|
AMINO ACID 4.25 % NO.1-DEXTROSE 5 %-ELECTROLYTES NO.39 IV SOLUTION
|
Facility
|
OP
|
$143.84
|
|
|
Service Code
|
NDC 00338702201
|
| Hospital Charge Code |
200244
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$53.22 |
| Max. Negotiated Rate |
$129.46 |
| Rate for Payer: Aetna American Axle |
$93.50
|
| Rate for Payer: Aetna Commercial |
$122.26
|
| Rate for Payer: Aetna Medicare |
$71.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.50
|
| Rate for Payer: BCBS Complete |
$57.54
|
| 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: MI Amish Medical Board Commercial |
$115.07
|
| 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: UHC All Payor (Choice/PPO) |
$93.50
|
| Rate for Payer: UHC Core |
$74.94
|
| Rate for Payer: UHC Exchange |
$56.53
|
| Rate for Payer: UMR Bronson Commercial |
$53.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.88
|
|
|
AMINO ACID 4.25 % NO.1-DEXTROSE 5 %-ELECTROLYTES NO.39 IV SOLUTION
|
Facility
|
IP
|
$134.56
|
|
|
Service Code
|
NDC 00338114403
|
| Hospital Charge Code |
200244
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$59.21 |
| Max. Negotiated Rate |
$121.10 |
| Rate for Payer: Aetna American Axle |
$87.46
|
| Rate for Payer: Aetna Commercial |
$114.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.46
|
| Rate for Payer: Cash Price |
$107.65
|
| Rate for Payer: Cofinity Advantage |
$94.19
|
| Rate for Payer: Cofinity Commercial |
$115.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.65
|
| Rate for Payer: Healthscope Commercial |
$121.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.92
|
| Rate for Payer: PHP Commercial |
$114.38
|
| Rate for Payer: Priority Health SBD |
$84.77
|
| Rate for Payer: UMR Bronson Commercial |
$59.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.92
|
|
|
AMINO ACID 4.25 % NO.1-DEXTROSE 5 %-ELECTROLYTES NO.39 IV SOLUTION
|
Facility
|
OP
|
$143.84
|
|
|
Service Code
|
NDC 00338702206
|
| Hospital Charge Code |
200244
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$53.22 |
| Max. Negotiated Rate |
$129.46 |
| Rate for Payer: Aetna American Axle |
$93.50
|
| Rate for Payer: Aetna Commercial |
$122.26
|
| Rate for Payer: Aetna Medicare |
$71.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.50
|
| Rate for Payer: BCBS Complete |
$57.54
|
| 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: MI Amish Medical Board Commercial |
$115.07
|
| 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: UHC All Payor (Choice/PPO) |
$93.50
|
| Rate for Payer: UHC Core |
$74.94
|
| Rate for Payer: UHC Exchange |
$56.53
|
| Rate for Payer: UMR Bronson Commercial |
$53.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.88
|
|
|
AMINO ACID 4.25 % NO.1-DEXTROSE 5 %-ELECTROLYTES NO.39 IV SOLUTION
|
Facility
|
IP
|
$143.84
|
|
|
Service Code
|
NDC 00338702206
|
| 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
|
|
|
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
|
|
|
AMINO ACID 5 % NO.6-DEXTROSE 15 %-ELECTROLYTES NO.23 IV SOLUTION
|
Facility
|
OP
|
$148.48
|
|
|
Service Code
|
NDC 00338114703
|
| Hospital Charge Code |
27963
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$54.94 |
| Max. Negotiated Rate |
$133.63 |
| Rate for Payer: Aetna American Axle |
$96.51
|
| Rate for Payer: Aetna Commercial |
$126.21
|
| Rate for Payer: Aetna Medicare |
$74.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.51
|
| Rate for Payer: BCBS Complete |
$59.39
|
| Rate for Payer: Cash Price |
$118.78
|
| Rate for Payer: Cofinity Advantage |
$103.94
|
| Rate for Payer: Cofinity Commercial |
$127.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.78
|
| Rate for Payer: Healthscope Commercial |
$133.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$118.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.36
|
| Rate for Payer: PHP Commercial |
$126.21
|
| Rate for Payer: Priority Health SBD |
$93.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.51
|
| Rate for Payer: UHC Core |
$77.36
|
| Rate for Payer: UHC Exchange |
$58.35
|
| Rate for Payer: UMR Bronson Commercial |
$54.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.36
|
|
|
AMINO ACID 5 % NO.6-DEXTROSE 15 %-ELECTROLYTES NO.23 IV SOLUTION
|
Facility
|
IP
|
$148.48
|
|
|
Service Code
|
NDC 00338114703
|
| Hospital Charge Code |
27963
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$65.33 |
| Max. Negotiated Rate |
$133.63 |
| Rate for Payer: Aetna American Axle |
$96.51
|
| Rate for Payer: Aetna Commercial |
