|
WARFARIN 2.5 MG TABLET
|
Facility
|
IP
|
$368.95
|
|
|
Service Code
|
NDC 00832121301
|
| Hospital Charge Code |
8750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$162.34 |
| Max. Negotiated Rate |
$332.06 |
| Rate for Payer: Aetna American Axle |
$239.82
|
| Rate for Payer: Aetna Commercial |
$313.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.82
|
| Rate for Payer: Cash Price |
$295.16
|
| Rate for Payer: Cofinity Commercial |
$258.26
|
| Rate for Payer: Cofinity Commercial |
$317.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$258.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.16
|
| Rate for Payer: Healthscope Commercial |
$332.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$258.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$276.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.61
|
| Rate for Payer: PHP Commercial |
$313.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.82
|
| Rate for Payer: Priority Health SBD |
$232.44
|
| Rate for Payer: UMR Bronson Commercial |
$162.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$276.71
|
|
|
WARFARIN 2.5 MG TABLET
|
Facility
|
OP
|
$272.60
|
|
|
Service Code
|
NDC 00093171401
|
| Hospital Charge Code |
8750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.86 |
| Max. Negotiated Rate |
$245.34 |
| Rate for Payer: Aetna American Axle |
$177.19
|
| Rate for Payer: Aetna Commercial |
$231.71
|
| Rate for Payer: Aetna Medicare |
$136.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.19
|
| Rate for Payer: BCBS Complete |
$109.04
|
| Rate for Payer: Cash Price |
$218.08
|
| Rate for Payer: Cofinity Commercial |
$190.82
|
| Rate for Payer: Cofinity Commercial |
$234.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.08
|
| Rate for Payer: Healthscope Commercial |
$245.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.71
|
| Rate for Payer: PHP Commercial |
$231.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.19
|
| Rate for Payer: Priority Health SBD |
$171.74
|
| Rate for Payer: UMR Bronson Commercial |
$100.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.45
|
|
|
WARFARIN 2.5 MG TABLET
|
Facility
|
OP
|
$3.69
|
|
|
Service Code
|
NDC 00832121389
|
| Hospital Charge Code |
8750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: Aetna American Axle |
$2.40
|
| Rate for Payer: Aetna Commercial |
$3.14
|
| Rate for Payer: Aetna Medicare |
$1.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.40
|
| Rate for Payer: BCBS Complete |
$1.48
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cofinity Commercial |
$2.58
|
| Rate for Payer: Cofinity Commercial |
$3.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.95
|
| Rate for Payer: Healthscope Commercial |
$3.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.14
|
| Rate for Payer: PHP Commercial |
$3.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.40
|
| Rate for Payer: Priority Health SBD |
$2.32
|
| Rate for Payer: UMR Bronson Commercial |
$1.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.77
|
|
|
WARFARIN 2 MG TABLET
|
Facility
|
OP
|
$201.40
|
|
|
Service Code
|
NDC 51672402801
|
| Hospital Charge Code |
8749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.52 |
| Max. Negotiated Rate |
$181.26 |
| Rate for Payer: Aetna American Axle |
$130.91
|
| Rate for Payer: Aetna Commercial |
$171.19
|
| Rate for Payer: Aetna Medicare |
$100.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.91
|
| Rate for Payer: BCBS Complete |
$80.56
|
| Rate for Payer: Cash Price |
$161.12
|
| Rate for Payer: Cofinity Commercial |
$140.98
|
| Rate for Payer: Cofinity Commercial |
$173.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.12
|
| Rate for Payer: Healthscope Commercial |
$181.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.19
|
| Rate for Payer: PHP Commercial |
$171.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.91
|
| Rate for Payer: Priority Health SBD |
$126.88
|
| Rate for Payer: UMR Bronson Commercial |
$74.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.05
|
|
|
WARFARIN 2 MG TABLET
|
Facility
|
OP
|
$236.55
|
|
|
Service Code
|
NDC 62584098411
|
| Hospital Charge Code |
8749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.52 |
| Max. Negotiated Rate |
$212.90 |
| Rate for Payer: Aetna American Axle |
$153.76
|
| Rate for Payer: Aetna Commercial |
$201.07
|
| Rate for Payer: Aetna Medicare |
$118.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.76
|
| Rate for Payer: BCBS Complete |
$94.62
|
| Rate for Payer: Cash Price |
$189.24
|
| Rate for Payer: Cofinity Commercial |
$165.58
|
| Rate for Payer: Cofinity Commercial |
$203.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$165.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.24
