|
FERRIC DERISOMALTOSE 100 MG IRON/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$5,599.47
|
|
|
Service Code
|
HCPCS J1437
|
| Hospital Charge Code |
194928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.47 |
| Max. Negotiated Rate |
$5,039.52 |
| Rate for Payer: Aetna American Axle |
$3,639.66
|
| Rate for Payer: Aetna Commercial |
$4,759.55
|
| Rate for Payer: Aetna Medicare |
$22.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,639.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.41
|
| Rate for Payer: BCBS Complete |
$12.04
|
| Rate for Payer: BCBS MAPPO |
$21.93
|
| Rate for Payer: BCBS Trust/PPO |
$74.00
|
| Rate for Payer: BCN Commercial |
$74.00
|
| Rate for Payer: BCN Medicare Advantage |
$21.93
|
| Rate for Payer: Cash Price |
$4,479.58
|
| Rate for Payer: Cash Price |
$4,479.58
|
| Rate for Payer: Cofinity Advantage |
$3,919.63
|
| Rate for Payer: Cofinity Commercial |
$4,815.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,479.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.93
|
| Rate for Payer: Healthscope Commercial |
$5,039.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,919.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,199.60
|
| Rate for Payer: Mclaren Medicaid |
$21.93
|
| Rate for Payer: Mclaren Medicare |
$21.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.03
|
| Rate for Payer: Meridian Medicaid |
$23.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,759.55
|
| Rate for Payer: Nomi Health Commercial |
$65.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,199.60
|
| Rate for Payer: PACE Medicare |
$20.83
|
| Rate for Payer: PACE SWMI |
$21.93
|
| Rate for Payer: PHP Commercial |
$4,759.55
|
| Rate for Payer: PHP Medicare Advantage |
$21.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$69.46
|
| Rate for Payer: Priority Health Medicare |
$21.93
|
| Rate for Payer: Priority Health SBD |
$3,527.67
|
| Rate for Payer: Priority Health Tiered Network |
$55.57
|
| Rate for Payer: Railroad Medicare Medicare |
$21.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.67
|
| Rate for Payer: UHC Core |
$37.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21.93
|
| Rate for Payer: UHC Exchange |
$37.67
|
| Rate for Payer: UHC Medicaid |
$11.47
|
| Rate for Payer: UHCCP Medicaid |
$11.47
|
| Rate for Payer: UMR Bronson Commercial |
$2,071.80
|
| Rate for Payer: VA VA |
$21.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,199.60
|
|
|
FERRIC DERISOMALTOSE 100 MG IRON/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$5,599.47
|
|
|
Service Code
|
HCPCS J1437
|
| Hospital Charge Code |
194928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,463.77 |
| Max. Negotiated Rate |
$5,039.52 |
| Rate for Payer: Aetna American Axle |
$3,639.66
|
| Rate for Payer: Aetna Commercial |
$4,759.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,639.66
|
| Rate for Payer: Cash Price |
$4,479.58
|
| Rate for Payer: Cofinity Advantage |
$3,919.63
|
| Rate for Payer: Cofinity Commercial |
$4,815.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,479.58
|
| Rate for Payer: Healthscope Commercial |
$5,039.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,919.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,199.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,759.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,199.60
|
| Rate for Payer: PHP Commercial |
$4,759.55
|
| Rate for Payer: Priority Health SBD |
$3,527.67
|
| Rate for Payer: UMR Bronson Commercial |
$2,463.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,199.60
|
|
|
FERRIC SUBSULFATE 1.04 GM TOPICAL PASTE
|
Facility
|
IP
|
$76.83
|
|
|
Service Code
|
NDC 48783011308
|
| Hospital Charge Code |
155166
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$69.15 |
| Rate for Payer: Aetna American Axle |
$49.94
|
| Rate for Payer: Aetna Commercial |
$65.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.94
|
| Rate for Payer: Cash Price |
$61.46
|
| Rate for Payer: Cofinity Advantage |
$53.78
|
| Rate for Payer: Cofinity Commercial |
$66.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.46
|
| Rate for Payer: Healthscope Commercial |
$69.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.62
|
| Rate for Payer: PHP Commercial |
$65.31
|
| Rate for Payer: Priority Health SBD |
$48.40
|
| Rate for Payer: UMR Bronson Commercial |
$33.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.62
|
|
|
