|
FEMALE REPRODUCTIVE SYSTEM MALIGNANCY
|
Facility
|
IP
|
$6,437.63
|
|
|
Service Code
|
APR-DRG 5302
|
| Min. Negotiated Rate |
$6,131.08 |
| Max. Negotiated Rate |
$6,437.63 |
| Rate for Payer: BCBS Complete |
$6,437.63
|
| Rate for Payer: Mclaren Medicaid |
$6,131.08
|
| Rate for Payer: Meridian Medicaid |
$6,437.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,131.08
|
| Rate for Payer: UHC Medicaid |
$6,131.08
|
| Rate for Payer: UHCCP Medicaid |
$6,131.08
|
|
|
FEMALE REPRODUCTIVE SYSTEM MALIGNANCY
|
Facility
|
IP
|
$4,933.40
|
|
|
Service Code
|
APR-DRG 5301
|
| Min. Negotiated Rate |
$4,698.48 |
| Max. Negotiated Rate |
$4,933.40 |
| Rate for Payer: BCBS Complete |
$4,933.40
|
| Rate for Payer: Mclaren Medicaid |
$4,698.48
|
| Rate for Payer: Meridian Medicaid |
$4,933.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,698.48
|
| Rate for Payer: UHC Medicaid |
$4,698.48
|
| Rate for Payer: UHCCP Medicaid |
$4,698.48
|
|
|
FEMALE REPRODUCTIVE SYSTEM MALIGNANCY
|
Facility
|
IP
|
$8,565.35
|
|
|
Service Code
|
APR-DRG 5303
|
| Min. Negotiated Rate |
$8,157.48 |
| Max. Negotiated Rate |
$8,565.35 |
| Rate for Payer: BCBS Complete |
$8,565.35
|
| Rate for Payer: Mclaren Medicaid |
$8,157.48
|
| Rate for Payer: Meridian Medicaid |
$8,565.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,157.48
|
| Rate for Payer: UHC Medicaid |
$8,157.48
|
| Rate for Payer: UHCCP Medicaid |
$8,157.48
|
|
|
FEMALE REPRODUCTIVE SYSTEM MALIGNANCY
|
Facility
|
IP
|
$14,876.47
|
|
|
Service Code
|
APR-DRG 5304
|
| Min. Negotiated Rate |
$14,168.06 |
| Max. Negotiated Rate |
$14,876.47 |
| Rate for Payer: BCBS Complete |
$14,876.47
|
| Rate for Payer: Mclaren Medicaid |
$14,168.06
|
| Rate for Payer: Meridian Medicaid |
$14,876.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,168.06
|
| Rate for Payer: UHC Medicaid |
$14,168.06
|
| Rate for Payer: UHCCP Medicaid |
$14,168.06
|
|
|
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
|
IP
|
$40,885.52
|
|
|
Service Code
|
MSDRG 748
|
| Min. Negotiated Rate |
$11,584.82 |
| Max. Negotiated Rate |
$40,885.52 |
| Rate for Payer: Aetna Medicare |
$12,682.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,243.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,243.19
|
| Rate for Payer: BCBS MAPPO |
$12,194.55
|
| Rate for Payer: BCBS Trust/PPO |
$40,885.52
|
| Rate for Payer: BCN Commercial |
$40,885.52
|
| Rate for Payer: BCN Medicare Advantage |
$12,194.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,194.55
|
| Rate for Payer: Mclaren Medicare |
$12,194.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,804.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,023.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,414.00
|
| Rate for Payer: Nomi Health Commercial |
$17,896.17
|
| Rate for Payer: PACE Medicare |
$11,584.82
|
| Rate for Payer: PACE SWMI |
$12,194.55
|
| Rate for Payer: PHP Medicare Advantage |
$12,194.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22,366.24
|
| Rate for Payer: Priority Health Medicare |
$12,194.55
|
| Rate for Payer: Priority Health Tiered Network |
$17,892.99
|
| Rate for Payer: Railroad Medicare Medicare |
$12,194.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,612.99
|
| Rate for Payer: UHC Core |
$18,918.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,194.55
|
| Rate for Payer: UHC Exchange |
$15,450.36
|
| Rate for Payer: VA VA |
$12,194.55
|
|
|
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
|
IP
|
$12,745.12
|
|
|
Service Code
|
APR-DRG 5142
|
| Min. Negotiated Rate |
$12,138.21 |
| Max. Negotiated Rate |
$12,745.12 |
| Rate for Payer: BCBS Complete |
$12,745.12
|
| Rate for Payer: Mclaren Medicaid |
$12,138.21
|
| Rate for Payer: Meridian Medicaid |
$12,745.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,138.21
|
| Rate for Payer: UHC Medicaid |
$12,138.21
|
| Rate for Payer: UHCCP Medicaid |
$12,138.21
|
|
|
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
|
IP
|
$31,667.58
|
|
|
Service Code
|
APR-DRG 5144
|
| Min. Negotiated Rate |
$30,159.60 |
| Max. Negotiated Rate |
$31,667.58 |
| Rate for Payer: BCBS Complete |
$31,667.58
|
| Rate for Payer: Mclaren Medicaid |
$30,159.60
|
| Rate for Payer: Meridian Medicaid |
$31,667.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$30,159.60
|
| Rate for Payer: UHC Medicaid |
$30,159.60
|
| Rate for Payer: UHCCP Medicaid |
$30,159.60
|
|
|
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
|
IP
|
$8,337.14
|
|
|
Service Code
|
APR-DRG 5141
|
| Min. Negotiated Rate |
$7,940.13 |
