|
CIPROFLOXACIN 750 MG TABLET
|
Facility
|
OP
|
$141.55
|
|
|
Service Code
|
NDC 55111012850
|
| Hospital Charge Code |
25120
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.37 |
| Max. Negotiated Rate |
$127.40 |
| Rate for Payer: Aetna American Axle |
$92.01
|
| Rate for Payer: Aetna Commercial |
$120.32
|
| Rate for Payer: Aetna Medicare |
$70.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.01
|
| Rate for Payer: BCBS Complete |
$56.62
|
| Rate for Payer: Cash Price |
$113.24
|
| Rate for Payer: Cofinity Commercial |
$121.73
|
| Rate for Payer: Cofinity Commercial |
$99.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$99.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.24
|
| Rate for Payer: Healthscope Commercial |
$127.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$99.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.32
|
| Rate for Payer: PHP Commercial |
$120.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.01
|
| Rate for Payer: Priority Health SBD |
$89.18
|
| Rate for Payer: UMR Bronson Commercial |
$52.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.16
|
|
|
CIRCUMCISION, SURGICAL EXCISION OTHER THAN CLAMP, DEVICE, OR DORSAL SLIT; OLDER THAN 28 DAYS OF AGE
|
Facility
|
OP
|
$6,308.24
|
|
|
Service Code
|
CPT 54161
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$189.70 |
| Max. Negotiated Rate |
$6,308.24 |
| Rate for Payer: Aetna Medicare |
$2,087.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,508.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,508.86
|
| Rate for Payer: BCBS Complete |
$1,129.59
|
| Rate for Payer: BCBS MAPPO |
$2,007.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,979.42
|
| Rate for Payer: BCN Commercial |
$2,979.42
|
| Rate for Payer: BCN Medicare Advantage |
$2,007.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,007.09
|
| Rate for Payer: Mclaren Medicaid |
$1,075.80
|
| Rate for Payer: Mclaren Medicare |
$2,007.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,107.44
|
| Rate for Payer: Meridian Medicaid |
$1,129.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,308.15
|
| Rate for Payer: Nomi Health Commercial |
$4,214.89
|
| Rate for Payer: PACE Medicare |
$1,906.74
|
| Rate for Payer: PACE SWMI |
$2,007.09
|
| Rate for Payer: PHP Medicare Advantage |
$2,007.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,308.24
|
| Rate for Payer: Priority Health Medicare |
$2,007.09
|
| Rate for Payer: Priority Health Narrow Network |
$5,046.59
|
| Rate for Payer: Railroad Medicare Medicare |
$2,007.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.67
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,007.09
|
| Rate for Payer: UHC Exchange |
$189.70
|
| Rate for Payer: UHC Medicare Advantage |
$2,007.09
|
| Rate for Payer: UHCCP Medicaid |
$1,075.80
|
| Rate for Payer: VA VA |
$2,007.09
|
|
|
CIRCUMCISION, USING CLAMP OR OTHER DEVICE WITH REGIONAL DORSAL PENILE OR RING BLOCK
|
Facility
|
OP
|
$6,308.24
|
|
|
Service Code
|
CPT 54150
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,075.80 |
| Max. Negotiated Rate |
$6,308.24 |
| Rate for Payer: Aetna Medicare |
$2,087.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,508.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,508.86
|
| Rate for Payer: BCBS Complete |
$1,129.59
|
| Rate for Payer: BCBS MAPPO |
$2,007.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,081.21
|
| Rate for Payer: BCN Commercial |
$1,081.21
|
| Rate for Payer: BCN Medicare Advantage |
$2,007.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,007.09
|
| Rate for Payer: Mclaren Medicaid |
$1,075.80
|
| Rate for Payer: Mclaren Medicare |
$2,007.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,107.44
|
| Rate for Payer: Meridian Medicaid |
$1,129.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,308.15
|
| Rate for Payer: Nomi Health Commercial |
$4,214.89
|
| Rate for Payer: PACE Medicare |
$1,906.74
|
| Rate for Payer: PACE SWMI |
$2,007.09
|
| Rate for Payer: PHP Medicare Advantage |
$2,007.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,308.24
|
| Rate for Payer: Priority Health Medicare |
$2,007.09
|
| Rate for Payer: Priority Health Narrow Network |
$5,046.59
|
| Rate for Payer: Railroad Medicare Medicare |
$2,007.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,649.76
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,007.09
|
| Rate for Payer: UHC Exchange |
$3,835.75
|
| Rate for Payer: UHC Medicare Advantage |
$2,007.09
|
| Rate for Payer: UHCCP Medicaid |
$1,075.80
|
| Rate for Payer: VA VA |
$2,007.09
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$95.19
|
|
|
Service Code
|
NDC 00703205601
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.22 |
| Max. Negotiated Rate |
$85.67 |
| Rate for Payer: Aetna American Axle |
$61.87
|
| Rate for Payer: Aetna Commercial |
$80.91
|
| Rate for Payer: Aetna Medicare |
$47.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.87
|
| Rate for Payer: BCBS Complete |
$38.08
|
| Rate for Payer: Cash Price |
$76.15
|
| Rate for Payer: Cofinity Commercial |
$66.63
|
| Rate for Payer: Cofinity Commercial |
$81.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.15
|
| Rate for Payer: Healthscope Commercial |
$85.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.91
