|
VITAMIN A 3,000 MCG (10,000 UNIT) CAPSULE
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
NDC 07610043310
|
| Hospital Charge Code |
8639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.16 |
| Max. Negotiated Rate |
$147.60 |
| Rate for Payer: Aetna American Axle |
$106.60
|
| Rate for Payer: Aetna Commercial |
$139.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.60
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cofinity Commercial |
$114.80
|
| Rate for Payer: Cofinity Commercial |
$141.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$114.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.20
|
| Rate for Payer: Healthscope Commercial |
$147.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$114.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.40
|
| Rate for Payer: PHP Commercial |
$139.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.60
|
| Rate for Payer: Priority Health SBD |
$103.32
|
| Rate for Payer: UMR Bronson Commercial |
$72.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.00
|
|
|
VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET
|
Facility
|
OP
|
$115.15
|
|
|
Service Code
|
NDC 60258016001
|
| Hospital Charge Code |
29833
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.61 |
| Max. Negotiated Rate |
$103.64 |
| Rate for Payer: Aetna American Axle |
$74.85
|
| Rate for Payer: Aetna Commercial |
$97.88
|
| Rate for Payer: Aetna Medicare |
$57.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.85
|
| Rate for Payer: BCBS Complete |
$46.06
|
| Rate for Payer: Cash Price |
$92.12
|
| Rate for Payer: Cofinity Commercial |
$80.60
|
| Rate for Payer: Cofinity Commercial |
$99.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$80.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.12
|
| Rate for Payer: Healthscope Commercial |
$103.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.88
|
| Rate for Payer: PHP Commercial |
$97.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.85
|
| Rate for Payer: Priority Health SBD |
$72.54
|
| Rate for Payer: UMR Bronson Commercial |
$42.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.36
|
|
|
VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET
|
Facility
|
OP
|
$103.40
|
|
|
Service Code
|
NDC 00536730001
|
| Hospital Charge Code |
29833
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.26 |
| Max. Negotiated Rate |
$93.06 |
| Rate for Payer: Aetna American Axle |
$67.21
|
| Rate for Payer: Aetna Commercial |
$87.89
|
| Rate for Payer: Aetna Medicare |
$51.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.21
|
| Rate for Payer: BCBS Complete |
$41.36
|
| Rate for Payer: Cash Price |
$82.72
|
| Rate for Payer: Cofinity Commercial |
$72.38
|
| Rate for Payer: Cofinity Commercial |
$88.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$72.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.72
|
| Rate for Payer: Healthscope Commercial |
$93.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.89
|
| Rate for Payer: PHP Commercial |
$87.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.21
|
| Rate for Payer: Priority Health SBD |
$65.14
|
| Rate for Payer: UMR Bronson Commercial |
$38.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.55
|
|
|
VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET
|
Facility
|
IP
|
$103.40
|
|
|
Service Code
|
NDC 00536730001
|
| Hospital Charge Code |
29833
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$93.06 |
| Rate for Payer: Aetna American Axle |
$67.21
|
| Rate for Payer: Aetna Commercial |
$87.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.21
|
| Rate for Payer: Cash Price |
$82.72
|
| Rate for Payer: Cofinity Commercial |
$72.38
|
| Rate for Payer: Cofinity Commercial |
$88.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$72.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.72
|
| Rate for Payer: Healthscope Commercial |
$93.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.89
|
| Rate for Payer: PHP Commercial |
$87.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.21
|
| Rate for Payer: Priority Health SBD |
$65.14
|
| Rate for Payer: UMR Bronson Commercial |
$45.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.55
|
|
|
VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET
|
Facility
|
IP
|
$115.15
|
|
|
Service Code
|
NDC 60258016001
|
| Hospital Charge Code |
29833
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.67 |
| Max. Negotiated Rate |
$103.64 |
| Rate for Payer: Aetna American Axle |
$74.85
|
| Rate for Payer: Aetna Commercial |
$97.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.85
|
| Rate for Payer: Cash Price |
$92.12
|
| Rate for Payer: Cofinity Commercial |
$80.60
|
| Rate for Payer: Cofinity Commercial |
$99.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$80.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.12
|
| Rate for Payer: Healthscope Commercial |
$103.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.88
|
| Rate for Payer: PHP Commercial |
$97.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.85
|
| Rate for Payer: Priority Health SBD |
