|
ELTROMBOPAG OLAMINE 25 MG ORAL POWDER PACKET
|
Facility
|
IP
|
$965.31
|
|
|
Service Code
|
NDC 00078069719
|
| Hospital Charge Code |
193346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$424.74 |
| Max. Negotiated Rate |
$868.78 |
| Rate for Payer: Aetna American Axle |
$627.45
|
| Rate for Payer: Aetna Commercial |
$820.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$627.45
|
| Rate for Payer: Cash Price |
$772.25
|
| Rate for Payer: Cofinity Advantage |
$675.72
|
| Rate for Payer: Cofinity Commercial |
$830.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$772.25
|
| Rate for Payer: Healthscope Commercial |
$868.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$675.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$723.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$820.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$723.98
|
| Rate for Payer: PHP Commercial |
$820.51
|
| Rate for Payer: Priority Health SBD |
$608.15
|
| Rate for Payer: UMR Bronson Commercial |
$424.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$723.98
|
|
|
EMOLLIENT TOPICAL CREAM
|
Facility
|
IP
|
$23.29
|
|
|
Service Code
|
NDC 00225052053
|
| Hospital Charge Code |
77778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.25 |
| Max. Negotiated Rate |
$20.96 |
| Rate for Payer: Aetna American Axle |
$15.14
|
| Rate for Payer: Aetna Commercial |
$19.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.14
|
| Rate for Payer: Cash Price |
$18.63
|
| Rate for Payer: Cofinity Advantage |
$16.30
|
| Rate for Payer: Cofinity Commercial |
$20.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.63
|
| Rate for Payer: Healthscope Commercial |
$20.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.47
|
| Rate for Payer: PHP Commercial |
$19.80
|
| Rate for Payer: Priority Health SBD |
$14.67
|
| Rate for Payer: UMR Bronson Commercial |
$10.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.47
|
|
|
EMOLLIENT TOPICAL CREAM
|
Facility
|
OP
|
$23.29
|
|
|
Service Code
|
NDC 00225052053
|
| Hospital Charge Code |
77778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$20.96 |
| Rate for Payer: Aetna American Axle |
$15.14
|
| Rate for Payer: Aetna Commercial |
$19.80
|
| Rate for Payer: Aetna Medicare |
$11.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.14
|
| Rate for Payer: BCBS Complete |
$9.32
|
| Rate for Payer: Cash Price |
$18.63
|
| Rate for Payer: Cofinity Advantage |
$16.30
|
| Rate for Payer: Cofinity Commercial |
$20.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.63
|
| Rate for Payer: Healthscope Commercial |
$20.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.47
|
| Rate for Payer: PHP Commercial |
$19.80
|
| Rate for Payer: Priority Health SBD |
$14.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.14
|
| Rate for Payer: UHC Core |
$12.13
|
| Rate for Payer: UHC Exchange |
$9.15
|
| Rate for Payer: UMR Bronson Commercial |
$8.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.47
|
|
|
EMPAGLIFLOZIN 10 MG TABLET
|
Facility
|
OP
|
$1,083.92
|
|
|
Service Code
|
NDC 00597015230
|
| Hospital Charge Code |
171967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$401.05 |
| Max. Negotiated Rate |
$975.53 |
| Rate for Payer: Aetna American Axle |
$704.55
|
| Rate for Payer: Aetna Commercial |
$921.33
|
| Rate for Payer: Aetna Medicare |
$541.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$704.55
|
| Rate for Payer: BCBS Complete |
$433.57
|
| Rate for Payer: Cash Price |
$867.14
|
| Rate for Payer: Cofinity Advantage |
$758.74
|
| Rate for Payer: Cofinity Commercial |
$932.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$867.14
|
| Rate for Payer: Healthscope Commercial |
$975.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$758.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$812.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$867.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$921.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$812.94
|
| Rate for Payer: PHP Commercial |
$921.33
|
| Rate for Payer: Priority Health SBD |
$682.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$704.55
|
| Rate for Payer: UHC Core |
$564.72
|
| Rate for Payer: UHC Exchange |
$425.98
|
| Rate for Payer: UMR Bronson Commercial |
$401.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$812.94
|
|
|
EMPAGLIFLOZIN 10 MG TABLET
|
Facility
|
IP
|
$3,251.75
|
|
|
Service Code
|
NDC 00597015290
|
| Hospital Charge Code |
171967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,430.77 |
| Max. Negotiated Rate |
