|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$195.73
|
|
|
Service Code
|
NDC 70121168007
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$72.42 |
| Max. Negotiated Rate |
$176.16 |
| Rate for Payer: Aetna American Axle |
$127.22
|
| Rate for Payer: Aetna Commercial |
$166.37
|
| Rate for Payer: Aetna Medicare |
$97.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.22
|
| Rate for Payer: BCBS Complete |
$78.29
|
| Rate for Payer: Cash Price |
$156.58
|
| Rate for Payer: Cofinity Commercial |
$137.01
|
| Rate for Payer: Cofinity Commercial |
$168.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.58
|
| Rate for Payer: Healthscope Commercial |
$176.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.37
|
| Rate for Payer: PHP Commercial |
$166.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.22
|
| Rate for Payer: Priority Health SBD |
$123.31
|
| Rate for Payer: UMR Bronson Commercial |
$72.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.80
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$202.73
|
|
|
Service Code
|
NDC 55150045910
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$89.20 |
| Max. Negotiated Rate |
$182.46 |
| Rate for Payer: Aetna American Axle |
$131.77
|
| Rate for Payer: Aetna Commercial |
$172.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.77
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Cofinity Commercial |
$141.91
|
| Rate for Payer: Cofinity Commercial |
$174.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$141.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.18
|
| Rate for Payer: Healthscope Commercial |
$182.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$141.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.32
|
| Rate for Payer: PHP Commercial |
$172.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.77
|
| Rate for Payer: Priority Health SBD |
$127.72
|
| Rate for Payer: UMR Bronson Commercial |
$89.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.05
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$164.59
|
|
|
Service Code
|
NDC 43598069858
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$72.42 |
| Max. Negotiated Rate |
$148.13 |
| Rate for Payer: Aetna American Axle |
$106.98
|
| Rate for Payer: Aetna Commercial |
$139.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.98
|
| Rate for Payer: Cash Price |
$131.67
|
| Rate for Payer: Cofinity Commercial |
$115.21
|
| Rate for Payer: Cofinity Commercial |
$141.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.67
|
| Rate for Payer: Healthscope Commercial |
$148.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.90
|
| Rate for Payer: PHP Commercial |
$139.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.98
|
| Rate for Payer: Priority Health SBD |
$103.69
|
| Rate for Payer: UMR Bronson Commercial |
$72.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.44
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$156.56
|
|
|
Service Code
|
NDC 43598069811
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$57.93 |
| Max. Negotiated Rate |
$140.90 |
| Rate for Payer: Aetna American Axle |
$101.76
|
| Rate for Payer: Aetna Commercial |
$133.08
|
| Rate for Payer: Aetna Medicare |
$78.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.76
|
| Rate for Payer: BCBS Complete |
$62.62
|
| Rate for Payer: Cash Price |
$125.25
|
| Rate for Payer: Cofinity Commercial |
$109.59
|
| Rate for Payer: Cofinity Commercial |
$134.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.25
|
| Rate for Payer: Healthscope Commercial |
$140.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.08
|
| Rate for Payer: PHP Commercial |
$133.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.76
|
| Rate for Payer: Priority Health SBD |
$98.63
|
| Rate for Payer: UMR Bronson Commercial |
$57.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.42
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$165.34
|
|
|
Service Code
|
NDC 70594011202
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$61.18 |
| Max. Negotiated Rate |
$148.81 |
| Rate for Payer: Aetna American Axle |
$107.47
|
| Rate for Payer: Aetna Commercial |
$140.54
|
| Rate for Payer: Aetna Medicare |
$82.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.47
|
| Rate for Payer: BCBS Complete |
$66.14
|
| Rate for Payer: Cash Price |
$132.27
|
| Rate for Payer: Cofinity Commercial |
$115.74
|
| Rate for Payer: Cofinity Commercial |
$142.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.27
|
| Rate for Payer: Healthscope Commercial |
$148.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.54
|
| Rate for Payer: PHP Commercial |
$140.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.47
|
| Rate for Payer: Priority Health SBD |
$104.16
|
| Rate for Payer: UMR Bronson Commercial |
$61.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.00
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$439.02
|
|
|
Service Code
|
NDC 00009085608
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$193.17 |
| Max. Negotiated Rate |
$395.12 |
| Rate for Payer: Aetna American Axle |
$285.36
|
| Rate for Payer: Aetna Commercial |