|
| Rate for Payer: Healthscope Commercial |
$212.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.07
|
| Rate for Payer: PHP Commercial |
$201.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.76
|
| Rate for Payer: Priority Health SBD |
$149.03
|
| Rate for Payer: UMR Bronson Commercial |
$87.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.41
|
|
|
WARFARIN 2 MG TABLET
|
Facility
|
OP
|
$236.55
|
|
|
Service Code
|
NDC 62584098401
|
| Hospital Charge Code |
8749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.52 |
| Max. Negotiated Rate |
$212.90 |
| Rate for Payer: Aetna American Axle |
$153.76
|
| Rate for Payer: Aetna Commercial |
$201.07
|
| Rate for Payer: Aetna Medicare |
$118.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.76
|
| Rate for Payer: BCBS Complete |
$94.62
|
| Rate for Payer: Cash Price |
$189.24
|
| Rate for Payer: Cofinity Commercial |
$165.58
|
| Rate for Payer: Cofinity Commercial |
$203.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$165.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.24
|
| Rate for Payer: Healthscope Commercial |
$212.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.07
|
| Rate for Payer: PHP Commercial |
$201.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.76
|
| Rate for Payer: Priority Health SBD |
$149.03
|
| Rate for Payer: UMR Bronson Commercial |
$87.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.41
|
|
|
WARFARIN 2 MG TABLET
|
Facility
|
IP
|
$236.55
|
|
|
Service Code
|
NDC 62584098411
|
| Hospital Charge Code |
8749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.08 |
| Max. Negotiated Rate |
$212.90 |
| Rate for Payer: Aetna American Axle |
$153.76
|
| Rate for Payer: Aetna Commercial |
$201.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.76
|
| Rate for Payer: Cash Price |
$189.24
|
| Rate for Payer: Cofinity Commercial |
$165.58
|
| Rate for Payer: Cofinity Commercial |
$203.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$165.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.24
|
| Rate for Payer: Healthscope Commercial |
$212.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.07
|
| Rate for Payer: PHP Commercial |
$201.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.76
|
| Rate for Payer: Priority Health SBD |
$149.03
|
| Rate for Payer: UMR Bronson Commercial |
$104.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.41
|
|
|
WARFARIN 2 MG TABLET
|
Facility
|
IP
|
$201.40
|
|
|
Service Code
|
NDC 51672402801
|
| Hospital Charge Code |
8749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.62 |
| Max. Negotiated Rate |
$181.26 |
| Rate for Payer: Aetna American Axle |
$130.91
|
| Rate for Payer: Aetna Commercial |
$171.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.91
|
| Rate for Payer: Cash Price |
$161.12
|
| Rate for Payer: Cofinity Commercial |
$140.98
|
| Rate for Payer: Cofinity Commercial |
$173.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.12
|
| Rate for Payer: Healthscope Commercial |
$181.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.19
|
| Rate for Payer: PHP Commercial |
$171.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.91
|
| Rate for Payer: Priority Health SBD |
$126.88
|
| Rate for Payer: UMR Bronson Commercial |
$88.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.05
|
|
|
WARFARIN 2 MG TABLET
|
Facility
|
IP
|
$236.55
|
|
|
Service Code
|
NDC 62584098401
|
| Hospital Charge Code |
8749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.08 |
| Max. Negotiated Rate |
$212.90 |
| Rate for Payer: Aetna American Axle |
$153.76
|
| Rate for Payer: Aetna Commercial |
$201.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.76
|
| Rate for Payer: Cash Price |
$189.24
|
| Rate for Payer: Cofinity Commercial |
$165.58
|
| Rate for Payer: Cofinity Commercial |
$203.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$165.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.24
|
| Rate for Payer: Healthscope Commercial |
$212.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.07
|
| Rate for Payer: PHP Commercial |
$201.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.76
|
| Rate for Payer: Priority Health SBD |
$149.03
|
| Rate for Payer: UMR Bronson Commercial |
$104.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.41
|
|
|
WARFARIN 5 MG TABLET
|
Facility
|
OP
|
$2.28
|
|
|
Service Code
|
NDC 62584099411
|
| Hospital Charge Code |
8751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$2.05 |
| Rate for Payer: Aetna American Axle |
$1.48
|
| Rate for Payer: Aetna Commercial |
$1.94
|
| Rate for Payer: Aetna Medicare |
$1.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.48
|
| Rate for Payer: BCBS Complete |
$0.91
