|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$13.49
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
2007
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$12.14 |
| Rate for Payer: Aetna American Axle |
$8.77
|
| Rate for Payer: Aetna American Axle |
$11.40
|
| Rate for Payer: Aetna American Axle |
$14.18
|
| Rate for Payer: Aetna Commercial |
$14.91
|
| Rate for Payer: Aetna Commercial |
$11.47
|
| Rate for Payer: Aetna Commercial |
$18.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.40
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cash Price |
$14.03
|
| Rate for Payer: Cash Price |
$10.79
|
| Rate for Payer: Cofinity Commercial |
$9.44
|
| Rate for Payer: Cofinity Commercial |
$15.08
|
| Rate for Payer: Cofinity Commercial |
$12.28
|
| Rate for Payer: Cofinity Commercial |
$18.77
|
| Rate for Payer: Cofinity Commercial |
$15.27
|
| Rate for Payer: Cofinity Commercial |
$11.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.03
|
| Rate for Payer: Healthscope Commercial |
$15.79
|
| Rate for Payer: Healthscope Commercial |
$12.14
|
| Rate for Payer: Healthscope Commercial |
$19.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.91
|
| Rate for Payer: PHP Commercial |
$18.55
|
| Rate for Payer: PHP Commercial |
$14.91
|
| Rate for Payer: PHP Commercial |
$11.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.77
|
| Rate for Payer: Priority Health SBD |
$13.75
|
| Rate for Payer: Priority Health SBD |
$11.05
|
| Rate for Payer: Priority Health SBD |
$8.50
|
| Rate for Payer: UMR Bronson Commercial |
$5.94
|
| Rate for Payer: UMR Bronson Commercial |
$9.60
|
| Rate for Payer: UMR Bronson Commercial |
$7.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.16
|
|
|
CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
NDC 79854020050
|
| Hospital Charge Code |
2008
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.36 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Aetna American Axle |
$93.60
|
| Rate for Payer: Aetna Commercial |
$122.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.60
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cofinity Commercial |
$100.80
|
| Rate for Payer: Cofinity Commercial |
$123.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.20
|
| Rate for Payer: Healthscope Commercial |
$129.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.40
|
| Rate for Payer: PHP Commercial |
$122.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.60
|
| Rate for Payer: Priority Health SBD |
$90.72
|
| Rate for Payer: UMR Bronson Commercial |
$63.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.00
|
|
|
CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET
|
Facility
|
IP
|
$81.90
|
|
|
Service Code
|
NDC 80681007100
|
| Hospital Charge Code |
2008
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.04 |
| Max. Negotiated Rate |
$73.71 |
| Rate for Payer: Aetna American Axle |
$53.24
|
| Rate for Payer: Aetna Commercial |
$69.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.24
|
| Rate for Payer: Cash Price |
$65.52
|
| Rate for Payer: Cofinity Commercial |
$57.33
|
| Rate for Payer: Cofinity Commercial |
$70.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.52
|
| Rate for Payer: Healthscope Commercial |
$73.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.62
|
| Rate for Payer: PHP Commercial |
$69.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.24
|
| Rate for Payer: Priority Health SBD |
$51.60
|
| Rate for Payer: UMR Bronson Commercial |
$36.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.42
|
|
|
CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
NDC 79854020050
|
| Hospital Charge Code |
2008
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.28 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Aetna American Axle |
$93.60
|
| Rate for Payer: Aetna Commercial |
$122.40
|
| Rate for Payer: Aetna Medicare |
$72.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.60
|
| Rate for Payer: BCBS Complete |
$57.60
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cofinity Commercial |
$100.80
|
| Rate for Payer: Cofinity Commercial |
$123.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.20
|
| Rate for Payer: Healthscope Commercial |
$129.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.40
|
| Rate for Payer: PHP Commercial |
$122.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.60
|
| Rate for Payer: Priority Health SBD |
$90.72
|
| Rate for Payer: UMR Bronson Commercial |
$53.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.00
|
|
|
CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET
|
Facility
|
OP
|
$81.90
|
|
|
Service Code
|
NDC 80681007100
|
| Hospital Charge Code |
2008
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.30 |
| Max. Negotiated Rate |
$73.71 |
| Rate for Payer: Aetna Medicare |
$40.95
|
| Rate for Payer: Aetna American Axle |
$53.24
|
| Rate for Payer: Aetna Commercial |
$69.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.24
|
| Rate for Payer: BCBS Complete |
$32.76
|