|
| Rate for Payer: PHP Commercial |
$80.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.87
|
| Rate for Payer: Priority Health SBD |
$59.97
|
| Rate for Payer: UMR Bronson Commercial |
$35.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.39
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19.73
|
|
|
Service Code
|
NDC 00781315095
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$17.76 |
| Rate for Payer: Aetna American Axle |
$12.82
|
| Rate for Payer: Aetna Commercial |
$16.77
|
| Rate for Payer: Aetna Medicare |
$9.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.82
|
| Rate for Payer: BCBS Complete |
$7.89
|
| Rate for Payer: Cash Price |
$15.78
|
| Rate for Payer: Cofinity Commercial |
$13.81
|
| Rate for Payer: Cofinity Commercial |
$16.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.78
|
| Rate for Payer: Healthscope Commercial |
$17.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.77
|
| Rate for Payer: PHP Commercial |
$16.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.82
|
| Rate for Payer: Priority Health SBD |
$12.43
|
| Rate for Payer: UMR Bronson Commercial |
$7.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.80
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.73
|
|
|
Service Code
|
NDC 00781315075
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$17.76 |
| Rate for Payer: Aetna American Axle |
$12.82
|
| Rate for Payer: Aetna Commercial |
$16.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.82
|
| Rate for Payer: Cash Price |
$15.78
|
| Rate for Payer: Cofinity Commercial |
$13.81
|
| Rate for Payer: Cofinity Commercial |
$16.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.78
|
| Rate for Payer: Healthscope Commercial |
$17.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.77
|
| Rate for Payer: PHP Commercial |
$16.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.82
|
| Rate for Payer: Priority Health SBD |
$12.43
|
| Rate for Payer: UMR Bronson Commercial |
$8.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.80
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$95.19
|
|
|
Service Code
|
NDC 00703205601
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.88 |
| Max. Negotiated Rate |
$85.67 |
| Rate for Payer: Aetna American Axle |
$61.87
|
| Rate for Payer: Aetna Commercial |
$80.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.87
|
| Rate for Payer: Cash Price |
$76.15
|
| Rate for Payer: Cofinity Commercial |
$66.63
|
| Rate for Payer: Cofinity Commercial |
$81.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.15
|
| Rate for Payer: Healthscope Commercial |
$85.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.91
|
| Rate for Payer: PHP Commercial |
$80.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.87
|
| Rate for Payer: Priority Health SBD |
$59.97
|
| Rate for Payer: UMR Bronson Commercial |
$41.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.39
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$95.19
|
|
|
Service Code
|
NDC 00703205603
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.22 |
| Max. Negotiated Rate |
$85.67 |
| Rate for Payer: Aetna American Axle |
$61.87
|
| Rate for Payer: Aetna Commercial |
$80.91
|
| Rate for Payer: Aetna Medicare |
$47.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.87
|
| Rate for Payer: BCBS Complete |
$38.08
|
| Rate for Payer: Cash Price |
$76.15
|
| Rate for Payer: Cofinity Commercial |
$66.63
|
| Rate for Payer: Cofinity Commercial |
$81.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.15
|
| Rate for Payer: Healthscope Commercial |
$85.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.91
|
| Rate for Payer: PHP Commercial |
$80.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.87
|
| Rate for Payer: Priority Health SBD |
$59.97
|
| Rate for Payer: UMR Bronson Commercial |
$35.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.39
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.73
|
|
|
Service Code
|
NDC 00781315095
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$17.76 |
| Rate for Payer: Aetna American Axle |
$12.82
|
| Rate for Payer: Aetna Commercial |
$16.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.82
|
| Rate for Payer: Cash Price |
$15.78
|
| Rate for Payer: Cofinity Commercial |
$13.81
|
| Rate for Payer: Cofinity Commercial |
$16.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.78
|
| Rate for Payer: Healthscope Commercial |
$17.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.77
|
| Rate for Payer: PHP Commercial |
$16.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.82
|
| Rate for Payer: Priority Health SBD |
$12.43
|
| Rate for Payer: UMR Bronson Commercial |
$8.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.80
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$38.90
|
|
|
Service Code
|
NDC 63323041605
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.12 |
| Max. Negotiated Rate |
$35.01 |
| Rate for Payer: Aetna American Axle |
$25.28
|
| Rate for Payer: Aetna Commercial |
$33.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.28
|
| Rate for Payer: Cash Price |
$31.12
|
| Rate for Payer: Cofinity Commercial |
$27.23
|
| Rate for Payer: Cofinity Commercial |