FERRIC SUBSULFATE 1.04 GM TOPICAL PASTE
|
Facility
|
OP
|
$87.81
|
|
|
Service Code
|
NDC 48783011208
|
| Hospital Charge Code |
155166
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.49 |
| Max. Negotiated Rate |
$79.03 |
| Rate for Payer: Aetna American Axle |
$57.08
|
| Rate for Payer: Aetna Commercial |
$74.64
|
| Rate for Payer: Aetna Medicare |
$43.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.08
|
| Rate for Payer: BCBS Complete |
$35.12
|
| Rate for Payer: Cash Price |
$70.25
|
| Rate for Payer: Cofinity Advantage |
$61.47
|
| Rate for Payer: Cofinity Commercial |
$75.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.25
|
| Rate for Payer: Healthscope Commercial |
$79.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.86
|
| Rate for Payer: PHP Commercial |
$74.64
|
| Rate for Payer: Priority Health SBD |
$55.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.08
|
| Rate for Payer: UHC Core |
$45.75
|
| Rate for Payer: UHC Exchange |
$34.51
|
| Rate for Payer: UMR Bronson Commercial |
$32.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.86
|
|
|
FERRIC SUBSULFATE 1.04 GM TOPICAL PASTE
|
Facility
|
OP
|
$76.83
|
|
|
Service Code
|
NDC 48783011308
|
| Hospital Charge Code |
155166
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.43 |
| Max. Negotiated Rate |
$69.15 |
| Rate for Payer: Aetna American Axle |
$49.94
|
| Rate for Payer: Aetna Commercial |
$65.31
|
| Rate for Payer: Aetna Medicare |
$38.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.94
|
| Rate for Payer: BCBS Complete |
$30.73
|
| Rate for Payer: Cash Price |
$61.46
|
| Rate for Payer: Cofinity Advantage |
$53.78
|
| Rate for Payer: Cofinity Commercial |
$66.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.46
|
| Rate for Payer: Healthscope Commercial |
$69.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.62
|
| Rate for Payer: PHP Commercial |
$65.31
|
| Rate for Payer: Priority Health SBD |
$48.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.94
|
| Rate for Payer: UHC Core |
$40.03
|
| Rate for Payer: UHC Exchange |
$30.19
|
| Rate for Payer: UMR Bronson Commercial |
$28.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.62
|
|
|
FERRIC SUBSULFATE 1.04 GM TOPICAL PASTE
|
Facility
|
IP
|
$87.81
|
|
|
Service Code
|
NDC 48783011208
|
| Hospital Charge Code |
155166
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.64 |
| Max. Negotiated Rate |
$79.03 |
| Rate for Payer: Aetna American Axle |
$57.08
|
| Rate for Payer: Aetna Commercial |
$74.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.08
|
| Rate for Payer: Cash Price |
$70.25
|
| Rate for Payer: Cofinity Advantage |
$61.47
|
| Rate for Payer: Cofinity Commercial |
$75.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.25
|
| Rate for Payer: Healthscope Commercial |
$79.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.86
|
| Rate for Payer: PHP Commercial |
$74.64
|
| Rate for Payer: Priority Health SBD |
$55.32
|
| Rate for Payer: UMR Bronson Commercial |
$38.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.86
|
|
|
FERRIC SUBSULFATE 259 MG/G TOPICAL SOLUTION
|
Facility
|
OP
|
$54.17
|
|
|
Service Code
|
NDC 59365606500
|
| Hospital Charge Code |
28357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.04 |
| Max. Negotiated Rate |
$48.75 |
| Rate for Payer: Aetna American Axle |
$35.21
|
| Rate for Payer: Aetna Commercial |
$46.04
|
| Rate for Payer: Aetna Medicare |
$27.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.21
|
| Rate for Payer: BCBS Complete |
$21.67
|
| Rate for Payer: Cash Price |
$43.34
|
| Rate for Payer: Cofinity Advantage |
$37.92
|
| Rate for Payer: Cofinity Commercial |
$46.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.34
|
| Rate for Payer: Healthscope Commercial |
$48.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.63
|
| Rate for Payer: PHP Commercial |
$46.04
|
| Rate for Payer: Priority Health SBD |
$34.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.21
|
| Rate for Payer: UHC Core |
$28.22
|
| Rate for Payer: UHC Exchange |
$21.29
|
| Rate for Payer: UMR Bronson Commercial |
$20.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.63
|
|
|
FERRIC SUBSULFATE 259 MG/G TOPICAL SOLUTION
|
Facility
|
IP
|
$54.17
|
|
|
Service Code
|
NDC 59365606500
|
| Hospital Charge Code |
28357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.83 |
| Max. Negotiated Rate |
$48.75 |
| Rate for Payer: Aetna American Axle |
