|
AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$400.16
|
|
|
Service Code
|
NDC 60432009316
|
| Hospital Charge Code |
365
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.06 |
| Max. Negotiated Rate |
$360.14 |
| Rate for Payer: Aetna American Axle |
$260.10
|
| Rate for Payer: Aetna Commercial |
$340.14
|
| Rate for Payer: Aetna Medicare |
$200.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.10
|
| Rate for Payer: BCBS Complete |
$160.06
|
| Rate for Payer: Cash Price |
$320.13
|
| Rate for Payer: Cofinity Commercial |
$280.11
|
| Rate for Payer: Cofinity Commercial |
$344.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$280.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.13
|
| Rate for Payer: Healthscope Commercial |
$360.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$280.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.14
|
| Rate for Payer: PHP Commercial |
$340.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.10
|
| Rate for Payer: Priority Health SBD |
$252.10
|
| Rate for Payer: UMR Bronson Commercial |
$148.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.12
|
|
|
AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$533.55
|
|
|
Service Code
|
NDC 00121064616
|
| Hospital Charge Code |
365
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$197.41 |
| Max. Negotiated Rate |
$480.19 |
| Rate for Payer: Aetna American Axle |
$346.81
|
| Rate for Payer: Aetna Commercial |
$453.52
|
| Rate for Payer: Aetna Medicare |
$266.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$346.81
|
| Rate for Payer: BCBS Complete |
$213.42
|
| Rate for Payer: Cash Price |
$426.84
|
| Rate for Payer: Cofinity Commercial |
$373.49
|
| Rate for Payer: Cofinity Commercial |
$458.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$373.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$426.84
|
| Rate for Payer: Healthscope Commercial |
$480.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$373.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$400.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$453.52
|
| Rate for Payer: PHP Commercial |
$453.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$346.81
|
| Rate for Payer: Priority Health SBD |
$336.14
|
| Rate for Payer: UMR Bronson Commercial |
$197.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$400.16
|
|
|
AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$400.16
|
|
|
Service Code
|
NDC 60432009316
|
| Hospital Charge Code |
365
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.07 |
| Max. Negotiated Rate |
$360.14 |
| Rate for Payer: Aetna American Axle |
$260.10
|
| Rate for Payer: Aetna Commercial |
$340.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.10
|
| Rate for Payer: Cash Price |
$320.13
|
| Rate for Payer: Cofinity Commercial |
$280.11
|
| Rate for Payer: Cofinity Commercial |
$344.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$280.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.13
|
| Rate for Payer: Healthscope Commercial |
$360.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$280.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.14
|
| Rate for Payer: PHP Commercial |
$340.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.10
|
| Rate for Payer: Priority Health SBD |
$252.10
|
| Rate for Payer: UMR Bronson Commercial |
$176.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.12
|
|
|
AMIFOSTINE CRYSTALLINE 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3,188.51
|
|
|
Service Code
|
HCPCS J0207
|
| Hospital Charge Code |
20803
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,402.94 |
| Max. Negotiated Rate |
$2,869.66 |
| Rate for Payer: Aetna American Axle |
$2,072.53
|
| Rate for Payer: Aetna Commercial |
$2,710.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,072.53
|
| Rate for Payer: Cash Price |
$2,550.81
|
| Rate for Payer: Cofinity Commercial |
$2,231.96
|
| Rate for Payer: Cofinity Commercial |
$2,742.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,231.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,550.81
|
| Rate for Payer: Healthscope Commercial |
$2,869.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,231.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,391.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,710.23
|
| Rate for Payer: PHP Commercial |
$2,710.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,072.53
|
| Rate for Payer: Priority Health SBD |
$2,008.76
|
| Rate for Payer: UMR Bronson Commercial |
$1,402.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,391.38
|
|
|
AMIFOSTINE CRYSTALLINE 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,188.51
|
|
|
Service Code
|
HCPCS J0207
|
| Hospital Charge Code |
20803
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,179.75 |
| Max. Negotiated Rate |
$2,869.66 |