$33.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.12
|
| Rate for Payer: Healthscope Commercial |
$35.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.06
|
| Rate for Payer: PHP Commercial |
$33.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.28
|
| Rate for Payer: Priority Health SBD |
$24.51
|
| Rate for Payer: UMR Bronson Commercial |
$17.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.18
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$95.19
|
|
|
Service Code
|
NDC 00703205603
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.88 |
| Max. Negotiated Rate |
$85.67 |
| Rate for Payer: Aetna American Axle |
$61.87
|
| Rate for Payer: Aetna Commercial |
$80.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.87
|
| Rate for Payer: Cash Price |
$76.15
|
| Rate for Payer: Cofinity Commercial |
$66.63
|
| Rate for Payer: Cofinity Commercial |
$81.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.15
|
| Rate for Payer: Healthscope Commercial |
$85.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.91
|
| Rate for Payer: PHP Commercial |
$80.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.87
|
| Rate for Payer: Priority Health SBD |
$59.97
|
| Rate for Payer: UMR Bronson Commercial |
$41.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.39
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$38.90
|
|
|
Service Code
|
NDC 63323041605
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$35.01 |
| Rate for Payer: Aetna American Axle |
$25.28
|
| Rate for Payer: Aetna Commercial |
$33.06
|
| Rate for Payer: Aetna Medicare |
$19.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.28
|
| Rate for Payer: BCBS Complete |
$15.56
|
| Rate for Payer: Cash Price |
$31.12
|
| Rate for Payer: Cofinity Commercial |
$27.23
|
| Rate for Payer: Cofinity Commercial |
$33.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.12
|
| Rate for Payer: Healthscope Commercial |
$35.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.06
|
| Rate for Payer: PHP Commercial |
$33.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.28
|
| Rate for Payer: Priority Health SBD |
$24.51
|
| Rate for Payer: UMR Bronson Commercial |
$14.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.18
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19.73
|
|
|
Service Code
|
NDC 00781315075
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$17.76 |
| Rate for Payer: Aetna American Axle |
$12.82
|
| Rate for Payer: Aetna Commercial |
$16.77
|
| Rate for Payer: Aetna Medicare |
$9.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.82
|
| Rate for Payer: BCBS Complete |
$7.89
|
| Rate for Payer: Cash Price |
$15.78
|
| Rate for Payer: Cofinity Commercial |
$13.81
|
| Rate for Payer: Cofinity Commercial |
$16.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.78
|
| Rate for Payer: Healthscope Commercial |
$17.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.77
|
| Rate for Payer: PHP Commercial |
$16.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.82
|
| Rate for Payer: Priority Health SBD |
$12.43
|
| Rate for Payer: UMR Bronson Commercial |
$7.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.80
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$65.26
|
|
|
Service Code
|
NDC 00074437805
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.15 |
| Max. Negotiated Rate |
$58.73 |
| Rate for Payer: Aetna American Axle |
$42.42
|
| Rate for Payer: Aetna Commercial |
$55.47
|
| Rate for Payer: Aetna Medicare |
$32.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.42
|
| Rate for Payer: BCBS Complete |
$26.10
|
| Rate for Payer: Cash Price |
$52.21
|
| Rate for Payer: Cofinity Commercial |
$45.68
|
| Rate for Payer: Cofinity Commercial |
$56.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.21
|
| Rate for Payer: Healthscope Commercial |
$58.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.47
|
| Rate for Payer: PHP Commercial |
$55.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.42
|
| Rate for Payer: Priority Health SBD |
$41.11
|
| Rate for Payer: UMR Bronson Commercial |
$24.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.94
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$65.26
|
|
|
Service Code
|
NDC 00074437805
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.71 |
| Max. Negotiated Rate |
$58.73 |
| Rate for Payer: Aetna American Axle |
$42.42
|
| Rate for Payer: Aetna Commercial |
$55.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.42
|
| Rate for Payer: Cash Price |
$52.21
|
| Rate for Payer: Cofinity Commercial |
$45.68
|
| Rate for Payer: Cofinity Commercial |
$56.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.21
|
| Rate for Payer: Healthscope Commercial |
$58.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.47
|
| Rate for Payer: PHP Commercial |
$55.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.42
|
| Rate for Payer: Priority Health SBD |
$41.11
|
| Rate for Payer: UMR Bronson Commercial |
$28.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.94
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$982.43
|
|
|
Service Code
|
NDC 00074438220
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$432.27 |
| Max. Negotiated Rate |
$884.19 |
| Rate for Payer: Aetna American Axle |