| Max. Negotiated Rate |
$8,337.14 |
| Rate for Payer: BCBS Complete |
$8,337.14
|
| Rate for Payer: Mclaren Medicaid |
$7,940.13
|
| Rate for Payer: Meridian Medicaid |
$8,337.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,940.13
|
| Rate for Payer: UHC Medicaid |
$7,940.13
|
| Rate for Payer: UHCCP Medicaid |
$7,940.13
|
|
|
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
|
IP
|
$15,097.41
|
|
|
Service Code
|
APR-DRG 5143
|
| Min. Negotiated Rate |
$14,378.49 |
| Max. Negotiated Rate |
$15,097.41 |
| Rate for Payer: BCBS Complete |
$15,097.41
|
| Rate for Payer: Mclaren Medicaid |
$14,378.49
|
| Rate for Payer: Meridian Medicaid |
$15,097.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,378.49
|
| Rate for Payer: UHC Medicaid |
$14,378.49
|
| Rate for Payer: UHCCP Medicaid |
$14,378.49
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET
|
Facility
|
OP
|
$176.99
|
|
|
Service Code
|
NDC 68180038909
|
| Hospital Charge Code |
40010
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.49 |
| Max. Negotiated Rate |
$159.29 |
| Rate for Payer: Aetna American Axle |
$115.04
|
| Rate for Payer: Aetna Commercial |
$150.44
|
| Rate for Payer: Aetna Medicare |
$88.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.04
|
| Rate for Payer: BCBS Complete |
$70.80
|
| Rate for Payer: Cash Price |
$141.59
|
| Rate for Payer: Cofinity Advantage |
$123.89
|
| Rate for Payer: Cofinity Commercial |
$152.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.59
|
| Rate for Payer: Healthscope Commercial |
$159.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$141.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.74
|
| Rate for Payer: PHP Commercial |
$150.44
|
| Rate for Payer: Priority Health SBD |
$111.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.04
|
| Rate for Payer: UHC Core |
$92.21
|
| Rate for Payer: UHC Exchange |
$69.56
|
| Rate for Payer: UMR Bronson Commercial |
$65.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.74
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET
|
Facility
|
IP
|
$855.07
|
|
|
Service Code
|
NDC 00904716161
|
| Hospital Charge Code |
40010
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$376.23 |
| Max. Negotiated Rate |
$769.56 |
| Rate for Payer: Aetna American Axle |
$555.80
|
| Rate for Payer: Aetna Commercial |
$726.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$555.80
|
| Rate for Payer: Cash Price |
$684.06
|
| Rate for Payer: Cofinity Advantage |
$598.55
|
| Rate for Payer: Cofinity Commercial |
$735.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$684.06
|
| Rate for Payer: Healthscope Commercial |
$769.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$598.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$641.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$726.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$641.30
|
| Rate for Payer: PHP Commercial |
$726.81
|
| Rate for Payer: Priority Health SBD |
$538.69
|
| Rate for Payer: UMR Bronson Commercial |
$376.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$641.30
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET
|
Facility
|
OP
|
$893.18
|
|
|
Service Code
|
NDC 51079060820
|
| Hospital Charge Code |
40010
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$330.48 |
| Max. Negotiated Rate |
$803.86 |
| Rate for Payer: Aetna American Axle |
$580.57
|
| Rate for Payer: Aetna Commercial |
$759.20
|
| Rate for Payer: Aetna Medicare |
$446.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$580.57
|
| Rate for Payer: BCBS Complete |
$357.27
|
| Rate for Payer: Cash Price |
$714.54
|
| Rate for Payer: Cofinity Advantage |
$625.23
|
| Rate for Payer: Cofinity Commercial |
$768.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$714.54
|
| Rate for Payer: Healthscope Commercial |
$803.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$625.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$669.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$714.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$759.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$669.88
|
| Rate for Payer: PHP Commercial |
$759.20
|
| Rate for Payer: Priority Health SBD |
$562.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$580.57
|
| Rate for Payer: UHC Core |
$465.35
|
| Rate for Payer: UHC Exchange |
$351.02
|
| Rate for Payer: UMR Bronson Commercial |
$330.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$669.88
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET
|
Facility
|
IP
|
$351.09
|
|
|
Service Code
