|
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET
|
Facility
|
IP
|
$9.16
|
|
|
Service Code
|
NDC 49884046663
|
| Hospital Charge Code |
113348
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.03 |
| Max. Negotiated Rate |
$8.24 |
| Rate for Payer: Aetna American Axle |
$5.95
|
| Rate for Payer: Aetna Commercial |
$7.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.95
|
| Rate for Payer: Cash Price |
$7.33
|
| Rate for Payer: Cofinity Commercial |
$6.41
|
| Rate for Payer: Cofinity Commercial |
$7.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.33
|
| Rate for Payer: Healthscope Commercial |
$8.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.79
|
| Rate for Payer: PHP Commercial |
$7.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.95
|
| Rate for Payer: Priority Health SBD |
$5.77
|
| Rate for Payer: UMR Bronson Commercial |
$4.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.87
|
|
|
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET
|
Facility
|
OP
|
$9.16
|
|
|
Service Code
|
NDC 49884046663
|
| Hospital Charge Code |
113348
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$8.24 |
| Rate for Payer: Aetna American Axle |
$5.95
|
| Rate for Payer: Aetna Commercial |
$7.79
|
| Rate for Payer: Aetna Medicare |
$4.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.95
|
| Rate for Payer: BCBS Complete |
$3.66
|
| Rate for Payer: Cash Price |
$7.33
|
| Rate for Payer: Cofinity Commercial |
$6.41
|
| Rate for Payer: Cofinity Commercial |
$7.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.33
|
| Rate for Payer: Healthscope Commercial |
$8.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.79
|
| Rate for Payer: PHP Commercial |
$7.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.95
|
| Rate for Payer: Priority Health SBD |
$5.77
|
| Rate for Payer: UMR Bronson Commercial |
$3.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.87
|
|
|
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET
|
Facility
|
IP
|
$9.36
|
|
|
Service Code
|
NDC 00245003689
|
| Hospital Charge Code |
113348
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Aetna American Axle |
$6.08
|
| Rate for Payer: Aetna Commercial |
$7.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.08
|
| Rate for Payer: Cash Price |
$7.49
|
| Rate for Payer: Cofinity Commercial |
$6.55
|
| Rate for Payer: Cofinity Commercial |
$8.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.49
|
| Rate for Payer: Healthscope Commercial |
$8.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.96
|
| Rate for Payer: PHP Commercial |
$7.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.08
|
| Rate for Payer: Priority Health SBD |
$5.90
|
| Rate for Payer: UMR Bronson Commercial |
$4.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.02
|
|
|
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET
|
Facility
|
OP
|
$561.03
|
|
|
Service Code
|
NDC 00245003660
|
| Hospital Charge Code |
113348
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$207.58 |
| Max. Negotiated Rate |
$504.93 |
| Rate for Payer: Aetna American Axle |
$364.67
|
| Rate for Payer: Aetna Commercial |
$476.88
|
| Rate for Payer: Aetna Medicare |
$280.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$364.67
|
| Rate for Payer: BCBS Complete |
$224.41
|
| Rate for Payer: Cash Price |
$448.82
|
| Rate for Payer: Cofinity Commercial |
$392.72
|
| Rate for Payer: Cofinity Commercial |
$482.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$392.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$448.82
|
| Rate for Payer: Healthscope Commercial |
$504.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$392.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$420.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$476.88
|
| Rate for Payer: PHP Commercial |
$476.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$364.67
|
| Rate for Payer: Priority Health SBD |
$353.45
|
| Rate for Payer: UMR Bronson Commercial |
$207.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$420.77
|
|
|
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET
|
Facility
|
IP
|
$210.53
|
|
|
Service Code
|
NDC 68382052960
|
| Hospital Charge Code |
113348
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.63 |
| Max. Negotiated Rate |
$189.48 |
| Rate for Payer: Aetna American Axle |
$136.84
|
| Rate for Payer: Aetna Commercial |
$178.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.84
|
| Rate for Payer: Cash Price |
$168.42
|
| Rate for Payer: Cofinity Commercial |
$147.37
|
| Rate for Payer: Cofinity Commercial |
$181.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$147.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.42
|
| Rate for Payer: Healthscope Commercial |