$638.58
|
| Rate for Payer: Aetna Commercial |
$835.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$638.58
|
| Rate for Payer: Cash Price |
$785.94
|
| Rate for Payer: Cofinity Commercial |
$687.70
|
| Rate for Payer: Cofinity Commercial |
$844.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$687.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$785.94
|
| Rate for Payer: Healthscope Commercial |
$884.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$687.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$736.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$835.07
|
| Rate for Payer: PHP Commercial |
$835.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$638.58
|
| Rate for Payer: Priority Health SBD |
$618.93
|
| Rate for Payer: UMR Bronson Commercial |
$432.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$736.82
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$192.33
|
|
|
Service Code
|
NDC 00781315395
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$71.16 |
| Max. Negotiated Rate |
$173.10 |
| Rate for Payer: Aetna American Axle |
$125.01
|
| Rate for Payer: Aetna Commercial |
$163.48
|
| Rate for Payer: Aetna Medicare |
$96.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.01
|
| Rate for Payer: BCBS Complete |
$76.93
|
| Rate for Payer: Cash Price |
$153.86
|
| Rate for Payer: Cofinity Commercial |
$134.63
|
| Rate for Payer: Cofinity Commercial |
$165.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$134.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.86
|
| Rate for Payer: Healthscope Commercial |
$173.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.48
|
| Rate for Payer: PHP Commercial |
$163.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.01
|
| Rate for Payer: Priority Health SBD |
$121.17
|
| Rate for Payer: UMR Bronson Commercial |
$71.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.25
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$982.43
|
|
|
Service Code
|
NDC 00074438220
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$363.50 |
| Max. Negotiated Rate |
$884.19 |
| Rate for Payer: Aetna American Axle |
$638.58
|
| Rate for Payer: Aetna Commercial |
$835.07
|
| Rate for Payer: Aetna Medicare |
$491.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$638.58
|
| Rate for Payer: BCBS Complete |
$392.97
|
| Rate for Payer: Cash Price |
$785.94
|
| Rate for Payer: Cofinity Commercial |
$687.70
|
| Rate for Payer: Cofinity Commercial |
$844.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$687.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$785.94
|
| Rate for Payer: Healthscope Commercial |
$884.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$687.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$736.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$835.07
|
| Rate for Payer: PHP Commercial |
$835.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$638.58
|
| Rate for Payer: Priority Health SBD |
$618.93
|
| Rate for Payer: UMR Bronson Commercial |
$363.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$736.82
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$213.78
|
|
|
Service Code
|
NDC 63323041820
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$94.06 |
| Max. Negotiated Rate |
$192.40 |
| Rate for Payer: Aetna American Axle |
$138.96
|
| Rate for Payer: Aetna Commercial |
$181.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.96
|
| Rate for Payer: Cash Price |
$171.02
|
| Rate for Payer: Cofinity Commercial |
$149.65
|
| Rate for Payer: Cofinity Commercial |
$183.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$149.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.02
|
| Rate for Payer: Healthscope Commercial |
$192.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$149.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$160.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.71
|
| Rate for Payer: PHP Commercial |
$181.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.96
|
| Rate for Payer: Priority Health SBD |
$134.68
|
| Rate for Payer: UMR Bronson Commercial |
$94.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$160.34
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$233.88
|
|
|
Service Code
|
NDC 00409110301
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$102.91 |
| Max. Negotiated Rate |
$210.49 |
| Rate for Payer: Aetna American Axle |
$152.02
|
| Rate for Payer: Aetna Commercial |
$198.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.02
|
| Rate for Payer: Cash Price |
$187.10
|
| Rate for Payer: Cofinity Commercial |
$163.72
|
| Rate for Payer: Cofinity Commercial |
$201.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$163.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.10
|
| Rate for Payer: Healthscope Commercial |
$210.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$163.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.80
|
| Rate for Payer: PHP Commercial |
$198.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.02
|
| Rate for Payer: Priority Health SBD |
$147.34
|
| Rate for Payer: UMR Bronson Commercial |
$102.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.41
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$192.33
|
|
|
Service Code
|
