|
ALVIMOPAN 12 MG CAPSULE
|
Facility
|
OP
|
$16,474.29
|
|
|
Service Code
|
NDC 00054066882
|
| Hospital Charge Code |
91870
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6,095.49 |
| Max. Negotiated Rate |
$14,826.86 |
| Rate for Payer: Aetna American Axle |
$10,708.29
|
| Rate for Payer: Aetna Commercial |
$14,003.15
|
| Rate for Payer: Aetna Medicare |
$8,237.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,708.29
|
| Rate for Payer: BCBS Complete |
$6,589.72
|
| Rate for Payer: Cash Price |
$13,179.43
|
| Rate for Payer: Cofinity Advantage |
$11,532.00
|
| Rate for Payer: Cofinity Commercial |
$14,167.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,179.43
|
| Rate for Payer: Healthscope Commercial |
$14,826.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,532.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,355.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,179.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,003.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,355.72
|
| Rate for Payer: PHP Commercial |
$14,003.15
|
| Rate for Payer: Priority Health SBD |
$10,378.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,708.29
|
| Rate for Payer: UHC Core |
$8,583.11
|
| Rate for Payer: UHC Exchange |
$6,474.40
|
| Rate for Payer: UMR Bronson Commercial |
$6,095.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,355.72
|
|
|
ALVIMOPAN 12 MG CAPSULE
|
Facility
|
OP
|
$20,184.24
|
|
|
Service Code
|
NDC 67919002010
|
| Hospital Charge Code |
91870
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7,468.17 |
| Max. Negotiated Rate |
$18,165.82 |
| Rate for Payer: Aetna American Axle |
$13,119.76
|
| Rate for Payer: Aetna Commercial |
$17,156.60
|
| Rate for Payer: Aetna Medicare |
$10,092.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,119.76
|
| Rate for Payer: BCBS Complete |
$8,073.70
|
| Rate for Payer: Cash Price |
$16,147.39
|
| Rate for Payer: Cofinity Advantage |
$14,128.97
|
| Rate for Payer: Cofinity Commercial |
$17,358.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,147.39
|
| Rate for Payer: Healthscope Commercial |
$18,165.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14,128.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15,138.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,147.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17,156.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15,138.18
|
| Rate for Payer: PHP Commercial |
$17,156.60
|
| Rate for Payer: Priority Health SBD |
$12,716.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,119.76
|
| Rate for Payer: UHC Core |
$10,515.99
|
| Rate for Payer: UHC Exchange |
$7,932.41
|
| Rate for Payer: UMR Bronson Commercial |
$7,468.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15,138.18
|
|
|
ALVIMOPAN 12 MG CAPSULE
|
Facility
|
IP
|
$20,184.24
|
|
|
Service Code
|
NDC 67919002010
|
| Hospital Charge Code |
91870
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8,881.07 |
| Max. Negotiated Rate |
$18,165.82 |
| Rate for Payer: Aetna American Axle |
$13,119.76
|
| Rate for Payer: Aetna Commercial |
$17,156.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,119.76
|
| Rate for Payer: Cash Price |
$16,147.39
|
| Rate for Payer: Cofinity Advantage |
$14,128.97
|
| Rate for Payer: Cofinity Commercial |
$17,358.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,147.39
|
| Rate for Payer: Healthscope Commercial |
$18,165.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14,128.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15,138.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17,156.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15,138.18
|
| Rate for Payer: PHP Commercial |
$17,156.60
|
| Rate for Payer: Priority Health SBD |
$12,716.07
|
| Rate for Payer: UMR Bronson Commercial |
$8,881.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15,138.18
|
|
|
ALVIMOPAN 12 MG CAPSULE
|
Facility
|
IP
|
$16,474.29
|
|
|
Service Code
|
NDC 00054066882
|
| Hospital Charge Code |
91870
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7,248.69 |
| Max. Negotiated Rate |
$14,826.86 |
| Rate for Payer: Aetna American Axle |
$10,708.29
|
| Rate for Payer: Aetna Commercial |
$14,003.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,708.29
|
| Rate for Payer: Cash Price |
$13,179.43
|
| Rate for Payer: Cofinity Advantage |
$11,532.00
|
| Rate for Payer: Cofinity Commercial |
