|
DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$663.84
|
|
|
Service Code
|
NDC 00904722061
|
| Hospital Charge Code |
29276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$245.62 |
| Max. Negotiated Rate |
$597.46 |
| Rate for Payer: Aetna American Axle |
$431.50
|
| Rate for Payer: Aetna Commercial |
$564.26
|
| Rate for Payer: Aetna Medicare |
$331.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$431.50
|
| Rate for Payer: BCBS Complete |
$265.54
|
| Rate for Payer: Cash Price |
$531.07
|
| Rate for Payer: Cofinity Advantage |
$464.69
|
| Rate for Payer: Cofinity Commercial |
$570.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$531.07
|
| Rate for Payer: Healthscope Commercial |
$597.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$464.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$497.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$531.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$564.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$497.88
|
| Rate for Payer: PHP Commercial |
$564.26
|
| Rate for Payer: Priority Health SBD |
$418.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$431.50
|
| Rate for Payer: UHC Core |
$345.86
|
| Rate for Payer: UHC Exchange |
$260.89
|
| Rate for Payer: UMR Bronson Commercial |
$245.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$497.88
|
|
|
DILTIAZEM ER 240 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$464.98
|
|
|
Service Code
|
NDC 00187204730
|
| Hospital Charge Code |
35179
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$204.59 |
| Max. Negotiated Rate |
$418.48 |
| Rate for Payer: Aetna American Axle |
$302.24
|
| Rate for Payer: Aetna Commercial |
$395.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.24
|
| Rate for Payer: Cash Price |
$371.98
|
| Rate for Payer: Cofinity Advantage |
$325.49
|
| Rate for Payer: Cofinity Commercial |
$399.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$371.98
|
| Rate for Payer: Healthscope Commercial |
$418.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$325.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$348.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$348.74
|
| Rate for Payer: PHP Commercial |
$395.23
|
| Rate for Payer: Priority Health SBD |
$292.94
|
| Rate for Payer: UMR Bronson Commercial |
$204.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$348.74
|
|
|
DILTIAZEM ER 240 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$464.98
|
|
|
Service Code
|
NDC 00187204730
|
| Hospital Charge Code |
35179
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.04 |
| Max. Negotiated Rate |
$418.48 |
| Rate for Payer: Aetna American Axle |
$302.24
|
| Rate for Payer: Aetna Commercial |
$395.23
|
| Rate for Payer: Aetna Medicare |
$232.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.24
|
| Rate for Payer: BCBS Complete |
$185.99
|
| Rate for Payer: Cash Price |
$371.98
|
| Rate for Payer: Cofinity Advantage |
$325.49
|
| Rate for Payer: Cofinity Commercial |
$399.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$371.98
|
| Rate for Payer: Healthscope Commercial |
$418.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$325.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$348.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$371.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$348.74
|
| Rate for Payer: PHP Commercial |
$395.23
|
| Rate for Payer: Priority Health SBD |
$292.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$302.24
|
| Rate for Payer: UHC Core |
$242.25
|
| Rate for Payer: UHC Exchange |
$182.74
|
| Rate for Payer: UMR Bronson Commercial |
$172.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$348.74
|
|
|
DILUENT NO.1 FOR LIVE VIRUS VACCINES (STERILE WATER) VIAL
|
Facility
|
IP
|
$0.02
|
|
|
Service Code
|
NDC 00006430900
|
| Hospital Charge Code |
173258
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna American Axle |
$0.01
|
| Rate for Payer: Aetna Commercial |
$0.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cofinity Advantage |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.02
|
| Rate for Payer: Healthscope Commercial |
$0.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.02
|
| Rate for Payer: PHP Commercial |
$0.02
|
| Rate for Payer: Priority Health SBD |
$0.01
|
| Rate for Payer: UMR Bronson Commercial |
