|
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
|
|
|
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
|
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
|
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
|
$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
|
|
|
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 |
$25.43 |
| 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 |
$19.77
|
| Rate for Payer: Cofinity Commercial |
$24.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.60
|
| Rate for Payer: Healthscope Commercial |
$25.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.77
|
| 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 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 |
$25.43 |
| 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 |
$19.77
|
| Rate for Payer: Cofinity Commercial |
$24.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.60
|
| Rate for Payer: Healthscope Commercial |
$25.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.77
|
| 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 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
|
|
|
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
|
|
|
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
|
|
|
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
|
|
|
CARDIOVERSION, ELECTIVE, ELECTRICAL CONVERSION OF ARRHYTHMIA; EXTERNAL
|
Facility
|
OP
|
$1,796.47
|
|
|
Service Code
|
CPT 92960
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$342.08 |
| Max. Negotiated Rate |
$1,796.47 |
| Rate for Payer: Aetna Medicare |
$663.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$797.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$797.75
|
| Rate for Payer: BCBS Complete |
$359.18
|
| Rate for Payer: BCBS MAPPO |
$638.20
|
| Rate for Payer: BCN Medicare Advantage |
$638.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$638.20
|
| Rate for Payer: Mclaren Medicaid |
$342.08
|
| Rate for Payer: Mclaren Medicare |
$638.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$670.11
|
| Rate for Payer: Meridian Medicaid |
$359.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$733.93
|
| Rate for Payer: PACE Medicare |
$606.29
|
| Rate for Payer: PACE SWMI |
$638.20
|
| Rate for Payer: PHP Medicare Advantage |
$638.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.08
|
| Rate for Payer: Priority Health Medicare |
$638.20
|
| Rate for Payer: Railroad Medicare Medicare |
$638.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,796.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$638.20
|
| Rate for Payer: UHC Exchange |
$1,219.66
|
| Rate for Payer: UHC Medicare Advantage |
$638.20
|
| Rate for Payer: UHCCP Medicaid |
$342.08
|
| Rate for Payer: VA VA |
$638.20
|
|
|
CARFILZOMIB 60 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$15,880.42
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
161768
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.83 |
| Max. Negotiated Rate |
$14,292.38 |
| Rate for Payer: Aetna American Axle |
$10,322.27
|
| Rate for Payer: Aetna Commercial |
$13,498.36
|
| Rate for Payer: Aetna Medicare |
$57.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,322.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69.56
|
| Rate for Payer: BCBS Complete |
$31.32
|
| Rate for Payer: BCBS MAPPO |
$55.65
|
| Rate for Payer: BCN Medicare Advantage |
$55.65
|
| Rate for Payer: Cash Price |
$12,704.34
|
| Rate for Payer: Cash Price |
$12,704.34
|
| Rate for Payer: Cofinity Commercial |
$13,657.16
|
| Rate for Payer: Cofinity Commercial |
$11,116.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$11,116.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,704.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.65
|
| Rate for Payer: Healthscope Commercial |
$14,292.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,116.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,910.32
|
| Rate for Payer: Mclaren Medicaid |
$29.83
|
| Rate for Payer: Mclaren Medicare |
$55.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.43
|
| Rate for Payer: Meridian Medicaid |
$31.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,498.36
|
| Rate for Payer: PACE Medicare |
$52.87
|
| Rate for Payer: PACE SWMI |
$55.65
|
| Rate for Payer: PHP Commercial |
$13,498.36
|
| Rate for Payer: PHP Medicare Advantage |
$55.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,322.27
|
| Rate for Payer: Priority Health Medicare |
$55.65
|
| Rate for Payer: Priority Health SBD |
$10,004.66
|
| Rate for Payer: Railroad Medicare Medicare |
$55.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.65
|
| Rate for Payer: UHC Exchange |
$106.35
|
| Rate for Payer: UHC Medicare Advantage |
$55.65
|
| Rate for Payer: UHCCP Medicaid |
$29.83
|
| Rate for Payer: UMR Bronson Commercial |
