|
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
|
OP
|
$276.90
|
|
|
Service Code
|
NDC 00338018401
|
| Hospital Charge Code |
195270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$102.45 |
| Max. Negotiated Rate |
$249.21 |
| Rate for Payer: Aetna American Axle |
$179.99
|
| Rate for Payer: Aetna Commercial |
$235.37
|
| Rate for Payer: Aetna Medicare |
$138.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.99
|
| Rate for Payer: BCBS Complete |
$110.76
|
| Rate for Payer: Cash Price |
$221.52
|
| Rate for Payer: Cofinity Commercial |
$193.83
|
| Rate for Payer: Cofinity Commercial |
$238.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$193.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.52
|
| Rate for Payer: Healthscope Commercial |
$249.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$193.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.37
|
| Rate for Payer: PHP Commercial |
$235.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.99
|
| Rate for Payer: Priority Health SBD |
$174.45
|
| Rate for Payer: UMR Bronson Commercial |
$102.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.68
|
|
|
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
|
|
|
AMINO ACID 8 % IN DEXTROSE 14 % WATER INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$169.10
|
|
|
Service Code
|
NDC 00338018001
|
| 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
|
$276.90
|
|
|
Service Code
|
NDC 00338018404
|
| Hospital Charge Code |
195270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$121.84 |
| Max. Negotiated Rate |
$249.21 |
| Rate for Payer: Aetna American Axle |
$179.99
|
| Rate for Payer: Aetna Commercial |
$235.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.99
|
| Rate for Payer: Cash Price |
$221.52
|
| Rate for Payer: Cofinity Commercial |
$193.83
|
| Rate for Payer: Cofinity Commercial |
$238.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$193.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.52
|
| Rate for Payer: Healthscope Commercial |
$249.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$193.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.37
|
| Rate for Payer: PHP Commercial |
$235.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.99
|
| Rate for Payer: Priority Health SBD |
$174.45
|
| Rate for Payer: UMR Bronson Commercial |
$121.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.68
|
|
|
AMINO ACID 8 % IN DEXTROSE 14 % WATER INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$169.10
|
|
|
Service Code
|
NDC 00338018006
|
| 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
|
|
|
AMINO ACIDS 4.25 % WITH LYTES AND CALCIUM IN D10W INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$137.95
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
27951
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.04 |
| Max. Negotiated Rate |
$124.16 |
| Rate for Payer: Aetna American Axle |
$89.67
|
| Rate for Payer: Aetna Commercial |
$117.26
|
| Rate for Payer: Aetna Medicare |
$68.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.67
|
| Rate for Payer: BCBS Complete |
$55.18
|
| Rate for Payer: Cash Price |
$110.36
|
| Rate for Payer: Cofinity Commercial |
$118.64
|
| Rate for Payer: Cofinity Commercial |
$96.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$96.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.36
|
| Rate for Payer: Healthscope Commercial |
$124.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.26
|
| Rate for Payer: PHP Commercial |
$117.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.67
|
| Rate for Payer: Priority Health SBD |
$86.91
|
| Rate for Payer: UMR Bronson Commercial |
$51.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.46
|
|
|
AMINO ACIDS 4.25 % WITH LYTES AND CALCIUM IN D10W INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$137.95
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
27951
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.70 |
| Max. Negotiated Rate |
$124.16 |
| Rate for Payer: Aetna American Axle |
$89.67
|
| Rate for Payer: Aetna Commercial |
$117.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.67
|
| Rate for Payer: Cash Price |
$110.36
|
| Rate for Payer: Cofinity Commercial |
$118.64
|
| Rate for Payer: Cofinity Commercial |
$96.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$96.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.36
|
| Rate for Payer: Healthscope Commercial |
$124.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.26
|