|
| Rate for Payer: Cash Price |
$1.82
|
| Rate for Payer: Cofinity Commercial |
$1.60
|
| Rate for Payer: Cofinity Commercial |
$1.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.82
|
| Rate for Payer: Healthscope Commercial |
$2.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.94
|
| Rate for Payer: PHP Commercial |
$1.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.48
|
| Rate for Payer: Priority Health SBD |
$1.44
|
| Rate for Payer: UMR Bronson Commercial |
$0.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.71
|
|
|
WARFARIN 5 MG TABLET
|
Facility
|
IP
|
$2.28
|
|
|
Service Code
|
NDC 62584099411
|
| Hospital Charge Code |
8751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$2.05 |
| Rate for Payer: Aetna American Axle |
$1.48
|
| Rate for Payer: Aetna Commercial |
$1.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.48
|
| Rate for Payer: Cash Price |
$1.82
|
| Rate for Payer: Cofinity Commercial |
$1.60
|
| Rate for Payer: Cofinity Commercial |
$1.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.82
|
| Rate for Payer: Healthscope Commercial |
$2.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.94
|
| Rate for Payer: PHP Commercial |
$1.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.48
|
| Rate for Payer: Priority Health SBD |
$1.44
|
| Rate for Payer: UMR Bronson Commercial |
$1.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.71
|
|
|
WARFARIN 5 MG TABLET
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
NDC 62584099401
|
| Hospital Charge Code |
8751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.32 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Aetna American Axle |
$148.20
|
| Rate for Payer: Aetna Commercial |
$193.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.20
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cofinity Commercial |
$159.60
|
| Rate for Payer: Cofinity Commercial |
$196.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$159.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.40
|
| Rate for Payer: Healthscope Commercial |
$205.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$159.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.80
|
| Rate for Payer: PHP Commercial |
$193.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.20
|
| Rate for Payer: Priority Health SBD |
$143.64
|
| Rate for Payer: UMR Bronson Commercial |
$100.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.00
|
|
|
WARFARIN 5 MG TABLET
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
NDC 62584099401
|
| Hospital Charge Code |
8751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.36 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Aetna American Axle |
$148.20
|
| Rate for Payer: Aetna Commercial |
$193.80
|
| Rate for Payer: Aetna Medicare |
$114.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.20
|
| Rate for Payer: BCBS Complete |
$91.20
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cofinity Commercial |
$159.60
|
| Rate for Payer: Cofinity Commercial |
$196.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$159.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.40
|
| Rate for Payer: Healthscope Commercial |
$205.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$159.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.80
|
| Rate for Payer: PHP Commercial |
$193.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.20
|
| Rate for Payer: Priority Health SBD |
$143.64
|
| Rate for Payer: UMR Bronson Commercial |
$84.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.00
|
|
|
WATER FOR INJECTION, BACTERIOSTATIC INJECTION SOLUTION
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
NDC 00409397703
|
| Hospital Charge Code |
864
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.80 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna American Axle |
$29.25
|
| Rate for Payer: Aetna Commercial |
$38.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.25
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$31.50
|
| Rate for Payer: Cofinity Commercial |
$38.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.00
|
| Rate for Payer: Healthscope Commercial |
$40.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.25
|
| Rate for Payer: PHP Commercial |
$38.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.25
|
| Rate for Payer: Priority Health SBD |
$28.35
|
| Rate for Payer: UMR Bronson Commercial |
$19.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.75
|
|
|
WATER FOR INJECTION, BACTERIOSTATIC INJECTION SOLUTION
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
NDC 00409397703
|
| Hospital Charge Code |
864
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna American Axle |
$29.25
|
