|
FAT EMULSION 20 % INTRAVENOUS
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
NDC 00338051913
|
| Hospital Charge Code |
10014
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna American Axle |
$130.00
|
| Rate for Payer: Aetna Commercial |
$170.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Advantage |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$172.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.00
|
| Rate for Payer: Healthscope Commercial |
$180.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.00
|
| Rate for Payer: PHP Commercial |
$170.00
|
| Rate for Payer: Priority Health SBD |
$126.00
|
| Rate for Payer: UMR Bronson Commercial |
$88.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.00
|
|
|
FAT EMULSION 20 % INTRAVENOUS
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
NDC 00338051913
|
| Hospital Charge Code |
10014
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna American Axle |
$130.00
|
| Rate for Payer: Aetna Commercial |
$170.00
|
| Rate for Payer: Aetna Medicare |
$100.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.00
|
| Rate for Payer: BCBS Complete |
$80.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Advantage |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$172.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.00
|
| Rate for Payer: Healthscope Commercial |
$180.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$160.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.00
|
| Rate for Payer: PHP Commercial |
$170.00
|
| Rate for Payer: Priority Health SBD |
$126.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.00
|
| Rate for Payer: UHC Core |
$104.20
|
| Rate for Payer: UHC Exchange |
$78.60
|
| Rate for Payer: UMR Bronson Commercial |
$74.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.00
|
|
|
FAT EMULSION 20 % INTRAVENOUS
|
Facility
|
OP
|
$9.50
|
|
|
Service Code
|
NDC 338051958
|
| Hospital Charge Code |
10014
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$8.55 |
| Rate for Payer: Aetna American Axle |
$6.17
|
| Rate for Payer: Aetna Commercial |
$8.07
|
| Rate for Payer: Aetna Medicare |
$4.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.17
|
| Rate for Payer: BCBS Complete |
$3.80
|
| Rate for Payer: Cash Price |
$7.60
|
| Rate for Payer: Cofinity Advantage |
$6.65
|
| Rate for Payer: Cofinity Commercial |
$8.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.60
|
| Rate for Payer: Healthscope Commercial |
$8.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.12
|
| Rate for Payer: PHP Commercial |
$8.07
|
| Rate for Payer: Priority Health SBD |
$5.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.17
|
| Rate for Payer: UHC Core |
$4.95
|
| Rate for Payer: UHC Exchange |
$3.73
|
| Rate for Payer: UMR Bronson Commercial |
$3.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.12
|
|
|
FAT EMULSION-OLIVE OIL-SOYBEAN OIL-EGG PHOSPHOLIPID 20 % INTRAVENOUS
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
NDC 00338954008
|
| Hospital Charge Code |
212074
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Aetna American Axle |
$16.90
|
| Rate for Payer: Aetna Commercial |
$22.10
|
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.90
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cofinity Advantage |
$18.20
|
| Rate for Payer: Cofinity Commercial |
$22.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.80
|
| Rate for Payer: Healthscope Commercial |
$23.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.50
|
| Rate for Payer: PHP Commercial |
$22.10
|
| Rate for Payer: Priority Health SBD |
$16.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.90
|
| Rate for Payer: UHC Core |
$13.55
|
| Rate for Payer: UHC Exchange |
$10.22
|
| Rate for Payer: UMR Bronson Commercial |
$9.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.50
|
|
|
FAT EMULSION-OLIVE OIL-SOYBEAN OIL-EGG PHOSPHOLIPID 20 % INTRAVENOUS
|
Facility
|
IP
|
$8.80
|
|
|
Service Code
|
NDC 00338954005
|
| Hospital Charge Code |
212074
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.87 |
| Max. Negotiated Rate |
$7.92 |
| Rate for Payer: Aetna American Axle |
$5.72
|
| Rate for Payer: Aetna Commercial |
$7.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.72
|
| Rate for Payer: Cash Price |
$7.04
|
| Rate for Payer: Cofinity Advantage |
$6.16
|
| Rate for Payer: Cofinity Commercial |
$7.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.04
|
| Rate for Payer: Healthscope Commercial |
$7.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.60
|
| Rate for Payer: PHP Commercial |
$7.48
|
| Rate for Payer: Priority Health SBD |
$5.54
|
| Rate for Payer: UMR Bronson Commercial |
$3.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.60
