|
ARTHROTOMY, WRIST JOINT; WITH JOINT EXPLORATION, WITH OR WITHOUT BIOPSY, WITH OR WITHOUT REMOVAL OF LOOSE OR FOREIGN BODY
|
Facility
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 25101
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$409.30 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,111.70
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$450.23
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$409.30
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
ARTHROTOMY, WRIST JOINT; WITH SYNOVECTOMY
|
Facility
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 25105
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$489.53 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,111.70
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$538.48
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$489.53
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
ARTIFICIAL TEARS EYE DROPS WRAPPER
|
Facility
IP
|
$58.14
|
|
|
Service Code
|
NDC 0536-1325-94
|
| Hospital Charge Code |
301578
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.58 |
| Max. Negotiated Rate |
$52.33 |
| Rate for Payer: Aetna American Axle |
$37.79
|
| Rate for Payer: Aetna Commercial |
$49.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.79
|
| Rate for Payer: Cash Price |
$46.51
|
| Rate for Payer: Cofinity Commercial |
$40.70
|
| Rate for Payer: Cofinity Commercial |
$50.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.51
|
| Rate for Payer: Healthscope Commercial |
$52.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.42
|
| Rate for Payer: PHP Commercial |
$49.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.70
|
| Rate for Payer: Priority Health SBD |
$36.63
|
| Rate for Payer: UMR Bronson Commercial |
$25.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.60
|
|
|
ARTIFICIAL TEARS EYE DROPS WRAPPER
|
Facility
IP
|
$81.54
|
|
|
Service Code
|
NDC 0536-1386-35
|
| Hospital Charge Code |
301578
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.88 |
| Max. Negotiated Rate |
$73.39 |
| Rate for Payer: Aetna American Axle |
$53.00
|
| Rate for Payer: Aetna Commercial |
$69.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.00
|
| Rate for Payer: Cash Price |
$65.23
|
| Rate for Payer: Cofinity Commercial |
$57.08
|
| Rate for Payer: Cofinity Commercial |
$70.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.23
|
| Rate for Payer: Healthscope Commercial |
$73.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.31
|
| Rate for Payer: PHP Commercial |
$69.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.08
|
| Rate for Payer: Priority Health SBD |
$51.37
|
| Rate for Payer: UMR Bronson Commercial |
$35.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.16
|
|
|
ARTIFICIAL TEARS EYE DROPS WRAPPER
|
Facility
IP
|
$78.84
|
|
|
Service Code
|
NDC 0536-1386-94
|
| Hospital Charge Code |
301578
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.69 |
| Max. Negotiated Rate |
$70.96 |
| Rate for Payer: Aetna American Axle |
$51.25
|
| Rate for Payer: Aetna Commercial |
$67.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.25
|
| Rate for Payer: Cash Price |
$63.07
|
| Rate for Payer: Cofinity Commercial |
$55.19
|
| Rate for Payer: Cofinity Commercial |
$67.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.07
|
| Rate for Payer: Healthscope Commercial |
$70.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$67.01
|
| Rate for Payer: PHP Commercial |
$67.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.19
|
| Rate for Payer: Priority Health SBD |
$49.67
|
| Rate for Payer: UMR Bronson Commercial |
$34.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.13
|
|
|
ARTIFICIAL TEARS (HYPROMELLOSE) 0.3 % EYE GEL
|
Facility
IP
|
$28.63
|
|
|
Service Code
|
NDC 0078-0429-57
|
| Hospital Charge Code |
21058
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$25.77 |
| Rate for Payer: Aetna American Axle |
$18.61
|
| Rate for Payer: Aetna Commercial |
$24.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.61
|
| Rate for Payer: Cash Price |
$22.90
|
| Rate for Payer: Cofinity Commercial |
$20.04
|
| Rate for Payer: Cofinity Commercial |
$24.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.90
|
| Rate for Payer: Healthscope Commercial |
$25.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.34
|
| Rate for Payer: PHP Commercial |
$24.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.04
|
| Rate for Payer: Priority Health SBD |
$18.04
|
| Rate for Payer: UMR Bronson Commercial |
$12.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.47
|
|
|
ARTIFICIAL TEARS (HYPROMELLOSE) 0.3 % EYE GEL
|
Facility
IP
|
$31.75
|
|
|
Service Code
|
NDC 0065-8064-01
|