$2,926.57 |
| Rate for Payer: Aetna American Axle |
$2,113.64
|
| Rate for Payer: Aetna Commercial |
$2,763.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,113.64
|
| Rate for Payer: Cash Price |
$2,601.40
|
| Rate for Payer: Cofinity Advantage |
$2,276.22
|
| Rate for Payer: Cofinity Commercial |
$2,796.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,601.40
|
| Rate for Payer: Healthscope Commercial |
$2,926.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,276.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,438.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,763.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,438.81
|
| Rate for Payer: PHP Commercial |
$2,763.99
|
| Rate for Payer: Priority Health SBD |
$2,048.60
|
| Rate for Payer: UMR Bronson Commercial |
$1,430.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,438.81
|
|
|
EMPAGLIFLOZIN 10 MG TABLET
|
Facility
|
OP
|
$3,251.75
|
|
|
Service Code
|
NDC 00597015290
|
| Hospital Charge Code |
171967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,203.15 |
| Max. Negotiated Rate |
$2,926.57 |
| Rate for Payer: Aetna American Axle |
$2,113.64
|
| Rate for Payer: Aetna Commercial |
$2,763.99
|
| Rate for Payer: Aetna Medicare |
$1,625.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,113.64
|
| Rate for Payer: BCBS Complete |
$1,300.70
|
| Rate for Payer: Cash Price |
$2,601.40
|
| Rate for Payer: Cofinity Advantage |
$2,276.22
|
| Rate for Payer: Cofinity Commercial |
$2,796.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,601.40
|
| Rate for Payer: Healthscope Commercial |
$2,926.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,276.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,438.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,601.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,763.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,438.81
|
| Rate for Payer: PHP Commercial |
$2,763.99
|
| Rate for Payer: Priority Health SBD |
$2,048.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,113.64
|
| Rate for Payer: UHC Core |
$1,694.16
|
| Rate for Payer: UHC Exchange |
$1,277.94
|
| Rate for Payer: UMR Bronson Commercial |
$1,203.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,438.81
|
|
|
EMPAGLIFLOZIN 10 MG TABLET
|
Facility
|
IP
|
$1,083.92
|
|
|
Service Code
|
NDC 00597015230
|
| Hospital Charge Code |
171967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$476.92 |
| Max. Negotiated Rate |
$975.53 |
| Rate for Payer: Aetna American Axle |
$704.55
|
| Rate for Payer: Aetna Commercial |
$921.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$704.55
|
| Rate for Payer: Cash Price |
$867.14
|
| Rate for Payer: Cofinity Advantage |
$758.74
|
| Rate for Payer: Cofinity Commercial |
$932.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$867.14
|
| Rate for Payer: Healthscope Commercial |
$975.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$758.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$812.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$921.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$812.94
|
| Rate for Payer: PHP Commercial |
$921.33
|
| Rate for Payer: Priority Health SBD |
$682.87
|
| Rate for Payer: UMR Bronson Commercial |
$476.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$812.94
|
|
|
EMPAGLIFLOZIN 25 MG TABLET
|
Facility
|
OP
|
$1,083.92
|
|
|
Service Code
|
NDC 00597015330
|
| Hospital Charge Code |
171966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$401.05 |
| Max. Negotiated Rate |
$975.53 |
| Rate for Payer: Aetna American Axle |
$704.55
|
| Rate for Payer: Aetna Commercial |
$921.33
|
| Rate for Payer: Aetna Medicare |
$541.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$704.55
|
| Rate for Payer: BCBS Complete |
$433.57
|
| Rate for Payer: Cash Price |
$867.14
|
| Rate for Payer: Cofinity Advantage |
$758.74
|
| Rate for Payer: Cofinity Commercial |
$932.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$867.14
|
| Rate for Payer: Healthscope Commercial |
$975.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$758.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$812.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$867.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$921.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$812.94
|
| Rate for Payer: PHP Commercial |
$921.33
|
| Rate for Payer: Priority Health SBD |
$682.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$704.55
|
| Rate for Payer: UHC Core |
$564.72
|