NDC 00781315395
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$84.63 |
| Max. Negotiated Rate |
$173.10 |
| Rate for Payer: Aetna American Axle |
$125.01
|
| Rate for Payer: Aetna Commercial |
$163.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.01
|
| Rate for Payer: Cash Price |
$153.86
|
| Rate for Payer: Cofinity Commercial |
$134.63
|
| Rate for Payer: Cofinity Commercial |
$165.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$134.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.86
|
| Rate for Payer: Healthscope Commercial |
$173.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.48
|
| Rate for Payer: PHP Commercial |
$163.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.01
|
| Rate for Payer: Priority Health SBD |
$121.17
|
| Rate for Payer: UMR Bronson Commercial |
$84.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.25
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$213.78
|
|
|
Service Code
|
NDC 63323041820
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$79.10 |
| Max. Negotiated Rate |
$192.40 |
| Rate for Payer: Aetna American Axle |
$138.96
|
| Rate for Payer: Aetna Commercial |
$181.71
|
| Rate for Payer: Aetna Medicare |
$106.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.96
|
| Rate for Payer: BCBS Complete |
$85.51
|
| Rate for Payer: Cash Price |
$171.02
|
| Rate for Payer: Cofinity Commercial |
$149.65
|
| Rate for Payer: Cofinity Commercial |
$183.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$149.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.02
|
| Rate for Payer: Healthscope Commercial |
$192.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$149.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$160.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.71
|
| Rate for Payer: PHP Commercial |
$181.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.96
|
| Rate for Payer: Priority Health SBD |
$134.68
|
| Rate for Payer: UMR Bronson Commercial |
$79.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$160.34
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$233.88
|
|
|
Service Code
|
NDC 00409110311
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$102.91 |
| Max. Negotiated Rate |
$210.49 |
| Rate for Payer: Aetna American Axle |
$152.02
|
| Rate for Payer: Aetna Commercial |
$198.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.02
|
| Rate for Payer: Cash Price |
$187.10
|
| Rate for Payer: Cofinity Commercial |
$163.72
|
| Rate for Payer: Cofinity Commercial |
$201.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$163.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.10
|
| Rate for Payer: Healthscope Commercial |
$210.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$163.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.80
|
| Rate for Payer: PHP Commercial |
$198.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.02
|
| Rate for Payer: Priority Health SBD |
$147.34
|
| Rate for Payer: UMR Bronson Commercial |
$102.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.41
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$233.88
|
|
|
Service Code
|
NDC 00409110311
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$86.54 |
| Max. Negotiated Rate |
$210.49 |
| Rate for Payer: Aetna American Axle |
$152.02
|
| Rate for Payer: Aetna Commercial |
$198.80
|
| Rate for Payer: Aetna Medicare |
$116.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.02
|
| Rate for Payer: BCBS Complete |
$93.55
|
| Rate for Payer: Cash Price |
$187.10
|
| Rate for Payer: Cofinity Commercial |
$163.72
|
| Rate for Payer: Cofinity Commercial |
$201.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$163.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.10
|
| Rate for Payer: Healthscope Commercial |
$210.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$163.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.80
|
| Rate for Payer: PHP Commercial |
$198.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.02
|
| Rate for Payer: Priority Health SBD |
$147.34
|
| Rate for Payer: UMR Bronson Commercial |
$86.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.41
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$233.88
|
|
|
Service Code
|
NDC 00409110301
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$86.54 |
| Max. Negotiated Rate |
$210.49 |
| Rate for Payer: Aetna American Axle |
$152.02
|
| Rate for Payer: Aetna Commercial |
$198.80
|
| Rate for Payer: Aetna Medicare |
$116.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.02
|
| Rate for Payer: BCBS Complete |
$93.55
|
| Rate for Payer: Cash Price |
$187.10
|
| Rate for Payer: Cofinity Commercial |
$163.72
|
| Rate for Payer: Cofinity Commercial |
$201.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$163.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.10
|
| Rate for Payer: Healthscope Commercial |
$210.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$163.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.80
|
| Rate for Payer: PHP Commercial |
$198.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.02
|
| Rate for Payer: Priority Health SBD |
$147.34
|
| Rate for Payer: UMR Bronson Commercial |
$86.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.41
|
|