| Rate for Payer: Aetna American Axle |
$2,072.53
|
| Rate for Payer: Aetna Commercial |
$2,710.23
|
| Rate for Payer: Aetna Medicare |
$1,594.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,072.53
|
| Rate for Payer: BCBS Complete |
$1,275.40
|
| Rate for Payer: Cash Price |
$2,550.81
|
| Rate for Payer: Cofinity Commercial |
$2,231.96
|
| Rate for Payer: Cofinity Commercial |
$2,742.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,231.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,550.81
|
| Rate for Payer: Healthscope Commercial |
$2,869.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,231.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,391.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,710.23
|
| Rate for Payer: PHP Commercial |
$2,710.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,072.53
|
| Rate for Payer: Priority Health SBD |
$2,008.76
|
| Rate for Payer: UMR Bronson Commercial |
$1,179.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,391.38
|
|
|
AMIKACIN 500 MG/2 ML INJECTION SOLUTION
|
Facility
|
IP
|
$16.36
|
|
|
Service Code
|
HCPCS J0278
|
| Hospital Charge Code |
119785
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$14.72 |
| Rate for Payer: Aetna American Axle |
$10.63
|
| Rate for Payer: Aetna American Axle |
$31.32
|
| Rate for Payer: Aetna American Axle |
$32.97
|
| Rate for Payer: Aetna Commercial |
$40.95
|
| Rate for Payer: Aetna Commercial |
$13.91
|
| Rate for Payer: Aetna Commercial |
$43.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.32
|
| Rate for Payer: Cash Price |
$40.58
|
| Rate for Payer: Cash Price |
$38.54
|
| Rate for Payer: Cash Price |
$13.09
|
| Rate for Payer: Cofinity Commercial |
$14.07
|
| Rate for Payer: Cofinity Commercial |
$41.43
|
| Rate for Payer: Cofinity Commercial |
$33.73
|
| Rate for Payer: Cofinity Commercial |
$43.63
|
| Rate for Payer: Cofinity Commercial |
$35.51
|
| Rate for Payer: Cofinity Commercial |
$11.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.54
|
| Rate for Payer: Healthscope Commercial |
$43.36
|
| Rate for Payer: Healthscope Commercial |
$14.72
|
| Rate for Payer: Healthscope Commercial |
$45.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.95
|
| Rate for Payer: PHP Commercial |
$43.12
|
| Rate for Payer: PHP Commercial |
$40.95
|
| Rate for Payer: PHP Commercial |
$13.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.63
|
| Rate for Payer: Priority Health SBD |
$31.96
|
| Rate for Payer: Priority Health SBD |
$30.35
|
| Rate for Payer: Priority Health SBD |
$10.31
|
| Rate for Payer: UMR Bronson Commercial |
$7.20
|
| Rate for Payer: UMR Bronson Commercial |
$22.32
|
| Rate for Payer: UMR Bronson Commercial |
$21.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.13
|
|
|
AMIKACIN 500 MG/2 ML INJECTION SOLUTION
|
Facility
|
OP
|
$19.27
|
|
|
Service Code
|
HCPCS J0278
|
| Hospital Charge Code |
119785
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.13 |
| Max. Negotiated Rate |
$17.34 |
| Rate for Payer: Aetna American Axle |
$12.53
|
| Rate for Payer: Aetna American Axle |
$32.97
|
| Rate for Payer: Aetna American Axle |
$10.63
|
| Rate for Payer: Aetna American Axle |
$31.32
|
| Rate for Payer: Aetna Commercial |
$43.12
|
| Rate for Payer: Aetna Commercial |
$16.38
|
| Rate for Payer: Aetna Commercial |
$40.95
|
| Rate for Payer: Aetna Commercial |
$13.91
|
| Rate for Payer: Aetna Medicare |
$24.09
|
| Rate for Payer: Aetna Medicare |
$8.18
|
| Rate for Payer: Aetna Medicare |
$25.36
|
| Rate for Payer: Aetna Medicare |
$9.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.63
|
| Rate for Payer: BCBS Complete |
$6.54
|
| Rate for Payer: BCBS Complete |
$20.29
|
| Rate for Payer: BCBS Complete |
$19.27
|
| Rate for Payer: BCBS Complete |
$7.71
|
| Rate for Payer: Cash Price |
$15.42
|
| Rate for Payer: Cash Price |
$38.54
|
| Rate for Payer: Cash Price |
$13.09
|
| Rate for Payer: Cash Price |
$40.58
|
| Rate for Payer: Cofinity Commercial |
$16.57
|
| Rate for Payer: Cofinity Commercial |
$43.63
|
| Rate for Payer: Cofinity Commercial |
$11.45
|
| Rate for Payer: Cofinity Commercial |
$41.43
|
| Rate for Payer: Cofinity Commercial |
$33.73
|
| Rate for Payer: Cofinity Commercial |
$35.51
|
| Rate for Payer: Cofinity Commercial |
$14.07
|
| Rate for Payer: Cofinity Commercial |
$13.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.42
|
| Rate for Payer: Healthscope Commercial |
$43.36
|
| Rate for Payer: Healthscope Commercial |
$14.72
|
| Rate for Payer: Healthscope Commercial |
$17.34
|
| Rate for Payer: Healthscope Commercial |
$45.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.95
|
| Rate for Payer: PHP Commercial |
$40.95
|
| Rate for Payer: PHP Commercial |
$16.38
|
| Rate for Payer: PHP Commercial |
$43.12
|
| Rate for Payer: PHP Commercial |
$13.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.63
|