$14,167.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,179.43
|
| Rate for Payer: Healthscope Commercial |
$14,826.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,532.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,355.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,003.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,355.72
|
| Rate for Payer: PHP Commercial |
$14,003.15
|
| Rate for Payer: Priority Health SBD |
$10,378.80
|
| Rate for Payer: UMR Bronson Commercial |
$7,248.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,355.72
|
|
|
AMANTADINE HCL 100 MG CAPSULE
|
Facility
|
IP
|
$359.52
|
|
|
Service Code
|
NDC 00832101500
|
| Hospital Charge Code |
364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.19 |
| Max. Negotiated Rate |
$323.57 |
| Rate for Payer: Aetna American Axle |
$233.69
|
| Rate for Payer: Aetna Commercial |
$305.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.69
|
| Rate for Payer: Cash Price |
$287.62
|
| Rate for Payer: Cofinity Advantage |
$251.66
|
| Rate for Payer: Cofinity Commercial |
$309.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.62
|
| Rate for Payer: Healthscope Commercial |
$323.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$251.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.64
|
| Rate for Payer: PHP Commercial |
$305.59
|
| Rate for Payer: Priority Health SBD |
$226.50
|
| Rate for Payer: UMR Bronson Commercial |
$158.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.64
|
|
|
AMANTADINE HCL 100 MG CAPSULE
|
Facility
|
IP
|
$5.68
|
|
|
Service Code
|
NDC 50268006911
|
| Hospital Charge Code |
364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$5.11 |
| Rate for Payer: Aetna American Axle |
$3.69
|
| Rate for Payer: Aetna Commercial |
$4.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.69
|
| Rate for Payer: Cash Price |
$4.54
|
| Rate for Payer: Cofinity Advantage |
$3.98
|
| Rate for Payer: Cofinity Commercial |
$4.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.54
|
| Rate for Payer: Healthscope Commercial |
$5.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.26
|
| Rate for Payer: PHP Commercial |
$4.83
|
| Rate for Payer: Priority Health SBD |
$3.58
|
| Rate for Payer: UMR Bronson Commercial |
$2.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.26
|
|
|
AMANTADINE HCL 100 MG CAPSULE
|
Facility
|
OP
|
$5.68
|
|
|
Service Code
|
NDC 50268006911
|
| Hospital Charge Code |
364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$5.11 |
| Rate for Payer: Aetna American Axle |
$3.69
|
| Rate for Payer: Aetna Commercial |
$4.83
|
| Rate for Payer: Aetna Medicare |
$2.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.69
|
| Rate for Payer: BCBS Complete |
$2.27
|
| Rate for Payer: Cash Price |
$4.54
|
| Rate for Payer: Cofinity Advantage |
$3.98
|
| Rate for Payer: Cofinity Commercial |
$4.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.54
|
| Rate for Payer: Healthscope Commercial |
$5.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.26
|
| Rate for Payer: PHP Commercial |
$4.83
|
| Rate for Payer: Priority Health SBD |
$3.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.69
|
| Rate for Payer: UHC Core |
$2.96
|
| Rate for Payer: UHC Exchange |
$2.23
|
| Rate for Payer: UMR Bronson Commercial |
$2.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.26
|
|
|
AMANTADINE HCL 100 MG CAPSULE
|
Facility
|
OP
|
$359.52
|
|
|
Service Code
|
NDC 00832101500
|
| Hospital Charge Code |
364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.02 |
| Max. Negotiated Rate |
$323.57 |
| Rate for Payer: Aetna American Axle |
$233.69
|
| Rate for Payer: Aetna Commercial |
$305.59
|
| Rate for Payer: Aetna Medicare |
$179.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.69
|
| Rate for Payer: BCBS Complete |
$143.81
|
| Rate for Payer: Cash Price |
$287.62
|
| Rate for Payer: Cofinity Advantage |
$251.66
|
| Rate for Payer: Cofinity Commercial |
$309.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.62
|
| Rate for Payer: Healthscope Commercial |
$323.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$251.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$287.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.64
|
| Rate for Payer: PHP Commercial |
$305.59
|
| Rate for Payer: Priority Health SBD |
$226.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$233.69
|