$373.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.36
|
| Rate for Payer: Cash Price |
$351.22
|
| Rate for Payer: Cofinity Commercial |
$307.31
|
| Rate for Payer: Cofinity Commercial |
$377.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$307.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.22
|
| Rate for Payer: Healthscope Commercial |
$395.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$307.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$329.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.17
|
| Rate for Payer: PHP Commercial |
$373.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.36
|
| Rate for Payer: Priority Health SBD |
$276.58
|
| Rate for Payer: UMR Bronson Commercial |
$193.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$329.26
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$202.73
|
|
|
Service Code
|
NDC 55150045910
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$75.01 |
| Max. Negotiated Rate |
$182.46 |
| Rate for Payer: Aetna American Axle |
$131.77
|
| Rate for Payer: Aetna Commercial |
$172.32
|
| Rate for Payer: Aetna Medicare |
$101.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.77
|
| Rate for Payer: BCBS Complete |
$81.09
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Cofinity Commercial |
$141.91
|
| Rate for Payer: Cofinity Commercial |
$174.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$141.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.18
|
| Rate for Payer: Healthscope Commercial |
$182.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$141.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.32
|
| Rate for Payer: PHP Commercial |
$172.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.77
|
| Rate for Payer: Priority Health SBD |
$127.72
|
| Rate for Payer: UMR Bronson Commercial |
$75.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.05
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$164.59
|
|
|
Service Code
|
NDC 43598069858
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$60.90 |
| Max. Negotiated Rate |
$148.13 |
| Rate for Payer: Aetna American Axle |
$106.98
|
| Rate for Payer: Aetna Commercial |
$139.90
|
| Rate for Payer: Aetna Medicare |
$82.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.98
|
| Rate for Payer: BCBS Complete |
$65.84
|
| Rate for Payer: Cash Price |
$131.67
|
| Rate for Payer: Cofinity Commercial |
$115.21
|
| Rate for Payer: Cofinity Commercial |
$141.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.67
|
| Rate for Payer: Healthscope Commercial |
$148.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.90
|
| Rate for Payer: PHP Commercial |
$139.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.98
|
| Rate for Payer: Priority Health SBD |
$103.69
|
| Rate for Payer: UMR Bronson Commercial |
$60.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.44
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$165.34
|
|
|
Service Code
|
NDC 70594011201
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$61.18 |
| Max. Negotiated Rate |
$148.81 |
| Rate for Payer: Aetna American Axle |
$107.47
|
| Rate for Payer: Aetna Commercial |
$140.54
|
| Rate for Payer: Aetna Medicare |
$82.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.47
|
| Rate for Payer: BCBS Complete |
$66.14
|
| Rate for Payer: Cash Price |
$132.27
|
| Rate for Payer: Cofinity Commercial |
$115.74
|
| Rate for Payer: Cofinity Commercial |
$142.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.27
|
| Rate for Payer: Healthscope Commercial |
$148.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.54
|
| Rate for Payer: PHP Commercial |
$140.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.47
|
| Rate for Payer: Priority Health SBD |
$104.16
|
| Rate for Payer: UMR Bronson Commercial |
$61.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.00
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$156.56
|
|
|
Service Code
|
NDC 43598069811
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$68.89 |
| Max. Negotiated Rate |
$140.90 |
| Rate for Payer: Aetna American Axle |
$101.76
|
| Rate for Payer: Aetna Commercial |
$133.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.76
|
| Rate for Payer: Cash Price |
$125.25
|
| Rate for Payer: Cofinity Commercial |
$109.59
|
| Rate for Payer: Cofinity Commercial |
$134.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.25
|
| Rate for Payer: Healthscope Commercial |
$140.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.08
|
| Rate for Payer: PHP Commercial |
$133.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.76
|
| Rate for Payer: Priority Health SBD |
$98.63
|
| Rate for Payer: UMR Bronson Commercial |
$68.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.42
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$165.34
|
|
|
Service Code
|
NDC 70594011201
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$72.75 |
| Max. Negotiated Rate |
$148.81 |
| Rate for Payer: Aetna American Axle |
$107.47
|
| Rate for Payer: Aetna Commercial |
$140.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.47
|
| Rate for Payer: Cash Price |
$132.27
|