$0.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.02
|
|
|
DILUENT NO.1 FOR LIVE VIRUS VACCINES (STERILE WATER) VIAL
|
Facility
|
IP
|
$0.02
|
|
|
Service Code
|
NDC 00006430901
|
| Hospital Charge Code |
173258
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna American Axle |
$0.01
|
| Rate for Payer: Aetna Commercial |
$0.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cofinity Advantage |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.02
|
| Rate for Payer: Healthscope Commercial |
$0.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.02
|
| Rate for Payer: PHP Commercial |
$0.02
|
| Rate for Payer: Priority Health SBD |
$0.01
|
| Rate for Payer: UMR Bronson Commercial |
$0.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.02
|
|
|
DILUENT NO.1 FOR LIVE VIRUS VACCINES (STERILE WATER) VIAL
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
NDC 00006430901
|
| Hospital Charge Code |
173258
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna American Axle |
$0.01
|
| Rate for Payer: Aetna Commercial |
$0.02
|
| Rate for Payer: Aetna Medicare |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.01
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cofinity Advantage |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.02
|
| Rate for Payer: Healthscope Commercial |
$0.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.02
|
| Rate for Payer: PHP Commercial |
$0.02
|
| Rate for Payer: Priority Health SBD |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.01
|
| Rate for Payer: UHC Core |
$0.01
|
| Rate for Payer: UHC Exchange |
$0.01
|
| Rate for Payer: UMR Bronson Commercial |
$0.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.02
|
|
|
DILUENT NO.1 FOR LIVE VIRUS VACCINES (STERILE WATER) VIAL
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
NDC 00006430900
|
| Hospital Charge Code |
173258
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna American Axle |
$0.01
|
| Rate for Payer: Aetna Commercial |
$0.02
|
| Rate for Payer: Aetna Medicare |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.01
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cofinity Advantage |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.02
|
| Rate for Payer: Healthscope Commercial |
$0.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.02
|
| Rate for Payer: PHP Commercial |
$0.02
|
| Rate for Payer: Priority Health SBD |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.01
|
| Rate for Payer: UHC Core |
$0.01
|
| Rate for Payer: UHC Exchange |
$0.01
|
| Rate for Payer: UMR Bronson Commercial |
$0.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.02
|
|
|
DILUENT NO.1 FOR LIVE VIRUS VACCINE (STERILE WATER) SYRINGE
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
NDC 00006417589
|
| Hospital Charge Code |
206168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna American Axle |
$0.01
|
| Rate for Payer: Aetna Commercial |
$0.02
|
| Rate for Payer: Aetna Medicare |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.01
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cofinity Advantage |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.02
|
| Rate for Payer: Healthscope Commercial |
$0.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.02
|
| Rate for Payer: PHP Commercial |
$0.02
|
| Rate for Payer: Priority Health SBD |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.01
|
| Rate for Payer: UHC Core |
$0.01
|
| Rate for Payer: UHC Exchange |
$0.01
|
| Rate for Payer: UMR Bronson Commercial |
$0.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.02
|
|
|
DILUENT NO.1 FOR LIVE VIRUS VACCINE (STERILE WATER) SYRINGE
|
Facility
|
IP
|
$0.02
|
|
|
Service Code
|
NDC 00006417589
|
| Hospital Charge Code |
206168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna American Axle |
$0.01
|
| Rate for Payer: Aetna Commercial |
$0.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cofinity Advantage |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.02
|
| Rate for Payer: Healthscope Commercial |
$0.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.02
|
| Rate for Payer: PHP Commercial |
$0.02
|
| Rate for Payer: Priority Health SBD |
$0.01
|
| Rate for Payer: UMR Bronson Commercial |
$0.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.02
|
|
|
DILUENT NO.1 FOR LIVE VIRUS VACCINE (STERILE WATER) SYRINGE
|
Facility
|
IP
|
$0.02
|
|
