|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$267.84
|
|
|
Service Code
|
NDC 62332014231
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.85 |
| Max. Negotiated Rate |
$241.06 |
| Rate for Payer: Aetna American Axle |
$174.10
|
| Rate for Payer: Aetna Commercial |
$227.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.10
|
| Rate for Payer: Cash Price |
$214.27
|
| Rate for Payer: Cofinity Commercial |
$187.49
|
| Rate for Payer: Cofinity Commercial |
$230.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.27
|
| Rate for Payer: Healthscope Commercial |
$241.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.66
|
| Rate for Payer: PHP Commercial |
$227.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.10
|
| Rate for Payer: Priority Health SBD |
$168.74
|
| Rate for Payer: UMR Bronson Commercial |
$117.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.88
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$265.05
|
|
|
Service Code
|
NDC 42571014401
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.62 |
| Max. Negotiated Rate |
$238.54 |
| Rate for Payer: Aetna American Axle |
$172.28
|
| Rate for Payer: Aetna Commercial |
$225.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.28
|
| Rate for Payer: Cash Price |
$212.04
|
| Rate for Payer: Cofinity Commercial |
$185.53
|
| Rate for Payer: Cofinity Commercial |
$227.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.04
|
| Rate for Payer: Healthscope Commercial |
$238.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.29
|
| Rate for Payer: PHP Commercial |
$225.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.28
|
| Rate for Payer: Priority Health SBD |
$166.98
|
| Rate for Payer: UMR Bronson Commercial |
$116.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.79
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
OP
|
$557.76
|
|
|
Service Code
|
NDC 60687044701
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$206.37 |
| Max. Negotiated Rate |
$501.98 |
| Rate for Payer: Aetna American Axle |
$362.54
|
| Rate for Payer: Aetna Commercial |
$474.10
|
| Rate for Payer: Aetna Medicare |
$278.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$362.54
|
| Rate for Payer: BCBS Complete |
$223.10
|
| Rate for Payer: Cash Price |
$446.21
|
| Rate for Payer: Cofinity Commercial |
$390.43
|
| Rate for Payer: Cofinity Commercial |
$479.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$390.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$446.21
|
| Rate for Payer: Healthscope Commercial |
$501.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$390.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$418.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$474.10
|
| Rate for Payer: PHP Commercial |
$474.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$362.54
|
| Rate for Payer: Priority Health SBD |
$351.39
|
| Rate for Payer: UMR Bronson Commercial |
$206.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$418.32
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
OP
|
$267.84
|
|
|
Service Code
|
NDC 62332014231
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.10 |
| Max. Negotiated Rate |
$241.06 |
| Rate for Payer: Aetna American Axle |
$174.10
|
| Rate for Payer: Aetna Commercial |
$227.66
|
| Rate for Payer: Aetna Medicare |
$133.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.10
|
| Rate for Payer: BCBS Complete |
$107.14
|
| Rate for Payer: Cash Price |
$214.27
|
| Rate for Payer: Cofinity Commercial |
$187.49
|
| Rate for Payer: Cofinity Commercial |
$230.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.27
|
| Rate for Payer: Healthscope Commercial |
$241.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.66
|
| Rate for Payer: PHP Commercial |
$227.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.10
|
| Rate for Payer: Priority Health SBD |
$168.74
|
| Rate for Payer: UMR Bronson Commercial |
$99.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.88
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
OP
|
$921.30
|
|
|
Service Code
|
NDC 51079021520
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$340.88 |
| Max. Negotiated Rate |
$829.17 |
| Rate for Payer: Aetna American Axle |
$598.85
|
| Rate for Payer: Aetna Commercial |
$783.11
|
| Rate for Payer: Aetna Medicare |
$460.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$598.85
|
| Rate for Payer: BCBS Complete |
$368.52
|
| Rate for Payer: Cash Price |
$737.04
|
| Rate for Payer: Cofinity Commercial |
$644.91
|
| Rate for Payer: Cofinity Commercial |