$189.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.95
|
| Rate for Payer: PHP Commercial |
$178.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.84
|
| Rate for Payer: Priority Health SBD |
$132.63
|
| Rate for Payer: UMR Bronson Commercial |
$92.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.90
|
|
|
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET
|
Facility
|
IP
|
$9.16
|
|
|
Service Code
|
NDC 49884046665
|
| Hospital Charge Code |
113348
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.03 |
| Max. Negotiated Rate |
$8.24 |
| Rate for Payer: Aetna American Axle |
$5.95
|
| Rate for Payer: Aetna Commercial |
$7.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.95
|
| Rate for Payer: Cash Price |
$7.33
|
| Rate for Payer: Cofinity Commercial |
$6.41
|
| Rate for Payer: Cofinity Commercial |
$7.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.33
|
| Rate for Payer: Healthscope Commercial |
$8.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.79
|
| Rate for Payer: PHP Commercial |
$7.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.95
|
| Rate for Payer: Priority Health SBD |
$5.77
|
| Rate for Payer: UMR Bronson Commercial |
$4.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.87
|
|
|
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET
|
Facility
|
IP
|
$561.03
|
|
|
Service Code
|
NDC 00245003660
|
| Hospital Charge Code |
113348
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$246.85 |
| Max. Negotiated Rate |
$504.93 |
| Rate for Payer: Aetna American Axle |
$364.67
|
| Rate for Payer: Aetna Commercial |
$476.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$364.67
|
| Rate for Payer: Cash Price |
$448.82
|
| Rate for Payer: Cofinity Commercial |
$392.72
|
| Rate for Payer: Cofinity Commercial |
$482.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$392.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$448.82
|
| Rate for Payer: Healthscope Commercial |
$504.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$392.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$420.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$476.88
|
| Rate for Payer: PHP Commercial |
$476.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$364.67
|
| Rate for Payer: Priority Health SBD |
$353.45
|
| Rate for Payer: UMR Bronson Commercial |
$246.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$420.77
|
|
|
CHONDROITIN-SOD HYALURON 3 %-4 %(0.5 ML)1 %(0.55 ML)INTRAOCULAR SYRING
|
Facility
|
OP
|
$345.54
|
|
|
Service Code
|
NDC 08065183150
|
| Hospital Charge Code |
28917
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$127.85 |
| Max. Negotiated Rate |
$310.99 |
| Rate for Payer: Aetna American Axle |
$224.60
|
| Rate for Payer: Aetna Commercial |
$293.71
|
| Rate for Payer: Aetna Medicare |
$172.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.60
|
| Rate for Payer: BCBS Complete |
$138.22
|
| Rate for Payer: Cash Price |
$276.43
|
| Rate for Payer: Cofinity Commercial |
$241.88
|
| Rate for Payer: Cofinity Commercial |
$297.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$241.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.43
|
| Rate for Payer: Healthscope Commercial |
$310.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$241.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.71
|
| Rate for Payer: PHP Commercial |
$293.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.60
|
| Rate for Payer: Priority Health SBD |
$217.69
|
| Rate for Payer: UMR Bronson Commercial |
$127.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.16
|
|
|
CHONDROITIN-SOD HYALURON 3 %-4 %(0.5 ML)1 %(0.55 ML)INTRAOCULAR SYRING
|
Facility
|
IP
|
$345.54
|
|
|
Service Code
|
NDC 08065183150
|
| Hospital Charge Code |
28917
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$152.04 |
| Max. Negotiated Rate |
$310.99 |
| Rate for Payer: Aetna American Axle |
$224.60
|
| Rate for Payer: Aetna Commercial |
$293.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.60
|
| Rate for Payer: Cash Price |
$276.43
|
| Rate for Payer: Cofinity Commercial |
$241.88
|
| Rate for Payer: Cofinity Commercial |
$297.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$241.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.43
|
| Rate for Payer: Healthscope Commercial |
$310.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$241.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.71
|
| Rate for Payer: PHP Commercial |
$293.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.60
|
| Rate for Payer: Priority Health SBD |
$217.69
|
| Rate for Payer: UMR Bronson Commercial |
$152.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.16
|
|
|
CHONDROITIN-SOD HYALURON 4 %-3 % (40 MG-30 MG/ML) INTRAOCULAR SYRINGE
|