| Rate for Payer: Cash Price |
$65.52
|
| Rate for Payer: Cofinity Commercial |
$57.33
|
| Rate for Payer: Cofinity Commercial |
$70.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.52
|
| Rate for Payer: Healthscope Commercial |
$73.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.62
|
| Rate for Payer: PHP Commercial |
$69.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.24
|
| Rate for Payer: Priority Health SBD |
$51.60
|
| Rate for Payer: UMR Bronson Commercial |
$30.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.42
|
|
|
CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
NDC 51645091301
|
| Hospital Charge Code |
2012
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.96 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Aetna American Axle |
$119.60
|
| Rate for Payer: Aetna Commercial |
$156.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.60
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cofinity Commercial |
$128.80
|
| Rate for Payer: Cofinity Commercial |
$158.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$128.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.20
|
| Rate for Payer: Healthscope Commercial |
$165.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.40
|
| Rate for Payer: PHP Commercial |
$156.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.60
|
| Rate for Payer: Priority Health SBD |
$115.92
|
| Rate for Payer: UMR Bronson Commercial |
$80.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.00
|
|
|
CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET
|
Facility
|
IP
|
$81.95
|
|
|
Service Code
|
NDC 50268085415
|
| Hospital Charge Code |
2012
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.06 |
| Max. Negotiated Rate |
$73.76 |
| Rate for Payer: Aetna American Axle |
$53.27
|
| Rate for Payer: Aetna Commercial |
$69.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.27
|
| Rate for Payer: Cash Price |
$65.56
|
| Rate for Payer: Cofinity Commercial |
$57.36
|
| Rate for Payer: Cofinity Commercial |
$70.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.56
|
| Rate for Payer: Healthscope Commercial |
$73.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.66
|
| Rate for Payer: PHP Commercial |
$69.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.27
|
| Rate for Payer: Priority Health SBD |
$51.63
|
| Rate for Payer: UMR Bronson Commercial |
$36.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.46
|
|
|
CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
NDC 20555003200
|
| Hospital Charge Code |
2012
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.88 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Aetna American Axle |
$50.05
|
| Rate for Payer: Aetna Commercial |
$65.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.05
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cofinity Commercial |
$53.90
|
| Rate for Payer: Cofinity Commercial |
$66.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.60
|
| Rate for Payer: Healthscope Commercial |
$69.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.45
|
| Rate for Payer: PHP Commercial |
$65.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.05
|
| Rate for Payer: Priority Health SBD |
$48.51
|
| Rate for Payer: UMR Bronson Commercial |
$33.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.75
|
|
|
CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET
|
Facility
|
OP
|
$1.64
|
|
|
Service Code
|
NDC 50268085411
|
| Hospital Charge Code |
2012
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Aetna American Axle |
$1.07
|
| Rate for Payer: Aetna Commercial |
$1.39
|
| Rate for Payer: Aetna Medicare |
$0.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.07
|
| Rate for Payer: BCBS Complete |
$0.66
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Cofinity Commercial |
$1.15
|
| Rate for Payer: Cofinity Commercial |
$1.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.31
|
| Rate for Payer: Healthscope Commercial |
$1.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.39
|
| Rate for Payer: PHP Commercial |
$1.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.07
|
| Rate for Payer: Priority Health SBD |
$1.03
|
| Rate for Payer: UMR Bronson Commercial |
$0.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.23
|
|
|
CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
NDC 51645091301
|
| Hospital Charge Code |
2012
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.08 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Aetna American Axle |
$119.60
|
| Rate for Payer: Aetna Commercial |
$156.40
|
| Rate for Payer: Aetna Medicare |
$92.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.60
|
| Rate for Payer: BCBS Complete |
$73.60
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cofinity Commercial |
$128.80
|
| Rate for Payer: Cofinity Commercial |
$158.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$128.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.20
|
| Rate for Payer: Healthscope Commercial |