$792.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$644.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$737.04
|
| Rate for Payer: Healthscope Commercial |
$829.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$644.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$690.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$783.11
|
| Rate for Payer: PHP Commercial |
$783.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$598.85
|
| Rate for Payer: Priority Health SBD |
$580.42
|
| Rate for Payer: UMR Bronson Commercial |
$340.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$690.98
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$5,682.09
|
|
|
Service Code
|
NDC 00025152534
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,500.12 |
| Max. Negotiated Rate |
$5,113.88 |
| Rate for Payer: Aetna American Axle |
$3,693.36
|
| Rate for Payer: Aetna Commercial |
$4,829.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,693.36
|
| Rate for Payer: Cash Price |
$4,545.67
|
| Rate for Payer: Cofinity Commercial |
$3,977.46
|
| Rate for Payer: Cofinity Commercial |
$4,886.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,977.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,545.67
|
| Rate for Payer: Healthscope Commercial |
$5,113.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,977.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,261.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,829.78
|
| Rate for Payer: PHP Commercial |
$4,829.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,693.36
|
| Rate for Payer: Priority Health SBD |
$3,579.72
|
| Rate for Payer: UMR Bronson Commercial |
$2,500.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,261.57
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$5.58
|
|
|
Service Code
|
NDC 60687044711
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$5.02 |
| Rate for Payer: Aetna American Axle |
$3.63
|
| Rate for Payer: Aetna Commercial |
$4.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.63
|
| Rate for Payer: Cash Price |
$4.46
|
| Rate for Payer: Cofinity Commercial |
$3.91
|
| Rate for Payer: Cofinity Commercial |
$4.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.46
|
| Rate for Payer: Healthscope Commercial |
$5.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.74
|
| Rate for Payer: PHP Commercial |
$4.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.63
|
| Rate for Payer: Priority Health SBD |
$3.52
|
| Rate for Payer: UMR Bronson Commercial |
$2.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.18
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$9.22
|
|
|
Service Code
|
NDC 51079021501
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$8.30 |
| Rate for Payer: Aetna American Axle |
$5.99
|
| Rate for Payer: Aetna Commercial |
$7.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.99
|
| Rate for Payer: Cash Price |
$7.38
|
| Rate for Payer: Cofinity Commercial |
$6.45
|
| Rate for Payer: Cofinity Commercial |
$7.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.38
|
| Rate for Payer: Healthscope Commercial |
$8.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.84
|
| Rate for Payer: PHP Commercial |
$7.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.99
|
| Rate for Payer: Priority Health SBD |
$5.81
|
| Rate for Payer: UMR Bronson Commercial |
$4.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.92
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
OP
|
$265.05
|
|
|
Service Code
|
NDC 68180039901
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.07 |
| Max. Negotiated Rate |
$238.54 |
| Rate for Payer: Aetna American Axle |
$172.28
|
| Rate for Payer: Aetna Commercial |
$225.29
|
| Rate for Payer: Aetna Medicare |
$132.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.28
|
| Rate for Payer: BCBS Complete |
$106.02
|
| Rate for Payer: Cash Price |
$212.04
|
| Rate for Payer: Cofinity Commercial |
$185.53
|
| Rate for Payer: Cofinity Commercial |
$227.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.04
|
| Rate for Payer: Healthscope Commercial |
$238.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.29
|
| Rate for Payer: PHP Commercial |
$225.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.28
|
| Rate for Payer: Priority Health SBD |
$166.98
|
| Rate for Payer: UMR Bronson Commercial |
$98.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.79
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$506.40
|
|
|
Service Code
|
NDC 00904650361