Facility
|
IP
|
$233.06
|
|
|
Service Code
|
HCPCS J7327
|
| Hospital Charge Code |
28923
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$102.55 |
| Max. Negotiated Rate |
$209.75 |
| Rate for Payer: Aetna American Axle |
$151.49
|
| Rate for Payer: Aetna Commercial |
$198.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.49
|
| Rate for Payer: Cash Price |
$186.45
|
| Rate for Payer: Cofinity Commercial |
$163.14
|
| Rate for Payer: Cofinity Commercial |
$200.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$163.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.45
|
| Rate for Payer: Healthscope Commercial |
$209.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$163.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.10
|
| Rate for Payer: PHP Commercial |
$198.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.49
|
| Rate for Payer: Priority Health SBD |
$146.83
|
| Rate for Payer: UMR Bronson Commercial |
$102.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.80
|
|
|
CHONDROITIN-SOD HYALURON 4 %-3 % (40 MG-30 MG/ML) INTRAOCULAR SYRINGE
|
Facility
|
OP
|
$233.06
|
|
|
Service Code
|
HCPCS J7327
|
| Hospital Charge Code |
28923
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$86.23 |
| Max. Negotiated Rate |
$1,966.17 |
| Rate for Payer: Aetna Medicare |
$587.24
|
| Rate for Payer: Aetna American Axle |
$151.49
|
| Rate for Payer: Aetna Commercial |
$198.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$705.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$705.81
|
| Rate for Payer: BCBS Complete |
$317.79
|
| Rate for Payer: BCBS MAPPO |
$564.65
|
| Rate for Payer: BCN Medicare Advantage |
$564.65
|
| Rate for Payer: Cash Price |
$186.45
|
| Rate for Payer: Cash Price |
$186.45
|
| Rate for Payer: Cofinity Commercial |
$200.43
|
| Rate for Payer: Cofinity Commercial |
$163.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$163.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$564.65
|
| Rate for Payer: Healthscope Commercial |
$209.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$163.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.80
|
| Rate for Payer: Mclaren Medicaid |
$302.65
|
| Rate for Payer: Mclaren Medicare |
$564.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$592.88
|
| Rate for Payer: Meridian Medicaid |
$317.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$649.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.10
|
| Rate for Payer: Nomi Health Commercial |
$1,693.95
|
| Rate for Payer: PACE Medicare |
$536.42
|
| Rate for Payer: PACE SWMI |
$564.65
|
| Rate for Payer: PHP Commercial |
$198.10
|
| Rate for Payer: PHP Medicare Advantage |
$564.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$302.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,966.17
|
| Rate for Payer: Priority Health Medicare |
$564.65
|
| Rate for Payer: Priority Health Narrow Network |
$1,572.94
|
| Rate for Payer: Priority Health SBD |
$146.83
|
| Rate for Payer: Railroad Medicare Medicare |
$564.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,589.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$564.65
|
| Rate for Payer: UHC Exchange |
$1,079.10
|
| Rate for Payer: UHC Medicare Advantage |
$564.65
|
| Rate for Payer: UHCCP Medicaid |
$302.65
|
| Rate for Payer: UMR Bronson Commercial |
$86.23
|
| Rate for Payer: VA VA |
$564.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.80
|
|
|
CHONDROITIN SULF-SODIUM HYALURONATE 40 MG-17 MG/ML INTRAOCULAR SYRINGE
|
Facility
|
OP
|
$321.34
|
|
|
Service Code
|
NDC 08065183710
|
| Hospital Charge Code |
70498
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$118.90 |
| Max. Negotiated Rate |
$289.21 |
| Rate for Payer: Aetna American Axle |
$208.87
|
| Rate for Payer: Aetna Commercial |
$273.14
|
| Rate for Payer: Aetna Medicare |
$160.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.87
|
| Rate for Payer: BCBS Complete |
$128.54
|
| Rate for Payer: Cash Price |
$257.07
|
| Rate for Payer: Cofinity Commercial |
$224.94
|
| Rate for Payer: Cofinity Commercial |
$276.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$224.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.07
|
| Rate for Payer: Healthscope Commercial |
$289.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$224.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.14
|
| Rate for Payer: PHP Commercial |
$273.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.87
|
| Rate for Payer: Priority Health SBD |
$202.44
|
| Rate for Payer: UMR Bronson Commercial |
$118.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.00
|
|
|
CHONDROITIN SULF-SODIUM HYALURONATE 40 MG-17 MG/ML INTRAOCULAR SYRINGE
|
Facility
|
IP
|
$321.34
|
|
|
Service Code
|
NDC 08065183710
|
| Hospital Charge Code |