| Rate for Payer: PHP Commercial |
$117.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.67
|
| Rate for Payer: Priority Health SBD |
$86.91
|
| Rate for Payer: UMR Bronson Commercial |
$60.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.46
|
|
|
AMINO ACIDS 8 %-DEXTROSE 14 %-ELECTROLYTES INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$173.55
|
|
|
Service Code
|
NDC 00338020206
|
| Hospital Charge Code |
195267
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$64.21 |
| Max. Negotiated Rate |
$156.19 |
| Rate for Payer: Aetna American Axle |
$112.81
|
| Rate for Payer: Aetna Commercial |
$147.52
|
| Rate for Payer: Aetna Medicare |
$86.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.81
|
| Rate for Payer: BCBS Complete |
$69.42
|
| Rate for Payer: Cash Price |
$138.84
|
| Rate for Payer: Cofinity Commercial |
$121.48
|
| Rate for Payer: Cofinity Commercial |
$149.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$121.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.84
|
| Rate for Payer: Healthscope Commercial |
$156.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.52
|
| Rate for Payer: PHP Commercial |
$147.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.81
|
| Rate for Payer: Priority Health SBD |
$109.34
|
| Rate for Payer: UMR Bronson Commercial |
$64.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.16
|
|
|
AMINO ACIDS 8 %-DEXTROSE 14 %-ELECTROLYTES INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$262.70
|
|
|
Service Code
|
NDC 00338020604
|
| Hospital Charge Code |
195267
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$97.20 |
| Max. Negotiated Rate |
$236.43 |
| Rate for Payer: Aetna American Axle |
$170.75
|
| Rate for Payer: Aetna Commercial |
$223.29
|
| Rate for Payer: Aetna Medicare |
$131.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.75
|
| Rate for Payer: BCBS Complete |
$105.08
|
| Rate for Payer: Cash Price |
$210.16
|
| Rate for Payer: Cofinity Commercial |
$183.89
|
| Rate for Payer: Cofinity Commercial |
$225.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$183.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.16
|
| Rate for Payer: Healthscope Commercial |
$236.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.29
|
| Rate for Payer: PHP Commercial |
$223.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.75
|
| Rate for Payer: Priority Health SBD |
$165.50
|
| Rate for Payer: UMR Bronson Commercial |
$97.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.03
|
|
|
AMINO ACIDS 8 %-DEXTROSE 14 %-ELECTROLYTES INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$173.55
|
|
|
Service Code
|
NDC 00338020201
|
| Hospital Charge Code |
195267
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$64.21 |
| Max. Negotiated Rate |
$156.19 |
| Rate for Payer: Aetna American Axle |
$112.81
|
| Rate for Payer: Aetna Commercial |
$147.52
|
| Rate for Payer: Aetna Medicare |
$86.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.81
|
| Rate for Payer: BCBS Complete |
$69.42
|
| Rate for Payer: Cash Price |
$138.84
|
| Rate for Payer: Cofinity Commercial |
$121.48
|
| Rate for Payer: Cofinity Commercial |
$149.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$121.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.84
|
| Rate for Payer: Healthscope Commercial |
$156.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.52
|
| Rate for Payer: PHP Commercial |
$147.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.81
|
| Rate for Payer: Priority Health SBD |
$109.34
|
| Rate for Payer: UMR Bronson Commercial |
$64.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.16
|
|
|
AMINO ACIDS 8 %-DEXTROSE 14 %-ELECTROLYTES INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$173.55
|
|
|
Service Code
|
NDC 00338020201
|
| Hospital Charge Code |
195267
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$76.36 |
| Max. Negotiated Rate |
$156.19 |
| Rate for Payer: Aetna American Axle |
$112.81
|
| Rate for Payer: Aetna Commercial |
$147.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.81
|
| Rate for Payer: Cash Price |
$138.84
|
| Rate for Payer: Cofinity Commercial |
$121.48
|
| Rate for Payer: Cofinity Commercial |
$149.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$121.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.84
|
| Rate for Payer: Healthscope Commercial |
$156.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.52
|
| Rate for Payer: PHP Commercial |
$147.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.81
|