| Rate for Payer: UHC Core |
$187.31
|
| Rate for Payer: UHC Exchange |
$141.29
|
| Rate for Payer: UMR Bronson Commercial |
$133.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.64
|
|
|
AMANTADINE HCL 100 MG CAPSULE
|
Facility
|
IP
|
$283.68
|
|
|
Service Code
|
NDC 50268006915
|
| Hospital Charge Code |
364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.82 |
| Max. Negotiated Rate |
$255.31 |
| Rate for Payer: Aetna American Axle |
$184.39
|
| Rate for Payer: Aetna Commercial |
$241.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.39
|
| Rate for Payer: Cash Price |
$226.94
|
| Rate for Payer: Cofinity Advantage |
$198.58
|
| Rate for Payer: Cofinity Commercial |
$243.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.94
|
| Rate for Payer: Healthscope Commercial |
$255.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$198.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$212.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$212.76
|
| Rate for Payer: PHP Commercial |
$241.13
|
| Rate for Payer: Priority Health SBD |
$178.72
|
| Rate for Payer: UMR Bronson Commercial |
$124.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$212.76
|
|
|
AMANTADINE HCL 100 MG CAPSULE
|
Facility
|
OP
|
$283.68
|
|
|
Service Code
|
NDC 50268006915
|
| Hospital Charge Code |
364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.96 |
| Max. Negotiated Rate |
$255.31 |
| Rate for Payer: Aetna American Axle |
$184.39
|
| Rate for Payer: Aetna Commercial |
$241.13
|
| Rate for Payer: Aetna Medicare |
$141.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.39
|
| Rate for Payer: BCBS Complete |
$113.47
|
| Rate for Payer: Cash Price |
$226.94
|
| Rate for Payer: Cofinity Advantage |
$198.58
|
| Rate for Payer: Cofinity Commercial |
$243.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.94
|
| Rate for Payer: Healthscope Commercial |
$255.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$198.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$212.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$226.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$212.76
|
| Rate for Payer: PHP Commercial |
$241.13
|
| Rate for Payer: Priority Health SBD |
$178.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.39
|
| Rate for Payer: UHC Core |
$147.80
|
| Rate for Payer: UHC Exchange |
$111.49
|
| Rate for Payer: UMR Bronson Commercial |
$104.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$212.76
|
|
|
AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$400.16
|
|
|
Service Code
|
NDC 00121064616
|
| Hospital Charge Code |
365
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.06 |
| Max. Negotiated Rate |
$360.14 |
| Rate for Payer: Aetna American Axle |
$260.10
|
| Rate for Payer: Aetna Commercial |
$340.14
|
| Rate for Payer: Aetna Medicare |
$200.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.10
|
| Rate for Payer: BCBS Complete |
$160.06
|
| Rate for Payer: Cash Price |
$320.13
|
| Rate for Payer: Cofinity Advantage |
$280.11
|
| Rate for Payer: Cofinity Commercial |
$344.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.13
|
| Rate for Payer: Healthscope Commercial |
$360.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$280.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$320.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$300.12
|
| Rate for Payer: PHP Commercial |
$340.14
|
| Rate for Payer: Priority Health SBD |
$252.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$260.10
|
| Rate for Payer: UHC Core |
$208.48
|
| Rate for Payer: UHC Exchange |
$157.26
|
| Rate for Payer: UMR Bronson Commercial |
$148.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.12
|
|
|
AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$133.39
|
|
|
Service Code
|
NDC 50383080716
|
| Hospital Charge Code |
365
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.35 |
| Max. Negotiated Rate |
$120.05 |
| Rate for Payer: Aetna American Axle |
$86.70
|
| Rate for Payer: Aetna Commercial |
$113.38
|
| Rate for Payer: Aetna Medicare |
$66.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.70
|
| Rate for Payer: BCBS Complete |
$53.36
|
| Rate for Payer: Cash Price |
$106.71
|
| Rate for Payer: Cofinity Advantage |
$93.37
|
| Rate for Payer: Cofinity Commercial |
$114.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.71
|
| Rate for Payer: Healthscope Commercial |