70498
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$141.39 |
| Max. Negotiated Rate |
$289.21 |
| Rate for Payer: Aetna American Axle |
$208.87
|
| Rate for Payer: Aetna Commercial |
$273.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.87
|
| Rate for Payer: Cash Price |
$257.07
|
| Rate for Payer: Cofinity Commercial |
$224.94
|
| Rate for Payer: Cofinity Commercial |
$276.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$224.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.07
|
| Rate for Payer: Healthscope Commercial |
$289.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$224.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.14
|
| Rate for Payer: PHP Commercial |
$273.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.87
|
| Rate for Payer: Priority Health SBD |
$202.44
|
| Rate for Payer: UMR Bronson Commercial |
$141.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.00
|
|
|
CHROMIUM CHLORIDE 4 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$258.83
|
|
|
Service Code
|
NDC 00409409311
|
| Hospital Charge Code |
1685
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$95.77 |
| Max. Negotiated Rate |
$232.95 |
| Rate for Payer: Aetna American Axle |
$168.24
|
| Rate for Payer: Aetna Commercial |
$220.01
|
| Rate for Payer: Aetna Medicare |
$129.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.24
|
| Rate for Payer: BCBS Complete |
$103.53
|
| Rate for Payer: Cash Price |
$207.06
|
| Rate for Payer: Cofinity Commercial |
$181.18
|
| Rate for Payer: Cofinity Commercial |
$222.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$181.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.06
|
| Rate for Payer: Healthscope Commercial |
$232.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$181.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.01
|
| Rate for Payer: PHP Commercial |
$220.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.24
|
| Rate for Payer: Priority Health SBD |
$163.06
|
| Rate for Payer: UMR Bronson Commercial |
$95.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.12
|
|
|
CHROMIUM CHLORIDE 4 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$248.10
|
|
|
Service Code
|
NDC 00409409310
|
| Hospital Charge Code |
1685
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$223.29 |
| Rate for Payer: Aetna American Axle |
$161.26
|
| Rate for Payer: Aetna Commercial |
$210.88
|
| Rate for Payer: Aetna Medicare |
$124.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.26
|
| Rate for Payer: BCBS Complete |
$99.24
|
| Rate for Payer: Cash Price |
$198.48
|
| Rate for Payer: Cofinity Commercial |
$173.67
|
| Rate for Payer: Cofinity Commercial |
$213.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$173.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.48
|
| Rate for Payer: Healthscope Commercial |
$223.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.88
|
| Rate for Payer: PHP Commercial |
$210.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.26
|
| Rate for Payer: Priority Health SBD |
$156.30
|
| Rate for Payer: UMR Bronson Commercial |
$91.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.08
|
|
|
CHROMIUM CHLORIDE 4 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$258.83
|
|
|
Service Code
|
NDC 00409409311
|
| Hospital Charge Code |
1685
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$113.89 |
| Max. Negotiated Rate |
$232.95 |
| Rate for Payer: Aetna American Axle |
$168.24
|
| Rate for Payer: Aetna Commercial |
$220.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.24
|
| Rate for Payer: Cash Price |
$207.06
|
| Rate for Payer: Cofinity Commercial |
$181.18
|
| Rate for Payer: Cofinity Commercial |
$222.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$181.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.06
|
| Rate for Payer: Healthscope Commercial |
$232.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$181.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.01
|
| Rate for Payer: PHP Commercial |
$220.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.24
|
| Rate for Payer: Priority Health SBD |
$163.06
|
| Rate for Payer: UMR Bronson Commercial |
$113.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.12
|
|
|
CHROMIUM CHLORIDE 4 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$248.10
|
|
|
Service Code
|
NDC 00409409309
|
| Hospital Charge Code |
1685
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$109.16 |
| Max. Negotiated Rate |
$223.29 |
| Rate for Payer: Aetna American Axle |
$161.26
|
| Rate for Payer: Aetna Commercial |
$210.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.26
|
| Rate for Payer: Cash Price |
$198.48
|
| Rate for Payer: Cofinity Commercial |
$173.67
|