$126.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.51
|
| Rate for Payer: Cash Price |
$118.78
|
| Rate for Payer: Cofinity Advantage |
$103.94
|
| Rate for Payer: Cofinity Commercial |
$127.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.78
|
| Rate for Payer: Healthscope Commercial |
$133.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.36
|
| Rate for Payer: PHP Commercial |
$126.21
|
| Rate for Payer: Priority Health SBD |
$93.54
|
| Rate for Payer: UMR Bronson Commercial |
$65.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.36
|
|
|
AMINOCAPROIC ACID 15 GM/250 ML NS INFUSION (OR)
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS J0281
|
| Hospital Charge Code |
155006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$176.00 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna American Axle |
$260.00
|
| Rate for Payer: Aetna Commercial |
$340.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cofinity Advantage |
$280.00
|
| Rate for Payer: Cofinity Commercial |
$344.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.00
|
| Rate for Payer: Healthscope Commercial |
$360.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$280.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$300.00
|
| Rate for Payer: PHP Commercial |
$340.00
|
| Rate for Payer: Priority Health SBD |
$252.00
|
| Rate for Payer: UMR Bronson Commercial |
$176.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.00
|
|
|
AMINOCAPROIC ACID 15 GM/250 ML NS INFUSION (OR)
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS J0281
|
| Hospital Charge Code |
155006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna American Axle |
$260.00
|
| Rate for Payer: Aetna Commercial |
$340.00
|
| Rate for Payer: Aetna Medicare |
$200.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.00
|
| Rate for Payer: BCBS Complete |
$160.00
|
| Rate for Payer: BCBS Trust/PPO |
$5.16
|
| Rate for Payer: BCN Commercial |
$5.16
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cofinity Advantage |
$280.00
|
| Rate for Payer: Cofinity Commercial |
$344.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.00
|
| Rate for Payer: Healthscope Commercial |
$360.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$280.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$320.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$300.00
|
| Rate for Payer: PHP Commercial |
$340.00
|
| Rate for Payer: Priority Health SBD |
$252.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.62
|
| Rate for Payer: UHC Core |
$2.62
|
| Rate for Payer: UHC Exchange |
$2.62
|
| Rate for Payer: UMR Bronson Commercial |
$148.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.00
|
|
|
AMINOCAPROIC ACID 250 MG/ML (25 %) ORAL SOLUTION
|
Facility
|
OP
|
$9,617.68
|
|
|
Service Code
|
NDC 49411005208
|
| Hospital Charge Code |
9062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,558.54 |
| Max. Negotiated Rate |
$8,655.91 |
| Rate for Payer: Aetna American Axle |
$6,251.49
|
| Rate for Payer: Aetna Commercial |
$8,175.03
|
| Rate for Payer: Aetna Medicare |
$4,808.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,251.49
|
| Rate for Payer: BCBS Complete |
$3,847.07
|
| Rate for Payer: Cash Price |
$7,694.14
|
| Rate for Payer: Cofinity Advantage |
$6,732.38
|
| Rate for Payer: Cofinity Commercial |
$8,271.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,694.14
|
| Rate for Payer: Healthscope Commercial |
$8,655.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,732.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,213.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,694.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,175.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,213.26
|
| Rate for Payer: PHP Commercial |
$8,175.03
|
| Rate for Payer: Priority Health SBD |
$6,059.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,251.49
|
| Rate for Payer: UHC Core |
$5,010.81
|
| Rate for Payer: UHC Exchange |
$3,779.75
|
| Rate for Payer: UMR Bronson Commercial |
$3,558.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,213.26
|
|
|
AMINOCAPROIC ACID 250 MG/ML (25 %) ORAL SOLUTION
|
Facility
|
IP
|
$9,617.68
|
|
|
Service Code
|
NDC 49411005208
|
| Hospital Charge Code |
9062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,231.78 |
| Max. Negotiated Rate |
$8,655.91 |
| Rate for Payer: Aetna American Axle |
$6,251.49
|
| Rate for Payer: Aetna Commercial |
$8,175.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,251.49