$120.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$106.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.04
|
| Rate for Payer: PHP Commercial |
$113.38
|
| Rate for Payer: Priority Health SBD |
$84.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.70
|
| Rate for Payer: UHC Core |
$69.50
|
| Rate for Payer: UHC Exchange |
$52.42
|
| Rate for Payer: UMR Bronson Commercial |
$49.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.04
|
|
|
AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$400.16
|
|
|
Service Code
|
NDC 60432009316
|
| Hospital Charge Code |
365
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.06 |
| Max. Negotiated Rate |
$360.14 |
| Rate for Payer: Aetna American Axle |
$260.10
|
| Rate for Payer: Aetna Commercial |
$340.14
|
| Rate for Payer: Aetna Medicare |
$200.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.10
|
| Rate for Payer: BCBS Complete |
$160.06
|
| Rate for Payer: Cash Price |
$320.13
|
| Rate for Payer: Cofinity Advantage |
$280.11
|
| Rate for Payer: Cofinity Commercial |
$344.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.13
|
| Rate for Payer: Healthscope Commercial |
$360.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$280.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$320.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$300.12
|
| Rate for Payer: PHP Commercial |
$340.14
|
| Rate for Payer: Priority Health SBD |
$252.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$260.10
|
| Rate for Payer: UHC Core |
$208.48
|
| Rate for Payer: UHC Exchange |
$157.26
|
| Rate for Payer: UMR Bronson Commercial |
$148.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.12
|
|
|
AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$133.39
|
|
|
Service Code
|
NDC 50383080716
|
| Hospital Charge Code |
365
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.69 |
| Max. Negotiated Rate |
$120.05 |
| Rate for Payer: Aetna American Axle |
$86.70
|
| Rate for Payer: Aetna Commercial |
$113.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.70
|
| Rate for Payer: Cash Price |
$106.71
|
| Rate for Payer: Cofinity Advantage |
$93.37
|
| Rate for Payer: Cofinity Commercial |
$114.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.71
|
| Rate for Payer: Healthscope Commercial |
$120.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.04
|
| Rate for Payer: PHP Commercial |
$113.38
|
| Rate for Payer: Priority Health SBD |
$84.04
|
| Rate for Payer: UMR Bronson Commercial |
$58.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.04
|
|
|
AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$400.16
|
|
|
Service Code
|
NDC 00121064616
|
| Hospital Charge Code |
365
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.07 |
| Max. Negotiated Rate |
$360.14 |
| Rate for Payer: Aetna American Axle |
$260.10
|
| Rate for Payer: Aetna Commercial |
$340.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.10
|
| Rate for Payer: Cash Price |
$320.13
|
| Rate for Payer: Cofinity Advantage |
$280.11
|
| Rate for Payer: Cofinity Commercial |
$344.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.13
|
| Rate for Payer: Healthscope Commercial |
$360.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$280.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$300.12
|
| Rate for Payer: PHP Commercial |
$340.14
|
| Rate for Payer: Priority Health SBD |
$252.10
|
| Rate for Payer: UMR Bronson Commercial |
$176.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.12
|
|
|
AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$400.16
|
|
|
Service Code
|
NDC 60432009316
|
| Hospital Charge Code |
365
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.07 |
| Max. Negotiated Rate |
$360.14 |
| Rate for Payer: Aetna American Axle |
$260.10
|
| Rate for Payer: Aetna Commercial |
$340.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.10
|
| Rate for Payer: Cash Price |
$320.13
|
| Rate for Payer: Cofinity Advantage |
$280.11
|
| Rate for Payer: Cofinity Commercial |
$344.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.13
|
| Rate for Payer: Healthscope Commercial |
$360.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$280.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$300.12
|
| Rate for Payer: PHP Commercial |
$340.14
|
| Rate for Payer: Priority Health SBD |
$252.10
|
| Rate for Payer: UMR Bronson Commercial |
$176.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.12