| Rate for Payer: UHC Exchange |
$425.98
|
| Rate for Payer: UMR Bronson Commercial |
$401.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$812.94
|
|
|
EMPAGLIFLOZIN 25 MG TABLET
|
Facility
|
IP
|
$1,083.92
|
|
|
Service Code
|
NDC 00597015330
|
| Hospital Charge Code |
171966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$476.92 |
| Max. Negotiated Rate |
$975.53 |
| Rate for Payer: Aetna American Axle |
$704.55
|
| Rate for Payer: Aetna Commercial |
$921.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$704.55
|
| Rate for Payer: Cash Price |
$867.14
|
| Rate for Payer: Cofinity Advantage |
$758.74
|
| Rate for Payer: Cofinity Commercial |
$932.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$867.14
|
| Rate for Payer: Healthscope Commercial |
$975.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$758.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$812.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$921.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$812.94
|
| Rate for Payer: PHP Commercial |
$921.33
|
| Rate for Payer: Priority Health SBD |
$682.87
|
| Rate for Payer: UMR Bronson Commercial |
$476.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$812.94
|
|
|
EMPTY CONTAINER BOTTLE
|
Facility
|
IP
|
$45.41
|
|
|
Service Code
|
NDC 85412046162
|
| Hospital Charge Code |
113131
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.98 |
| Max. Negotiated Rate |
$40.87 |
| Rate for Payer: Aetna American Axle |
$29.52
|
| Rate for Payer: Aetna Commercial |
$38.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.52
|
| Rate for Payer: Cash Price |
$36.33
|
| Rate for Payer: Cofinity Advantage |
$31.79
|
| Rate for Payer: Cofinity Commercial |
$39.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.33
|
| Rate for Payer: Healthscope Commercial |
$40.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.06
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: Priority Health SBD |
$28.61
|
| Rate for Payer: UMR Bronson Commercial |
$19.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.06
|
|
|
EMPTY CONTAINER BOTTLE
|
Facility
|
OP
|
$45.41
|
|
|
Service Code
|
NDC 85412046162
|
| Hospital Charge Code |
113131
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$40.87 |
| Rate for Payer: Aetna American Axle |
$29.52
|
| Rate for Payer: Aetna Commercial |
$38.60
|
| Rate for Payer: Aetna Medicare |
$22.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.52
|
| Rate for Payer: BCBS Complete |
$18.16
|
| Rate for Payer: Cash Price |
$36.33
|
| Rate for Payer: Cofinity Advantage |
$31.79
|
| Rate for Payer: Cofinity Commercial |
$39.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.33
|
| Rate for Payer: Healthscope Commercial |
$40.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.06
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: Priority Health SBD |
$28.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.52
|
| Rate for Payer: UHC Core |
$23.66
|
| Rate for Payer: UHC Exchange |
$17.85
|
| Rate for Payer: UMR Bronson Commercial |
$16.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.06
|
|
|
EMPTY CONTAINER BOTTLE
|
Facility
|
IP
|
$35.22
|
|
|
Service Code
|
NDC 00409161402
|
| Hospital Charge Code |
113131
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.50 |
| Max. Negotiated Rate |
$31.70 |
| Rate for Payer: Aetna American Axle |
$22.89
|
| Rate for Payer: Aetna Commercial |
$29.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.89
|
| Rate for Payer: Cash Price |
$28.18
|
| Rate for Payer: Cofinity Advantage |
$24.65
|
| Rate for Payer: Cofinity Commercial |
$30.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.18
|
| Rate for Payer: Healthscope Commercial |
$31.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.41
|
| Rate for Payer: PHP Commercial |
$29.94
|
| Rate for Payer: Priority Health SBD |
$22.19
|
| Rate for Payer: UMR Bronson Commercial |
$15.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.41
|
|
|
EMPTY CONTAINER BOTTLE
|
Facility
|
IP
|
$22.54
|
|
|
Service Code
|
NDC 33516140505
|
| Hospital Charge Code |
113131
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.92 |
| Max. Negotiated Rate |
$20.29 |
| Rate for Payer: Aetna American Axle |
$14.65
|
| Rate for Payer: Aetna Commercial |
$19.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.65
|
| Rate for Payer: Cash Price |
$18.03
|
| Rate for Payer: Cofinity Advantage |
$15.78
|
| Rate for Payer: Cofinity Commercial |
$19.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.03
|
| Rate for Payer: Healthscope Commercial |