| Rate for Payer: Priority Health SBD |
$30.35
|
| Rate for Payer: Priority Health SBD |
$31.96
|
| Rate for Payer: Priority Health SBD |
$12.14
|
| Rate for Payer: Priority Health SBD |
$10.31
|
| Rate for Payer: UMR Bronson Commercial |
$17.83
|
| Rate for Payer: UMR Bronson Commercial |
$7.13
|
| Rate for Payer: UMR Bronson Commercial |
$18.77
|
| Rate for Payer: UMR Bronson Commercial |
$6.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.45
|
|
|
AMILORIDE 5 MG TABLET
|
Facility
|
IP
|
$411.84
|
|
|
Service Code
|
NDC 49884011701
|
| Hospital Charge Code |
391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$181.21 |
| Max. Negotiated Rate |
$370.66 |
| Rate for Payer: Aetna American Axle |
$267.70
|
| Rate for Payer: Aetna Commercial |
$350.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.70
|
| Rate for Payer: Cash Price |
$329.47
|
| Rate for Payer: Cofinity Commercial |
$288.29
|
| Rate for Payer: Cofinity Commercial |
$354.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$288.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.47
|
| Rate for Payer: Healthscope Commercial |
$370.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$288.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$308.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$350.06
|
| Rate for Payer: PHP Commercial |
$350.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.70
|
| Rate for Payer: Priority Health SBD |
$259.46
|
| Rate for Payer: UMR Bronson Commercial |
$181.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$308.88
|
|
|
AMILORIDE 5 MG TABLET
|
Facility
|
IP
|
$211.85
|
|
|
Service Code
|
NDC 00574029201
|
| Hospital Charge Code |
391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.21 |
| Max. Negotiated Rate |
$190.66 |
| Rate for Payer: Aetna American Axle |
$137.70
|
| Rate for Payer: Aetna Commercial |
$180.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.70
|
| Rate for Payer: Cash Price |
$169.48
|
| Rate for Payer: Cofinity Commercial |
$148.29
|
| Rate for Payer: Cofinity Commercial |
$182.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$148.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.48
|
| Rate for Payer: Healthscope Commercial |
$190.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.07
|
| Rate for Payer: PHP Commercial |
$180.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.70
|
| Rate for Payer: Priority Health SBD |
$133.47
|
| Rate for Payer: UMR Bronson Commercial |
$93.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.89
|
|
|
AMILORIDE 5 MG TABLET
|
Facility
|
OP
|
$211.85
|
|
|
Service Code
|
NDC 00574029201
|
| Hospital Charge Code |
391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.38 |
| Max. Negotiated Rate |
$190.66 |
| Rate for Payer: Aetna American Axle |
$137.70
|
| Rate for Payer: Aetna Commercial |
$180.07
|
| Rate for Payer: Aetna Medicare |
$105.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.70
|
| Rate for Payer: BCBS Complete |
$84.74
|
| Rate for Payer: Cash Price |
$169.48
|
| Rate for Payer: Cofinity Commercial |
$148.29
|
| Rate for Payer: Cofinity Commercial |
$182.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$148.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.48
|
| Rate for Payer: Healthscope Commercial |
$190.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.07
|
| Rate for Payer: PHP Commercial |
$180.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.70
|
| Rate for Payer: Priority Health SBD |
$133.47
|
| Rate for Payer: UMR Bronson Commercial |
$78.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.89
|
|
|
AMILORIDE 5 MG TABLET
|
Facility
|
OP
|
$411.84
|
|
|
Service Code
|
NDC 49884011701
|
| Hospital Charge Code |
391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.38 |
| Max. Negotiated Rate |
$370.66 |
| Rate for Payer: Aetna American Axle |
$267.70
|
| Rate for Payer: Aetna Commercial |
$350.06
|
| Rate for Payer: Aetna Medicare |
$205.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.70
|
| Rate for Payer: BCBS Complete |
$164.74
|
| Rate for Payer: Cash Price |
$329.47
|
| Rate for Payer: Cofinity Commercial |
$288.29
|
| Rate for Payer: Cofinity Commercial |
$354.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$288.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.47
|
| Rate for Payer: Healthscope Commercial |
$370.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$288.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$308.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$350.06
|
| Rate for Payer: PHP Commercial |
$350.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.70
|
| Rate for Payer: Priority Health SBD |
$259.46
|
| Rate for Payer: UMR Bronson Commercial |
$152.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$308.88
|
|
|
AMINO ACID 10 % INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$55.10