$5,875.76
|
| Rate for Payer: VA VA |
$55.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,910.32
|
|
|
CARFILZOMIB 60 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$15,880.42
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
161768
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,987.38 |
| Max. Negotiated Rate |
$14,292.38 |
| Rate for Payer: Aetna American Axle |
$10,322.27
|
| Rate for Payer: Aetna Commercial |
$13,498.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,322.27
|
| Rate for Payer: Cash Price |
$12,704.34
|
| Rate for Payer: Cofinity Commercial |
$11,116.29
|
| Rate for Payer: Cofinity Commercial |
$13,657.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$11,116.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,704.34
|
| Rate for Payer: Healthscope Commercial |
$14,292.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,116.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,910.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,498.36
|
| Rate for Payer: PHP Commercial |
$13,498.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,322.27
|
| Rate for Payer: Priority Health SBD |
$10,004.66
|
| Rate for Payer: UMR Bronson Commercial |
$6,987.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,910.32
|
|
|
CARIPRAZINE 1.5 MG CAPSULE
|
Facility
|
IP
|
$1,741.30
|
|
|
Service Code
|
NDC 61874011511
|
| Hospital Charge Code |
177102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$766.17 |
| Max. Negotiated Rate |
$1,567.17 |
| Rate for Payer: Aetna American Axle |
$1,131.85
|
| Rate for Payer: Aetna Commercial |
$1,480.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,131.85
|
| Rate for Payer: Cash Price |
$1,393.04
|
| Rate for Payer: Cofinity Commercial |
$1,218.91
|
| Rate for Payer: Cofinity Commercial |
$1,497.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,218.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,393.04
|
| Rate for Payer: Healthscope Commercial |
$1,567.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,218.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,305.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,480.11
|
| Rate for Payer: PHP Commercial |
$1,480.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,131.85
|
| Rate for Payer: Priority Health SBD |
$1,097.02
|
| Rate for Payer: UMR Bronson Commercial |
$766.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,305.97
|
|
|
CARIPRAZINE 1.5 MG CAPSULE
|
Facility
|
OP
|
$3,482.59
|
|
|
Service Code
|
NDC 61874011520
|
| Hospital Charge Code |
177102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,288.56 |
| Max. Negotiated Rate |
$3,134.33 |
| Rate for Payer: Aetna American Axle |
$2,263.68
|
| Rate for Payer: Aetna Commercial |
$2,960.20
|
| Rate for Payer: Aetna Medicare |
$1,741.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,263.68
|
| Rate for Payer: BCBS Complete |
$1,393.04
|
| Rate for Payer: Cash Price |
$2,786.07
|
| Rate for Payer: Cofinity Commercial |
$2,437.81
|
| Rate for Payer: Cofinity Commercial |
$2,995.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,437.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,786.07
|
| Rate for Payer: Healthscope Commercial |
$3,134.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,437.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,611.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,960.20
|
| Rate for Payer: PHP Commercial |
$2,960.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,263.68
|
| Rate for Payer: Priority Health SBD |
$2,194.03
|
| Rate for Payer: UMR Bronson Commercial |
$1,288.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,611.94
|
|
|
CARIPRAZINE 1.5 MG CAPSULE
|
Facility
|
OP
|
$5,223.89
|
|
|
Service Code
|
NDC 61874011530
|
| Hospital Charge Code |
177102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,932.84 |
| Max. Negotiated Rate |
$4,701.50 |
| Rate for Payer: Aetna American Axle |
$3,395.53
|
| Rate for Payer: Aetna Commercial |
$4,440.31
|
| Rate for Payer: Aetna Medicare |
$2,611.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,395.53
|
| Rate for Payer: BCBS Complete |
$2,089.56
|
| Rate for Payer: Cash Price |
$4,179.11
|
| Rate for Payer: Cofinity Commercial |
$3,656.72
|
| Rate for Payer: Cofinity Commercial |
$4,492.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,656.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,179.11
|
| Rate for Payer: Healthscope Commercial |
$4,701.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,656.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,917.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,440.31
|
| Rate for Payer: PHP Commercial |
$4,440.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,395.53
|
| Rate for Payer: Priority Health SBD |
$3,291.05
|