| Rate for Payer: Aetna Commercial |
$38.25
|
| Rate for Payer: Aetna Medicare |
$22.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.25
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$31.50
|
| Rate for Payer: Cofinity Commercial |
$38.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.00
|
| Rate for Payer: Healthscope Commercial |
$40.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.25
|
| Rate for Payer: PHP Commercial |
$38.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.25
|
| Rate for Payer: Priority Health SBD |
$28.35
|
| Rate for Payer: UMR Bronson Commercial |
$16.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.75
|
|
|
WATER FOR INJECTION, BACTERIOSTATIC INJECTION SOLUTION
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
NDC 00409397701
|
| Hospital Charge Code |
864
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna American Axle |
$29.25
|
| Rate for Payer: Aetna Commercial |
$38.25
|
| Rate for Payer: Aetna Medicare |
$22.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.25
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$31.50
|
| Rate for Payer: Cofinity Commercial |
$38.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.00
|
| Rate for Payer: Healthscope Commercial |
$40.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.25
|
| Rate for Payer: PHP Commercial |
$38.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.25
|
| Rate for Payer: Priority Health SBD |
$28.35
|
| Rate for Payer: UMR Bronson Commercial |
$16.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.75
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$26.83
|
|
|
Service Code
|
NDC 00409488724
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.81 |
| Max. Negotiated Rate |
$24.15 |
| Rate for Payer: Aetna American Axle |
$17.44
|
| Rate for Payer: Aetna Commercial |
$22.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.44
|
| Rate for Payer: Cash Price |
$21.46
|
| Rate for Payer: Cofinity Commercial |
$18.78
|
| Rate for Payer: Cofinity Commercial |
$23.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.46
|
| Rate for Payer: Healthscope Commercial |
$24.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.81
|
| Rate for Payer: PHP Commercial |
$22.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.44
|
| Rate for Payer: Priority Health SBD |
$16.90
|
| Rate for Payer: UMR Bronson Commercial |
$11.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.12
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$18.12
|
|
|
Service Code
|
NDC 63323018510
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$16.31 |
| Rate for Payer: Aetna American Axle |
$11.78
|
| Rate for Payer: Aetna Commercial |
$15.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.78
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cofinity Commercial |
$12.68
|
| Rate for Payer: Cofinity Commercial |
$15.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.50
|
| Rate for Payer: Healthscope Commercial |
$16.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.40
|
| Rate for Payer: PHP Commercial |
$15.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.78
|
| Rate for Payer: Priority Health SBD |
$11.42
|
| Rate for Payer: UMR Bronson Commercial |
$7.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.59
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$18.12
|
|
|
Service Code
|
NDC 72572074701
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$16.31 |
| Rate for Payer: Aetna American Axle |
$11.78
|
| Rate for Payer: Aetna Commercial |
$15.40
|
| Rate for Payer: Aetna Medicare |
$9.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.78
|
| Rate for Payer: BCBS Complete |
$7.25
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cofinity Commercial |
$12.68
|
| Rate for Payer: Cofinity Commercial |
$15.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.50
|
| Rate for Payer: Healthscope Commercial |
$16.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.40
|
| Rate for Payer: PHP Commercial |
$15.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.78
|
| Rate for Payer: Priority Health SBD |
$11.42
|
| Rate for Payer: UMR Bronson Commercial |
$6.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.59
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$13.75
|
|
|
Service Code
|
NDC 00409488717
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$12.38 |
| Rate for Payer: Aetna American Axle |
$8.94
|
| Rate for Payer: Aetna Commercial |
$11.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.94
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cofinity Commercial |
$11.82
|
| Rate for Payer: Cofinity Commercial |
$9.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.00
|