|
| Rate for Payer: Cash Price |
$7,694.14
|
| Rate for Payer: Cofinity Advantage |
$6,732.38
|
| Rate for Payer: Cofinity Commercial |
$8,271.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,694.14
|
| Rate for Payer: Healthscope Commercial |
$8,655.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,732.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,213.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,175.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,213.26
|
| Rate for Payer: PHP Commercial |
$8,175.03
|
| Rate for Payer: Priority Health SBD |
$6,059.14
|
| Rate for Payer: UMR Bronson Commercial |
$4,231.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,213.26
|
|
|
AMINOCAPROIC ACID 250 MG/ML (25 %) ORAL SOLUTION
|
Facility
|
IP
|
$1,260.08
|
|
|
Service Code
|
NDC 31722003523
|
| Hospital Charge Code |
9062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$554.44 |
| Max. Negotiated Rate |
$1,134.07 |
| Rate for Payer: Aetna American Axle |
$819.05
|
| Rate for Payer: Aetna Commercial |
$1,071.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$819.05
|
| Rate for Payer: Cash Price |
$1,008.06
|
| Rate for Payer: Cofinity Advantage |
$882.06
|
| Rate for Payer: Cofinity Commercial |
$1,083.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,008.06
|
| Rate for Payer: Healthscope Commercial |
$1,134.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$882.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$945.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,071.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$945.06
|
| Rate for Payer: PHP Commercial |
$1,071.07
|
| Rate for Payer: Priority Health SBD |
$793.85
|
| Rate for Payer: UMR Bronson Commercial |
$554.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$945.06
|
|
|
AMINOCAPROIC ACID 250 MG/ML (25 %) ORAL SOLUTION
|
Facility
|
OP
|
$1,260.08
|
|
|
Service Code
|
NDC 31722003523
|
| Hospital Charge Code |
9062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$466.23 |
| Max. Negotiated Rate |
$1,134.07 |
| Rate for Payer: Aetna American Axle |
$819.05
|
| Rate for Payer: Aetna Commercial |
$1,071.07
|
| Rate for Payer: Aetna Medicare |
$630.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$819.05
|
| Rate for Payer: BCBS Complete |
$504.03
|
| Rate for Payer: Cash Price |
$1,008.06
|
| Rate for Payer: Cofinity Advantage |
$882.06
|
| Rate for Payer: Cofinity Commercial |
$1,083.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,008.06
|
| Rate for Payer: Healthscope Commercial |
$1,134.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$882.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$945.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,008.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,071.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$945.06
|
| Rate for Payer: PHP Commercial |
$1,071.07
|
| Rate for Payer: Priority Health SBD |
$793.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$819.05
|
| Rate for Payer: UHC Core |
$656.50
|
| Rate for Payer: UHC Exchange |
$495.21
|
| Rate for Payer: UMR Bronson Commercial |
$466.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$945.06
|
|
|
AMINOCAPROIC ACID 250 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$33.11
|
|
|
Service Code
|
HCPCS J0281
|
| Hospital Charge Code |
403
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$29.80 |
| Rate for Payer: Aetna American Axle |
$21.52
|
| Rate for Payer: Aetna American Axle |
$28.46
|
| Rate for Payer: Aetna Commercial |
$28.14
|
| Rate for Payer: Aetna Commercial |
$37.22
|
| Rate for Payer: Aetna Medicare |
$16.55
|
| Rate for Payer: Aetna Medicare |
$21.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.46
|
| Rate for Payer: BCBS Complete |
$17.52
|
| Rate for Payer: BCBS Complete |
$13.24
|
| Rate for Payer: BCBS Trust/PPO |
$5.16
|
| Rate for Payer: BCBS Trust/PPO |
$5.16
|
| Rate for Payer: BCN Commercial |
$5.16
|
| Rate for Payer: BCN Commercial |
$5.16
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cash Price |
$35.03
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cash Price |
$35.03
|
| Rate for Payer: Cofinity Advantage |
$23.18
|
| Rate for Payer: Cofinity Advantage |
$30.65
|
| Rate for Payer: Cofinity Commercial |
$28.47
|
| Rate for Payer: Cofinity Commercial |
$37.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.03
|
| Rate for Payer: Healthscope Commercial |
$29.80
|