$35.21
|
| Rate for Payer: Aetna Commercial |
$46.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.21
|
| Rate for Payer: Cash Price |
$43.34
|
| Rate for Payer: Cofinity Advantage |
$37.92
|
| Rate for Payer: Cofinity Commercial |
$46.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.34
|
| Rate for Payer: Healthscope Commercial |
$48.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.63
|
| Rate for Payer: PHP Commercial |
$46.04
|
| Rate for Payer: Priority Health SBD |
$34.13
|
| Rate for Payer: UMR Bronson Commercial |
$23.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.63
|
|
|
FERRIC SUBSULFATE 259 MG/G TOPICAL SOLUTION
|
Facility
|
IP
|
$54.17
|
|
|
Service Code
|
NDC 59365606501
|
| Hospital Charge Code |
28357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.83 |
| Max. Negotiated Rate |
$48.75 |
| Rate for Payer: Aetna American Axle |
$35.21
|
| Rate for Payer: Aetna Commercial |
$46.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.21
|
| Rate for Payer: Cash Price |
$43.34
|
| Rate for Payer: Cofinity Advantage |
$37.92
|
| Rate for Payer: Cofinity Commercial |
$46.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.34
|
| Rate for Payer: Healthscope Commercial |
$48.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.63
|
| Rate for Payer: PHP Commercial |
$46.04
|
| Rate for Payer: Priority Health SBD |
$34.13
|
| Rate for Payer: UMR Bronson Commercial |
$23.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.63
|
|
|
FERRIC SUBSULFATE 259 MG/G TOPICAL SOLUTION
|
Facility
|
OP
|
$54.17
|
|
|
Service Code
|
NDC 59365606501
|
| Hospital Charge Code |
28357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.04 |
| Max. Negotiated Rate |
$48.75 |
| Rate for Payer: Aetna American Axle |
$35.21
|
| Rate for Payer: Aetna Commercial |
$46.04
|
| Rate for Payer: Aetna Medicare |
$27.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.21
|
| Rate for Payer: BCBS Complete |
$21.67
|
| Rate for Payer: Cash Price |
$43.34
|
| Rate for Payer: Cofinity Advantage |
$37.92
|
| Rate for Payer: Cofinity Commercial |
$46.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.34
|
| Rate for Payer: Healthscope Commercial |
$48.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.63
|
| Rate for Payer: PHP Commercial |
$46.04
|
| Rate for Payer: Priority Health SBD |
$34.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.21
|
| Rate for Payer: UHC Core |
$28.22
|
| Rate for Payer: UHC Exchange |
$21.29
|
| Rate for Payer: UMR Bronson Commercial |
$20.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.63
|
|
|
FERROUS FUMARATE 324 MG (106 MG IRON) TABLET
|
Facility
|
IP
|
$193.80
|
|
|
Service Code
|
NDC 60258018201
|
| Hospital Charge Code |
3063
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.27 |
| Max. Negotiated Rate |
$174.42 |
| Rate for Payer: Aetna American Axle |
$125.97
|
| Rate for Payer: Aetna Commercial |
$164.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.97
|
| Rate for Payer: Cash Price |
$155.04
|
| Rate for Payer: Cofinity Advantage |
$135.66
|
| Rate for Payer: Cofinity Commercial |
$166.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.04
|
| Rate for Payer: Healthscope Commercial |
$174.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.35
|
| Rate for Payer: PHP Commercial |
$164.73
|
| Rate for Payer: Priority Health SBD |
$122.09
|
| Rate for Payer: UMR Bronson Commercial |
$85.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.35
|
|
|
FERROUS FUMARATE 324 MG (106 MG IRON) TABLET
|
Facility
|
OP
|
$193.80
|
|
|
Service Code
|
NDC 60258018201
|
| Hospital Charge Code |
3063
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.71 |
| Max. Negotiated Rate |
$174.42 |
| Rate for Payer: Aetna American Axle |
$125.97
|
| Rate for Payer: Aetna Commercial |
$164.73
|
| Rate for Payer: Aetna Medicare |
$96.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.97
|
| Rate for Payer: BCBS Complete |
$77.52
|
| Rate for Payer: Cash Price |
$155.04
|
| Rate for Payer: Cofinity Advantage |
$135.66
|
| Rate for Payer: Cofinity Commercial |
$166.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.04
|
| Rate for Payer: Healthscope Commercial |
$174.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$155.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.35
|
| Rate for Payer: PHP Commercial |
$164.73
|
| Rate for Payer: Priority Health SBD |