|
NDC 69097045805
|
| Hospital Charge Code |
40010
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.48 |
| Max. Negotiated Rate |
$315.98 |
| Rate for Payer: Aetna American Axle |
$228.21
|
| Rate for Payer: Aetna Commercial |
$298.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.21
|
| Rate for Payer: Cash Price |
$280.87
|
| Rate for Payer: Cofinity Advantage |
$245.76
|
| Rate for Payer: Cofinity Commercial |
$301.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.87
|
| Rate for Payer: Healthscope Commercial |
$315.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$245.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$263.32
|
| Rate for Payer: PHP Commercial |
$298.43
|
| Rate for Payer: Priority Health SBD |
$221.19
|
| Rate for Payer: UMR Bronson Commercial |
$154.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.32
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET
|
Facility
|
IP
|
$176.99
|
|
|
Service Code
|
NDC 68180038909
|
| Hospital Charge Code |
40010
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.88 |
| Max. Negotiated Rate |
$159.29 |
| Rate for Payer: Aetna American Axle |
$115.04
|
| Rate for Payer: Aetna Commercial |
$150.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.04
|
| Rate for Payer: Cash Price |
$141.59
|
| Rate for Payer: Cofinity Advantage |
$123.89
|
| Rate for Payer: Cofinity Commercial |
$152.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.59
|
| Rate for Payer: Healthscope Commercial |
$159.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.74
|
| Rate for Payer: PHP Commercial |
$150.44
|
| Rate for Payer: Priority Health SBD |
$111.50
|
| Rate for Payer: UMR Bronson Commercial |
$77.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.74
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET
|
Facility
|
OP
|
$855.07
|
|
|
Service Code
|
NDC 00904716161
|
| Hospital Charge Code |
40010
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$316.38 |
| Max. Negotiated Rate |
$769.56 |
| Rate for Payer: Aetna American Axle |
$555.80
|
| Rate for Payer: Aetna Commercial |
$726.81
|
| Rate for Payer: Aetna Medicare |
$427.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$555.80
|
| Rate for Payer: BCBS Complete |
$342.03
|
| Rate for Payer: Cash Price |
$684.06
|
| Rate for Payer: Cofinity Advantage |
$598.55
|
| Rate for Payer: Cofinity Commercial |
$735.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$684.06
|
| Rate for Payer: Healthscope Commercial |
$769.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$598.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$641.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$684.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$726.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$641.30
|
| Rate for Payer: PHP Commercial |
$726.81
|
| Rate for Payer: Priority Health SBD |
$538.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$555.80
|
| Rate for Payer: UHC Core |
$445.49
|
| Rate for Payer: UHC Exchange |
$336.04
|
| Rate for Payer: UMR Bronson Commercial |
$316.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$641.30
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET
|
Facility
|
OP
|
$351.09
|
|
|
Service Code
|
NDC 69097045805
|
| Hospital Charge Code |
40010
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.90 |
| Max. Negotiated Rate |
$315.98 |
| Rate for Payer: Aetna American Axle |
$228.21
|
| Rate for Payer: Aetna Commercial |
$298.43
|
| Rate for Payer: Aetna Medicare |
$175.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.21
|
| Rate for Payer: BCBS Complete |
$140.44
|
| Rate for Payer: Cash Price |
$280.87
|
| Rate for Payer: Cofinity Advantage |
$245.76
|
| Rate for Payer: Cofinity Commercial |
$301.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.87
|
| Rate for Payer: Healthscope Commercial |
$315.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$245.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$280.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$263.32
|
| Rate for Payer: PHP Commercial |
$298.43
|
| Rate for Payer: Priority Health SBD |
$221.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$228.21
|
| Rate for Payer: UHC Core |
$182.92
|
| Rate for Payer: UHC Exchange |
$137.98
|
| Rate for Payer: UMR Bronson Commercial |
$129.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.32
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET
|
Facility
|
IP
|
$893.18
|
|
|
Service Code
|
NDC 51079060820
|
| Hospital Charge Code |
40010