| Rate for Payer: Healthscope Commercial |
$39.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.83
|
| Rate for Payer: PHP Commercial |
$28.14
|
| Rate for Payer: PHP Commercial |
$37.22
|
| Rate for Payer: Priority Health SBD |
$20.86
|
| Rate for Payer: Priority Health SBD |
$27.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.62
|
| Rate for Payer: UHC Core |
$2.62
|
| Rate for Payer: UHC Core |
$2.62
|
| Rate for Payer: UHC Exchange |
$2.62
|
| Rate for Payer: UHC Exchange |
$2.62
|
| Rate for Payer: UMR Bronson Commercial |
$12.25
|
| Rate for Payer: UMR Bronson Commercial |
$16.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.84
|
|
|
AMINOCAPROIC ACID 250 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$33.11
|
|
|
Service Code
|
HCPCS J0281
|
| Hospital Charge Code |
403
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$29.80 |
| Rate for Payer: Aetna American Axle |
$21.52
|
| Rate for Payer: Aetna American Axle |
$28.46
|
| Rate for Payer: Aetna Commercial |
$28.14
|
| Rate for Payer: Aetna Commercial |
$37.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.46
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cash Price |
$35.03
|
| Rate for Payer: Cofinity Advantage |
$30.65
|
| Rate for Payer: Cofinity Advantage |
$23.18
|
| Rate for Payer: Cofinity Commercial |
$37.66
|
| Rate for Payer: Cofinity Commercial |
$28.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.03
|
| Rate for Payer: Healthscope Commercial |
$29.80
|
| Rate for Payer: Healthscope Commercial |
$39.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.84
|
| Rate for Payer: PHP Commercial |
$28.14
|
| Rate for Payer: PHP Commercial |
$37.22
|
| Rate for Payer: Priority Health SBD |
$27.59
|
| Rate for Payer: Priority Health SBD |
$20.86
|
| Rate for Payer: UMR Bronson Commercial |
$14.57
|
| Rate for Payer: UMR Bronson Commercial |
$19.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.84
|
|
|
AMINOCAPROIC ACID 500 MG TABLET
|
Facility
|
OP
|
$615.94
|
|
|
Service Code
|
NDC 69680011530
|
| Hospital Charge Code |
9063
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$227.90 |
| Max. Negotiated Rate |
$554.35 |
| Rate for Payer: Aetna American Axle |
$400.36
|
| Rate for Payer: Aetna Commercial |
$523.55
|
| Rate for Payer: Aetna Medicare |
$307.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$400.36
|
| Rate for Payer: BCBS Complete |
$246.38
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Cofinity Advantage |
$431.16
|
| Rate for Payer: Cofinity Commercial |
$529.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$492.75
|
| Rate for Payer: Healthscope Commercial |
$554.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$431.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$461.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$492.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$523.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$461.95
|
| Rate for Payer: PHP Commercial |
$523.55
|
| Rate for Payer: Priority Health SBD |
$388.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$400.36
|
| Rate for Payer: UHC Core |
$320.90
|
| Rate for Payer: UHC Exchange |
$242.06
|
| Rate for Payer: UMR Bronson Commercial |
$227.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$461.95
|
|
|
AMINOCAPROIC ACID 500 MG TABLET
|
Facility
|
IP
|
$2,217.34
|
|
|
Service Code
|
NDC 49411005030
|
| Hospital Charge Code |
9063
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$975.63 |
| Max. Negotiated Rate |
$1,995.61 |
| Rate for Payer: Aetna American Axle |
$1,441.27
|
| Rate for Payer: Aetna Commercial |
$1,884.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,441.27
|
| Rate for Payer: Cash Price |
$1,773.87
|
| Rate for Payer: Cofinity Advantage |
$1,552.14
|
| Rate for Payer: Cofinity Commercial |
$1,906.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,773.87
|
| Rate for Payer: Healthscope Commercial |
$1,995.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,552.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,663.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,884.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,663.01
|
| Rate for Payer: PHP Commercial |
$1,884.74
|
| Rate for Payer: Priority Health SBD |
$1,396.92
|
| Rate for Payer: UMR Bronson Commercial |
$975.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,663.01
|
|
|
AMINOCAPROIC ACID 500 MG TABLET
|
Facility
|
OP
|
$2,217.34
|
|
|
Service Code
|
NDC 49411005030