|
|
|
FAT EMULSION-OLIVE OIL-SOYBEAN OIL-EGG PHOSPHOLIPID 20 % INTRAVENOUS
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
NDC 00338954008
|
| Hospital Charge Code |
212074
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Aetna American Axle |
$16.90
|
| Rate for Payer: Aetna Commercial |
$22.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.90
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cofinity Advantage |
$18.20
|
| Rate for Payer: Cofinity Commercial |
$22.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.80
|
| Rate for Payer: Healthscope Commercial |
$23.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.50
|
| Rate for Payer: PHP Commercial |
$22.10
|
| Rate for Payer: Priority Health SBD |
$16.38
|
| Rate for Payer: UMR Bronson Commercial |
$11.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.50
|
|
|
FAT EMULSION-OLIVE OIL-SOYBEAN OIL-EGG PHOSPHOLIPID 20 % INTRAVENOUS
|
Facility
|
IP
|
$13.50
|
|
|
Service Code
|
NDC 00338954007
|
| Hospital Charge Code |
212074
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$12.15 |
| Rate for Payer: Aetna American Axle |
$8.78
|
| Rate for Payer: Aetna Commercial |
$11.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.78
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cofinity Advantage |
$9.45
|
| Rate for Payer: Cofinity Commercial |
$11.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.80
|
| Rate for Payer: Healthscope Commercial |
$12.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.12
|
| Rate for Payer: PHP Commercial |
$11.47
|
| Rate for Payer: Priority Health SBD |
$8.51
|
| Rate for Payer: UMR Bronson Commercial |
$5.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.12
|
|
|
FAT EMULSION-OLIVE OIL-SOYBEAN OIL-EGG PHOSPHOLIPID 20 % INTRAVENOUS
|
Facility
|
IP
|
$10.75
|
|
|
Service Code
|
NDC 00338954002
|
| Hospital Charge Code |
212074
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.73 |
| Max. Negotiated Rate |
$9.68 |
| Rate for Payer: Aetna American Axle |
$6.99
|
| Rate for Payer: Aetna Commercial |
$9.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.99
|
| Rate for Payer: Cash Price |
$8.60
|
| Rate for Payer: Cofinity Advantage |
$7.53
|
| Rate for Payer: Cofinity Commercial |
$9.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.60
|
| Rate for Payer: Healthscope Commercial |
$9.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.06
|
| Rate for Payer: PHP Commercial |
$9.14
|
| Rate for Payer: Priority Health SBD |
$6.77
|
| Rate for Payer: UMR Bronson Commercial |
$4.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.06
|
|
|
FAT EMULSION-OLIVE OIL-SOYBEAN OIL-EGG PHOSPHOLIPID 20 % INTRAVENOUS
|
Facility
|
OP
|
$8.80
|
|
|
Service Code
|
NDC 00338954005
|
| Hospital Charge Code |
212074
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$7.92 |
| Rate for Payer: Aetna American Axle |
$5.72
|
| Rate for Payer: Aetna Commercial |
$7.48
|
| Rate for Payer: Aetna Medicare |
$4.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.72
|
| Rate for Payer: BCBS Complete |
$3.52
|
| Rate for Payer: Cash Price |
$7.04
|
| Rate for Payer: Cofinity Advantage |
$6.16
|
| Rate for Payer: Cofinity Commercial |
$7.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.04
|
| Rate for Payer: Healthscope Commercial |
$7.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.60
|
| Rate for Payer: PHP Commercial |
$7.48
|
| Rate for Payer: Priority Health SBD |
$5.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.72
|
| Rate for Payer: UHC Core |
$4.58
|
| Rate for Payer: UHC Exchange |
$3.46
|
| Rate for Payer: UMR Bronson Commercial |
$3.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.60
|
|
|
FAT EMULSION-OLIVE OIL-SOYBEAN OIL-EGG PHOSPHOLIPID 20 % INTRAVENOUS
|
Facility
|
OP
|
$10.75
|
|
|
Service Code
|
NDC 00338954002
|
| Hospital Charge Code |
212074
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$9.68 |
| Rate for Payer: Aetna American Axle |
$6.99
|
| Rate for Payer: Aetna Commercial |
$9.14
|
| Rate for Payer: Aetna Medicare |
$5.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.99
|
| Rate for Payer: BCBS Complete |
$4.30
|
| Rate for Payer: Cash Price |
$8.60
|
| Rate for Payer: Cofinity Advantage |
$7.53
|
| Rate for Payer: Cofinity Commercial |
$9.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.60
|
| Rate for Payer: Healthscope Commercial |
$9.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.06
|
| Rate for Payer: PHP Commercial |
$9.14
|
| Rate for Payer: Priority Health SBD |
$6.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.99
|
| Rate for Payer: UHC Core |
$5.60
|
| Rate for Payer: UHC Exchange |
$4.22
|
| Rate for Payer: UMR Bronson Commercial |