| Rate for Payer: Priority Health SBD |
$109.34
|
| Rate for Payer: UMR Bronson Commercial |
$76.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.16
|
|
|
AMINO ACIDS 8 %-DEXTROSE 14 %-ELECTROLYTES INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$262.70
|
|
|
Service Code
|
NDC 00338020601
|
| Hospital Charge Code |
195267
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$97.20 |
| Max. Negotiated Rate |
$236.43 |
| Rate for Payer: Aetna American Axle |
$170.75
|
| Rate for Payer: Aetna Commercial |
$223.29
|
| Rate for Payer: Aetna Medicare |
$131.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.75
|
| Rate for Payer: BCBS Complete |
$105.08
|
| Rate for Payer: Cash Price |
$210.16
|
| Rate for Payer: Cofinity Commercial |
$183.89
|
| Rate for Payer: Cofinity Commercial |
$225.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$183.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.16
|
| Rate for Payer: Healthscope Commercial |
$236.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.29
|
| Rate for Payer: PHP Commercial |
$223.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.75
|
| Rate for Payer: Priority Health SBD |
$165.50
|
| Rate for Payer: UMR Bronson Commercial |
$97.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.03
|
|
|
AMINO ACIDS 8 %-DEXTROSE 14 %-ELECTROLYTES INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$262.70
|
|
|
Service Code
|
NDC 00338020604
|
| Hospital Charge Code |
195267
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$115.59 |
| Max. Negotiated Rate |
$236.43 |
| Rate for Payer: Aetna American Axle |
$170.75
|
| Rate for Payer: Aetna Commercial |
$223.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.75
|
| Rate for Payer: Cash Price |
$210.16
|
| Rate for Payer: Cofinity Commercial |
$183.89
|
| Rate for Payer: Cofinity Commercial |
$225.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$183.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.16
|
| Rate for Payer: Healthscope Commercial |
$236.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.29
|
| Rate for Payer: PHP Commercial |
$223.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.75
|
| Rate for Payer: Priority Health SBD |
$165.50
|
| Rate for Payer: UMR Bronson Commercial |
$115.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.03
|
|
|
AMINO ACIDS 8 %-DEXTROSE 14 %-ELECTROLYTES INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$262.70
|
|
|
Service Code
|
NDC 00338020601
|
| Hospital Charge Code |
195267
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$115.59 |
| Max. Negotiated Rate |
$236.43 |
| Rate for Payer: Aetna American Axle |
$170.75
|
| Rate for Payer: Aetna Commercial |
$223.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.75
|
| Rate for Payer: Cash Price |
$210.16
|
| Rate for Payer: Cofinity Commercial |
$183.89
|
| Rate for Payer: Cofinity Commercial |
$225.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$183.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.16
|
| Rate for Payer: Healthscope Commercial |
$236.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.29
|
| Rate for Payer: PHP Commercial |
$223.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.75
|
| Rate for Payer: Priority Health SBD |
$165.50
|
| Rate for Payer: UMR Bronson Commercial |
$115.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.03
|
|
|
AMINO ACIDS 8 %-DEXTROSE 14 %-ELECTROLYTES INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$173.55
|
|
|
Service Code
|
NDC 00338020206
|
| Hospital Charge Code |
195267
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$76.36 |
| Max. Negotiated Rate |
$156.19 |
| Rate for Payer: Aetna American Axle |
$112.81
|
| Rate for Payer: Aetna Commercial |
$147.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.81
|
| Rate for Payer: Cash Price |
$138.84
|
| Rate for Payer: Cofinity Commercial |
$121.48
|
| Rate for Payer: Cofinity Commercial |
$149.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$121.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.84
|
| Rate for Payer: Healthscope Commercial |
$156.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.52
|
| Rate for Payer: PHP Commercial |
$147.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.81
|
| Rate for Payer: Priority Health SBD |
$109.34
|
| Rate for Payer: UMR Bronson Commercial |
$76.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.16
|
|
|
AMINOCAPROIC ACID 15 GM/250 ML NS INFUSION (OR)
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