$122.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.97
|
| Rate for Payer: UHC Core |
$100.97
|
| Rate for Payer: UHC Exchange |
$76.16
|
| Rate for Payer: UMR Bronson Commercial |
$71.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.35
|
|
|
FERROUS FUMARATE 324 MG (106 MG IRON) TABLET
|
Facility
|
IP
|
$371.30
|
|
|
Service Code
|
NDC 51991018142
|
| Hospital Charge Code |
3063
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.37 |
| Max. Negotiated Rate |
$334.17 |
| Rate for Payer: Aetna American Axle |
$241.34
|
| Rate for Payer: Aetna Commercial |
$315.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.34
|
| Rate for Payer: Cash Price |
$297.04
|
| Rate for Payer: Cofinity Advantage |
$259.91
|
| Rate for Payer: Cofinity Commercial |
$319.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.04
|
| Rate for Payer: Healthscope Commercial |
$334.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$259.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$278.48
|
| Rate for Payer: PHP Commercial |
$315.61
|
| Rate for Payer: Priority Health SBD |
$233.92
|
| Rate for Payer: UMR Bronson Commercial |
$163.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.48
|
|
|
FERROUS FUMARATE 324 MG (106 MG IRON) TABLET
|
Facility
|
OP
|
$371.30
|
|
|
Service Code
|
NDC 51991018142
|
| Hospital Charge Code |
3063
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.38 |
| Max. Negotiated Rate |
$334.17 |
| Rate for Payer: Aetna American Axle |
$241.34
|
| Rate for Payer: Aetna Commercial |
$315.61
|
| Rate for Payer: Aetna Medicare |
$185.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.34
|
| Rate for Payer: BCBS Complete |
$148.52
|
| Rate for Payer: Cash Price |
$297.04
|
| Rate for Payer: Cofinity Advantage |
$259.91
|
| Rate for Payer: Cofinity Commercial |
$319.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.04
|
| Rate for Payer: Healthscope Commercial |
$334.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$259.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$297.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$278.48
|
| Rate for Payer: PHP Commercial |
$315.61
|
| Rate for Payer: Priority Health SBD |
$233.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.34
|
| Rate for Payer: UHC Core |
$193.45
|
| Rate for Payer: UHC Exchange |
$145.92
|
| Rate for Payer: UMR Bronson Commercial |
$137.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.48
|
|
|
FERROUS SULFATE 15 MG IRON (75 MG)/ML ORAL DROPS
|
Facility
|
IP
|
$64.63
|
|
|
Service Code
|
NDC 50383062750
|
| Hospital Charge Code |
95693
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.44 |
| Max. Negotiated Rate |
$58.17 |
| Rate for Payer: Aetna American Axle |
$42.01
|
| Rate for Payer: Aetna Commercial |
$54.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.01
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cofinity Advantage |
$45.24
|
| Rate for Payer: Cofinity Commercial |
$55.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.70
|
| Rate for Payer: Healthscope Commercial |
$58.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.47
|
| Rate for Payer: PHP Commercial |
$54.94
|
| Rate for Payer: Priority Health SBD |
$40.72
|
| Rate for Payer: UMR Bronson Commercial |
$28.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.47
|
|
|
FERROUS SULFATE 15 MG IRON (75 MG)/ML ORAL DROPS
|
Facility
|
OP
|
$64.63
|
|
|
Service Code
|
NDC 50383062750
|
| Hospital Charge Code |
95693
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.91 |
| Max. Negotiated Rate |
$58.17 |
| Rate for Payer: Aetna American Axle |
$42.01
|
| Rate for Payer: Aetna Commercial |
$54.94
|
| Rate for Payer: Aetna Medicare |
$32.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.01
|
| Rate for Payer: BCBS Complete |
$25.85
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cofinity Advantage |
$45.24
|
| Rate for Payer: Cofinity Commercial |
$55.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.70
|
| Rate for Payer: Healthscope Commercial |
$58.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.47
|
| Rate for Payer: PHP Commercial |
$54.94
|
| Rate for Payer: Priority Health SBD |
$40.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.01
|
| Rate for Payer: UHC Core |
$33.67
|
| Rate for Payer: UHC Exchange |
$25.40
|
| Rate for Payer: UMR Bronson Commercial |
$23.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.47
|
|
|
FERROUS SULFATE 15 MG IRON (75 MG)/ML ORAL DROPS