$72.54
|
| Rate for Payer: UMR Bronson Commercial |
$50.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.36
|
|
|
VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET
|
Facility
|
OP
|
$105.75
|
|
|
Service Code
|
NDC 00536141501
|
| Hospital Charge Code |
29833
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.13 |
| Max. Negotiated Rate |
$95.18 |
| Rate for Payer: BCBS Complete |
$42.30
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cofinity Commercial |
$74.02
|
| Rate for Payer: Cofinity Commercial |
$90.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.02
|
| 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: Encore Health Key Benefits Commercial |
$84.60
|
| Rate for Payer: Healthscope Commercial |
$95.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.89
|
| Rate for Payer: PHP Commercial |
$89.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.74
|
| Rate for Payer: Priority Health SBD |
$66.62
|
| Rate for Payer: UMR Bronson Commercial |
$39.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.31
|
|
|
VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET
|
Facility
|
IP
|
$105.75
|
|
|
Service Code
|
NDC 00536141501
|
| Hospital Charge Code |
29833
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.53 |
| Max. Negotiated Rate |
$95.18 |
| 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 Commercial |
$74.02
|
| Rate for Payer: Cofinity Commercial |
$90.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.60
|
| Rate for Payer: Healthscope Commercial |
$95.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.89
|
| Rate for Payer: PHP Commercial |
$89.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.74
|
| 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
|
|
|
VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) CAPSULE
|
Facility
|
OP
|
$179.30
|
|
|
Service Code
|
NDC 77333095110
|
| Hospital Charge Code |
118622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.34 |
| Max. Negotiated Rate |
$161.37 |
| Rate for Payer: Aetna American Axle |
$116.54
|
| Rate for Payer: Aetna Commercial |
$152.40
|
| Rate for Payer: Aetna Medicare |
$89.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.54
|
| Rate for Payer: BCBS Complete |
$71.72
|
| Rate for Payer: Cash Price |
$143.44
|
| Rate for Payer: Cofinity Commercial |
$125.51
|
| Rate for Payer: Cofinity Commercial |
$154.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$125.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.44
|
| Rate for Payer: Healthscope Commercial |
$161.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$125.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$134.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.40
|
| Rate for Payer: PHP Commercial |
$152.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.54
|
| Rate for Payer: Priority Health SBD |
$112.96
|
| Rate for Payer: UMR Bronson Commercial |
$66.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.48
|
|
|
VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) CAPSULE
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
NDC 77333095125
|
| Hospital Charge Code |
118622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: Aetna American Axle |
$1.17
|
| Rate for Payer: Aetna Commercial |
$1.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.17
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Cofinity Commercial |
$1.26
|
| Rate for Payer: Cofinity Commercial |
$1.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.44
|
| Rate for Payer: Healthscope Commercial |
$1.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.53
|
| Rate for Payer: PHP Commercial |
$1.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.17
|
| Rate for Payer: Priority Health SBD |
$1.13
|
| Rate for Payer: UMR Bronson Commercial |
$0.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.35
|
|
|
VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) CAPSULE
|
Facility
|
IP
|
$179.30
|
|
|
Service Code
|
NDC 77333095110
|
| Hospital Charge Code |
118622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.89 |
| Max. Negotiated Rate |
$161.37 |
| Rate for Payer: Aetna American Axle |
$116.54
|
| Rate for Payer: Aetna Commercial |
$152.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.54
|
| Rate for Payer: Cash Price |
$143.44
|
| Rate for Payer: Cofinity Commercial |
$125.51
|
| Rate for Payer: Cofinity Commercial |
$154.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$125.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.44
|
| Rate for Payer: Healthscope Commercial |
$161.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$125.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$134.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.40
|
| Rate for Payer: PHP Commercial |
$152.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.54
|
| Rate for Payer: Priority Health SBD |
$112.96
|
| Rate for Payer: UMR Bronson Commercial |
$78.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.48
|
|
|
VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) CAPSULE