NDC 09900000194
|
| Hospital Charge Code |
155006
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$176.00 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna American Axle |
$260.00
|
| Rate for Payer: Aetna Commercial |
$340.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cofinity Commercial |
$280.00
|
| Rate for Payer: Cofinity Commercial |
$344.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$280.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.00
|
| Rate for Payer: Healthscope Commercial |
$360.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$280.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.00
|
| Rate for Payer: PHP Commercial |
$340.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.00
|
| Rate for Payer: Priority Health SBD |
$252.00
|
| Rate for Payer: UMR Bronson Commercial |
$176.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.00
|
|
|
AMINOCAPROIC ACID 15 GM/250 ML NS INFUSION (OR)
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
NDC 09900000194
|
| Hospital Charge Code |
155006
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$148.00 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna American Axle |
$260.00
|
| Rate for Payer: Aetna Commercial |
$340.00
|
| Rate for Payer: Aetna Medicare |
$200.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.00
|
| Rate for Payer: BCBS Complete |
$160.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cofinity Commercial |
$280.00
|
| Rate for Payer: Cofinity Commercial |
$344.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$280.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.00
|
| Rate for Payer: Healthscope Commercial |
$360.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$280.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.00
|
| Rate for Payer: PHP Commercial |
$340.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.00
|
| Rate for Payer: Priority Health SBD |
$252.00
|
| Rate for Payer: UMR Bronson Commercial |
$148.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.00
|
|
|
AMINOCAPROIC ACID 250 MG/ML (25 %) ORAL SOLUTION
|
Facility
|
IP
|
$9,617.68
|
|
|
Service Code
|
NDC 49411005208
|
| Hospital Charge Code |
9062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,231.78 |
| Max. Negotiated Rate |
$8,655.91 |
| Rate for Payer: Aetna American Axle |
$6,251.49
|
| Rate for Payer: Aetna Commercial |
$8,175.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,251.49
|
| Rate for Payer: Cash Price |
$7,694.14
|
| Rate for Payer: Cofinity Commercial |
$6,732.38
|
| Rate for Payer: Cofinity Commercial |
$8,271.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,732.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,694.14
|
| Rate for Payer: Healthscope Commercial |
$8,655.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,732.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,213.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,175.03
|
| Rate for Payer: PHP Commercial |
$8,175.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,251.49
|
| Rate for Payer: Priority Health SBD |
$6,059.14
|
| Rate for Payer: UMR Bronson Commercial |
$4,231.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,213.26
|
|
|
AMINOCAPROIC ACID 250 MG/ML (25 %) ORAL SOLUTION
|
Facility
|
OP
|
$9,617.68
|
|
|
Service Code
|
NDC 49411005208
|
| Hospital Charge Code |
9062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,558.54 |
| Max. Negotiated Rate |
$8,655.91 |
| Rate for Payer: Aetna American Axle |
$6,251.49
|
| Rate for Payer: Aetna Commercial |
$8,175.03
|
| Rate for Payer: Aetna Medicare |
$4,808.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,251.49
|
| Rate for Payer: BCBS Complete |
$3,847.07
|
| Rate for Payer: Cash Price |
$7,694.14
|
| Rate for Payer: Cofinity Commercial |
$6,732.38
|
| Rate for Payer: Cofinity Commercial |
$8,271.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,732.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,694.14
|
| Rate for Payer: Healthscope Commercial |
$8,655.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,732.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,213.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,175.03
|
| Rate for Payer: PHP Commercial |
$8,175.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,251.49
|
| Rate for Payer: Priority Health SBD |
$6,059.14
|
| Rate for Payer: UMR Bronson Commercial |
$3,558.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,213.26
|
|
|