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$803.86 |
| Rate for Payer: Aetna American Axle |
$580.57
|
| Rate for Payer: Aetna Commercial |
$759.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$580.57
|
| Rate for Payer: Cash Price |
$714.54
|
| Rate for Payer: Cofinity Advantage |
$625.23
|
| Rate for Payer: Cofinity Commercial |
$768.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$714.54
|
| Rate for Payer: Healthscope Commercial |
$803.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$625.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$669.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$759.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$669.88
|
| Rate for Payer: PHP Commercial |
$759.20
|
| Rate for Payer: Priority Health SBD |
$562.70
|
| Rate for Payer: UMR Bronson Commercial |
$393.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$669.88
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET
|
Facility
|
IP
|
$4.03
|
|
|
Service Code
|
NDC 60687061811
|
| Hospital Charge Code |
40009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$3.63 |
| Rate for Payer: Aetna American Axle |
$2.62
|
| Rate for Payer: Aetna Commercial |
$3.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.62
|
| Rate for Payer: Cash Price |
$3.22
|
| Rate for Payer: Cofinity Advantage |
$2.82
|
| Rate for Payer: Cofinity Commercial |
$3.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.22
|
| Rate for Payer: Healthscope Commercial |
$3.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.02
|
| Rate for Payer: PHP Commercial |
$3.43
|
| Rate for Payer: Priority Health SBD |
$2.54
|
| Rate for Payer: UMR Bronson Commercial |
$1.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.02
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET
|
Facility
|
IP
|
$502.08
|
|
|
Service Code
|
NDC 51079059920
|
| Hospital Charge Code |
40009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$220.92 |
| Max. Negotiated Rate |
$451.87 |
| Rate for Payer: Aetna American Axle |
$326.35
|
| Rate for Payer: Aetna Commercial |
$426.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$326.35
|
| Rate for Payer: Cash Price |
$401.66
|
| Rate for Payer: Cofinity Advantage |
$351.46
|
| Rate for Payer: Cofinity Commercial |
$431.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$401.66
|
| Rate for Payer: Healthscope Commercial |
$451.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$351.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$376.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$426.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$376.56
|
| Rate for Payer: PHP Commercial |
$426.77
|
| Rate for Payer: Priority Health SBD |
$316.31
|
| Rate for Payer: UMR Bronson Commercial |
$220.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$376.56
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET
|
Facility
|
OP
|
$120.82
|
|
|
Service Code
|
NDC 60687061821
|
| Hospital Charge Code |
40009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.70 |
| Max. Negotiated Rate |
$108.74 |
| Rate for Payer: Aetna American Axle |
$78.53
|
| Rate for Payer: Aetna Commercial |
$102.70
|
| Rate for Payer: Aetna Medicare |
$60.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.53
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: Cash Price |
$96.66
|
| Rate for Payer: Cofinity Advantage |
$84.57
|
| Rate for Payer: Cofinity Commercial |
$103.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.66
|
| Rate for Payer: Healthscope Commercial |
$108.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$90.61
|
| Rate for Payer: PHP Commercial |
$102.70
|
| Rate for Payer: Priority Health SBD |
$76.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.53
|
| Rate for Payer: UHC Core |
$62.95
|
| Rate for Payer: UHC Exchange |
$47.48
|
| Rate for Payer: UMR Bronson Commercial |
$44.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.61
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET
|
Facility
|
IP
|
$120.82
|
|
|
Service Code
|
NDC 60687061821
|
| Hospital Charge Code |
40009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.16 |
| Max. Negotiated Rate |
$108.74 |
| Rate for Payer: Aetna American Axle |
$78.53
|
| Rate for Payer: Aetna Commercial |
$102.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.53
|
| Rate for Payer: Cash Price |
$96.66
|
| Rate for Payer: Cofinity Advantage |
$84.57
|
| Rate for Payer: Cofinity Commercial |
$103.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.66
|
| Rate for Payer: Healthscope Commercial |