|
Facility
|
OP
|
$91.65
|
|
|
Service Code
|
NDC 54838001150
|
| Hospital Charge Code |
95693
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.91 |
| Max. Negotiated Rate |
$82.48 |
| Rate for Payer: Aetna American Axle |
$59.57
|
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: Aetna Medicare |
$45.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.57
|
| Rate for Payer: BCBS Complete |
$36.66
|
| Rate for Payer: Cash Price |
$73.32
|
| Rate for Payer: Cofinity Advantage |
$64.16
|
| Rate for Payer: Cofinity Commercial |
$78.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.32
|
| Rate for Payer: Healthscope Commercial |
$82.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.74
|
| Rate for Payer: PHP Commercial |
$77.90
|
| Rate for Payer: Priority Health SBD |
$57.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.57
|
| Rate for Payer: UHC Core |
$47.75
|
| Rate for Payer: UHC Exchange |
$36.02
|
| Rate for Payer: UMR Bronson Commercial |
$33.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.74
|
|
|
FERROUS SULFATE 15 MG IRON (75 MG)/ML ORAL DROPS
|
Facility
|
IP
|
$91.65
|
|
|
Service Code
|
NDC 54838001150
|
| Hospital Charge Code |
95693
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.33 |
| Max. Negotiated Rate |
$82.48 |
| Rate for Payer: Aetna American Axle |
$59.57
|
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.57
|
| Rate for Payer: Cash Price |
$73.32
|
| Rate for Payer: Cofinity Advantage |
$64.16
|
| Rate for Payer: Cofinity Commercial |
$78.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.32
|
| Rate for Payer: Healthscope Commercial |
$82.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.74
|
| Rate for Payer: PHP Commercial |
$77.90
|
| Rate for Payer: Priority Health SBD |
$57.74
|
| Rate for Payer: UMR Bronson Commercial |
$40.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.74
|
|
|
FERROUS SULFATE 220 MG (44 MG IRON)/5 ML ORAL ELIXIR
|
Facility
|
IP
|
$73.79
|
|
|
Service Code
|
NDC 50383077816
|
| Hospital Charge Code |
179529
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.47 |
| Max. Negotiated Rate |
$66.41 |
| Rate for Payer: Aetna American Axle |
$47.96
|
| Rate for Payer: Aetna Commercial |
$62.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.96
|
| Rate for Payer: Cash Price |
$59.03
|
| Rate for Payer: Cofinity Advantage |
$51.65
|
| Rate for Payer: Cofinity Commercial |
$63.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.03
|
| Rate for Payer: Healthscope Commercial |
$66.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.34
|
| Rate for Payer: PHP Commercial |
$62.72
|
| Rate for Payer: Priority Health SBD |
$46.49
|
| Rate for Payer: UMR Bronson Commercial |
$32.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.34
|
|
|
FERROUS SULFATE 220 MG (44 MG IRON)/5 ML ORAL ELIXIR
|
Facility
|
OP
|
$73.79
|
|
|
Service Code
|
NDC 50383077816
|
| Hospital Charge Code |
179529
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$66.41 |
| Rate for Payer: Aetna American Axle |
$47.96
|
| Rate for Payer: Aetna Commercial |
$62.72
|
| Rate for Payer: Aetna Medicare |
$36.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.96
|
| Rate for Payer: BCBS Complete |
$29.52
|
| Rate for Payer: Cash Price |
$59.03
|
| Rate for Payer: Cofinity Advantage |
$51.65
|
| Rate for Payer: Cofinity Commercial |
$63.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.03
|
| Rate for Payer: Healthscope Commercial |
$66.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.34
|
| Rate for Payer: PHP Commercial |
$62.72
|
| Rate for Payer: Priority Health SBD |
$46.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.96
|
| Rate for Payer: UHC Core |
$38.44
|
| Rate for Payer: UHC Exchange |
$29.00
|
| Rate for Payer: UMR Bronson Commercial |
$27.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.34
|
|
|
FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID
|
Facility
|
IP
|
$9.96
|
|
|
Service Code
|
NDC 00121053005
|
| Hospital Charge Code |
3071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$8.96 |
| Rate for Payer: Aetna American Axle |
$6.47
|
| Rate for Payer: Aetna Commercial |
$8.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.47
|
| Rate for Payer: Cash Price |
$7.97
|
| Rate for Payer: Cofinity Advantage |
$6.97
|
| Rate for Payer: Cofinity Commercial |
$8.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.97
|