$20.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.91
|
| Rate for Payer: PHP Commercial |
$19.16
|
| Rate for Payer: Priority Health SBD |
$14.20
|
| Rate for Payer: UMR Bronson Commercial |
$9.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.91
|
|
|
EMPTY CONTAINER BOTTLE
|
Facility
|
OP
|
$50.99
|
|
|
Service Code
|
NDC 00264975706
|
| Hospital Charge Code |
113131
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.87 |
| Max. Negotiated Rate |
$45.89 |
| Rate for Payer: Aetna American Axle |
$33.14
|
| Rate for Payer: Aetna Commercial |
$43.34
|
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.14
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: Cash Price |
$40.79
|
| Rate for Payer: Cofinity Advantage |
$35.69
|
| Rate for Payer: Cofinity Commercial |
$43.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.79
|
| Rate for Payer: Healthscope Commercial |
$45.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.24
|
| Rate for Payer: PHP Commercial |
$43.34
|
| Rate for Payer: Priority Health SBD |
$32.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.14
|
| Rate for Payer: UHC Core |
$26.57
|
| Rate for Payer: UHC Exchange |
$20.04
|
| Rate for Payer: UMR Bronson Commercial |
$18.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.24
|
|
|
EMPTY CONTAINER BOTTLE
|
Facility
|
OP
|
$35.22
|
|
|
Service Code
|
NDC 00409161402
|
| Hospital Charge Code |
113131
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.03 |
| Max. Negotiated Rate |
$31.70 |
| Rate for Payer: Aetna American Axle |
$22.89
|
| Rate for Payer: Aetna Commercial |
$29.94
|
| Rate for Payer: Aetna Medicare |
$17.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.89
|
| Rate for Payer: BCBS Complete |
$14.09
|
| Rate for Payer: Cash Price |
$28.18
|
| Rate for Payer: Cofinity Advantage |
$24.65
|
| Rate for Payer: Cofinity Commercial |
$30.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.18
|
| Rate for Payer: Healthscope Commercial |
$31.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.41
|
| Rate for Payer: PHP Commercial |
$29.94
|
| Rate for Payer: Priority Health SBD |
$22.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.89
|
| Rate for Payer: UHC Core |
$18.35
|
| Rate for Payer: UHC Exchange |
$13.84
|
| Rate for Payer: UMR Bronson Commercial |
$13.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.41
|
|
|
EMPTY CONTAINER BOTTLE
|
Facility
|
OP
|
$22.54
|
|
|
Service Code
|
NDC 33516140505
|
| Hospital Charge Code |
113131
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$20.29 |
| Rate for Payer: Aetna American Axle |
$14.65
|
| Rate for Payer: Aetna Commercial |
$19.16
|
| Rate for Payer: Aetna Medicare |
$11.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.65
|
| Rate for Payer: BCBS Complete |
$9.02
|
| Rate for Payer: Cash Price |
$18.03
|
| Rate for Payer: Cofinity Advantage |
$15.78
|
| Rate for Payer: Cofinity Commercial |
$19.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.03
|
| Rate for Payer: Healthscope Commercial |
$20.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.91
|
| Rate for Payer: PHP Commercial |
$19.16
|
| Rate for Payer: Priority Health SBD |
$14.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.65
|
| Rate for Payer: UHC Core |
$11.74
|
| Rate for Payer: UHC Exchange |
$8.86
|
| Rate for Payer: UMR Bronson Commercial |
$8.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.91
|
|
|
EMPTY CONTAINER BOTTLE
|
Facility
|
IP
|
$50.99
|
|
|
Service Code
|
NDC 00264975706
|
| Hospital Charge Code |
113131
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$45.89 |
| Rate for Payer: Aetna American Axle |
$33.14
|
| Rate for Payer: Aetna Commercial |
$43.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.14
|
| Rate for Payer: Cash Price |
$40.79
|
| Rate for Payer: Cofinity Advantage |
$35.69
|
| Rate for Payer: Cofinity Commercial |
$43.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.79
|
| Rate for Payer: Healthscope Commercial |
$45.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.24
|
| Rate for Payer: PHP Commercial |
$43.34
|
| Rate for Payer: Priority Health SBD |
$32.12
|
| Rate for Payer: UMR Bronson Commercial |
$22.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.24
|
|
|
EMTRICITABINE 200 MG-TENOFOVIR ALAFENAMIDE FUMARATE 25 MG TABLET
|
Facility
|
IP
|
$7,944.83
|
|
|
Service Code
|
NDC 61958200201
|
| Hospital Charge Code |
178497
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,495.73 |
| Max. Negotiated Rate |
$7,150.35 |
| Rate for Payer: Aetna American Axle |