$165.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.40
|
| Rate for Payer: PHP Commercial |
$156.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.60
|
| Rate for Payer: Priority Health SBD |
$115.92
|
| Rate for Payer: UMR Bronson Commercial |
$68.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.00
|
|
|
CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET
|
Facility
|
OP
|
$81.95
|
|
|
Service Code
|
NDC 50268085415
|
| Hospital Charge Code |
2012
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.32 |
| Max. Negotiated Rate |
$73.76 |
| Rate for Payer: Aetna American Axle |
$53.27
|
| Rate for Payer: Aetna Commercial |
$69.66
|
| Rate for Payer: Aetna Medicare |
$40.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.27
|
| Rate for Payer: BCBS Complete |
$32.78
|
| Rate for Payer: Cash Price |
$65.56
|
| Rate for Payer: Cofinity Commercial |
$57.36
|
| Rate for Payer: Cofinity Commercial |
$70.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.56
|
| Rate for Payer: Healthscope Commercial |
$73.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.66
|
| Rate for Payer: PHP Commercial |
$69.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.27
|
| Rate for Payer: Priority Health SBD |
$51.63
|
| Rate for Payer: UMR Bronson Commercial |
$30.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.46
|
|
|
CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
NDC 20555003200
|
| Hospital Charge Code |
2012
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.49 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Aetna American Axle |
$50.05
|
| Rate for Payer: Aetna Commercial |
$65.45
|
| Rate for Payer: Aetna Medicare |
$38.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.05
|
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cofinity Commercial |
$53.90
|
| Rate for Payer: Cofinity Commercial |
$66.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.60
|
| Rate for Payer: Healthscope Commercial |
$69.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.45
|
| Rate for Payer: PHP Commercial |
$65.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.05
|
| Rate for Payer: Priority Health SBD |
$48.51
|
| Rate for Payer: UMR Bronson Commercial |
$28.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.75
|
|
|
CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET
|
Facility
|
IP
|
$1.64
|
|
|
Service Code
|
NDC 50268085411
|
| Hospital Charge Code |
2012
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Aetna American Axle |
$1.07
|
| Rate for Payer: Aetna Commercial |
$1.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.07
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Cofinity Commercial |
$1.15
|
| Rate for Payer: Cofinity Commercial |
$1.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.31
|
| Rate for Payer: Healthscope Commercial |
$1.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.39
|
| Rate for Payer: PHP Commercial |
$1.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.07
|
| Rate for Payer: Priority Health SBD |
$1.03
|
| Rate for Payer: UMR Bronson Commercial |
$0.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.23
|
|
|
CYCLOBENZAPRINE 10 MG TABLET
|
Facility
|
IP
|
$3.22
|
|
|
Service Code
|
NDC 50268019111
|
| Hospital Charge Code |
2017
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$2.90 |
| Rate for Payer: Aetna American Axle |
$2.09
|
| Rate for Payer: Aetna Commercial |
$2.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.09
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cofinity Commercial |
$2.25
|
| Rate for Payer: Cofinity Commercial |
$2.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.58
|
| Rate for Payer: Healthscope Commercial |
$2.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.74
|
| Rate for Payer: PHP Commercial |
$2.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.09
|
| Rate for Payer: Priority Health SBD |
$2.03
|
| Rate for Payer: UMR Bronson Commercial |
$1.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.42
|
|
|
CYCLOBENZAPRINE 10 MG TABLET
|
Facility
|
IP
|
$51.70
|
|
|
Service Code
|
NDC 69097084607
|
| Hospital Charge Code |
2017
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$46.53 |
| Rate for Payer: Aetna American Axle |
$33.60
|
| Rate for Payer: Aetna Commercial |
$43.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.60
|
| Rate for Payer: Cash Price |
$41.36
|
| Rate for Payer: Cofinity Commercial |
$36.19
|
| Rate for Payer: Cofinity Commercial |
$44.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.36
|
| Rate for Payer: Healthscope Commercial |
$46.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.94
|
| Rate for Payer: PHP Commercial |
$43.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.60
|
| Rate for Payer: Priority Health SBD |
$32.57
|
| Rate for Payer: UMR Bronson Commercial |
$22.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.78
|
|
|
CYCLOBENZAPRINE 10 MG TABLET
|
Facility
|
OP
|
$119.85
|
|
|
Service Code
|
NDC 43547040010
|
| Hospital Charge Code |
2017