| Rate for Payer: Cofinity Commercial |
$115.74
|
| Rate for Payer: Cofinity Commercial |
$142.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.27
|
| Rate for Payer: Healthscope Commercial |
$148.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.54
|
| Rate for Payer: PHP Commercial |
$140.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.47
|
| Rate for Payer: Priority Health SBD |
$104.16
|
| Rate for Payer: UMR Bronson Commercial |
$72.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.00
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$169.68
|
|
|
Service Code
|
NDC 71839013701
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$74.66 |
| Max. Negotiated Rate |
$152.71 |
| Rate for Payer: Aetna American Axle |
$110.29
|
| Rate for Payer: Aetna Commercial |
$144.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.29
|
| Rate for Payer: Cash Price |
$135.74
|
| Rate for Payer: Cofinity Commercial |
$118.78
|
| Rate for Payer: Cofinity Commercial |
$145.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$118.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.74
|
| Rate for Payer: Healthscope Commercial |
$152.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.23
|
| Rate for Payer: PHP Commercial |
$144.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.29
|
| Rate for Payer: Priority Health SBD |
$106.90
|
| Rate for Payer: UMR Bronson Commercial |
$74.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.26
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$439.02
|
|
|
Service Code
|
NDC 00009085608
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$162.44 |
| Max. Negotiated Rate |
$395.12 |
| Rate for Payer: Aetna American Axle |
$285.36
|
| Rate for Payer: Aetna Commercial |
$373.17
|
| Rate for Payer: Aetna Medicare |
$219.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.36
|
| Rate for Payer: BCBS Complete |
$175.61
|
| Rate for Payer: Cash Price |
$351.22
|
| Rate for Payer: Cofinity Commercial |
$307.31
|
| Rate for Payer: Cofinity Commercial |
$377.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$307.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.22
|
| Rate for Payer: Healthscope Commercial |
$395.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$307.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$329.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.17
|
| Rate for Payer: PHP Commercial |
$373.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.36
|
| Rate for Payer: Priority Health SBD |
$276.58
|
| Rate for Payer: UMR Bronson Commercial |
$162.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$329.26
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$169.68
|
|
|
Service Code
|
NDC 71839013701
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$62.78 |
| Max. Negotiated Rate |
$152.71 |
| Rate for Payer: Aetna American Axle |
$110.29
|
| Rate for Payer: Aetna Commercial |
$144.23
|
| Rate for Payer: Aetna Medicare |
$84.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.29
|
| Rate for Payer: BCBS Complete |
$67.87
|
| Rate for Payer: Cash Price |
$135.74
|
| Rate for Payer: Cofinity Commercial |
$118.78
|
| Rate for Payer: Cofinity Commercial |
$145.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$118.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.74
|
| Rate for Payer: Healthscope Commercial |
$152.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.23
|
| Rate for Payer: PHP Commercial |
$144.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.29
|
| Rate for Payer: Priority Health SBD |
$106.90
|
| Rate for Payer: UMR Bronson Commercial |
$62.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.26
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$169.68
|
|
|
Service Code
|
NDC 71839013710
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$62.78 |
| Max. Negotiated Rate |
$152.71 |
| Rate for Payer: Aetna American Axle |
$110.29
|
| Rate for Payer: Aetna Commercial |
$144.23
|
| Rate for Payer: Aetna Medicare |
$84.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.29
|
| Rate for Payer: BCBS Complete |
$67.87
|
| Rate for Payer: Cash Price |
$135.74
|
| Rate for Payer: Cofinity Commercial |
$118.78
|
| Rate for Payer: Cofinity Commercial |
$145.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$118.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.74
|
| Rate for Payer: Healthscope Commercial |
$152.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.23
|
| Rate for Payer: PHP Commercial |
$144.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.29
|
| Rate for Payer: Priority Health SBD |
$106.90
|
| Rate for Payer: UMR Bronson Commercial |
$62.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.26
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$195.73
|
|
|
Service Code
|
NDC 70121168001
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$72.42 |
| Max. Negotiated Rate |
$176.16 |
| Rate for Payer: Aetna American Axle |
$127.22
|
| Rate for Payer: Aetna Commercial |
$166.37
|
| Rate for Payer: Aetna Medicare |
$97.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.22
|
| Rate for Payer: BCBS Complete |
$78.29
|