|
|
|
AMIFOSTINE CRYSTALLINE 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3,188.51
|
|
|
Service Code
|
HCPCS J0207
|
| Hospital Charge Code |
20803
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,402.94 |
| Max. Negotiated Rate |
$2,869.66 |
| Rate for Payer: Aetna American Axle |
$2,072.53
|
| Rate for Payer: Aetna Commercial |
$2,710.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,072.53
|
| Rate for Payer: Cash Price |
$2,550.81
|
| Rate for Payer: Cofinity Advantage |
$2,231.96
|
| Rate for Payer: Cofinity Commercial |
$2,742.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,550.81
|
| Rate for Payer: Healthscope Commercial |
$2,869.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,231.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,391.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,710.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,391.38
|
| Rate for Payer: PHP Commercial |
$2,710.23
|
| Rate for Payer: Priority Health SBD |
$2,008.76
|
| Rate for Payer: UMR Bronson Commercial |
$1,402.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,391.38
|
|
|
AMIFOSTINE CRYSTALLINE 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,188.51
|
|
|
Service Code
|
HCPCS J0207
|
| Hospital Charge Code |
20803
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$722.52 |
| Max. Negotiated Rate |
$3,377.79 |
| Rate for Payer: Aetna American Axle |
$2,072.53
|
| Rate for Payer: Aetna Commercial |
$2,710.23
|
| Rate for Payer: Aetna Medicare |
$1,594.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,072.53
|
| Rate for Payer: BCBS Complete |
$1,275.40
|
| Rate for Payer: BCBS Trust/PPO |
$3,377.79
|
| Rate for Payer: BCN Commercial |
$3,377.79
|
| Rate for Payer: Cash Price |
$2,550.81
|
| Rate for Payer: Cash Price |
$2,550.81
|
| Rate for Payer: Cofinity Advantage |
$2,231.96
|
| Rate for Payer: Cofinity Commercial |
$2,742.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,550.81
|
| Rate for Payer: Healthscope Commercial |
$2,869.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,231.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,391.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,550.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,710.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,391.38
|
| Rate for Payer: PHP Commercial |
$2,710.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,135.69
|
| Rate for Payer: Priority Health SBD |
$2,008.76
|
| Rate for Payer: Priority Health Tiered Network |
$908.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$722.52
|
| Rate for Payer: UHC Core |
$722.52
|
| Rate for Payer: UHC Exchange |
$722.52
|
| Rate for Payer: UMR Bronson Commercial |
$1,179.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,391.38
|
|
|
AMIKACIN 500 MG/2 ML INJECTION SOLUTION
|
Facility
|
IP
|
$16.36
|
|
|
Service Code
|
HCPCS J0278
|
| Hospital Charge Code |
119785
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$14.72 |
| Rate for Payer: Aetna American Axle |
$10.63
|
| Rate for Payer: Aetna American Axle |
$32.97
|
| Rate for Payer: Aetna American Axle |
$31.32
|
| Rate for Payer: Aetna Commercial |
$40.95
|
| Rate for Payer: Aetna Commercial |
$13.91
|
| Rate for Payer: Aetna Commercial |
$43.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.32
|
| Rate for Payer: Cash Price |
$38.54
|
| Rate for Payer: Cash Price |
$13.09
|
| Rate for Payer: Cash Price |
$40.58
|
| Rate for Payer: Cofinity Advantage |
$35.51
|
| Rate for Payer: Cofinity Advantage |
$11.45
|
| Rate for Payer: Cofinity Advantage |
$33.73
|
| Rate for Payer: Cofinity Commercial |
$43.63
|
| Rate for Payer: Cofinity Commercial |
$14.07
|
| Rate for Payer: Cofinity Commercial |
$41.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.58
|
| Rate for Payer: Healthscope Commercial |
$43.36
|
| Rate for Payer: Healthscope Commercial |
$45.66
|
| Rate for Payer: Healthscope Commercial |
$14.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.05
|
| Rate for Payer: PHP Commercial |
$40.95
|
| Rate for Payer: PHP Commercial |
$13.91
|
| Rate for Payer: PHP Commercial |
$43.12
|
| Rate for Payer: Priority Health SBD |
$10.31
|
| Rate for Payer: Priority Health SBD |
$30.35
|
| Rate for Payer: Priority Health SBD |
$31.96
|
| Rate for Payer: UMR Bronson Commercial |
$7.20
|
| Rate for Payer: UMR Bronson Commercial |
$22.32
|
| Rate for Payer: UMR Bronson Commercial |
