180.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$146.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.89
|
| Rate for Payer: Healthscope Commercial |
$188.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.38
|
| Rate for Payer: PHP Commercial |
$178.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.41
|
| Rate for Payer: Priority Health SBD |
$132.21
|
| Rate for Payer: UMR Bronson Commercial |
$92.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.40
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % DENTAL PASTE
|
Facility
|
IP
|
$207.59
|
|
|
Service Code
|
NDC 51672126705
|
| Hospital Charge Code |
8121
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.34 |
| Max. Negotiated Rate |
$186.83 |
| Rate for Payer: Aetna American Axle |
$134.93
|
| Rate for Payer: Aetna Commercial |
$176.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.93
|
| Rate for Payer: Cash Price |
$166.07
|
| Rate for Payer: Cofinity Commercial |
$145.31
|
| Rate for Payer: Cofinity Commercial |
$178.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$145.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.07
|
| Rate for Payer: Healthscope Commercial |
$186.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$145.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.45
|
| Rate for Payer: PHP Commercial |
$176.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.93
|
| Rate for Payer: Priority Health SBD |
$130.78
|
| Rate for Payer: UMR Bronson Commercial |
$91.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.69
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % DENTAL PASTE
|
Facility
|
IP
|
$87.47
|
|
|
Service Code
|
NDC 64980032005
|
| Hospital Charge Code |
8121
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.49 |
| Max. Negotiated Rate |
$78.72 |
| Rate for Payer: Aetna American Axle |
$56.86
|
| Rate for Payer: Aetna Commercial |
$74.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.86
|
| Rate for Payer: Cash Price |
$69.98
|
| Rate for Payer: Cofinity Commercial |
$61.23
|
| Rate for Payer: Cofinity Commercial |
$75.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.98
|
| Rate for Payer: Healthscope Commercial |
$78.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.35
|
| Rate for Payer: PHP Commercial |
$74.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.86
|
| Rate for Payer: Priority Health SBD |
$55.11
|
| Rate for Payer: UMR Bronson Commercial |
$38.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.60
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % LOTION
|
Facility
|
IP
|
$106.89
|
|
|
Service Code
|
NDC 60432056160
|
| Hospital Charge Code |
8116
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.03 |
| Max. Negotiated Rate |
$96.20 |
| Rate for Payer: Aetna American Axle |
$69.48
|
| Rate for Payer: Aetna Commercial |
$90.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.48
|
| Rate for Payer: Cash Price |
$85.51
|
| Rate for Payer: Cofinity Commercial |
$74.82
|
| Rate for Payer: Cofinity Commercial |
$91.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.51
|
| Rate for Payer: Healthscope Commercial |
$96.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.86
|
| Rate for Payer: PHP Commercial |
$90.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.48
|
| Rate for Payer: Priority Health SBD |
$67.34
|
| Rate for Payer: UMR Bronson Commercial |
$47.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.17
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % LOTION
|
Facility
|
OP
|
$106.89
|
|
|
Service Code
|
NDC 60432056160
|
| Hospital Charge Code |
8116
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.55 |
| Max. Negotiated Rate |
$96.20 |
| Rate for Payer: Aetna American Axle |
$69.48
|
| Rate for Payer: Aetna Commercial |
$90.86
|
| Rate for Payer: Aetna Medicare |
$53.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.48
|
| Rate for Payer: BCBS Complete |
$42.76
|
| Rate for Payer: Cash Price |
$85.51
|
| Rate for Payer: Cofinity Commercial |
$74.82
|
| Rate for Payer: Cofinity Commercial |
$91.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.51
|
| Rate for Payer: Healthscope Commercial |
$96.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.86
|
| Rate for Payer: PHP Commercial |
$90.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.48
|
| Rate for Payer: Priority Health SBD |
$67.34
|
| Rate for Payer: UMR Bronson Commercial |
$39.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.17
|
|