$5,164.14
|
| Rate for Payer: Aetna Commercial |
$6,753.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,164.14
|
| Rate for Payer: Cash Price |
$6,355.86
|
| Rate for Payer: Cofinity Advantage |
$5,561.38
|
| Rate for Payer: Cofinity Commercial |
$6,832.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,355.86
|
| Rate for Payer: Healthscope Commercial |
$7,150.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,561.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,958.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,753.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,958.62
|
| Rate for Payer: PHP Commercial |
$6,753.11
|
| Rate for Payer: Priority Health SBD |
$5,005.24
|
| Rate for Payer: UMR Bronson Commercial |
$3,495.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,958.62
|
|
|
EMTRICITABINE 200 MG-TENOFOVIR ALAFENAMIDE FUMARATE 25 MG TABLET
|
Facility
|
OP
|
$7,944.83
|
|
|
Service Code
|
NDC 61958200201
|
| Hospital Charge Code |
178497
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,939.59 |
| Max. Negotiated Rate |
$7,150.35 |
| Rate for Payer: Aetna American Axle |
$5,164.14
|
| Rate for Payer: Aetna Commercial |
$6,753.11
|
| Rate for Payer: Aetna Medicare |
$3,972.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,164.14
|
| Rate for Payer: BCBS Complete |
$3,177.93
|
| Rate for Payer: Cash Price |
$6,355.86
|
| Rate for Payer: Cofinity Advantage |
$5,561.38
|
| Rate for Payer: Cofinity Commercial |
$6,832.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,355.86
|
| Rate for Payer: Healthscope Commercial |
$7,150.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,561.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,958.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,355.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,753.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,958.62
|
| Rate for Payer: PHP Commercial |
$6,753.11
|
| Rate for Payer: Priority Health SBD |
$5,005.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,164.14
|
| Rate for Payer: UHC Core |
$4,139.26
|
| Rate for Payer: UHC Exchange |
$3,122.32
|
| Rate for Payer: UMR Bronson Commercial |
$2,939.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,958.62
|
|
|
EMTRICITABINE 200 MG-TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET
|
Facility
|
OP
|
$6,646.02
|
|
|
Service Code
|
NDC 61958070101
|
| Hospital Charge Code |
39255
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,459.03 |
| Max. Negotiated Rate |
$5,981.42 |
| Rate for Payer: Aetna American Axle |
$4,319.91
|
| Rate for Payer: Aetna Commercial |
$5,649.12
|
| Rate for Payer: Aetna Medicare |
$3,323.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,319.91
|
| Rate for Payer: BCBS Complete |
$2,658.41
|
| Rate for Payer: Cash Price |
$5,316.82
|
| Rate for Payer: Cofinity Advantage |
$4,652.21
|
| Rate for Payer: Cofinity Commercial |
$5,715.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,316.82
|
| Rate for Payer: Healthscope Commercial |
$5,981.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,652.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,984.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,316.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,649.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,984.52
|
| Rate for Payer: PHP Commercial |
$5,649.12
|
| Rate for Payer: Priority Health SBD |
$4,186.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,319.91
|
| Rate for Payer: UHC Core |
$3,462.58
|
| Rate for Payer: UHC Exchange |
$2,611.89
|
| Rate for Payer: UMR Bronson Commercial |
$2,459.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,984.52
|
|
|
EMTRICITABINE 200 MG-TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET
|
Facility
|
IP
|
$6,646.02
|
|
|
Service Code
|
NDC 61958070101
|
| Hospital Charge Code |
39255
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,924.25 |
| Max. Negotiated Rate |
$5,981.42 |
| Rate for Payer: Aetna American Axle |
$4,319.91
|
| Rate for Payer: Aetna Commercial |
$5,649.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,319.91
|
| Rate for Payer: Cash Price |
$5,316.82
|
| Rate for Payer: Cofinity Advantage |
$4,652.21
|
| Rate for Payer: Cofinity Commercial |
$5,715.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,316.82
|
| Rate for Payer: Healthscope Commercial |
$5,981.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,652.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,984.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,649.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,984.52