|
Service Code
|
NDC 00006417588
|
| Hospital Charge Code |
206168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna American Axle |
$0.01
|
| Rate for Payer: Aetna Commercial |
$0.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cofinity Advantage |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.02
|
| Rate for Payer: Healthscope Commercial |
$0.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.02
|
| Rate for Payer: PHP Commercial |
$0.02
|
| Rate for Payer: Priority Health SBD |
$0.01
|
| Rate for Payer: UMR Bronson Commercial |
$0.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.02
|
|
|
DILUENT NO.1 FOR LIVE VIRUS VACCINE (STERILE WATER) SYRINGE
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
NDC 00006417588
|
| Hospital Charge Code |
206168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna American Axle |
$0.01
|
| Rate for Payer: Aetna Commercial |
$0.02
|
| Rate for Payer: Aetna Medicare |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.01
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cofinity Advantage |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.02
|
| Rate for Payer: Healthscope Commercial |
$0.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.02
|
| Rate for Payer: PHP Commercial |
$0.02
|
| Rate for Payer: Priority Health SBD |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.01
|
| Rate for Payer: UHC Core |
$0.01
|
| Rate for Payer: UHC Exchange |
$0.01
|
| Rate for Payer: UMR Bronson Commercial |
$0.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.02
|
|
|
DIMENHYDRINATE 25 MG TABLET (CUSTOM)
|
Facility
|
IP
|
$0.45
|
|
|
Service Code
|
NDC 09900001999
|
| Hospital Charge Code |
301909
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Aetna American Axle |
$0.29
|
| Rate for Payer: Aetna Commercial |
$0.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.29
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cofinity Advantage |
$0.32
|
| Rate for Payer: Cofinity Commercial |
$0.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.36
|
| Rate for Payer: Healthscope Commercial |
$0.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.34
|
| Rate for Payer: PHP Commercial |
$0.38
|
| Rate for Payer: Priority Health SBD |
$0.28
|
| Rate for Payer: UMR Bronson Commercial |
$0.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.34
|
|
|
DIMENHYDRINATE 25 MG TABLET (CUSTOM)
|
Facility
|
OP
|
$0.45
|
|
|
Service Code
|
NDC 09900001999
|
| Hospital Charge Code |
301909
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Aetna American Axle |
$0.29
|
| Rate for Payer: Aetna Commercial |
$0.38
|
| Rate for Payer: Aetna Medicare |
$0.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.29
|
| Rate for Payer: BCBS Complete |
$0.18
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cofinity Advantage |
$0.32
|
| Rate for Payer: Cofinity Commercial |
$0.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.36
|
| Rate for Payer: Healthscope Commercial |
$0.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.34
|
| Rate for Payer: PHP Commercial |
$0.38
|
| Rate for Payer: Priority Health SBD |
$0.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.29
|
| Rate for Payer: UHC Core |
$0.23
|
| Rate for Payer: UHC Exchange |
$0.18
|
| Rate for Payer: UMR Bronson Commercial |
$0.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.34
|
|
|
DIMENHYDRINATE 50 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$24.01
|
|
|
Service Code
|
HCPCS J1240
|
| Hospital Charge Code |
2483
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$21.61 |
| Rate for Payer: Aetna American Axle |
$15.61
|
| Rate for Payer: Aetna Commercial |
$20.41
|
| Rate for Payer: Aetna Medicare |
$12.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.61
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: BCBS Trust/PPO |
$19.89
|
| Rate for Payer: BCN Commercial |
$19.89
|
| Rate for Payer: Cash Price |
$19.21
|
| Rate for Payer: Cash Price |
$19.21
|
| Rate for Payer: Cofinity Advantage |
$16.81
|
| Rate for Payer: Cofinity Commercial |
$20.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.21
|
| Rate for Payer: Healthscope Commercial |
$21.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.01
|
| Rate for Payer: PHP Commercial |
$20.41
|
| Rate for Payer: Priority Health SBD |
$15.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.52