$21.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.05
|
|
|
AMIKACIN 500 MG/2 ML INJECTION SOLUTION
|
Facility
|
OP
|
$50.73
|
|
|
Service Code
|
HCPCS J0278
|
| Hospital Charge Code |
119785
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$45.66 |
| Rate for Payer: Aetna American Axle |
$32.97
|
| Rate for Payer: Aetna American Axle |
$10.63
|
| Rate for Payer: Aetna American Axle |
$12.53
|
| Rate for Payer: Aetna American Axle |
$31.32
|
| Rate for Payer: Aetna Commercial |
$43.12
|
| Rate for Payer: Aetna Commercial |
$40.95
|
| Rate for Payer: Aetna Commercial |
$13.91
|
| Rate for Payer: Aetna Commercial |
$16.38
|
| Rate for Payer: Aetna Medicare |
$24.09
|
| Rate for Payer: Aetna Medicare |
$9.63
|
| Rate for Payer: Aetna Medicare |
$25.36
|
| Rate for Payer: Aetna Medicare |
$8.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.32
|
| Rate for Payer: BCBS Complete |
$6.54
|
| Rate for Payer: BCBS Complete |
$7.71
|
| Rate for Payer: BCBS Complete |
$19.27
|
| Rate for Payer: BCBS Complete |
$20.29
|
| Rate for Payer: BCBS Trust/PPO |
$2.01
|
| Rate for Payer: BCBS Trust/PPO |
$2.01
|
| Rate for Payer: BCBS Trust/PPO |
$2.01
|
| Rate for Payer: BCBS Trust/PPO |
$2.01
|
| Rate for Payer: BCN Commercial |
$2.01
|
| Rate for Payer: BCN Commercial |
$2.01
|
| Rate for Payer: BCN Commercial |
$2.01
|
| Rate for Payer: BCN Commercial |
$2.01
|
| Rate for Payer: Cash Price |
$38.54
|
| Rate for Payer: Cash Price |
$40.58
|
| Rate for Payer: Cash Price |
$13.09
|
| Rate for Payer: Cash Price |
$40.58
|
| Rate for Payer: Cash Price |
$38.54
|
| Rate for Payer: Cash Price |
$15.42
|
| Rate for Payer: Cash Price |
$15.42
|
| Rate for Payer: Cash Price |
$13.09
|
| Rate for Payer: Cofinity Advantage |
$35.51
|
| Rate for Payer: Cofinity Advantage |
$33.73
|
| Rate for Payer: Cofinity Advantage |
$13.49
|
| Rate for Payer: Cofinity Advantage |
$11.45
|
| Rate for Payer: Cofinity Commercial |
$16.57
|
| Rate for Payer: Cofinity Commercial |
$41.43
|
| Rate for Payer: Cofinity Commercial |
$43.63
|
| Rate for Payer: Cofinity Commercial |
$14.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.09
|
| Rate for Payer: Healthscope Commercial |
$43.36
|
| Rate for Payer: Healthscope Commercial |
$14.72
|
| Rate for Payer: Healthscope Commercial |
$17.34
|
| Rate for Payer: Healthscope Commercial |
$45.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.05
|
| Rate for Payer: PHP Commercial |
$13.91
|
| Rate for Payer: PHP Commercial |
$40.95
|
| Rate for Payer: PHP Commercial |
$43.12
|
| Rate for Payer: PHP Commercial |
$16.38
|
| Rate for Payer: Priority Health SBD |
$30.35
|
| Rate for Payer: Priority Health SBD |
$10.31
|
| Rate for Payer: Priority Health SBD |
$12.14
|
| Rate for Payer: Priority Health SBD |
$31.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.02
|
| Rate for Payer: UHC Core |
$1.02
|
| Rate for Payer: UHC Core |
$1.02
|
| Rate for Payer: UHC Core |
$1.02
|
| Rate for Payer: UHC Core |
$1.02
|
| Rate for Payer: UHC Exchange |
$1.02
|
| Rate for Payer: UHC Exchange |
$1.02
|
| Rate for Payer: UHC Exchange |
$1.02
|
| Rate for Payer: UHC Exchange |
$1.02
|
| Rate for Payer: UMR Bronson Commercial |
$18.77
|
| Rate for Payer: UMR Bronson Commercial |
$6.05
|
| Rate for Payer: UMR Bronson Commercial |
$7.13
|
| Rate for Payer: UMR Bronson Commercial |
$17.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.05
|
|
|
AMILORIDE 5 MG TABLET
|
Facility
|
IP
|
$237.50
|
|
|
Service Code
|
NDC 00574029201
|
| Hospital Charge Code |
391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.50 |
| Max. Negotiated Rate |
$213.75 |
| Rate for Payer: Aetna American Axle |
$154.38
|
| Rate for Payer: Aetna Commercial |
$201.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.38
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: Cofinity Advantage |
$166.25
|
| Rate for Payer: Cofinity Commercial |
$204.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.00
|
| Rate for Payer: Healthscope Commercial |
$213.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$166.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$178.12
|
| Rate for Payer: PHP Commercial |
$201.88
|
| Rate for Payer: Priority Health SBD |
$149.62
|
| Rate for Payer: UMR Bronson Commercial |
$104.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.12
|
|
|
AMILORIDE 5 MG TABLET
|
Facility
|
IP
|
$403.20
|
|
|
Service Code
|
NDC 49884011701