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
NDC 09629513796
|
| Hospital Charge Code |
118622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.12 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna American Axle |
$114.40
|
| Rate for Payer: Aetna Commercial |
$149.60
|
| Rate for Payer: Aetna Medicare |
$88.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.40
|
| Rate for Payer: BCBS Complete |
$70.40
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cofinity Commercial |
$123.20
|
| Rate for Payer: Cofinity Commercial |
$151.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.80
|
| Rate for Payer: Healthscope Commercial |
$158.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.60
|
| Rate for Payer: PHP Commercial |
$149.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.40
|
| Rate for Payer: Priority Health SBD |
$110.88
|
| Rate for Payer: UMR Bronson Commercial |
$65.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.00
|
|
|
VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) CAPSULE
|
Facility
|
OP
|
$1.80
|
|
|
Service Code
|
NDC 77333095125
|
| Hospital Charge Code |
118622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: Aetna American Axle |
$1.17
|
| Rate for Payer: Aetna Commercial |
$1.53
|
| Rate for Payer: Aetna Medicare |
$0.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.17
|
| Rate for Payer: BCBS Complete |
$0.72
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Cofinity Commercial |
$1.26
|
| Rate for Payer: Cofinity Commercial |
$1.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.44
|
| Rate for Payer: Healthscope Commercial |
$1.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.53
|
| Rate for Payer: PHP Commercial |
$1.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.17
|
| Rate for Payer: Priority Health SBD |
$1.13
|
| Rate for Payer: UMR Bronson Commercial |
$0.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.35
|
|
|
VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) CAPSULE
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
NDC 09629513796
|
| Hospital Charge Code |
118622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.44 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna American Axle |
$114.40
|
| Rate for Payer: Aetna Commercial |
$149.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.40
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cofinity Commercial |
$123.20
|
| Rate for Payer: Cofinity Commercial |
$151.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.80
|
| Rate for Payer: Healthscope Commercial |
$158.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.60
|
| Rate for Payer: PHP Commercial |
$149.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.40
|
| Rate for Payer: Priority Health SBD |
$110.88
|
| Rate for Payer: UMR Bronson Commercial |
$77.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.00
|
|
|
VITAMIN E (DL, ACETATE) 22.5 MG (50 UNIT)/ML ORAL DROPS
|
Facility
|
IP
|
$96.05
|
|
|
Service Code
|
NDC 71321080230
|
| Hospital Charge Code |
116319
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.26 |
| Max. Negotiated Rate |
$86.44 |
| Rate for Payer: Aetna American Axle |
$62.43
|
| Rate for Payer: Aetna Commercial |
$81.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.43
|
| Rate for Payer: Cash Price |
$76.84
|
| Rate for Payer: Cofinity Commercial |
$67.24
|
| Rate for Payer: Cofinity Commercial |
$82.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.84
|
| Rate for Payer: Healthscope Commercial |
$86.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.64
|
| Rate for Payer: PHP Commercial |
$81.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.43
|
| Rate for Payer: Priority Health SBD |
$60.51
|
| Rate for Payer: UMR Bronson Commercial |
$42.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.04
|
|
|
VITAMIN E (DL, ACETATE) 22.5 MG (50 UNIT)/ML ORAL DROPS
|
Facility
|
OP
|
$96.05
|
|
|
Service Code
|
NDC 71321080230
|
| Hospital Charge Code |
116319
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.54 |
| Max. Negotiated Rate |
$86.44 |
| Rate for Payer: Aetna American Axle |
$62.43
|
| Rate for Payer: Aetna Commercial |
$81.64
|
| Rate for Payer: Aetna Medicare |
$48.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.43
|
| Rate for Payer: BCBS Complete |
$38.42
|
| Rate for Payer: Cash Price |
$76.84
|
| Rate for Payer: Cofinity Commercial |
$67.24
|
| Rate for Payer: Cofinity Commercial |
$82.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.84
|
| Rate for Payer: Healthscope Commercial |
$86.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.64
|
| Rate for Payer: PHP Commercial |
$81.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.43
|
| Rate for Payer: Priority Health SBD |
$60.51
|
| Rate for Payer: UMR Bronson Commercial |
$35.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.04
|
|
|
VITAMIN E (DL, ACETATE) 450 MG (1,000 UNIT) CAPSULE
|
Facility
|
OP
|
$81.08
|
|
|
Service Code
|
NDC 00904027746
|
| Hospital Charge Code |
152874
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$72.97 |
| Rate for Payer: Aetna American Axle |