| Rate for Payer: Cash Price |
$156.58
|
| Rate for Payer: Cofinity Commercial |
$137.01
|
| Rate for Payer: Cofinity Commercial |
$168.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.58
|
| Rate for Payer: Healthscope Commercial |
$176.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.37
|
| Rate for Payer: PHP Commercial |
$166.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.22
|
| Rate for Payer: Priority Health SBD |
$123.31
|
| Rate for Payer: UMR Bronson Commercial |
$72.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.80
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$202.73
|
|
|
Service Code
|
NDC 55150045901
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$75.01 |
| Max. Negotiated Rate |
$182.46 |
| Rate for Payer: Aetna American Axle |
$131.77
|
| Rate for Payer: Aetna Commercial |
$172.32
|
| Rate for Payer: Aetna Medicare |
$101.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.77
|
| Rate for Payer: BCBS Complete |
$81.09
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Cofinity Commercial |
$141.91
|
| Rate for Payer: Cofinity Commercial |
$174.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$141.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.18
|
| Rate for Payer: Healthscope Commercial |
$182.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$141.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.32
|
| Rate for Payer: PHP Commercial |
$172.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.77
|
| Rate for Payer: Priority Health SBD |
$127.72
|
| Rate for Payer: UMR Bronson Commercial |
$75.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.05
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$195.73
|
|
|
Service Code
|
NDC 70121168001
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$86.12 |
| Max. Negotiated Rate |
$176.16 |
| Rate for Payer: Aetna American Axle |
$127.22
|
| Rate for Payer: Aetna Commercial |
$166.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.22
|
| Rate for Payer: Cash Price |
$156.58
|
| Rate for Payer: Cofinity Commercial |
$137.01
|
| Rate for Payer: Cofinity Commercial |
$168.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.58
|
| Rate for Payer: Healthscope Commercial |
$176.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.37
|
| Rate for Payer: PHP Commercial |
$166.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.22
|
| Rate for Payer: Priority Health SBD |
$123.31
|
| Rate for Payer: UMR Bronson Commercial |
$86.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.80
|
|
|
CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS
|
Facility
|
OP
|
$28.25
|
|
|
Service Code
|
NDC 00023920515
|
| Hospital Charge Code |
27992
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.45 |
| Max. Negotiated Rate |
$25.42 |
| Rate for Payer: Aetna American Axle |
$18.36
|
| Rate for Payer: Aetna Commercial |
$24.01
|
| Rate for Payer: Aetna Medicare |
$14.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.36
|
| Rate for Payer: BCBS Complete |
$11.30
|
| Rate for Payer: Cash Price |
$22.60
|
| Rate for Payer: Cofinity Commercial |
$19.78
|
| Rate for Payer: Cofinity Commercial |
$24.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.60
|
| Rate for Payer: Healthscope Commercial |
$25.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.01
|
| Rate for Payer: PHP Commercial |
$24.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.36
|
| Rate for Payer: Priority Health SBD |
$17.80
|
| Rate for Payer: UMR Bronson Commercial |
$10.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.19
|
|
|
CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS
|
Facility
|
IP
|
$28.25
|
|
|
Service Code
|
NDC 00023920515
|
| Hospital Charge Code |
27992
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.43 |
| Max. Negotiated Rate |
$25.42 |
| Rate for Payer: Aetna American Axle |
$18.36
|
| Rate for Payer: Aetna Commercial |
$24.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.36
|
| Rate for Payer: Cash Price |
$22.60
|
| Rate for Payer: Cofinity Commercial |
$19.78
|
| Rate for Payer: Cofinity Commercial |
$24.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.60
|
| Rate for Payer: Healthscope Commercial |
$25.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.01
|
| Rate for Payer: PHP Commercial |
$24.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.36
|
| Rate for Payer: Priority Health SBD |
$17.80
|
| Rate for Payer: UMR Bronson Commercial |
$12.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.19
|
|
|
CARBOXYMETHYLCELLULOSE SODIUM EYE DROPS
|
Facility
|
IP
|
$21.77
|
|
|
Service Code
|
NDC 00023182212
|
| Hospital Charge Code |
118076
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.58 |
| Max. Negotiated Rate |
$19.59 |
| Rate for Payer: Aetna American Axle |
$14.15
|
| Rate for Payer: Aetna Commercial |
$18.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.15
|
| Rate for Payer: Cash Price |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$15.24
|
| Rate for Payer: Cofinity Commercial |
$18.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.42
|
| Rate for Payer: Healthscope Commercial |