$108.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$90.61
|
| Rate for Payer: PHP Commercial |
$102.70
|
| Rate for Payer: Priority Health SBD |
$76.12
|
| Rate for Payer: UMR Bronson Commercial |
$53.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.61
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET
|
Facility
|
OP
|
$4.03
|
|
|
Service Code
|
NDC 60687061811
|
| Hospital Charge Code |
40009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$3.63 |
| Rate for Payer: Aetna American Axle |
$2.62
|
| Rate for Payer: Aetna Commercial |
$3.43
|
| Rate for Payer: Aetna Medicare |
$2.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.62
|
| Rate for Payer: BCBS Complete |
$1.61
|
| Rate for Payer: Cash Price |
$3.22
|
| Rate for Payer: Cofinity Advantage |
$2.82
|
| Rate for Payer: Cofinity Commercial |
$3.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.22
|
| Rate for Payer: Healthscope Commercial |
$3.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.02
|
| Rate for Payer: PHP Commercial |
$3.43
|
| Rate for Payer: Priority Health SBD |
$2.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.62
|
| Rate for Payer: UHC Core |
$2.10
|
| Rate for Payer: UHC Exchange |
$1.58
|
| Rate for Payer: UMR Bronson Commercial |
$1.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.02
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET
|
Facility
|
OP
|
$5.03
|
|
|
Service Code
|
NDC 51079059901
|
| Hospital Charge Code |
40009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$4.53 |
| Rate for Payer: Aetna American Axle |
$3.27
|
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: Aetna Medicare |
$2.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.27
|
| Rate for Payer: BCBS Complete |
$2.01
|
| Rate for Payer: Cash Price |
$4.02
|
| Rate for Payer: Cofinity Advantage |
$3.52
|
| Rate for Payer: Cofinity Commercial |
$4.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.02
|
| Rate for Payer: Healthscope Commercial |
$4.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.77
|
| Rate for Payer: PHP Commercial |
$4.28
|
| Rate for Payer: Priority Health SBD |
$3.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.27
|
| Rate for Payer: UHC Core |
$2.62
|
| Rate for Payer: UHC Exchange |
$1.98
|
| Rate for Payer: UMR Bronson Commercial |
$1.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.77
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET
|
Facility
|
IP
|
$5.03
|
|
|
Service Code
|
NDC 51079059901
|
| Hospital Charge Code |
40009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$4.53 |
| Rate for Payer: Aetna American Axle |
$3.27
|
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.27
|
| Rate for Payer: Cash Price |
$4.02
|
| Rate for Payer: Cofinity Advantage |
$3.52
|
| Rate for Payer: Cofinity Commercial |
$4.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.02
|
| Rate for Payer: Healthscope Commercial |
$4.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.77
|
| Rate for Payer: PHP Commercial |
$4.28
|
| Rate for Payer: Priority Health SBD |
$3.17
|
| Rate for Payer: UMR Bronson Commercial |
$2.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.77
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET
|
Facility
|
OP
|
$502.08
|
|
|
Service Code
|
NDC 51079059920
|
| Hospital Charge Code |
40009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.77 |
| Max. Negotiated Rate |
$451.87 |
| Rate for Payer: Aetna American Axle |
$326.35
|
| Rate for Payer: Aetna Commercial |
$426.77
|
| Rate for Payer: Aetna Medicare |
$251.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$326.35
|
| Rate for Payer: BCBS Complete |
$200.83
|
| Rate for Payer: Cash Price |
$401.66
|
| Rate for Payer: Cofinity Advantage |
$351.46
|
| Rate for Payer: Cofinity Commercial |
$431.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$401.66
|
| Rate for Payer: Healthscope Commercial |
$451.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$351.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$376.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$401.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$426.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$376.56
|
| Rate for Payer: PHP Commercial |
$426.77
|
| Rate for Payer: Priority Health SBD |
$316.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.35
|
| Rate for Payer: UHC Core |
$261.58
|
| Rate for Payer: UHC Exchange |
$197.32
|
| Rate for Payer: UMR Bronson Commercial |
$185.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$376.56
|
|