| Rate for Payer: UMR Bronson Commercial |
$1,932.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,917.92
|
|
|
CARIPRAZINE 1.5 MG CAPSULE
|
Facility
|
IP
|
$5,223.89
|
|
|
Service Code
|
NDC 61874011530
|
| Hospital Charge Code |
177102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,298.51 |
| Max. Negotiated Rate |
$4,701.50 |
| Rate for Payer: Aetna American Axle |
$3,395.53
|
| Rate for Payer: Aetna Commercial |
$4,440.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,395.53
|
| Rate for Payer: Cash Price |
$4,179.11
|
| Rate for Payer: Cofinity Commercial |
$3,656.72
|
| Rate for Payer: Cofinity Commercial |
$4,492.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,656.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,179.11
|
| Rate for Payer: Healthscope Commercial |
$4,701.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,656.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,917.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,440.31
|
| Rate for Payer: PHP Commercial |
$4,440.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,395.53
|
| Rate for Payer: Priority Health SBD |
$3,291.05
|
| Rate for Payer: UMR Bronson Commercial |
$2,298.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,917.92
|
|
|
CARIPRAZINE 1.5 MG CAPSULE
|
Facility
|
IP
|
$3,482.59
|
|
|
Service Code
|
NDC 61874011520
|
| Hospital Charge Code |
177102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,532.34 |
| Max. Negotiated Rate |
$3,134.33 |
| Rate for Payer: Aetna American Axle |
$2,263.68
|
| Rate for Payer: Aetna Commercial |
$2,960.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,263.68
|
| Rate for Payer: Cash Price |
$2,786.07
|
| Rate for Payer: Cofinity Commercial |
$2,437.81
|
| Rate for Payer: Cofinity Commercial |
$2,995.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,437.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,786.07
|
| Rate for Payer: Healthscope Commercial |
$3,134.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,437.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,611.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,960.20
|
| Rate for Payer: PHP Commercial |
$2,960.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,263.68
|
| Rate for Payer: Priority Health SBD |
$2,194.03
|
| Rate for Payer: UMR Bronson Commercial |
$1,532.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,611.94
|
|
|
CARIPRAZINE 1.5 MG CAPSULE
|
Facility
|
OP
|
$1,741.30
|
|
|
Service Code
|
NDC 61874011511
|
| Hospital Charge Code |
177102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$644.28 |
| Max. Negotiated Rate |
$1,567.17 |
| Rate for Payer: Aetna American Axle |
$1,131.85
|
| Rate for Payer: Aetna Commercial |
$1,480.11
|
| Rate for Payer: Aetna Medicare |
$870.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,131.85
|
| Rate for Payer: BCBS Complete |
$696.52
|
| Rate for Payer: Cash Price |
$1,393.04
|
| Rate for Payer: Cofinity Commercial |
$1,218.91
|
| Rate for Payer: Cofinity Commercial |
$1,497.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,218.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,393.04
|
| Rate for Payer: Healthscope Commercial |
$1,567.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,218.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,305.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,480.11
|
| Rate for Payer: PHP Commercial |
$1,480.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,131.85
|
| Rate for Payer: Priority Health SBD |
$1,097.02
|
| Rate for Payer: UMR Bronson Commercial |
$644.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,305.97
|
|
|
CARIPRAZINE 3 MG CAPSULE
|
Facility
|
OP
|
$5,223.89
|
|
|
Service Code
|
NDC 61874013030
|
| Hospital Charge Code |
177103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,932.84 |
| Max. Negotiated Rate |
$4,701.50 |
| Rate for Payer: Aetna American Axle |
$3,395.53
|
| Rate for Payer: Aetna Commercial |
$4,440.31
|
| Rate for Payer: Aetna Medicare |
$2,611.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,395.53
|
| Rate for Payer: BCBS Complete |
$2,089.56
|
| Rate for Payer: Cash Price |
$4,179.11
|
| Rate for Payer: Cofinity Commercial |
$3,656.72
|
| Rate for Payer: Cofinity Commercial |
$4,492.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,656.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,179.11
|
| Rate for Payer: Healthscope Commercial |
$4,701.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,656.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,917.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,440.31
|
| Rate for Payer: PHP Commercial |
$4,440.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,395.53
|
| Rate for Payer: Priority Health SBD |
$3,291.05
|
| Rate for Payer: UMR Bronson Commercial |