$19.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.50
|
| Rate for Payer: PHP Commercial |
$18.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.15
|
| Rate for Payer: Priority Health SBD |
$13.72
|
| Rate for Payer: UMR Bronson Commercial |
$9.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.33
|
|
|
CARBOXYMETHYLCELLULOSE SODIUM EYE DROPS
|
Facility
|
OP
|
$21.77
|
|
|
Service Code
|
NDC 00023182212
|
| Hospital Charge Code |
118076
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.05 |
| Max. Negotiated Rate |
$19.59 |
| Rate for Payer: Aetna American Axle |
$14.15
|
| Rate for Payer: Aetna Commercial |
$18.50
|
| Rate for Payer: Aetna Medicare |
$10.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.15
|
| Rate for Payer: BCBS Complete |
$8.71
|
| Rate for Payer: Cash Price |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$15.24
|
| Rate for Payer: Cofinity Commercial |
$18.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.42
|
| Rate for Payer: Healthscope Commercial |
$19.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.50
|
| Rate for Payer: PHP Commercial |
$18.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.15
|
| Rate for Payer: Priority Health SBD |
$13.72
|
| Rate for Payer: UMR Bronson Commercial |
$8.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.33
|
|
|
CARDIOPLEGIC SOLUTION 16 MEQ/L (POTASSIUM) FOR PERFUSION
|
Facility
|
IP
|
$180.96
|
|
|
Service Code
|
NDC 00338034104
|
| Hospital Charge Code |
30275
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$79.62 |
| Max. Negotiated Rate |
$162.86 |
| Rate for Payer: Aetna American Axle |
$117.62
|
| Rate for Payer: Aetna Commercial |
$153.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.62
|
| Rate for Payer: Cash Price |
$144.77
|
| Rate for Payer: Cofinity Commercial |
$126.67
|
| Rate for Payer: Cofinity Commercial |
$155.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$126.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.77
|
| Rate for Payer: Healthscope Commercial |
$162.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.82
|
| Rate for Payer: PHP Commercial |
$153.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.62
|
| Rate for Payer: Priority Health SBD |
$114.00
|
| Rate for Payer: UMR Bronson Commercial |
$79.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.72
|
|
|
CARDIOPLEGIC SOLUTION 16 MEQ/L (POTASSIUM) FOR PERFUSION
|
Facility
|
OP
|
$180.96
|
|
|
Service Code
|
NDC 00338034104
|
| Hospital Charge Code |
30275
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$66.96 |
| Max. Negotiated Rate |
$162.86 |
| Rate for Payer: Aetna American Axle |
$117.62
|
| Rate for Payer: Aetna Commercial |
$153.82
|
| Rate for Payer: Aetna Medicare |
$90.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.62
|
| Rate for Payer: BCBS Complete |
$72.38
|
| Rate for Payer: Cash Price |
$144.77
|
| Rate for Payer: Cofinity Commercial |
$126.67
|
| Rate for Payer: Cofinity Commercial |
$155.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$126.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.77
|
| Rate for Payer: Healthscope Commercial |
$162.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.82
|
| Rate for Payer: PHP Commercial |
$153.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.62
|
| Rate for Payer: Priority Health SBD |
$114.00
|
| Rate for Payer: UMR Bronson Commercial |
$66.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.72
|
|
|
CARDIOVERSION, ELECTIVE, ELECTRICAL CONVERSION OF ARRHYTHMIA; EXTERNAL
|
Facility
|
OP
|
$2,015.13
|
|
|
Service Code
|
CPT 92960
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$101.97 |
| Max. Negotiated Rate |
$2,015.13 |
| Rate for Payer: Aetna Medicare |
$666.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$801.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$801.44
|
| Rate for Payer: BCBS Complete |
$360.84
|
| Rate for Payer: BCBS MAPPO |
$641.15
|
| Rate for Payer: BCBS Trust/PPO |
$626.86
|
| Rate for Payer: BCN Commercial |
$626.86
|
| Rate for Payer: BCN Medicare Advantage |
$641.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$641.15
|
| Rate for Payer: Mclaren Medicaid |
$343.66
|
| Rate for Payer: Mclaren Medicare |
$641.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$673.21
|
| Rate for Payer: Meridian Medicaid |
$360.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$737.32
|
| Rate for Payer: Nomi Health Commercial |
$1,923.45
|
| Rate for Payer: PACE Medicare |
$609.09
|
| Rate for Payer: PACE SWMI |
$641.15
|
| Rate for Payer: PHP Medicare Advantage |
$641.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$343.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,015.13
|
| Rate for Payer: Priority Health Medicare |
$641.15
|
| Rate for Payer: Priority Health Narrow Network |
$1,612.10
|
| Rate for Payer: Railroad Medicare Medicare |
$641.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.17
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$641.15
|
| Rate for Payer: UHC Exchange |
$101.97
|
| Rate for Payer: UHC Medicare Advantage |
$641.15
|
| Rate for Payer: UHCCP Medicaid |
$343.66
|
| Rate for Payer: VA VA |
$641.15
|
|