|
| Rate for Payer: UHC Core |
$1.52
|
| Rate for Payer: UHC Exchange |
$1.52
|
| Rate for Payer: UMR Bronson Commercial |
$8.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.01
|
|
|
DIMENHYDRINATE 50 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$24.01
|
|
|
Service Code
|
HCPCS J1240
|
| Hospital Charge Code |
2483
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$21.61 |
| Rate for Payer: Aetna American Axle |
$15.61
|
| Rate for Payer: Aetna Commercial |
$20.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.61
|
| Rate for Payer: Cash Price |
$19.21
|
| Rate for Payer: Cofinity Advantage |
$16.81
|
| Rate for Payer: Cofinity Commercial |
$20.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.21
|
| Rate for Payer: Healthscope Commercial |
$21.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.01
|
| Rate for Payer: PHP Commercial |
$20.41
|
| Rate for Payer: Priority Health SBD |
$15.13
|
| Rate for Payer: UMR Bronson Commercial |
$10.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.01
|
|
|
DIMENHYDRINATE 50 MG TABLET
|
Facility
|
OP
|
$107.10
|
|
|
Service Code
|
NDC 00904205159
|
| Hospital Charge Code |
2485
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.63 |
| Max. Negotiated Rate |
$96.39 |
| Rate for Payer: Aetna American Axle |
$69.61
|
| Rate for Payer: Aetna Commercial |
$91.03
|
| Rate for Payer: Aetna Medicare |
$53.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.61
|
| Rate for Payer: BCBS Complete |
$42.84
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Advantage |
$74.97
|
| Rate for Payer: Cofinity Commercial |
$92.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
| Rate for Payer: Healthscope Commercial |
$96.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.33
|
| Rate for Payer: PHP Commercial |
$91.03
|
| Rate for Payer: Priority Health SBD |
$67.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.61
|
| Rate for Payer: UHC Core |
$55.80
|
| Rate for Payer: UHC Exchange |
$42.09
|
| Rate for Payer: UMR Bronson Commercial |
$39.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.33
|
|
|
DIMENHYDRINATE 50 MG TABLET
|
Facility
|
OP
|
$35.03
|
|
|
Service Code
|
NDC 31248000197
|
| Hospital Charge Code |
2485
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$31.53 |
| Rate for Payer: Aetna American Axle |
$22.77
|
| Rate for Payer: Aetna Commercial |
$29.78
|
| Rate for Payer: Aetna Medicare |
$17.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.77
|
| Rate for Payer: BCBS Complete |
$14.01
|
| Rate for Payer: Cash Price |
$28.02
|
| Rate for Payer: Cofinity Advantage |
$24.52
|
| Rate for Payer: Cofinity Commercial |
$30.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.02
|
| Rate for Payer: Healthscope Commercial |
$31.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.27
|
| Rate for Payer: PHP Commercial |
$29.78
|
| Rate for Payer: Priority Health SBD |
$22.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.77
|
| Rate for Payer: UHC Core |
$18.25
|
| Rate for Payer: UHC Exchange |
$13.77
|
| Rate for Payer: UMR Bronson Commercial |
$12.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.27
|
|
|
DIMENHYDRINATE 50 MG TABLET
|
Facility
|
IP
|
$35.03
|
|
|
Service Code
|
NDC 31248000197
|
| Hospital Charge Code |
2485
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.41 |
| Max. Negotiated Rate |
$31.53 |
| Rate for Payer: Aetna American Axle |
$22.77
|
| Rate for Payer: Aetna Commercial |
$29.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.77
|
| Rate for Payer: Cash Price |
$28.02
|
| Rate for Payer: Cofinity Advantage |
$24.52
|
| Rate for Payer: Cofinity Commercial |
$30.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.02
|
| Rate for Payer: Healthscope Commercial |
$31.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.27
|
| Rate for Payer: PHP Commercial |
$29.78
|
| Rate for Payer: Priority Health SBD |
$22.07
|
| Rate for Payer: UMR Bronson Commercial |
$15.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.27
|
|
|
DIMENHYDRINATE 50 MG TABLET
|
Facility
|
IP
|
$24.96
|
|
|
Service Code
|
NDC 00904677212
|
| Hospital Charge Code |
2485
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.98 |
| Max. Negotiated Rate |
$22.46 |
| Rate for Payer: Aetna American Axle |
$16.22
|
| Rate for Payer: Aetna Commercial |
$21.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.22