$3.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.06
|
|
|
FAT EMULSION-OLIVE OIL-SOYBEAN OIL-EGG PHOSPHOLIPID 20 % INTRAVENOUS
|
Facility
|
OP
|
$13.50
|
|
|
Service Code
|
NDC 00338954003
|
| Hospital Charge Code |
212074
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$12.15 |
| Rate for Payer: Aetna American Axle |
$8.78
|
| Rate for Payer: Aetna Commercial |
$11.47
|
| Rate for Payer: Aetna Medicare |
$6.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.78
|
| Rate for Payer: BCBS Complete |
$5.40
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cofinity Advantage |
$9.45
|
| Rate for Payer: Cofinity Commercial |
$11.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.80
|
| Rate for Payer: Healthscope Commercial |
$12.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.12
|
| Rate for Payer: PHP Commercial |
$11.47
|
| Rate for Payer: Priority Health SBD |
$8.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.78
|
| Rate for Payer: UHC Core |
$7.03
|
| Rate for Payer: UHC Exchange |
$5.31
|
| Rate for Payer: UMR Bronson Commercial |
$5.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.12
|
|
|
FAT EMULSION-OLIVE OIL-SOYBEAN OIL-EGG PHOSPHOLIPID 20 % INTRAVENOUS
|
Facility
|
OP
|
$13.50
|
|
|
Service Code
|
NDC 00338954007
|
| Hospital Charge Code |
212074
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$12.15 |
| Rate for Payer: Aetna American Axle |
$8.78
|
| Rate for Payer: Aetna Commercial |
$11.47
|
| Rate for Payer: Aetna Medicare |
$6.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.78
|
| Rate for Payer: BCBS Complete |
$5.40
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cofinity Advantage |
$9.45
|
| Rate for Payer: Cofinity Commercial |
$11.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.80
|
| Rate for Payer: Healthscope Commercial |
$12.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.12
|
| Rate for Payer: PHP Commercial |
$11.47
|
| Rate for Payer: Priority Health SBD |
$8.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.78
|
| Rate for Payer: UHC Core |
$7.03
|
| Rate for Payer: UHC Exchange |
$5.31
|
| Rate for Payer: UMR Bronson Commercial |
$5.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.12
|
|
|
FAT EMULSION-OLIVE OIL-SOYBEAN OIL-EGG PHOSPHOLIPID 20 % INTRAVENOUS
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
NDC 00338954004
|
| Hospital Charge Code |
212074
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Aetna American Axle |
$16.90
|
| Rate for Payer: Aetna Commercial |
$22.10
|
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.90
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cofinity Advantage |
$18.20
|
| Rate for Payer: Cofinity Commercial |
$22.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.80
|
| Rate for Payer: Healthscope Commercial |
$23.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.50
|
| Rate for Payer: PHP Commercial |
$22.10
|
| Rate for Payer: Priority Health SBD |
$16.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.90
|
| Rate for Payer: UHC Core |
$13.55
|
| Rate for Payer: UHC Exchange |
$10.22
|
| Rate for Payer: UMR Bronson Commercial |
$9.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.50
|
|
|
FAT EMULSION-OLIVE OIL-SOYBEAN OIL-EGG PHOSPHOLIPID 20 % INTRAVENOUS
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
NDC 00338954004
|
| Hospital Charge Code |
212074
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Aetna American Axle |
$16.90
|
| Rate for Payer: Aetna Commercial |
$22.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.90
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cofinity Advantage |
$18.20
|
| Rate for Payer: Cofinity Commercial |
$22.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.80
|
| Rate for Payer: Healthscope Commercial |
$23.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.50
|
| Rate for Payer: PHP Commercial |
$22.10
|
| Rate for Payer: Priority Health SBD |
$16.38
|
| Rate for Payer: UMR Bronson Commercial |
$11.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.50
|
|
|
FAT EMULSION-OLIVE OIL-SOYBEAN OIL-EGG PHOSPHOLIPID 20 % INTRAVENOUS
|
Facility
|
IP
|
$13.50
|
|
|
Service Code
|
NDC 00338954003
|
| Hospital Charge Code |
212074
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$12.15 |
| Rate for Payer: Aetna American Axle |
$8.78
|
| Rate for Payer: Aetna Commercial |
$11.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.78
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cofinity Advantage |
$9.45
|
| Rate for Payer: Cofinity Commercial |
$11.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.80
|
| Rate for Payer: Healthscope Commercial |
$12.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.12