| Rate for Payer: Cofinity Commercial |
$213.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$173.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.48
|
| Rate for Payer: Healthscope Commercial |
$223.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.88
|
| Rate for Payer: PHP Commercial |
$210.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.26
|
| Rate for Payer: Priority Health SBD |
$156.30
|
| Rate for Payer: UMR Bronson Commercial |
$109.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.08
|
|
|
CHROMIUM CHLORIDE 4 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$248.10
|
|
|
Service Code
|
NDC 00409409310
|
| Hospital Charge Code |
1685
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$109.16 |
| Max. Negotiated Rate |
$223.29 |
| Rate for Payer: Aetna American Axle |
$161.26
|
| Rate for Payer: Aetna Commercial |
$210.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.26
|
| Rate for Payer: Cash Price |
$198.48
|
| Rate for Payer: Cofinity Commercial |
$173.67
|
| Rate for Payer: Cofinity Commercial |
$213.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$173.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.48
|
| Rate for Payer: Healthscope Commercial |
$223.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.88
|
| Rate for Payer: PHP Commercial |
$210.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.26
|
| Rate for Payer: Priority Health SBD |
$156.30
|
| Rate for Payer: UMR Bronson Commercial |
$109.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.08
|
|
|
CHROMIUM CHLORIDE 4 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$248.10
|
|
|
Service Code
|
NDC 00409409309
|
| Hospital Charge Code |
1685
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$223.29 |
| Rate for Payer: Aetna American Axle |
$161.26
|
| Rate for Payer: Aetna Commercial |
$210.88
|
| Rate for Payer: Aetna Medicare |
$124.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.26
|
| Rate for Payer: BCBS Complete |
$99.24
|
| Rate for Payer: Cash Price |
$198.48
|
| Rate for Payer: Cofinity Commercial |
$173.67
|
| Rate for Payer: Cofinity Commercial |
$213.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$173.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.48
|
| Rate for Payer: Healthscope Commercial |
$223.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.88
|
| Rate for Payer: PHP Commercial |
$210.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.26
|
| Rate for Payer: Priority Health SBD |
$156.30
|
| Rate for Payer: UMR Bronson Commercial |
$91.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.08
|
|
|
CHROMIUM CHLORIDE 4 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$258.83
|
|
|
Service Code
|
NDC 00409409301
|
| Hospital Charge Code |
1685
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$95.77 |
| Max. Negotiated Rate |
$232.95 |
| Rate for Payer: Aetna American Axle |
$168.24
|
| Rate for Payer: Aetna Commercial |
$220.01
|
| Rate for Payer: Aetna Medicare |
$129.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.24
|
| Rate for Payer: BCBS Complete |
$103.53
|
| Rate for Payer: Cash Price |
$207.06
|
| Rate for Payer: Cofinity Commercial |
$181.18
|
| Rate for Payer: Cofinity Commercial |
$222.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$181.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.06
|
| Rate for Payer: Healthscope Commercial |
$232.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$181.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.01
|
| Rate for Payer: PHP Commercial |
$220.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.24
|
| Rate for Payer: Priority Health SBD |
$163.06
|
| Rate for Payer: UMR Bronson Commercial |
$95.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.12
|
|
|
CHROMIUM CHLORIDE 4 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$258.83
|
|
|
Service Code
|
NDC 00409409301
|
| Hospital Charge Code |
1685
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$113.89 |
| Max. Negotiated Rate |
$232.95 |
| Rate for Payer: Aetna American Axle |
$168.24
|
| Rate for Payer: Aetna Commercial |
$220.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.24
|
| Rate for Payer: Cash Price |
$207.06
|
| Rate for Payer: Cofinity Commercial |
$181.18
|
| Rate for Payer: Cofinity Commercial |
$222.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$181.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.06
|
| Rate for Payer: Healthscope Commercial |
$232.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$181.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.01
|
| Rate for Payer: PHP Commercial |
$220.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.24
|
| Rate for Payer: Priority Health SBD |
$163.06
|
| Rate for Payer: UMR Bronson Commercial |