|
| Hospital Charge Code |
9063
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$820.42 |
| Max. Negotiated Rate |
$1,995.61 |
| Rate for Payer: Aetna American Axle |
$1,441.27
|
| Rate for Payer: Aetna Commercial |
$1,884.74
|
| Rate for Payer: Aetna Medicare |
$1,108.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,441.27
|
| Rate for Payer: BCBS Complete |
$886.94
|
| Rate for Payer: Cash Price |
$1,773.87
|
| Rate for Payer: Cofinity Advantage |
$1,552.14
|
| Rate for Payer: Cofinity Commercial |
$1,906.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,773.87
|
| Rate for Payer: Healthscope Commercial |
$1,995.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,552.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,663.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,773.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,884.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,663.01
|
| Rate for Payer: PHP Commercial |
$1,884.74
|
| Rate for Payer: Priority Health SBD |
$1,396.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,441.27
|
| Rate for Payer: UHC Core |
$1,155.23
|
| Rate for Payer: UHC Exchange |
$871.41
|
| Rate for Payer: UMR Bronson Commercial |
$820.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,663.01
|
|
|
AMINOCAPROIC ACID 500 MG TABLET
|
Facility
|
IP
|
$359.31
|
|
|
Service Code
|
NDC 69238163703
|
| Hospital Charge Code |
9063
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.10 |
| Max. Negotiated Rate |
$323.38 |
| Rate for Payer: Aetna American Axle |
$233.55
|
| Rate for Payer: Aetna Commercial |
$305.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.55
|
| Rate for Payer: Cash Price |
$287.45
|
| Rate for Payer: Cofinity Advantage |
$251.52
|
| Rate for Payer: Cofinity Commercial |
$309.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.45
|
| Rate for Payer: Healthscope Commercial |
$323.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$251.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.48
|
| Rate for Payer: PHP Commercial |
$305.41
|
| Rate for Payer: Priority Health SBD |
$226.37
|
| Rate for Payer: UMR Bronson Commercial |
$158.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.48
|
|
|
AMINOCAPROIC ACID 500 MG TABLET
|
Facility
|
IP
|
$615.94
|
|
|
Service Code
|
NDC 69680011530
|
| Hospital Charge Code |
9063
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$271.01 |
| Max. Negotiated Rate |
$554.35 |
| Rate for Payer: Aetna American Axle |
$400.36
|
| Rate for Payer: Aetna Commercial |
$523.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$400.36
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Cofinity Advantage |
$431.16
|
| Rate for Payer: Cofinity Commercial |
$529.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$492.75
|
| Rate for Payer: Healthscope Commercial |
$554.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$431.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$461.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$523.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$461.95
|
| Rate for Payer: PHP Commercial |
$523.55
|
| Rate for Payer: Priority Health SBD |
$388.04
|
| Rate for Payer: UMR Bronson Commercial |
$271.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$461.95
|
|
|
AMINOCAPROIC ACID 500 MG TABLET
|
Facility
|
OP
|
$359.31
|
|
|
Service Code
|
NDC 69238163703
|
| Hospital Charge Code |
9063
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.94 |
| Max. Negotiated Rate |
$323.38 |
| Rate for Payer: Aetna American Axle |
$233.55
|
| Rate for Payer: Aetna Commercial |
$305.41
|
| Rate for Payer: Aetna Medicare |
$179.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.55
|
| Rate for Payer: BCBS Complete |
$143.72
|
| Rate for Payer: Cash Price |
$287.45
|
| Rate for Payer: Cofinity Advantage |
$251.52
|
| Rate for Payer: Cofinity Commercial |
$309.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.45
|
| Rate for Payer: Healthscope Commercial |
$323.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$251.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$287.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.48
|
| Rate for Payer: PHP Commercial |
$305.41
|
| Rate for Payer: Priority Health SBD |
$226.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$233.55
|
| Rate for Payer: UHC Core |
$187.20
|
| Rate for Payer: UHC Exchange |
$141.21
|
| Rate for Payer: UMR Bronson Commercial |
$132.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.48