AMINOCAPROIC ACID 250 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$33.11
|
|
|
Service Code
|
NDC 00517912001
|
| Hospital Charge Code |
403
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$29.80 |
| Rate for Payer: Aetna American Axle |
$21.52
|
| Rate for Payer: Aetna Commercial |
$28.14
|
| Rate for Payer: Aetna Medicare |
$16.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.52
|
| Rate for Payer: BCBS Complete |
$13.24
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cofinity Commercial |
$23.18
|
| Rate for Payer: Cofinity Commercial |
$28.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$29.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.14
|
| Rate for Payer: PHP Commercial |
$28.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.52
|
| Rate for Payer: Priority Health SBD |
$20.86
|
| Rate for Payer: UMR Bronson Commercial |
$12.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.83
|
|
|
AMINOCAPROIC ACID 250 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$28.84
|
|
|
Service Code
|
NDC 00409434673
|
| Hospital Charge Code |
403
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.69 |
| Max. Negotiated Rate |
$25.96 |
| Rate for Payer: Aetna American Axle |
$18.75
|
| Rate for Payer: Aetna Commercial |
$24.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.75
|
| Rate for Payer: Cash Price |
$23.07
|
| Rate for Payer: Cofinity Commercial |
$20.19
|
| Rate for Payer: Cofinity Commercial |
$24.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.07
|
| Rate for Payer: Healthscope Commercial |
$25.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.51
|
| Rate for Payer: PHP Commercial |
$24.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.75
|
| Rate for Payer: Priority Health SBD |
$18.17
|
| Rate for Payer: UMR Bronson Commercial |
$12.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.63
|
|
|
AMINOCAPROIC ACID 250 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$28.84
|
|
|
Service Code
|
NDC 00409434616
|
| Hospital Charge Code |
403
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.69 |
| Max. Negotiated Rate |
$25.96 |
| Rate for Payer: Aetna American Axle |
$18.75
|
| Rate for Payer: Aetna Commercial |
$24.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.75
|
| Rate for Payer: Cash Price |
$23.07
|
| Rate for Payer: Cofinity Commercial |
$20.19
|
| Rate for Payer: Cofinity Commercial |
$24.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.07
|
| Rate for Payer: Healthscope Commercial |
$25.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.51
|
| Rate for Payer: PHP Commercial |
$24.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.75
|
| Rate for Payer: Priority Health SBD |
$18.17
|
| Rate for Payer: UMR Bronson Commercial |
$12.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.63
|
|
|
AMINOCAPROIC ACID 250 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$33.11
|
|
|
Service Code
|
NDC 00517912001
|
| Hospital Charge Code |
403
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$29.80 |
| Rate for Payer: Aetna American Axle |
$21.52
|
| Rate for Payer: Aetna Commercial |
$28.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.52
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cofinity Commercial |
$23.18
|
| Rate for Payer: Cofinity Commercial |
$28.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$29.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.14
|
| Rate for Payer: PHP Commercial |
$28.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.52
|
| Rate for Payer: Priority Health SBD |
$20.86
|
| Rate for Payer: UMR Bronson Commercial |
$14.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.83
|
|
|
AMINOCAPROIC ACID 250 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$33.11
|
|
|
Service Code
|
NDC 00517912025
|
| Hospital Charge Code |
403
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$29.80 |
| Rate for Payer: Aetna American Axle |
$21.52
|
| Rate for Payer: Aetna Commercial |
$28.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.52
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cofinity Commercial |
$23.18
|
| Rate for Payer: Cofinity Commercial |
$28.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$29.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.14
|
| Rate for Payer: PHP Commercial |
$28.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.52
|
| Rate for Payer: Priority Health SBD |
$20.86
|
| Rate for Payer: UMR Bronson Commercial |
$14.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.83
|
|