|
|
|
Service Code
|
NDC 00264934155
|
| Hospital Charge Code |
108157
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.39 |
| Max. Negotiated Rate |
$49.59 |
| Rate for Payer: Aetna American Axle |
$35.81
|
| Rate for Payer: Aetna Commercial |
$46.84
|
| Rate for Payer: Aetna Medicare |
$27.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.81
|
| Rate for Payer: BCBS Complete |
$22.04
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Cofinity Commercial |
$38.57
|
| Rate for Payer: Cofinity Commercial |
$47.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$38.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.08
|
| Rate for Payer: Healthscope Commercial |
$49.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.84
|
| Rate for Payer: PHP Commercial |
$46.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.81
|
| Rate for Payer: Priority Health SBD |
$34.71
|
| Rate for Payer: UMR Bronson Commercial |
$20.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.33
|
|
|
AMINO ACID 10 % INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$55.10
|
|
|
Service Code
|
NDC 00264934155
|
| Hospital Charge Code |
108157
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.24 |
| Max. Negotiated Rate |
$49.59 |
| Rate for Payer: Aetna American Axle |
$35.81
|
| Rate for Payer: Aetna Commercial |
$46.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.81
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Cofinity Commercial |
$38.57
|
| Rate for Payer: Cofinity Commercial |
$47.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$38.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.08
|
| Rate for Payer: Healthscope Commercial |
$49.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.84
|
| Rate for Payer: PHP Commercial |
$46.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.81
|
| Rate for Payer: Priority Health SBD |
$34.71
|
| Rate for Payer: UMR Bronson Commercial |
$24.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.33
|
|
|
AMINO ACID 4.25 % IN 10 % DEXTROSE INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$124.60
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
27928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.10 |
| Max. Negotiated Rate |
$112.14 |
| Rate for Payer: Aetna American Axle |
$80.99
|
| Rate for Payer: Aetna Commercial |
$105.91
|
| Rate for Payer: Aetna Medicare |
$62.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.99
|
| Rate for Payer: BCBS Complete |
$49.84
|
| Rate for Payer: Cash Price |
$99.68
|
| Rate for Payer: Cofinity Commercial |
$107.16
|
| Rate for Payer: Cofinity Commercial |
$87.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.68
|
| Rate for Payer: Healthscope Commercial |
$112.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.91
|
| Rate for Payer: PHP Commercial |
$105.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.99
|
| Rate for Payer: Priority Health SBD |
$78.50
|
| Rate for Payer: UMR Bronson Commercial |
$46.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.45
|
|
|
AMINO ACID 4.25 % IN 10 % DEXTROSE INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$124.60
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
27928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.82 |
| Max. Negotiated Rate |
$112.14 |
| Rate for Payer: Aetna American Axle |
$80.99
|
| Rate for Payer: Aetna Commercial |
$105.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.99
|
| Rate for Payer: Cash Price |
$99.68
|
| Rate for Payer: Cofinity Commercial |
$107.16
|
| Rate for Payer: Cofinity Commercial |
$87.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.68
|
| Rate for Payer: Healthscope Commercial |
$112.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.91
|
| Rate for Payer: PHP Commercial |
$105.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.99
|
| Rate for Payer: Priority Health SBD |
$78.50
|
| Rate for Payer: UMR Bronson Commercial |
$54.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.45
|
|
|
AMINO ACID 6 % IN DEXTROSE 5 % WATER INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$155.75
|
|
|
Service Code
|
NDC 00338019801
|
| Hospital Charge Code |
195260
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$57.63 |
| Max. Negotiated Rate |
$140.18 |
| Rate for Payer: Aetna American Axle |
$101.24
|
| Rate for Payer: Aetna Commercial |
$132.39
|
| Rate for Payer: Aetna Medicare |
$77.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.24
|
| Rate for Payer: BCBS Complete |
$62.30
|
| Rate for Payer: Cash Price |
$124.60
|
| Rate for Payer: Cofinity Commercial |
$109.03
|
| Rate for Payer: Cofinity Commercial |
$133.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.60
|
| Rate for Payer: Healthscope Commercial |
$140.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.39
|
| Rate for Payer: PHP Commercial |