|
| Rate for Payer: Cash Price |
$19.97
|
| Rate for Payer: Cofinity Advantage |
$17.47
|
| Rate for Payer: Cofinity Commercial |
$21.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.97
|
| Rate for Payer: Healthscope Commercial |
$22.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.72
|
| Rate for Payer: PHP Commercial |
$21.22
|
| Rate for Payer: Priority Health SBD |
$15.72
|
| Rate for Payer: UMR Bronson Commercial |
$10.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.72
|
|
|
DIMENHYDRINATE 50 MG TABLET
|
Facility
|
OP
|
$24.96
|
|
|
Service Code
|
NDC 00904677212
|
| Hospital Charge Code |
2485
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.24 |
| Max. Negotiated Rate |
$22.46 |
| Rate for Payer: Aetna American Axle |
$16.22
|
| Rate for Payer: Aetna Commercial |
$21.22
|
| Rate for Payer: Aetna Medicare |
$12.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.22
|
| Rate for Payer: BCBS Complete |
$9.98
|
| Rate for Payer: Cash Price |
$19.97
|
| Rate for Payer: Cofinity Advantage |
$17.47
|
| Rate for Payer: Cofinity Commercial |
$21.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.97
|
| Rate for Payer: Healthscope Commercial |
$22.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.72
|
| Rate for Payer: PHP Commercial |
$21.22
|
| Rate for Payer: Priority Health SBD |
$15.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.22
|
| Rate for Payer: UHC Core |
$13.00
|
| Rate for Payer: UHC Exchange |
$9.81
|
| Rate for Payer: UMR Bronson Commercial |
$9.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.72
|
|
|
DIMENHYDRINATE 50 MG TABLET
|
Facility
|
IP
|
$107.10
|
|
|
Service Code
|
NDC 00904205159
|
| Hospital Charge Code |
2485
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$96.39 |
| Rate for Payer: Aetna American Axle |
$69.61
|
| Rate for Payer: Aetna Commercial |
$91.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.61
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Advantage |
$74.97
|
| Rate for Payer: Cofinity Commercial |
$92.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
| Rate for Payer: Healthscope Commercial |
$96.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.33
|
| Rate for Payer: PHP Commercial |
$91.03
|
| Rate for Payer: Priority Health SBD |
$67.47
|
| Rate for Payer: UMR Bronson Commercial |
$47.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.33
|
|
|
DIMETHYL SULFOXIDE 50 % INTRAVESICAL SOLUTION
|
Facility
|
OP
|
$2,511.01
|
|
|
Service Code
|
HCPCS J1212
|
| Hospital Charge Code |
118456
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$391.72 |
| Max. Negotiated Rate |
$2,429.47 |
| Rate for Payer: Aetna American Axle |
$1,632.16
|
| Rate for Payer: Aetna Commercial |
$2,134.36
|
| Rate for Payer: Aetna Medicare |
$778.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,632.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$936.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$936.23
|
| Rate for Payer: BCBS Complete |
$411.34
|
| Rate for Payer: BCBS MAPPO |
$748.98
|
| Rate for Payer: BCBS Trust/PPO |
$2,429.47
|
| Rate for Payer: BCN Commercial |
$2,429.47
|
| Rate for Payer: BCN Medicare Advantage |
$748.98
|
| Rate for Payer: Cash Price |
$2,008.81
|
| Rate for Payer: Cash Price |
$2,008.81
|
| Rate for Payer: Cofinity Advantage |
$1,757.71
|
| Rate for Payer: Cofinity Commercial |
$2,159.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,008.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$748.98
|
| Rate for Payer: Healthscope Commercial |
$2,259.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,757.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,883.26
|
| Rate for Payer: Mclaren Medicaid |
$748.98
|
| Rate for Payer: Mclaren Medicare |
$748.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$786.43
|
| Rate for Payer: Meridian Medicaid |
$786.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$861.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$823.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,134.36
|
| Rate for Payer: Nomi Health Commercial |
$2,246.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,883.26
|
| Rate for Payer: PACE Medicare |
$711.53
|
| Rate for Payer: PACE SWMI |
$748.98
|
| Rate for Payer: PHP Commercial |
$2,134.36
|
| Rate for Payer: PHP Medicare Advantage |