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$107.86 |
| Rate for Payer: Aetna American Axle |
$77.90
|
| Rate for Payer: Aetna Commercial |
$101.87
|
| Rate for Payer: Aetna Medicare |
$59.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.90
|
| Rate for Payer: BCBS Complete |
$47.94
|
| Rate for Payer: Cash Price |
$95.88
|
| Rate for Payer: Cofinity Commercial |
$103.07
|
| Rate for Payer: Cofinity Commercial |
$83.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$83.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.88
|
| Rate for Payer: Healthscope Commercial |
$107.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.87
|
| Rate for Payer: PHP Commercial |
$101.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.90
|
| Rate for Payer: Priority Health SBD |
$75.51
|
| Rate for Payer: UMR Bronson Commercial |
$44.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.89
|
|
|
CYCLOBENZAPRINE 10 MG TABLET
|
Facility
|
IP
|
$2.52
|
|
|
Service Code
|
NDC 51079064401
|
| Hospital Charge Code |
2017
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$2.27 |
| Rate for Payer: Cofinity Commercial |
$1.76
|
| Rate for Payer: Cofinity Commercial |
$2.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.76
|
| Rate for Payer: Aetna American Axle |
$1.64
|
| Rate for Payer: Aetna Commercial |
$2.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.64
|
| Rate for Payer: Cash Price |
$2.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.02
|
| Rate for Payer: Healthscope Commercial |
$2.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.14
|
| Rate for Payer: PHP Commercial |
$2.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.64
|
| Rate for Payer: Priority Health SBD |
$1.59
|
| Rate for Payer: UMR Bronson Commercial |
$1.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.89
|
|
|
CYCLOBENZAPRINE 10 MG TABLET
|
Facility
|
OP
|
$51.70
|
|
|
Service Code
|
NDC 72888001401
|
| Hospital Charge Code |
2017
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.13 |
| Max. Negotiated Rate |
$46.53 |
| Rate for Payer: Aetna American Axle |
$33.60
|
| Rate for Payer: Aetna Commercial |
$43.94
|
| Rate for Payer: Aetna Medicare |
$25.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.60
|
| Rate for Payer: BCBS Complete |
$20.68
|
| Rate for Payer: Cash Price |
$41.36
|
| Rate for Payer: Cofinity Commercial |
$36.19
|
| Rate for Payer: Cofinity Commercial |
$44.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.36
|
| Rate for Payer: Healthscope Commercial |
$46.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.94
|
| Rate for Payer: PHP Commercial |
$43.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.60
|
| Rate for Payer: Priority Health SBD |
$32.57
|
| Rate for Payer: UMR Bronson Commercial |
$19.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.78
|
|
|
CYCLOBENZAPRINE 10 MG TABLET
|
Facility
|
OP
|
$251.45
|
|
|
Service Code
|
NDC 51079064420
|
| Hospital Charge Code |
2017
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.04 |
| Max. Negotiated Rate |
$226.30 |
| Rate for Payer: Aetna American Axle |
$163.44
|
| Rate for Payer: Aetna Commercial |
$213.73
|
| Rate for Payer: Aetna Medicare |
$125.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.44
|
| Rate for Payer: BCBS Complete |
$100.58
|
| Rate for Payer: Cash Price |
$201.16
|
| Rate for Payer: Cofinity Commercial |
$176.02
|
| Rate for Payer: Cofinity Commercial |
$216.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$176.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.16
|
| Rate for Payer: Healthscope Commercial |
$226.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$176.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.73
|
| Rate for Payer: PHP Commercial |
$213.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.44
|
| Rate for Payer: Priority Health SBD |
$158.41
|
| Rate for Payer: UMR Bronson Commercial |
$93.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.59
|
|
|
CYCLOBENZAPRINE 10 MG TABLET
|
Facility
|
OP
|
$160.98
|
|
|
Service Code
|
NDC 50268019115
|
| Hospital Charge Code |
2017
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.56 |
| Max. Negotiated Rate |
$144.88 |
| Rate for Payer: Aetna American Axle |
$104.64
|
| Rate for Payer: Aetna Commercial |
$136.83
|
| Rate for Payer: Aetna Medicare |
$80.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.64
|
| Rate for Payer: BCBS Complete |
$64.39
|
| Rate for Payer: Cash Price |
$128.78
|
| Rate for Payer: Cofinity Commercial |
$112.69
|
| Rate for Payer: Cofinity Commercial |
$138.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$112.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.78
|
| Rate for Payer: Healthscope Commercial |
$144.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$112.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.83
|
| Rate for Payer: PHP Commercial |
$136.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.64
|
| Rate for Payer: Priority Health SBD |
$101.42
|
| Rate for Payer: UMR Bronson Commercial |