|
| Rate for Payer: PHP Commercial |
$11.47
|
| Rate for Payer: Priority Health SBD |
$8.51
|
| Rate for Payer: UMR Bronson Commercial |
$5.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.12
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
NDC 63323082010
|
| Hospital Charge Code |
179808
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.96 |
| Max. Negotiated Rate |
$53.10 |
| Rate for Payer: Aetna American Axle |
$38.35
|
| Rate for Payer: Aetna Commercial |
$50.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.35
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cofinity Advantage |
$41.30
|
| Rate for Payer: Cofinity Commercial |
$50.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.20
|
| Rate for Payer: Healthscope Commercial |
$53.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.25
|
| Rate for Payer: PHP Commercial |
$50.15
|
| Rate for Payer: Priority Health SBD |
$37.17
|
| Rate for Payer: UMR Bronson Commercial |
$25.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.25
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
NDC 63323082004
|
| Hospital Charge Code |
179808
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna American Axle |
$15.60
|
| Rate for Payer: Aetna Commercial |
$20.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.60
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Advantage |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$20.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.20
|
| Rate for Payer: Healthscope Commercial |
$21.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.00
|
| Rate for Payer: PHP Commercial |
$20.40
|
| Rate for Payer: Priority Health SBD |
$15.12
|
| Rate for Payer: UMR Bronson Commercial |
$10.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.00
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
NDC 63323082005
|
| Hospital Charge Code |
179808
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.83 |
| Max. Negotiated Rate |
$53.10 |
| Rate for Payer: Aetna American Axle |
$38.35
|
| Rate for Payer: Aetna Commercial |
$50.15
|
| Rate for Payer: Aetna Medicare |
$29.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.35
|
| Rate for Payer: BCBS Complete |
$23.60
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cofinity Advantage |
$41.30
|
| Rate for Payer: Cofinity Commercial |
$50.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.20
|
| Rate for Payer: Healthscope Commercial |
$53.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.25
|
| Rate for Payer: PHP Commercial |
$50.15
|
| Rate for Payer: Priority Health SBD |
$37.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.35
|
| Rate for Payer: UHC Core |
$30.74
|
| Rate for Payer: UHC Exchange |
$23.19
|
| Rate for Payer: UMR Bronson Commercial |
$21.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.25
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
NDC 63323082004
|
| Hospital Charge Code |
179808
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.88 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna American Axle |
$15.60
|
| Rate for Payer: Aetna Commercial |
$20.40
|
| Rate for Payer: Aetna Medicare |
$12.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.60
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Advantage |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$20.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.20
|
| Rate for Payer: Healthscope Commercial |
$21.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.00
|
| Rate for Payer: PHP Commercial |
$20.40
|
| Rate for Payer: Priority Health SBD |
$15.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.60
|
| Rate for Payer: UHC Core |
$12.50
|
| Rate for Payer: UHC Exchange |
$9.43
|
| Rate for Payer: UMR Bronson Commercial |
$8.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.00
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
NDC 63323082074
|
| Hospital Charge Code |
179808
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna American Axle |
$15.60
|
| Rate for Payer: Aetna Commercial |
$20.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.60
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Advantage |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$20.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.20
|
| Rate for Payer: Healthscope Commercial |
$21.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.00
|
| Rate for Payer: PHP Commercial |
$20.40
|
| Rate for Payer: Priority Health SBD |
$15.12
|
| Rate for Payer: UMR Bronson Commercial |
$10.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.00
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS
|
Facility
|
IP
|
$34.50
|
|
|
Service Code
|