$748.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$391.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,361.83
|
| Rate for Payer: Priority Health Medicare |
$748.98
|
| Rate for Payer: Priority Health SBD |
$1,581.94
|
| Rate for Payer: Priority Health Tiered Network |
$1,889.46
|
| Rate for Payer: Railroad Medicare Medicare |
$748.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,236.23
|
| Rate for Payer: UHC Core |
$1,236.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$748.98
|
| Rate for Payer: UHC Exchange |
$1,236.23
|
| Rate for Payer: UHC Medicaid |
$391.72
|
| Rate for Payer: UHCCP Medicaid |
$391.72
|
| Rate for Payer: UMR Bronson Commercial |
$929.07
|
| Rate for Payer: VA VA |
$748.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,883.26
|
|
|
DIMETHYL SULFOXIDE 50 % INTRAVESICAL SOLUTION
|
Facility
|
IP
|
$2,511.01
|
|
|
Service Code
|
HCPCS J1212
|
| Hospital Charge Code |
118456
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,104.84 |
| Max. Negotiated Rate |
$2,259.91 |
| Rate for Payer: Aetna American Axle |
$1,632.16
|
| Rate for Payer: Aetna Commercial |
$2,134.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,632.16
|
| Rate for Payer: Cash Price |
$2,008.81
|
| Rate for Payer: Cofinity Advantage |
$1,757.71
|
| Rate for Payer: Cofinity Commercial |
$2,159.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,008.81
|
| Rate for Payer: Healthscope Commercial |
$2,259.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,757.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,883.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,134.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,883.26
|
| Rate for Payer: PHP Commercial |
$2,134.36
|
| Rate for Payer: Priority Health SBD |
$1,581.94
|
| Rate for Payer: UMR Bronson Commercial |
$1,104.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,883.26
|
|
|
DINOPROSTONE ER 10 MG VAGINAL INSERT,CONTROLLED RELEASE
|
Facility
|
IP
|
$1,893.18
|
|
|
Service Code
|
NDC 55566280000
|
| Hospital Charge Code |
27467
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$833.00 |
| Max. Negotiated Rate |
$1,703.86 |
| Rate for Payer: Aetna American Axle |
$1,230.57
|
| Rate for Payer: Aetna Commercial |
$1,609.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,230.57
|
| Rate for Payer: Cash Price |
$1,514.54
|
| Rate for Payer: Cofinity Advantage |
$1,325.23
|
| Rate for Payer: Cofinity Commercial |
$1,628.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,514.54
|
| Rate for Payer: Healthscope Commercial |
$1,703.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,325.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,419.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,609.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,419.88
|
| Rate for Payer: PHP Commercial |
$1,609.20
|
| Rate for Payer: Priority Health SBD |
$1,192.70
|
| Rate for Payer: UMR Bronson Commercial |
$833.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,419.88
|
|
|
DINOPROSTONE ER 10 MG VAGINAL INSERT,CONTROLLED RELEASE
|
Facility
|
OP
|
$1,893.18
|
|
|
Service Code
|
NDC 55566280000
|
| Hospital Charge Code |
27467
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$700.48 |
| Max. Negotiated Rate |
$1,703.86 |
| Rate for Payer: Aetna American Axle |
$1,230.57
|
| Rate for Payer: Aetna Commercial |
$1,609.20
|
| Rate for Payer: Aetna Medicare |
$946.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,230.57
|
| Rate for Payer: BCBS Complete |
$757.27
|
| Rate for Payer: Cash Price |
$1,514.54
|
| Rate for Payer: Cofinity Advantage |
$1,325.23
|
| Rate for Payer: Cofinity Commercial |
$1,628.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,514.54
|
| Rate for Payer: Healthscope Commercial |
$1,703.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,325.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,419.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,514.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,609.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,419.88
|
| Rate for Payer: PHP Commercial |
$1,609.20
|
| Rate for Payer: Priority Health SBD |
$1,192.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,230.57
|
| Rate for Payer: UHC Core |
$986.35
|
| Rate for Payer: UHC Exchange |
$744.02
|
| Rate for Payer: UMR Bronson Commercial |
$700.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,419.88
|
|