$132.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.24
|
| Rate for Payer: Priority Health SBD |
$98.12
|
| Rate for Payer: UMR Bronson Commercial |
$57.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.81
|
|
|
AMINO ACID 6 % IN DEXTROSE 5 % WATER INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$155.75
|
|
|
Service Code
|
NDC 00338019806
|
| Hospital Charge Code |
195260
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$57.63 |
| Max. Negotiated Rate |
$140.18 |
| Rate for Payer: Aetna American Axle |
$101.24
|
| Rate for Payer: Aetna Commercial |
$132.39
|
| Rate for Payer: Aetna Medicare |
$77.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.24
|
| Rate for Payer: BCBS Complete |
$62.30
|
| Rate for Payer: Cash Price |
$124.60
|
| Rate for Payer: Cofinity Commercial |
$109.03
|
| Rate for Payer: Cofinity Commercial |
$133.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.60
|
| Rate for Payer: Healthscope Commercial |
$140.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.39
|
| Rate for Payer: PHP Commercial |
$132.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.24
|
| Rate for Payer: Priority Health SBD |
$98.12
|
| Rate for Payer: UMR Bronson Commercial |
$57.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.81
|
|
|
AMINO ACID 6 % IN DEXTROSE 5 % WATER INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$155.75
|
|
|
Service Code
|
NDC 00338019806
|
| Hospital Charge Code |
195260
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$68.53 |
| Max. Negotiated Rate |
$140.18 |
| Rate for Payer: Aetna American Axle |
$101.24
|
| Rate for Payer: Aetna Commercial |
$132.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.24
|
| Rate for Payer: Cash Price |
$124.60
|
| Rate for Payer: Cofinity Commercial |
$109.03
|
| Rate for Payer: Cofinity Commercial |
$133.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.60
|
| Rate for Payer: Healthscope Commercial |
$140.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.39
|
| Rate for Payer: PHP Commercial |
$132.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.24
|
| Rate for Payer: Priority Health SBD |
$98.12
|
| Rate for Payer: UMR Bronson Commercial |
$68.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.81
|
|
|
AMINO ACID 6 % IN DEXTROSE 5 % WATER INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$155.75
|
|
|
Service Code
|
NDC 00338019801
|
| Hospital Charge Code |
195260
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$68.53 |
| Max. Negotiated Rate |
$140.18 |
| Rate for Payer: Aetna American Axle |
$101.24
|
| Rate for Payer: Aetna Commercial |
$132.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.24
|
| Rate for Payer: Cash Price |
$124.60
|
| Rate for Payer: Cofinity Commercial |
$109.03
|
| Rate for Payer: Cofinity Commercial |
$133.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.60
|
| Rate for Payer: Healthscope Commercial |
$140.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.39
|
| Rate for Payer: PHP Commercial |
$132.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.24
|
| Rate for Payer: Priority Health SBD |
$98.12
|
| Rate for Payer: UMR Bronson Commercial |
$68.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.81
|
|
|
AMINO ACID 8 % IN DEXTROSE 10% WATER INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$234.30
|
|
|
Service Code
|
NDC 00338019401
|
| Hospital Charge Code |
195269
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$86.69 |
| Max. Negotiated Rate |
$210.87 |
| Rate for Payer: Aetna American Axle |
$152.29
|
| Rate for Payer: Aetna Commercial |
$199.16
|
| Rate for Payer: Aetna Medicare |
$117.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.29
|
| Rate for Payer: BCBS Complete |
$93.72
|
| Rate for Payer: Cash Price |
$187.44
|
| Rate for Payer: Cofinity Commercial |
$164.01
|
| Rate for Payer: Cofinity Commercial |
$201.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$164.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.44
|
| Rate for Payer: Healthscope Commercial |
$210.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.16
|
| Rate for Payer: PHP Commercial |
$199.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.29
|
| Rate for Payer: Priority Health SBD |
$147.61
|
| Rate for Payer: UMR Bronson Commercial |
$86.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.72
|
|
|
AMINO ACID 8 % IN DEXTROSE 10% WATER INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$234.30
|
|
|
Service Code
|
NDC 00338019404
|
| Hospital Charge Code |
195269
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$86.69 |
| Max. Negotiated Rate |
$210.87 |
| Rate for Payer: Aetna American Axle |
$152.29
|
| Rate for Payer: Aetna Commercial |
$199.16
|
| Rate for Payer: Aetna Medicare |
$117.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.29
|
| Rate for Payer: BCBS Complete |