$113.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.12
|
|
|
CHROMIUM CHLORIDE SD 0.5 MCG/ML IV
|
Facility
|
IP
|
$4.50
|
|
|
Service Code
|
NDC 09900000057
|
| Hospital Charge Code |
150942
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Aetna American Axle |
$2.92
|
| Rate for Payer: Aetna Commercial |
$3.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.92
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cofinity Commercial |
$3.15
|
| Rate for Payer: Cofinity Commercial |
$3.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.60
|
| Rate for Payer: Healthscope Commercial |
$4.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.82
|
| Rate for Payer: PHP Commercial |
$3.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.92
|
| Rate for Payer: Priority Health SBD |
$2.84
|
| Rate for Payer: UMR Bronson Commercial |
$1.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.38
|
|
|
CHROMIUM CHLORIDE SD 0.5 MCG/ML IV
|
Facility
|
OP
|
$4.50
|
|
|
Service Code
|
NDC 09900000057
|
| Hospital Charge Code |
150942
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Aetna American Axle |
$2.92
|
| Rate for Payer: Aetna Commercial |
$3.82
|
| Rate for Payer: Aetna Medicare |
$2.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.92
|
| Rate for Payer: BCBS Complete |
$1.80
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cofinity Commercial |
$3.15
|
| Rate for Payer: Cofinity Commercial |
$3.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.60
|
| Rate for Payer: Healthscope Commercial |
$4.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.82
|
| Rate for Payer: PHP Commercial |
$3.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.92
|
| Rate for Payer: Priority Health SBD |
$2.84
|
| Rate for Payer: UMR Bronson Commercial |
$1.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.38
|
|
|
CHROMOTUBATION OF OVIDUCT, INCLUDING MATERIALS
|
Facility
|
OP
|
$15,201.47
|
|
|
Service Code
|
CPT 58350
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,582.58 |
| Max. Negotiated Rate |
$15,201.47 |
| Rate for Payer: Aetna Medicare |
$5,030.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,045.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,045.79
|
| Rate for Payer: BCBS Complete |
$2,722.06
|
| Rate for Payer: BCBS MAPPO |
$4,836.63
|
| Rate for Payer: BCBS Trust/PPO |
$2,582.58
|
| Rate for Payer: BCN Commercial |
$2,582.58
|
| Rate for Payer: BCN Medicare Advantage |
$4,836.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,836.63
|
| Rate for Payer: Mclaren Medicaid |
$2,592.43
|
| Rate for Payer: Mclaren Medicare |
$4,836.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,078.46
|
| Rate for Payer: Meridian Medicaid |
$2,722.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,562.12
|
| Rate for Payer: Nomi Health Commercial |
$10,156.92
|
| Rate for Payer: PACE Medicare |
$4,594.80
|
| Rate for Payer: PACE SWMI |
$4,836.63
|
| Rate for Payer: PHP Medicare Advantage |
$4,836.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,592.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,201.47
|
| Rate for Payer: Priority Health Medicare |
$4,836.63
|
| Rate for Payer: Priority Health Narrow Network |
$12,161.18
|
| Rate for Payer: Railroad Medicare Medicare |
$4,836.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,614.63
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,836.63
|
| Rate for Payer: UHC Exchange |
$9,243.28
|
| Rate for Payer: UHC Medicare Advantage |
$4,836.63
|
| Rate for Payer: UHCCP Medicaid |
$2,592.43
|
| Rate for Payer: VA VA |
$4,836.63
|
|
|
CIDOFOVIR 75 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,539.14
|
|
|
Service Code
|
HCPCS J0740
|
| Hospital Charge Code |
17378
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$677.22 |
| Max. Negotiated Rate |
$1,385.23 |
| Rate for Payer: Aetna American Axle |
$1,000.44
|
| Rate for Payer: Aetna Commercial |
$1,308.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,000.44
|
| Rate for Payer: Cash Price |
$1,231.31
|
| Rate for Payer: Cofinity Commercial |
$1,077.40
|
| Rate for Payer: Cofinity Commercial |
$1,323.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,077.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,231.31
|
| Rate for Payer: Healthscope Commercial |
$1,385.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,077.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,154.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,308.27
|
| Rate for Payer: PHP Commercial |
$1,308.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,000.44
|
| Rate for Payer: Priority Health SBD |
$969.66
|
| Rate for Payer: UMR Bronson Commercial |
$677.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,154.36
|
|