|
|
|
AMINOPHYLLINE 250 MG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$167.77
|
|
|
Service Code
|
HCPCS J0280
|
| Hospital Charge Code |
407
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.82 |
| Max. Negotiated Rate |
$150.99 |
| Rate for Payer: Aetna American Axle |
$109.05
|
| Rate for Payer: Aetna Commercial |
$142.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.05
|
| Rate for Payer: Cash Price |
$134.22
|
| Rate for Payer: Cofinity Advantage |
$117.44
|
| Rate for Payer: Cofinity Commercial |
$144.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.22
|
| Rate for Payer: Healthscope Commercial |
$150.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$117.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.83
|
| Rate for Payer: PHP Commercial |
$142.60
|
| Rate for Payer: Priority Health SBD |
$105.70
|
| Rate for Payer: UMR Bronson Commercial |
$73.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.83
|
|
|
AMINOPHYLLINE 250 MG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$167.77
|
|
|
Service Code
|
HCPCS J0280
|
| Hospital Charge Code |
407
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.18 |
| Max. Negotiated Rate |
$150.99 |
| Rate for Payer: Aetna American Axle |
$109.05
|
| Rate for Payer: Aetna Commercial |
$142.60
|
| Rate for Payer: Aetna Medicare |
$83.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.05
|
| Rate for Payer: BCBS Complete |
$67.11
|
| Rate for Payer: BCBS Trust/PPO |
$33.74
|
| Rate for Payer: BCN Commercial |
$33.74
|
| Rate for Payer: Cash Price |
$134.22
|
| Rate for Payer: Cash Price |
$134.22
|
| Rate for Payer: Cofinity Advantage |
$117.44
|
| Rate for Payer: Cofinity Commercial |
$144.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.22
|
| Rate for Payer: Healthscope Commercial |
$150.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$117.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$134.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.83
|
| Rate for Payer: PHP Commercial |
$142.60
|
| Rate for Payer: Priority Health SBD |
$105.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.18
|
| Rate for Payer: UHC Core |
$17.18
|
| Rate for Payer: UHC Exchange |
$17.18
|
| Rate for Payer: UMR Bronson Commercial |
$62.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.83
|
|
|
AMINOPHYLLINE 500 MG/20 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$33.20
|
|
|
Service Code
|
HCPCS J0280
|
| Hospital Charge Code |
113386
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.28 |
| Max. Negotiated Rate |
$33.74 |
| Rate for Payer: Aetna American Axle |
$21.58
|
| Rate for Payer: Aetna Commercial |
$28.22
|
| Rate for Payer: Aetna Medicare |
$16.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.58
|
| Rate for Payer: BCBS Complete |
$13.28
|
| Rate for Payer: BCBS Trust/PPO |
$33.74
|
| Rate for Payer: BCN Commercial |
$33.74
|
| Rate for Payer: Cash Price |
$26.56
|
| Rate for Payer: Cash Price |
$26.56
|
| Rate for Payer: Cofinity Advantage |
$23.24
|
| Rate for Payer: Cofinity Commercial |
$28.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.56
|
| Rate for Payer: Healthscope Commercial |
$29.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.90
|
| Rate for Payer: PHP Commercial |
$28.22
|
| Rate for Payer: Priority Health SBD |
$20.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.18
|
| Rate for Payer: UHC Core |
$17.18
|
| Rate for Payer: UHC Exchange |
$17.18
|
| Rate for Payer: UMR Bronson Commercial |
$12.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.90
|
|
|
AMINOPHYLLINE 500 MG/20 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$33.20
|
|
|
Service Code
|
HCPCS J0280
|
| Hospital Charge Code |
113386
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.61 |
| Max. Negotiated Rate |
$29.88 |
| Rate for Payer: Aetna American Axle |
$21.58
|
| Rate for Payer: Aetna Commercial |
$28.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.58
|
| Rate for Payer: Cash Price |
$26.56
|
| Rate for Payer: Cofinity Advantage |
$23.24
|
| Rate for Payer: Cofinity Commercial |
$28.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.56
|
| Rate for Payer: Healthscope Commercial |
$29.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.90
|
| Rate for Payer: PHP Commercial |
$28.22
|
| Rate for Payer: Priority Health SBD |
$20.92
|
| Rate for Payer: UMR Bronson Commercial |
$14.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.90
|
|