| Rate for Payer: Healthscope Commercial |
$8.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.47
|
| Rate for Payer: PHP Commercial |
$8.47
|
| Rate for Payer: Priority Health SBD |
$6.27
|
| Rate for Payer: UMR Bronson Commercial |
$4.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.47
|
|
|
FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID
|
Facility
|
OP
|
$9.96
|
|
|
Service Code
|
NDC 00121053005
|
| Hospital Charge Code |
3071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$8.96 |
| Rate for Payer: Aetna American Axle |
$6.47
|
| Rate for Payer: Aetna Commercial |
$8.47
|
| Rate for Payer: Aetna Medicare |
$4.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.47
|
| Rate for Payer: BCBS Complete |
$3.98
|
| Rate for Payer: Cash Price |
$7.97
|
| Rate for Payer: Cofinity Advantage |
$6.97
|
| Rate for Payer: Cofinity Commercial |
$8.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.97
|
| Rate for Payer: Healthscope Commercial |
$8.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.47
|
| Rate for Payer: PHP Commercial |
$8.47
|
| Rate for Payer: Priority Health SBD |
$6.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.47
|
| Rate for Payer: UHC Core |
$5.19
|
| Rate for Payer: UHC Exchange |
$3.91
|
| Rate for Payer: UMR Bronson Commercial |
$3.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.47
|
|
|
FERROUS SULFATE 325 MG (65 MG IRON) TABLET
|
Facility
|
IP
|
$25.85
|
|
|
Service Code
|
NDC 00904759060
|
| Hospital Charge Code |
3074
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.37 |
| Max. Negotiated Rate |
$23.27 |
| Rate for Payer: Aetna American Axle |
$16.80
|
| Rate for Payer: Aetna Commercial |
$21.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.80
|
| Rate for Payer: Cash Price |
$20.68
|
| Rate for Payer: Cofinity Advantage |
$18.09
|
| Rate for Payer: Cofinity Commercial |
$22.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.68
|
| Rate for Payer: Healthscope Commercial |
$23.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.39
|
| Rate for Payer: PHP Commercial |
$21.97
|
| Rate for Payer: Priority Health SBD |
$16.29
|
| Rate for Payer: UMR Bronson Commercial |
$11.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.39
|
|
|
FERROUS SULFATE 325 MG (65 MG IRON) TABLET
|
Facility
|
OP
|
$25.85
|
|
|
Service Code
|
NDC 00904759060
|
| Hospital Charge Code |
3074
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.56 |
| Max. Negotiated Rate |
$23.27 |
| Rate for Payer: Aetna American Axle |
$16.80
|
| Rate for Payer: Aetna Commercial |
$21.97
|
| Rate for Payer: Aetna Medicare |
$12.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.80
|
| Rate for Payer: BCBS Complete |
$10.34
|
| Rate for Payer: Cash Price |
$20.68
|
| Rate for Payer: Cofinity Advantage |
$18.09
|
| Rate for Payer: Cofinity Commercial |
$22.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.68
|
| Rate for Payer: Healthscope Commercial |
$23.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.39
|
| Rate for Payer: PHP Commercial |
$21.97
|
| Rate for Payer: Priority Health SBD |
$16.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.80
|
| Rate for Payer: UHC Core |
$13.47
|
| Rate for Payer: UHC Exchange |
$10.16
|
| Rate for Payer: UMR Bronson Commercial |
$9.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.39
|
|
|
FERROUS SULFATE 325 MG (65 MG IRON) TABLET
|
Facility
|
OP
|
$68.15
|
|
|
Service Code
|
NDC 00904759161
|
| Hospital Charge Code |
3074
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.22 |
| Max. Negotiated Rate |
$61.34 |
| Rate for Payer: Aetna American Axle |
$44.30
|
| Rate for Payer: Aetna Commercial |
$57.93
|
| Rate for Payer: Aetna Medicare |
$34.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.30
|
| Rate for Payer: BCBS Complete |
$27.26
|
| Rate for Payer: Cash Price |
$54.52
|
| Rate for Payer: Cofinity Advantage |
$47.70
|
| Rate for Payer: Cofinity Commercial |
$58.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.52
|
| Rate for Payer: Healthscope Commercial |
$61.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.11
|
| Rate for Payer: PHP Commercial |
$57.93
|
| Rate for Payer: Priority Health SBD |
$42.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.30
|
| Rate for Payer: UHC Core |
$35.51
|
| Rate for Payer: UHC Exchange |
$26.78
|
| Rate for Payer: UMR Bronson Commercial |
$25.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.11
|
|