| Rate for Payer: Healthscope Commercial |
$12.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.69
|
| Rate for Payer: PHP Commercial |
$11.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.94
|
| Rate for Payer: Priority Health SBD |
$8.66
|
| Rate for Payer: UMR Bronson Commercial |
$6.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.31
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$14.79
|
|
|
Service Code
|
NDC 00409488723
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$13.31 |
| Rate for Payer: Aetna American Axle |
$9.61
|
| Rate for Payer: Aetna Commercial |
$12.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.61
|
| Rate for Payer: Cash Price |
$11.83
|
| Rate for Payer: Cofinity Commercial |
$10.35
|
| Rate for Payer: Cofinity Commercial |
$12.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.83
|
| Rate for Payer: Healthscope Commercial |
$13.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.57
|
| Rate for Payer: PHP Commercial |
$12.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.61
|
| Rate for Payer: Priority Health SBD |
$9.32
|
| Rate for Payer: UMR Bronson Commercial |
$6.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.09
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$19.14
|
|
|
Service Code
|
NDC 00409488725
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$17.23 |
| Rate for Payer: Aetna American Axle |
$12.44
|
| Rate for Payer: Aetna Commercial |
$16.27
|
| Rate for Payer: Aetna Medicare |
$9.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.44
|
| Rate for Payer: BCBS Complete |
$7.66
|
| Rate for Payer: Cash Price |
$15.31
|
| Rate for Payer: Cofinity Commercial |
$13.40
|
| Rate for Payer: Cofinity Commercial |
$16.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.31
|
| Rate for Payer: Healthscope Commercial |
$17.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.27
|
| Rate for Payer: PHP Commercial |
$16.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.44
|
| Rate for Payer: Priority Health SBD |
$12.06
|
| Rate for Payer: UMR Bronson Commercial |
$7.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.36
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$19.14
|
|
|
Service Code
|
NDC 00409488725
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.42 |
| Max. Negotiated Rate |
$17.23 |
| Rate for Payer: Aetna American Axle |
$12.44
|
| Rate for Payer: Aetna Commercial |
$16.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.44
|
| Rate for Payer: Cash Price |
$15.31
|
| Rate for Payer: Cofinity Commercial |
$13.40
|
| Rate for Payer: Cofinity Commercial |
$16.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.31
|
| Rate for Payer: Healthscope Commercial |
$17.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.27
|
| Rate for Payer: PHP Commercial |
$16.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.44
|
| Rate for Payer: Priority Health SBD |
$12.06
|
| Rate for Payer: UMR Bronson Commercial |
$8.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.36
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$23.68
|
|
|
Service Code
|
NDC 63323018520
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$21.31 |
| Rate for Payer: Aetna American Axle |
$15.39
|
| Rate for Payer: Aetna Commercial |
$20.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.39
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cofinity Commercial |
$16.58
|
| Rate for Payer: Cofinity Commercial |
$20.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.94
|
| Rate for Payer: Healthscope Commercial |
$21.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.13
|
| Rate for Payer: PHP Commercial |
$20.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.39
|
| Rate for Payer: Priority Health SBD |
$14.92
|
| Rate for Payer: UMR Bronson Commercial |
$10.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.76
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$21.46
|
|
|
Service Code
|
NDC 00517301001
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$19.31 |
| Rate for Payer: Aetna American Axle |
$13.95
|
| Rate for Payer: Aetna Commercial |
$18.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.95
|
| Rate for Payer: Cash Price |
$17.17
|
| Rate for Payer: Cofinity Commercial |
$15.02
|
| Rate for Payer: Cofinity Commercial |
$18.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.17
|
| Rate for Payer: Healthscope Commercial |
$19.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.24
|
| Rate for Payer: PHP Commercial |
$18.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.95
|
| Rate for Payer: Priority Health SBD |
$13.52
|
| Rate for Payer: UMR Bronson Commercial |
$9.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.10
|
|