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$222.82 |
| Max. Negotiated Rate |
$455.76 |
| Rate for Payer: Aetna American Axle |
$329.16
|
| Rate for Payer: Aetna Commercial |
$430.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$329.16
|
| Rate for Payer: Cash Price |
$405.12
|
| Rate for Payer: Cofinity Commercial |
$354.48
|
| Rate for Payer: Cofinity Commercial |
$435.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$354.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$405.12
|
| Rate for Payer: Healthscope Commercial |
$455.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$354.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$379.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$430.44
|
| Rate for Payer: PHP Commercial |
$430.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.16
|
| Rate for Payer: Priority Health SBD |
$319.03
|
| Rate for Payer: UMR Bronson Commercial |
$222.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$379.80
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
OP
|
$506.40
|
|
|
Service Code
|
NDC 00904650361
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$187.37 |
| Max. Negotiated Rate |
$455.76 |
| Rate for Payer: Aetna American Axle |
$329.16
|
| Rate for Payer: Aetna Commercial |
$430.44
|
| Rate for Payer: Aetna Medicare |
$253.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$329.16
|
| Rate for Payer: BCBS Complete |
$202.56
|
| Rate for Payer: Cash Price |
$405.12
|
| Rate for Payer: Cofinity Commercial |
$354.48
|
| Rate for Payer: Cofinity Commercial |
$435.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$354.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$405.12
|
| Rate for Payer: Healthscope Commercial |
$455.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$354.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$379.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$430.44
|
| Rate for Payer: PHP Commercial |
$430.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.16
|
| Rate for Payer: Priority Health SBD |
$319.03
|
| Rate for Payer: UMR Bronson Commercial |
$187.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$379.80
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
OP
|
$465.30
|
|
|
Service Code
|
NDC 69097042107
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.16 |
| Max. Negotiated Rate |
$418.77 |
| Rate for Payer: Aetna American Axle |
$302.44
|
| Rate for Payer: Aetna Commercial |
$395.50
|
| Rate for Payer: Aetna Medicare |
$232.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.44
|
| Rate for Payer: BCBS Complete |
$186.12
|
| Rate for Payer: Cash Price |
$372.24
|
| Rate for Payer: Cofinity Commercial |
$325.71
|
| Rate for Payer: Cofinity Commercial |
$400.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$325.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.24
|
| Rate for Payer: Healthscope Commercial |
$418.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$325.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$348.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.50
|
| Rate for Payer: PHP Commercial |
$395.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.44
|
| Rate for Payer: Priority Health SBD |
$293.14
|
| Rate for Payer: UMR Bronson Commercial |
$172.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$348.98
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$265.05
|
|
|
Service Code
|
NDC 68180039901
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.62 |
| Max. Negotiated Rate |
$238.54 |
| Rate for Payer: Aetna American Axle |
$172.28
|
| Rate for Payer: Aetna Commercial |
$225.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.28
|
| Rate for Payer: Cash Price |
$212.04
|
| Rate for Payer: Cofinity Commercial |
$185.53
|
| Rate for Payer: Cofinity Commercial |
$227.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.04
|
| Rate for Payer: Healthscope Commercial |
$238.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.29
|
| Rate for Payer: PHP Commercial |
$225.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.28
|
| Rate for Payer: Priority Health SBD |
$166.98
|
| Rate for Payer: UMR Bronson Commercial |
$116.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.79
|
|
|
CELLULOSE, OXIDIZED 2" X 14" PADS
|
Facility
|
IP
|
$250.27
|
|
|
Service Code
|
NDC 09900000602
|
| Hospital Charge Code |
169202
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$110.12 |
| Max. Negotiated Rate |
$225.24 |
| Rate for Payer: Aetna American Axle |
$162.68
|
| Rate for Payer: Aetna Commercial |