$59.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.74
|
|
|
CYCLOBENZAPRINE 10 MG TABLET
|
Facility
|
IP
|
$160.98
|
|
|
Service Code
|
NDC 50268019115
|
| Hospital Charge Code |
2017
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.83 |
| Max. Negotiated Rate |
$144.88 |
| Rate for Payer: Aetna American Axle |
$104.64
|
| Rate for Payer: Aetna Commercial |
$136.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.64
|
| Rate for Payer: Cash Price |
$128.78
|
| Rate for Payer: Cofinity Commercial |
$112.69
|
| Rate for Payer: Cofinity Commercial |
$138.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$112.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.78
|
| Rate for Payer: Healthscope Commercial |
$144.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$112.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.83
|
| Rate for Payer: PHP Commercial |
$136.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.64
|
| Rate for Payer: Priority Health SBD |
$101.42
|
| Rate for Payer: UMR Bronson Commercial |
$70.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.74
|
|
|
CYCLOBENZAPRINE 10 MG TABLET
|
Facility
|
IP
|
$51.70
|
|
|
Service Code
|
NDC 72888001401
|
| Hospital Charge Code |
2017
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$46.53 |
| Rate for Payer: Aetna American Axle |
$33.60
|
| Rate for Payer: Aetna Commercial |
$43.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.60
|
| Rate for Payer: Cash Price |
$41.36
|
| Rate for Payer: Cofinity Commercial |
$36.19
|
| Rate for Payer: Cofinity Commercial |
$44.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.36
|
| Rate for Payer: Healthscope Commercial |
$46.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.94
|
| Rate for Payer: PHP Commercial |
$43.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.60
|
| Rate for Payer: Priority Health SBD |
$32.57
|
| Rate for Payer: UMR Bronson Commercial |
$22.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.78
|
|
|
CYCLOBENZAPRINE 10 MG TABLET
|
Facility
|
OP
|
$51.70
|
|
|
Service Code
|
NDC 69097084607
|
| Hospital Charge Code |
2017
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.13 |
| Max. Negotiated Rate |
$46.53 |
| Rate for Payer: Aetna American Axle |
$33.60
|
| Rate for Payer: Aetna Commercial |
$43.94
|
| Rate for Payer: Aetna Medicare |
$25.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.60
|
| Rate for Payer: BCBS Complete |
$20.68
|
| Rate for Payer: Cash Price |
$41.36
|
| Rate for Payer: Cofinity Commercial |
$36.19
|
| Rate for Payer: Cofinity Commercial |
$44.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.36
|
| Rate for Payer: Healthscope Commercial |
$46.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.94
|
| Rate for Payer: PHP Commercial |
$43.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.60
|
| Rate for Payer: Priority Health SBD |
$32.57
|
| Rate for Payer: UMR Bronson Commercial |
$19.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.78
|
|
|
CYCLOBENZAPRINE 10 MG TABLET
|
Facility
|
IP
|
$251.45
|
|
|
Service Code
|
NDC 51079064420
|
| Hospital Charge Code |
2017
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.64 |
| Max. Negotiated Rate |
$226.30 |
| Rate for Payer: Aetna American Axle |
$163.44
|
| Rate for Payer: Aetna Commercial |
$213.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.44
|
| Rate for Payer: Cash Price |
$201.16
|
| Rate for Payer: Cofinity Commercial |
$176.02
|
| Rate for Payer: Cofinity Commercial |
$216.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$176.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.16
|
| Rate for Payer: Healthscope Commercial |
$226.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$176.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.73
|
| Rate for Payer: PHP Commercial |
$213.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.44
|
| Rate for Payer: Priority Health SBD |
$158.41
|
| Rate for Payer: UMR Bronson Commercial |
$110.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.59
|
|
|
CYCLOBENZAPRINE 10 MG TABLET
|
Facility
|
IP
|
$119.85
|
|
|
Service Code
|
NDC 43547040010
|
| Hospital Charge Code |
2017
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.73 |
| Max. Negotiated Rate |
$107.86 |
| Rate for Payer: Aetna American Axle |
$77.90
|
| Rate for Payer: Aetna Commercial |
$101.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.90
|
| Rate for Payer: Cash Price |
$95.88
|
| Rate for Payer: Cofinity Commercial |
$103.07
|
| Rate for Payer: Cofinity Commercial |
$83.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$83.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.88
|
| Rate for Payer: Healthscope Commercial |
$107.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.87
|
| Rate for Payer: PHP Commercial |
$101.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.90
|
| Rate for Payer: Priority Health SBD |
$75.51
|
| Rate for Payer: UMR Bronson Commercial |
$52.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.89
|
|