$52.70
|
| Rate for Payer: Aetna Commercial |
$68.92
|
| Rate for Payer: Aetna Medicare |
$40.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.70
|
| Rate for Payer: BCBS Complete |
$32.43
|
| Rate for Payer: Cash Price |
$64.86
|
| Rate for Payer: Cofinity Commercial |
$56.76
|
| Rate for Payer: Cofinity Commercial |
$69.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.86
|
| Rate for Payer: Healthscope Commercial |
$72.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.92
|
| Rate for Payer: PHP Commercial |
$68.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.70
|
| Rate for Payer: Priority Health SBD |
$51.08
|
| Rate for Payer: UMR Bronson Commercial |
$30.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.81
|
|
|
VITAMIN E (DL, ACETATE) 450 MG (1,000 UNIT) CAPSULE
|
Facility
|
IP
|
$81.08
|
|
|
Service Code
|
NDC 00904027746
|
| Hospital Charge Code |
152874
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.68 |
| Max. Negotiated Rate |
$72.97 |
| Rate for Payer: Aetna American Axle |
$52.70
|
| Rate for Payer: Aetna Commercial |
$68.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.70
|
| Rate for Payer: Cash Price |
$64.86
|
| Rate for Payer: Cofinity Commercial |
$56.76
|
| Rate for Payer: Cofinity Commercial |
$69.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.86
|
| Rate for Payer: Healthscope Commercial |
$72.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.92
|
| Rate for Payer: PHP Commercial |
$68.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.70
|
| Rate for Payer: Priority Health SBD |
$51.08
|
| Rate for Payer: UMR Bronson Commercial |
$35.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.81
|
|
|
VITAMIN E (DL, ACETATE) 45 MG (100 UNIT) CAPSULE
|
Facility
|
IP
|
$35.25
|
|
|
Service Code
|
NDC 80681013400
|
| Hospital Charge Code |
115972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.51 |
| Max. Negotiated Rate |
$31.72 |
| Rate for Payer: Aetna American Axle |
$22.91
|
| Rate for Payer: Aetna Commercial |
$29.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.91
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cofinity Commercial |
$24.68
|
| Rate for Payer: Cofinity Commercial |
$30.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.20
|
| Rate for Payer: Healthscope Commercial |
$31.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.96
|
| Rate for Payer: PHP Commercial |
$29.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.91
|
| Rate for Payer: Priority Health SBD |
$22.21
|
| Rate for Payer: UMR Bronson Commercial |
$15.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.44
|
|
|
VITAMIN E (DL, ACETATE) 45 MG (100 UNIT) CAPSULE
|
Facility
|
OP
|
$35.25
|
|
|
Service Code
|
NDC 80681013400
|
| Hospital Charge Code |
115972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.04 |
| Max. Negotiated Rate |
$31.72 |
| Rate for Payer: Aetna American Axle |
$22.91
|
| Rate for Payer: Aetna Commercial |
$29.96
|
| Rate for Payer: Aetna Medicare |
$17.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.91
|
| Rate for Payer: BCBS Complete |
$14.10
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cofinity Commercial |
$24.68
|
| Rate for Payer: Cofinity Commercial |
$30.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.20
|
| Rate for Payer: Healthscope Commercial |
$31.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.96
|
| Rate for Payer: PHP Commercial |
$29.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.91
|
| Rate for Payer: Priority Health SBD |
$22.21
|
| Rate for Payer: UMR Bronson Commercial |
$13.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.44
|
|
|
VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT
|
Facility
|
OP
|
$10.52
|
|
|
Service Code
|
NDC 65197040010
|
| Hospital Charge Code |
118725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$9.47 |
| Rate for Payer: Aetna American Axle |
$6.84
|
| Rate for Payer: Aetna Commercial |
$8.94
|
| Rate for Payer: Aetna Medicare |
$5.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.84
|
| Rate for Payer: BCBS Complete |
$4.21
|
| Rate for Payer: Cash Price |
$8.42
|
| Rate for Payer: Cofinity Commercial |
$7.36
|
| Rate for Payer: Cofinity Commercial |
$9.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.42
|
| Rate for Payer: Healthscope Commercial |
$9.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.94
|
| Rate for Payer: PHP Commercial |
$8.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.84
|
| Rate for Payer: Priority Health SBD |
$6.63
|
| Rate for Payer: UMR Bronson Commercial |
$3.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.89
|
|
|
VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT
|
Facility
|
IP
|
$15.11
|
|
|
Service Code
|
NDC 41100081122
|
| Hospital Charge Code |
118725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.65 |
| Max. Negotiated Rate |
$13.60 |
| Rate for Payer: Aetna American Axle |
$9.82
|
| Rate for Payer: Aetna Commercial |
$12.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.82
|
| Rate for Payer: Cash Price |
$12.09
|