$93.72
|
| Rate for Payer: Cash Price |
$187.44
|
| Rate for Payer: Cofinity Commercial |
$164.01
|
| Rate for Payer: Cofinity Commercial |
$201.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$164.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.44
|
| Rate for Payer: Healthscope Commercial |
$210.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.16
|
| Rate for Payer: PHP Commercial |
$199.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.29
|
| Rate for Payer: Priority Health SBD |
$147.61
|
| Rate for Payer: UMR Bronson Commercial |
$86.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.72
|
|
|
AMINO ACID 8 % IN DEXTROSE 10% WATER INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$234.30
|
|
|
Service Code
|
NDC 00338019404
|
| Hospital Charge Code |
195269
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$103.09 |
| Max. Negotiated Rate |
$210.87 |
| Rate for Payer: Aetna American Axle |
$152.29
|
| Rate for Payer: Aetna Commercial |
$199.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.29
|
| Rate for Payer: Cash Price |
$187.44
|
| Rate for Payer: Cofinity Commercial |
$164.01
|
| Rate for Payer: Cofinity Commercial |
$201.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$164.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.44
|
| Rate for Payer: Healthscope Commercial |
$210.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.16
|
| Rate for Payer: PHP Commercial |
$199.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.29
|
| Rate for Payer: Priority Health SBD |
$147.61
|
| Rate for Payer: UMR Bronson Commercial |
$103.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.72
|
|
|
AMINO ACID 8 % IN DEXTROSE 10% WATER INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$234.30
|
|
|
Service Code
|
NDC 00338019401
|
| Hospital Charge Code |
195269
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$103.09 |
| Max. Negotiated Rate |
$210.87 |
| Rate for Payer: Aetna American Axle |
$152.29
|
| Rate for Payer: Aetna Commercial |
$199.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.29
|
| Rate for Payer: Cash Price |
$187.44
|
| Rate for Payer: Cofinity Commercial |
$164.01
|
| Rate for Payer: Cofinity Commercial |
$201.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$164.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.44
|
| Rate for Payer: Healthscope Commercial |
$210.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.16
|
| Rate for Payer: PHP Commercial |
$199.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.29
|
| Rate for Payer: Priority Health SBD |
$147.61
|
| Rate for Payer: UMR Bronson Commercial |
$103.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.72
|
|
|
AMINO ACID 8 % IN DEXTROSE 14 % WATER INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$169.10
|
|
|
Service Code
|
NDC 00338018006
|
| Hospital Charge Code |
195270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$62.57 |
| Max. Negotiated Rate |
$152.19 |
| Rate for Payer: Aetna American Axle |
$109.92
|
| Rate for Payer: Aetna Commercial |
$143.74
|
| Rate for Payer: Aetna Medicare |
$84.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.92
|
| Rate for Payer: BCBS Complete |
$67.64
|
| Rate for Payer: Cash Price |
$135.28
|
| Rate for Payer: Cofinity Commercial |
$118.37
|
| Rate for Payer: Cofinity Commercial |
$145.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$118.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.28
|
| Rate for Payer: Healthscope Commercial |
$152.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.74
|
| Rate for Payer: PHP Commercial |
$143.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.92
|
| Rate for Payer: Priority Health SBD |
$106.53
|
| Rate for Payer: UMR Bronson Commercial |
$62.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.83
|
|
|
AMINO ACID 8 % IN DEXTROSE 14 % WATER INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$169.10
|
|
|
Service Code
|
NDC 00338018001
|
| Hospital Charge Code |
195270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$74.40 |
| Max. Negotiated Rate |
$152.19 |
| Rate for Payer: Aetna American Axle |
$109.92
|
| Rate for Payer: Aetna Commercial |
$143.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.92
|
| Rate for Payer: Cash Price |
$135.28
|
| Rate for Payer: Cofinity Commercial |
$118.37
|
| Rate for Payer: Cofinity Commercial |
$145.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$118.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.28
|
| Rate for Payer: Healthscope Commercial |
$152.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.74
|
| Rate for Payer: PHP Commercial |
$143.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.92
|
| Rate for Payer: Priority Health SBD |
$106.53
|
| Rate for Payer: UMR Bronson Commercial |
$74.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.83
|
|