| Hospital Charge Code |
21058
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.97 |
| Max. Negotiated Rate |
$28.58 |
| Rate for Payer: Aetna American Axle |
$20.64
|
| Rate for Payer: Aetna Commercial |
$26.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.64
|
| Rate for Payer: Cash Price |
$25.40
|
| Rate for Payer: Cofinity Commercial |
$22.22
|
| Rate for Payer: Cofinity Commercial |
$27.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.40
|
| Rate for Payer: Healthscope Commercial |
$28.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.99
|
| Rate for Payer: PHP Commercial |
$26.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.22
|
| Rate for Payer: Priority Health SBD |
$20.00
|
| Rate for Payer: UMR Bronson Commercial |
$13.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.81
|
|
|
ARTIFICIAL TEARS (HYPROMELLOSE) 0.3 % EYE GEL
|
Facility
OP
|
$43.51
|
|
|
Service Code
|
NDC 0065-0474-01
|
| Hospital Charge Code |
21058
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.10 |
| Max. Negotiated Rate |
$39.16 |
| Rate for Payer: Aetna American Axle |
$28.28
|
| Rate for Payer: Aetna Commercial |
$36.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.28
|
| Rate for Payer: BCBS Complete |
$17.40
|
| Rate for Payer: Cash Price |
$34.81
|
| Rate for Payer: Cofinity Commercial |
$30.46
|
| Rate for Payer: Cofinity Commercial |
$37.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.81
|
| Rate for Payer: Healthscope Commercial |
$39.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.98
|
| Rate for Payer: PHP Commercial |
$36.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.46
|
| Rate for Payer: Priority Health SBD |
$27.41
|
| Rate for Payer: UMR Bronson Commercial |
$16.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.63
|
|
|
ARTIFICIAL TEARS (HYPROMELLOSE) 0.3 % EYE GEL
|
Facility
IP
|
$28.63
|
|
|
Service Code
|
NDC 0078-0429-47
|
| Hospital Charge Code |
21058
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$25.77 |
| Rate for Payer: Aetna American Axle |
$18.61
|
| Rate for Payer: Aetna Commercial |
$24.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.61
|
| Rate for Payer: Cash Price |
$22.90
|
| Rate for Payer: Cofinity Commercial |
$20.04
|
| Rate for Payer: Cofinity Commercial |
$24.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.90
|
| Rate for Payer: Healthscope Commercial |
$25.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.34
|
| Rate for Payer: PHP Commercial |
$24.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.04
|
| Rate for Payer: Priority Health SBD |
$18.04
|
| Rate for Payer: UMR Bronson Commercial |
$12.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.47
|
|
|
ARTIFICIAL TEARS (HYPROMELLOSE) 0.3 % EYE GEL
|
Facility
IP
|
$43.51
|
|
|
Service Code
|
NDC 0065-0474-01
|
| Hospital Charge Code |
21058
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.14 |
| Max. Negotiated Rate |
$39.16 |
| Rate for Payer: Aetna American Axle |
$28.28
|
| Rate for Payer: Aetna Commercial |
$36.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.28
|
| Rate for Payer: Cash Price |
$34.81
|
| Rate for Payer: Cofinity Commercial |
$30.46
|
| Rate for Payer: Cofinity Commercial |
$37.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.81
|
| Rate for Payer: Healthscope Commercial |
$39.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.98
|
| Rate for Payer: PHP Commercial |
$36.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.46
|
| Rate for Payer: Priority Health SBD |
$27.41
|
| Rate for Payer: UMR Bronson Commercial |
$19.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.63
|
|
|
ASCORBIC ACID (VITAMIN C) 250 MG TABLET
|
Facility
IP
|
$72.45
|
|
|
Service Code
|
NDC 5026886015
|
| Hospital Charge Code |
663
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.88 |
| Max. Negotiated Rate |
$65.20 |
| Rate for Payer: Aetna American Axle |
$47.09
|
| Rate for Payer: Aetna Commercial |
$61.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.09
|
| Rate for Payer: Cash Price |
$57.96
|
| Rate for Payer: Cofinity Commercial |
$50.72
|
| Rate for Payer: Cofinity Commercial |
$62.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.96
|
| Rate for Payer: Healthscope Commercial |
$65.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.58
|
| Rate for Payer: PHP Commercial |
$61.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health SBD |
$45.64
|
| Rate for Payer: UMR Bronson Commercial |
$31.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.34
|
|
|
ASCORBIC ACID (VITAMIN C) 250 MG TABLET
|
Facility
IP
|
$138.60
|
|
|
Service Code
|
NDC 5789683101
|
| Hospital Charge Code |
663
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.98 |