$212.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.68
|
| Rate for Payer: Cash Price |
$200.22
|
| Rate for Payer: Cofinity Commercial |
$175.19
|
| Rate for Payer: Cofinity Commercial |
$215.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$175.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.22
|
| Rate for Payer: Healthscope Commercial |
$225.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.73
|
| Rate for Payer: PHP Commercial |
$212.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.68
|
| Rate for Payer: Priority Health SBD |
$157.67
|
| Rate for Payer: UMR Bronson Commercial |
$110.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.70
|
|
|
CELLULOSE, OXIDIZED 2" X 14" PADS
|
Facility
|
OP
|
$250.27
|
|
|
Service Code
|
NDC 09900000602
|
| Hospital Charge Code |
169202
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$92.60 |
| Max. Negotiated Rate |
$225.24 |
| Rate for Payer: Aetna American Axle |
$162.68
|
| Rate for Payer: Aetna Commercial |
$212.73
|
| Rate for Payer: Aetna Medicare |
$125.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.68
|
| Rate for Payer: BCBS Complete |
$100.11
|
| Rate for Payer: Cash Price |
$200.22
|
| Rate for Payer: Cofinity Commercial |
$175.19
|
| Rate for Payer: Cofinity Commercial |
$215.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$175.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.22
|
| Rate for Payer: Healthscope Commercial |
$225.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.73
|
| Rate for Payer: PHP Commercial |
$212.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.68
|
| Rate for Payer: Priority Health SBD |
$157.67
|
| Rate for Payer: UMR Bronson Commercial |
$92.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.70
|
|
|
CELLULOSE, OXIDIZED 2" X 3" MISC
|
Facility
|
IP
|
$222.06
|
|
|
Service Code
|
NDC 63713091953
|
| Hospital Charge Code |
169203
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$97.71 |
| Max. Negotiated Rate |
$199.85 |
| Rate for Payer: Aetna American Axle |
$144.34
|
| Rate for Payer: Aetna Commercial |
$188.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.34
|
| Rate for Payer: Cash Price |
$177.65
|
| Rate for Payer: Cofinity Commercial |
$155.44
|
| Rate for Payer: Cofinity Commercial |
$190.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$155.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.65
|
| Rate for Payer: Healthscope Commercial |
$199.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$155.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.75
|
| Rate for Payer: PHP Commercial |
$188.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.34
|
| Rate for Payer: Priority Health SBD |
$139.90
|
| Rate for Payer: UMR Bronson Commercial |
$97.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.54
|
|
|
CELLULOSE, OXIDIZED 2" X 3" MISC
|
Facility
|
IP
|
$159.91
|
|
|
Service Code
|
NDC 09900000603
|
| Hospital Charge Code |
169203
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$70.36 |
| Max. Negotiated Rate |
$143.92 |
| Rate for Payer: Aetna American Axle |
$103.94
|
| Rate for Payer: Aetna Commercial |
$135.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.94
|
| Rate for Payer: Cash Price |
$127.93
|
| Rate for Payer: Cofinity Commercial |
$111.94
|
| Rate for Payer: Cofinity Commercial |
$137.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$111.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.93
|
| Rate for Payer: Healthscope Commercial |
$143.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.92
|
| Rate for Payer: PHP Commercial |
$135.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.94
|
| Rate for Payer: Priority Health SBD |
$100.74
|
| Rate for Payer: UMR Bronson Commercial |
$70.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.93
|
|
|
CELLULOSE, OXIDIZED 2" X 3" MISC
|
Facility
|
OP
|
$222.06
|
|
|
Service Code
|
NDC 63713091953
|
| Hospital Charge Code |
169203
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$82.16 |
| Max. Negotiated Rate |
$199.85 |
| Rate for Payer: Aetna American Axle |
$144.34
|
| Rate for Payer: Aetna Commercial |
$188.75
|
| Rate for Payer: Aetna Medicare |
$111.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.34
|
| Rate for Payer: BCBS Complete |
$88.82
|
| Rate for Payer: Cash Price |
$177.65
|
| Rate for Payer: Cofinity Commercial |
$155.44
|
| Rate for Payer: Cofinity Commercial |
$190.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$155.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.65