| Rate for Payer: Cofinity Commercial |
$10.58
|
| Rate for Payer: Cofinity Commercial |
$12.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.09
|
| Rate for Payer: Healthscope Commercial |
$13.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.84
|
| Rate for Payer: PHP Commercial |
$12.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.82
|
| Rate for Payer: Priority Health SBD |
$9.52
|
| Rate for Payer: UMR Bronson Commercial |
$6.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.33
|
|
|
VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT
|
Facility
|
IP
|
$10.52
|
|
|
Service Code
|
NDC 65197040010
|
| Hospital Charge Code |
118725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.63 |
| Max. Negotiated Rate |
$9.47 |
| Rate for Payer: Aetna American Axle |
$6.84
|
| Rate for Payer: Aetna Commercial |
$8.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.84
|
| Rate for Payer: Cash Price |
$8.42
|
| Rate for Payer: Cofinity Commercial |
$7.36
|
| Rate for Payer: Cofinity Commercial |
$9.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.42
|
| Rate for Payer: Healthscope Commercial |
$9.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.94
|
| Rate for Payer: PHP Commercial |
$8.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.84
|
| Rate for Payer: Priority Health SBD |
$6.63
|
| Rate for Payer: UMR Bronson Commercial |
$4.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.89
|
|
|
VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT
|
Facility
|
OP
|
$15.11
|
|
|
Service Code
|
NDC 41100081122
|
| Hospital Charge Code |
118725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.59 |
| Max. Negotiated Rate |
$13.60 |
| Rate for Payer: Aetna American Axle |
$9.82
|
| Rate for Payer: Aetna Commercial |
$12.84
|
| Rate for Payer: Aetna Medicare |
$7.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.82
|
| Rate for Payer: BCBS Complete |
$6.04
|
| Rate for Payer: Cash Price |
$12.09
|
| Rate for Payer: Cofinity Commercial |
$10.58
|
| Rate for Payer: Cofinity Commercial |
$12.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.09
|
| Rate for Payer: Healthscope Commercial |
$13.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.84
|
| Rate for Payer: PHP Commercial |
$12.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.82
|
| Rate for Payer: Priority Health SBD |
$9.52
|
| Rate for Payer: UMR Bronson Commercial |
$5.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.33
|
|
|
VITRECTOMY, MECHANICAL, PARS PLANA APPROACH;
|
Facility
|
OP
|
$12,388.13
|
|
|
Service Code
|
CPT 67036
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$836.76 |
| Max. Negotiated Rate |
$12,388.13 |
| Rate for Payer: Aetna Medicare |
$4,099.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,926.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,926.90
|
| Rate for Payer: BCBS Complete |
$2,218.29
|
| Rate for Payer: BCBS MAPPO |
$3,941.52
|
| Rate for Payer: BCBS Trust/PPO |
$3,590.95
|
| Rate for Payer: BCN Commercial |
$3,590.95
|
| Rate for Payer: BCN Medicare Advantage |
$3,941.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,941.52
|
| Rate for Payer: Mclaren Medicaid |
$2,112.65
|
| Rate for Payer: Mclaren Medicare |
$3,941.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,138.60
|
| Rate for Payer: Meridian Medicaid |
$2,218.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,532.75
|
| Rate for Payer: Nomi Health Commercial |
$8,277.19
|
| Rate for Payer: PACE Medicare |
$3,744.44
|
| Rate for Payer: PACE SWMI |
$3,941.52
|
| Rate for Payer: PHP Medicare Advantage |
$3,941.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,112.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,388.13
|
| Rate for Payer: Priority Health Medicare |
$3,941.52
|
| Rate for Payer: Priority Health Narrow Network |
$9,910.50
|
| Rate for Payer: Railroad Medicare Medicare |
$3,941.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$920.44
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,941.52
|
| Rate for Payer: UHC Exchange |
$836.76
|
| Rate for Payer: UHC Medicare Advantage |
$3,941.52
|
| Rate for Payer: UHCCP Medicaid |
$2,112.65
|
| Rate for Payer: VA VA |
$3,941.52
|
|
|
VIVONEX RTF BOLUS FEED
|
Facility
|
OP
|
$14.80
|
|
|
Service Code
|
NDC 43900036250
|
| Hospital Charge Code |
150771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.48 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: Aetna American Axle |
$9.62
|
| Rate for Payer: Aetna Commercial |
$12.58
|
| Rate for Payer: Aetna Medicare |
$7.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.62
|
| Rate for Payer: BCBS Complete |
$5.92
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$10.36
|
| Rate for Payer: Cofinity Commercial |
$12.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$13.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.58
|
| Rate for Payer: PHP Commercial |
$12.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.62
|
| Rate for Payer: Priority Health SBD |
$9.32
|
| Rate for Payer: UMR Bronson Commercial |
$5.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.10
|
|