|
| Hospital Charge Code |
391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.41 |
| Max. Negotiated Rate |
$362.88 |
| Rate for Payer: Aetna American Axle |
$262.08
|
| Rate for Payer: Aetna Commercial |
$342.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.08
|
| Rate for Payer: Cash Price |
$322.56
|
| Rate for Payer: Cofinity Advantage |
$282.24
|
| Rate for Payer: Cofinity Commercial |
$346.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.56
|
| Rate for Payer: Healthscope Commercial |
$362.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$282.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$302.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$342.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$302.40
|
| Rate for Payer: PHP Commercial |
$342.72
|
| Rate for Payer: Priority Health SBD |
$254.02
|
| Rate for Payer: UMR Bronson Commercial |
$177.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$302.40
|
|
|
AMILORIDE 5 MG TABLET
|
Facility
|
OP
|
$237.50
|
|
|
Service Code
|
NDC 00574029201
|
| Hospital Charge Code |
391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.88 |
| Max. Negotiated Rate |
$213.75 |
| Rate for Payer: Aetna American Axle |
$154.38
|
| Rate for Payer: Aetna Commercial |
$201.88
|
| Rate for Payer: Aetna Medicare |
$118.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.38
|
| Rate for Payer: BCBS Complete |
$95.00
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: Cofinity Advantage |
$166.25
|
| Rate for Payer: Cofinity Commercial |
$204.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.00
|
| Rate for Payer: Healthscope Commercial |
$213.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$166.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$190.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$178.12
|
| Rate for Payer: PHP Commercial |
$201.88
|
| Rate for Payer: Priority Health SBD |
$149.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.38
|
| Rate for Payer: UHC Core |
$123.74
|
| Rate for Payer: UHC Exchange |
$93.34
|
| Rate for Payer: UMR Bronson Commercial |
$87.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.12
|
|
|
AMILORIDE 5 MG TABLET
|
Facility
|
OP
|
$403.20
|
|
|
Service Code
|
NDC 49884011701
|
| Hospital Charge Code |
391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.18 |
| Max. Negotiated Rate |
$362.88 |
| Rate for Payer: Aetna American Axle |
$262.08
|
| Rate for Payer: Aetna Commercial |
$342.72
|
| Rate for Payer: Aetna Medicare |
$201.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.08
|
| Rate for Payer: BCBS Complete |
$161.28
|
| Rate for Payer: Cash Price |
$322.56
|
| Rate for Payer: Cofinity Advantage |
$282.24
|
| Rate for Payer: Cofinity Commercial |
$346.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.56
|
| Rate for Payer: Healthscope Commercial |
$362.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$282.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$302.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$322.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$342.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$302.40
|
| Rate for Payer: PHP Commercial |
$342.72
|
| Rate for Payer: Priority Health SBD |
$254.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.08
|
| Rate for Payer: UHC Core |
$210.07
|
| Rate for Payer: UHC Exchange |
$158.46
|
| Rate for Payer: UMR Bronson Commercial |
$149.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$302.40
|
|
|
AMINO ACID 4.25 % NO.1-DEXTROSE 5 %-ELECTROLYTES NO.39 IV SOLUTION
|
Facility
|
IP
|
$143.84
|
|
|
Service Code
|
NDC 00338702201
|
| Hospital Charge Code |
200244
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$63.29 |
| Max. Negotiated Rate |
$129.46 |
| Rate for Payer: Aetna American Axle |
$93.50
|
| Rate for Payer: Aetna Commercial |
$122.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.50
|
| Rate for Payer: Cash Price |
$115.07
|
| Rate for Payer: Cofinity Advantage |
$100.69
|
| Rate for Payer: Cofinity Commercial |
$123.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.07
|
| Rate for Payer: Healthscope Commercial |
$129.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.88
|
| Rate for Payer: PHP Commercial |
$122.26
|
| Rate for Payer: Priority Health SBD |
$90.62
|
| Rate for Payer: UMR Bronson Commercial |
$63.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.88
|
|