|
| Rate for Payer: Healthscope Commercial |
$199.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$155.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.75
|
| Rate for Payer: PHP Commercial |
$188.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.34
|
| Rate for Payer: Priority Health SBD |
$139.90
|
| Rate for Payer: UMR Bronson Commercial |
$82.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.54
|
|
|
CELLULOSE, OXIDIZED 2" X 3" MISC
|
Facility
|
OP
|
$159.91
|
|
|
Service Code
|
NDC 09900000603
|
| Hospital Charge Code |
169203
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$59.17 |
| Max. Negotiated Rate |
$143.92 |
| Rate for Payer: Aetna American Axle |
$103.94
|
| Rate for Payer: Aetna Commercial |
$135.92
|
| Rate for Payer: Aetna Medicare |
$79.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.94
|
| Rate for Payer: BCBS Complete |
$63.96
|
| Rate for Payer: Cash Price |
$127.93
|
| Rate for Payer: Cofinity Commercial |
$111.94
|
| Rate for Payer: Cofinity Commercial |
$137.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$111.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.93
|
| Rate for Payer: Healthscope Commercial |
$143.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.92
|
| Rate for Payer: PHP Commercial |
$135.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.94
|
| Rate for Payer: Priority Health SBD |
$100.74
|
| Rate for Payer: UMR Bronson Commercial |
$59.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.93
|
|
|
CELLULOSE, OXIDIZED 4" X 8" PADS
|
Facility
|
IP
|
$279.50
|
|
|
Service Code
|
NDC 09900000604
|
| Hospital Charge Code |
169204
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$122.98 |
| Max. Negotiated Rate |
$251.55 |
| Rate for Payer: Aetna American Axle |
$181.68
|
| Rate for Payer: Aetna Commercial |
$237.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.68
|
| Rate for Payer: Cash Price |
$223.60
|
| Rate for Payer: Cofinity Commercial |
$195.65
|
| Rate for Payer: Cofinity Commercial |
$240.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$195.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.60
|
| Rate for Payer: Healthscope Commercial |
$251.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$195.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.57
|
| Rate for Payer: PHP Commercial |
$237.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.68
|
| Rate for Payer: Priority Health SBD |
$176.09
|
| Rate for Payer: UMR Bronson Commercial |
$122.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.62
|
|
|
CELLULOSE, OXIDIZED 4" X 8" PADS
|
Facility
|
OP
|
$279.50
|
|
|
Service Code
|
NDC 09900000604
|
| Hospital Charge Code |
169204
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$103.42 |
| Max. Negotiated Rate |
$251.55 |
| Rate for Payer: Aetna American Axle |
$181.68
|
| Rate for Payer: Aetna Commercial |
$237.57
|
| Rate for Payer: Aetna Medicare |
$139.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.68
|
| Rate for Payer: BCBS Complete |
$111.80
|
| Rate for Payer: Cash Price |
$223.60
|
| Rate for Payer: Cofinity Commercial |
$195.65
|
| Rate for Payer: Cofinity Commercial |
$240.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$195.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.60
|
| Rate for Payer: Healthscope Commercial |
$251.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$195.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.57
|
| Rate for Payer: PHP Commercial |
$237.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.68
|
| Rate for Payer: Priority Health SBD |
$176.09
|
| Rate for Payer: UMR Bronson Commercial |
$103.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.62
|
|
|
CELLULOSE,OXIDIZED-COLLAGEN 4.34" X 4.34" 45 %-55 % BANDAGE
|
Facility
|
OP
|
$38.41
|
|
|
Service Code
|
NDC 09900000605
|
| Hospital Charge Code |
169205
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.21 |
| Max. Negotiated Rate |
$34.57 |
| Rate for Payer: Aetna American Axle |
$24.97
|
| Rate for Payer: Aetna Commercial |
$32.65
|
| Rate for Payer: Aetna Medicare |
$19.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.97
|
| Rate for Payer: BCBS Complete |
$15.36
|
| Rate for Payer: Cash Price |
$30.73
|
| Rate for Payer: Cofinity Commercial |
$26.89
|
| Rate for Payer: Cofinity Commercial |
$33.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.73
|
| Rate for Payer: Healthscope Commercial |
$34.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.65
|
| Rate for Payer: PHP Commercial |