|
| Rate for Payer: PHP Commercial |
$5,649.12
|
| Rate for Payer: Priority Health SBD |
$4,186.99
|
| Rate for Payer: UMR Bronson Commercial |
$2,924.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,984.52
|
|
|
EMTRICITABINE 200 MG-TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET
|
Facility
|
OP
|
$89.28
|
|
|
Service Code
|
NDC 42385095330
|
| Hospital Charge Code |
39255
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.03 |
| Max. Negotiated Rate |
$80.35 |
| Rate for Payer: Aetna American Axle |
$58.03
|
| Rate for Payer: Aetna Commercial |
$75.89
|
| Rate for Payer: Aetna Medicare |
$44.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.03
|
| Rate for Payer: BCBS Complete |
$35.71
|
| Rate for Payer: Cash Price |
$71.42
|
| Rate for Payer: Cofinity Advantage |
$62.50
|
| Rate for Payer: Cofinity Commercial |
$76.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.42
|
| Rate for Payer: Healthscope Commercial |
$80.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.96
|
| Rate for Payer: PHP Commercial |
$75.89
|
| Rate for Payer: Priority Health SBD |
$56.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.03
|
| Rate for Payer: UHC Core |
$46.51
|
| Rate for Payer: UHC Exchange |
$35.09
|
| Rate for Payer: UMR Bronson Commercial |
$33.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.96
|
|
|
EMTRICITABINE 200 MG-TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET
|
Facility
|
OP
|
$226.95
|
|
|
Service Code
|
NDC 00904717207
|
| Hospital Charge Code |
39255
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.97 |
| Max. Negotiated Rate |
$204.25 |
| Rate for Payer: Aetna American Axle |
$147.52
|
| Rate for Payer: Aetna Commercial |
$192.91
|
| Rate for Payer: Aetna Medicare |
$113.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.52
|
| Rate for Payer: BCBS Complete |
$90.78
|
| Rate for Payer: Cash Price |
$181.56
|
| Rate for Payer: Cofinity Advantage |
$158.87
|
| Rate for Payer: Cofinity Commercial |
$195.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.56
|
| Rate for Payer: Healthscope Commercial |
$204.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$158.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$181.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.21
|
| Rate for Payer: PHP Commercial |
$192.91
|
| Rate for Payer: Priority Health SBD |
$142.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.52
|
| Rate for Payer: UHC Core |
$118.24
|
| Rate for Payer: UHC Exchange |
$89.19
|
| Rate for Payer: UMR Bronson Commercial |
$83.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.21
|
|
|
EMTRICITABINE 200 MG-TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET
|
Facility
|
IP
|
$89.28
|
|
|
Service Code
|
NDC 42385095330
|
| Hospital Charge Code |
39255
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$80.35 |
| Rate for Payer: Aetna American Axle |
$58.03
|
| Rate for Payer: Aetna Commercial |
$75.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.03
|
| Rate for Payer: Cash Price |
$71.42
|
| Rate for Payer: Cofinity Advantage |
$62.50
|
| Rate for Payer: Cofinity Commercial |
$76.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.42
|
| Rate for Payer: Healthscope Commercial |
$80.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.96
|
| Rate for Payer: PHP Commercial |
$75.89
|
| Rate for Payer: Priority Health SBD |
$56.25
|
| Rate for Payer: UMR Bronson Commercial |
$39.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.96
|
|
|
EMTRICITABINE 200 MG-TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET
|
Facility
|
IP
|
$226.95
|
|
|
Service Code
|
NDC 00904717207
|
| Hospital Charge Code |
39255
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.86 |
| Max. Negotiated Rate |
$204.25 |
| Rate for Payer: Aetna American Axle |
$147.52
|
| Rate for Payer: Aetna Commercial |
$192.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.52
|
| Rate for Payer: Cash Price |
$181.56
|
| Rate for Payer: Cofinity Advantage |
$158.87
|
| Rate for Payer: Cofinity Commercial |
$195.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.56
|
| Rate for Payer: Healthscope Commercial |
$204.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$158.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.21
|
| Rate for Payer: PHP Commercial |
$192.91
|
| Rate for Payer: Priority Health SBD |
$142.98
|
| Rate for Payer: UMR Bronson Commercial |
$99.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.21
|
|