$1,932.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,917.92
|
|
|
CARIPRAZINE 3 MG CAPSULE
|
Facility
|
IP
|
$1,741.30
|
|
|
Service Code
|
NDC 61874013011
|
| Hospital Charge Code |
177103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$766.17 |
| Max. Negotiated Rate |
$1,567.17 |
| Rate for Payer: Aetna American Axle |
$1,131.85
|
| Rate for Payer: Aetna Commercial |
$1,480.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,131.85
|
| Rate for Payer: Cash Price |
$1,393.04
|
| Rate for Payer: Cofinity Commercial |
$1,218.91
|
| Rate for Payer: Cofinity Commercial |
$1,497.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,218.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,393.04
|
| Rate for Payer: Healthscope Commercial |
$1,567.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,218.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,305.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,480.11
|
| Rate for Payer: PHP Commercial |
$1,480.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,131.85
|
| Rate for Payer: Priority Health SBD |
$1,097.02
|
| Rate for Payer: UMR Bronson Commercial |
$766.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,305.97
|
|
|
CARIPRAZINE 3 MG CAPSULE
|
Facility
|
IP
|
$3,482.59
|
|
|
Service Code
|
NDC 61874013020
|
| Hospital Charge Code |
177103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,532.34 |
| Max. Negotiated Rate |
$3,134.33 |
| Rate for Payer: Aetna American Axle |
$2,263.68
|
| Rate for Payer: Aetna Commercial |
$2,960.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,263.68
|
| Rate for Payer: Cash Price |
$2,786.07
|
| Rate for Payer: Cofinity Commercial |
$2,437.81
|
| Rate for Payer: Cofinity Commercial |
$2,995.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,437.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,786.07
|
| Rate for Payer: Healthscope Commercial |
$3,134.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,437.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,611.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,960.20
|
| Rate for Payer: PHP Commercial |
$2,960.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,263.68
|
| Rate for Payer: Priority Health SBD |
$2,194.03
|
| Rate for Payer: UMR Bronson Commercial |
$1,532.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,611.94
|
|
|
CARIPRAZINE 3 MG CAPSULE
|
Facility
|
OP
|
$1,741.30
|
|
|
Service Code
|
NDC 61874013011
|
| Hospital Charge Code |
177103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$644.28 |
| Max. Negotiated Rate |
$1,567.17 |
| Rate for Payer: Aetna American Axle |
$1,131.85
|
| Rate for Payer: Aetna Commercial |
$1,480.11
|
| Rate for Payer: Aetna Medicare |
$870.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,131.85
|
| Rate for Payer: BCBS Complete |
$696.52
|
| Rate for Payer: Cash Price |
$1,393.04
|
| Rate for Payer: Cofinity Commercial |
$1,218.91
|
| Rate for Payer: Cofinity Commercial |
$1,497.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,218.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,393.04
|
| Rate for Payer: Healthscope Commercial |
$1,567.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,218.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,305.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,480.11
|
| Rate for Payer: PHP Commercial |
$1,480.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,131.85
|
| Rate for Payer: Priority Health SBD |
$1,097.02
|
| Rate for Payer: UMR Bronson Commercial |
$644.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,305.97
|
|
|
CARIPRAZINE 3 MG CAPSULE
|
Facility
|
OP
|
$3,482.59
|
|
|
Service Code
|
NDC 61874013020
|
| Hospital Charge Code |
177103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,288.56 |
| Max. Negotiated Rate |
$3,134.33 |
| Rate for Payer: Aetna American Axle |
$2,263.68
|
| Rate for Payer: Aetna Commercial |
$2,960.20
|
| Rate for Payer: Aetna Medicare |
$1,741.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,263.68
|
| Rate for Payer: BCBS Complete |
$1,393.04
|
| Rate for Payer: Cash Price |
$2,786.07
|
| Rate for Payer: Cofinity Commercial |
$2,437.81
|
| Rate for Payer: Cofinity Commercial |
$2,995.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,437.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,786.07
|
| Rate for Payer: Healthscope Commercial |
$3,134.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,437.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,611.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,960.20
|
| Rate for Payer: PHP Commercial |
$2,960.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,263.68
|
| Rate for Payer: Priority Health SBD |
$2,194.03
|
| Rate for Payer: UMR Bronson Commercial |
$1,288.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,611.94
|
|