$32.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.97
|
| Rate for Payer: Priority Health SBD |
$24.20
|
| Rate for Payer: UMR Bronson Commercial |
$14.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.81
|
|
|
CELLULOSE,OXIDIZED-COLLAGEN 4.34" X 4.34" 45 %-55 % BANDAGE
|
Facility
|
IP
|
$38.41
|
|
|
Service Code
|
NDC 09900000605
|
| Hospital Charge Code |
169205
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.90 |
| Max. Negotiated Rate |
$34.57 |
| Rate for Payer: Aetna American Axle |
$24.97
|
| Rate for Payer: Aetna Commercial |
$32.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.97
|
| Rate for Payer: Cash Price |
$30.73
|
| Rate for Payer: Cofinity Commercial |
$26.89
|
| Rate for Payer: Cofinity Commercial |
$33.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.73
|
| Rate for Payer: Healthscope Commercial |
$34.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.65
|
| Rate for Payer: PHP Commercial |
$32.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.97
|
| Rate for Payer: Priority Health SBD |
$24.20
|
| Rate for Payer: UMR Bronson Commercial |
$16.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.81
|
|
|
CEMIPLIMAB-RWLC 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$47,624.34
|
|
|
Service Code
|
HCPCS J9119
|
| Hospital Charge Code |
188612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20,954.71 |
| Max. Negotiated Rate |
$42,861.91 |
| Rate for Payer: Aetna American Axle |
$30,955.82
|
| Rate for Payer: Aetna Commercial |
$40,480.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30,955.82
|
| Rate for Payer: Cash Price |
$38,099.47
|
| Rate for Payer: Cofinity Commercial |
$33,337.04
|
| Rate for Payer: Cofinity Commercial |
$40,956.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$33,337.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38,099.47
|
| Rate for Payer: Healthscope Commercial |
$42,861.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33,337.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35,718.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40,480.69
|
| Rate for Payer: PHP Commercial |
$40,480.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30,955.82
|
| Rate for Payer: Priority Health SBD |
$30,003.33
|
| Rate for Payer: UMR Bronson Commercial |
$20,954.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35,718.25
|
|
|
CEMIPLIMAB-RWLC 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$47,624.34
|
|
|
Service Code
|
HCPCS J9119
|
| Hospital Charge Code |
188612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.70 |
| Max. Negotiated Rate |
$42,861.91 |
| Rate for Payer: Aetna American Axle |
$30,955.82
|
| Rate for Payer: Aetna Commercial |
$40,480.69
|
| Rate for Payer: Aetna Medicare |
$30.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30,955.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.61
|
| Rate for Payer: BCBS Complete |
$16.48
|
| Rate for Payer: BCBS MAPPO |
$29.29
|
| Rate for Payer: BCN Medicare Advantage |
$29.29
|
| Rate for Payer: Cash Price |
$38,099.47
|
| Rate for Payer: Cash Price |
$38,099.47
|
| Rate for Payer: Cofinity Commercial |
$40,956.93
|
| Rate for Payer: Cofinity Commercial |
$33,337.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$33,337.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38,099.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.29
|
| Rate for Payer: Healthscope Commercial |
$42,861.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33,337.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35,718.25
|
| Rate for Payer: Mclaren Medicaid |
$15.70
|
| Rate for Payer: Mclaren Medicare |
$29.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.75
|
| Rate for Payer: Meridian Medicaid |
$16.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40,480.69
|
| Rate for Payer: PACE Medicare |
$27.83
|
| Rate for Payer: PACE SWMI |
$29.29
|
| Rate for Payer: PHP Commercial |
$40,480.69
|
| Rate for Payer: PHP Medicare Advantage |
$29.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30,955.82
|
| Rate for Payer: Priority Health Medicare |
$29.29
|
| Rate for Payer: Priority Health SBD |
$30,003.33
|
| Rate for Payer: Railroad Medicare Medicare |
$29.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.29
|
| Rate for Payer: UHC Exchange |
$55.98
|
| Rate for Payer: UHC Medicare Advantage |
$29.29
|
| Rate for Payer: UHCCP Medicaid |
$15.70
|
| Rate for Payer: UMR Bronson Commercial |
$17,621.01
|
| Rate for Payer: VA VA |
$29.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35,718.25
|
|