NDC 63323082050
|
| Hospital Charge Code |
179808
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$31.05 |
| Rate for Payer: Aetna American Axle |
$22.43
|
| Rate for Payer: Aetna Commercial |
$29.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.43
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cofinity Advantage |
$24.15
|
| Rate for Payer: Cofinity Commercial |
$29.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.60
|
| Rate for Payer: Healthscope Commercial |
$31.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.88
|
| Rate for Payer: PHP Commercial |
$29.32
|
| Rate for Payer: Priority Health SBD |
$21.73
|
| Rate for Payer: UMR Bronson Commercial |
$15.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.88
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
NDC 63323082010
|
| Hospital Charge Code |
179808
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.83 |
| Max. Negotiated Rate |
$53.10 |
| Rate for Payer: Aetna American Axle |
$38.35
|
| Rate for Payer: Aetna Commercial |
$50.15
|
| Rate for Payer: Aetna Medicare |
$29.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.35
|
| Rate for Payer: BCBS Complete |
$23.60
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cofinity Advantage |
$41.30
|
| Rate for Payer: Cofinity Commercial |
$50.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.20
|
| Rate for Payer: Healthscope Commercial |
$53.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.25
|
| Rate for Payer: PHP Commercial |
$50.15
|
| Rate for Payer: Priority Health SBD |
$37.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.35
|
| Rate for Payer: UHC Core |
$30.74
|
| Rate for Payer: UHC Exchange |
$23.19
|
| Rate for Payer: UMR Bronson Commercial |
$21.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.25
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
NDC 63323082005
|
| Hospital Charge Code |
179808
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.96 |
| Max. Negotiated Rate |
$53.10 |
| Rate for Payer: Aetna American Axle |
$38.35
|
| Rate for Payer: Aetna Commercial |
$50.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.35
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cofinity Advantage |
$41.30
|
| Rate for Payer: Cofinity Commercial |
$50.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.20
|
| Rate for Payer: Healthscope Commercial |
$53.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.25
|
| Rate for Payer: PHP Commercial |
$50.15
|
| Rate for Payer: Priority Health SBD |
$37.17
|
| Rate for Payer: UMR Bronson Commercial |
$25.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.25
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
NDC 63323082074
|
| Hospital Charge Code |
179808
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.88 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna American Axle |
$15.60
|
| Rate for Payer: Aetna Commercial |
$20.40
|
| Rate for Payer: Aetna Medicare |
$12.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.60
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Advantage |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$20.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.20
|
| Rate for Payer: Healthscope Commercial |
$21.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.00
|
| Rate for Payer: PHP Commercial |
$20.40
|
| Rate for Payer: Priority Health SBD |
$15.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.60
|
| Rate for Payer: UHC Core |
$12.50
|
| Rate for Payer: UHC Exchange |
$9.43
|
| Rate for Payer: UMR Bronson Commercial |
$8.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.00
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS
|
Facility
|
OP
|
$34.50
|
|
|
Service Code
|
NDC 63323082050
|
| Hospital Charge Code |
179808
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.77 |
| Max. Negotiated Rate |
$31.05 |
| Rate for Payer: Aetna American Axle |
$22.43
|
| Rate for Payer: Aetna Commercial |
$29.32
|
| Rate for Payer: Aetna Medicare |
$17.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.43
|
| Rate for Payer: BCBS Complete |
$13.80
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cofinity Advantage |
$24.15
|
| Rate for Payer: Cofinity Commercial |
$29.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.60
|
| Rate for Payer: Healthscope Commercial |
$31.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.88
|
| Rate for Payer: PHP Commercial |
$29.32
|
| Rate for Payer: Priority Health SBD |
$21.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.43
|
| Rate for Payer: UHC Core |
$17.97
|
| Rate for Payer: UHC Exchange |
$13.56
|
| Rate for Payer: UMR Bronson Commercial |
$12.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.88
|
|