| Max. Negotiated Rate |
$124.74 |
| Rate for Payer: Aetna American Axle |
$90.09
|
| Rate for Payer: Aetna Commercial |
$117.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.09
|
| Rate for Payer: Cash Price |
$110.88
|
| Rate for Payer: Cofinity Commercial |
$119.20
|
| Rate for Payer: Cofinity Commercial |
$97.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.88
|
| Rate for Payer: Healthscope Commercial |
$124.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$117.81
|
| Rate for Payer: PHP Commercial |
$117.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.02
|
| Rate for Payer: Priority Health SBD |
$87.32
|
| Rate for Payer: UMR Bronson Commercial |
$60.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.95
|
|
|
ASCORBIC ACID (VITAMIN C) 250 MG TABLET
|
Facility
IP
|
$88.20
|
|
|
Service Code
|
NDC 2055500100
|
| Hospital Charge Code |
663
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.81 |
| Max. Negotiated Rate |
$79.38 |
| Rate for Payer: Aetna American Axle |
$57.33
|
| Rate for Payer: Aetna Commercial |
$74.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.33
|
| Rate for Payer: Cash Price |
$70.56
|
| Rate for Payer: Cofinity Commercial |
$61.74
|
| Rate for Payer: Cofinity Commercial |
$75.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.56
|
| Rate for Payer: Healthscope Commercial |
$79.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.97
|
| Rate for Payer: PHP Commercial |
$74.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.74
|
| Rate for Payer: Priority Health SBD |
$55.57
|
| Rate for Payer: UMR Bronson Commercial |
$38.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.15
|
|
|
ASCORBIC ACID (VITAMIN C) 250 MG TABLET
|
Facility
IP
|
$1.45
|
|
|
Service Code
|
NDC 5026886011
|
| Hospital Charge Code |
663
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Aetna American Axle |
$0.94
|
| Rate for Payer: Aetna Commercial |
$1.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.94
|
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: Cofinity Commercial |
$1.02
|
| Rate for Payer: Cofinity Commercial |
$1.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.16
|
| Rate for Payer: Healthscope Commercial |
$1.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.23
|
| Rate for Payer: PHP Commercial |
$1.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.02
|
| Rate for Payer: Priority Health SBD |
$0.91
|
| Rate for Payer: UMR Bronson Commercial |
$0.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.09
|
|
|
ASCORBIC ACID (VITAMIN C) 250 MG TABLET
|
Facility
IP
|
$132.30
|
|
|
Service Code
|
NDC 9629512843
|
| Hospital Charge Code |
663
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.21 |
| Max. Negotiated Rate |
$119.07 |
| Rate for Payer: Aetna American Axle |
$86.00
|
| Rate for Payer: Aetna Commercial |
$112.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.00
|
| Rate for Payer: Cash Price |
$105.84
|
| Rate for Payer: Cofinity Commercial |
$113.78
|
| Rate for Payer: Cofinity Commercial |
$92.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.84
|
| Rate for Payer: Healthscope Commercial |
$119.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.46
|
| Rate for Payer: PHP Commercial |
$112.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.61
|
| Rate for Payer: Priority Health SBD |
$83.35
|
| Rate for Payer: UMR Bronson Commercial |
$58.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.22
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG/ML INJECTION SOLUTION
|
Facility
IP
|
$291.28
|
|
|
Service Code
|
NDC 67457-118-50
|
| Hospital Charge Code |
654
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$128.16 |
| Max. Negotiated Rate |
$262.15 |
| Rate for Payer: Aetna American Axle |
$189.33
|
| Rate for Payer: Aetna Commercial |
$247.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.33
|
| Rate for Payer: Cash Price |
$233.02
|
| Rate for Payer: Cofinity Commercial |
$203.90
|
| Rate for Payer: Cofinity Commercial |
$250.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.02
|
| Rate for Payer: Healthscope Commercial |
$262.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$247.59
|
| Rate for Payer: PHP Commercial |
$247.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.90
|
| Rate for Payer: Priority Health SBD |
$183.51
|
| Rate for Payer: UMR Bronson Commercial |
$128.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.46
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG/ML INJECTION SOLUTION
|
Facility
IP
|
$292.17
|
|
|
Service Code
|
NDC 71414-115-01
|
| Hospital Charge Code |
654
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$128.55 |
| Max. Negotiated Rate |
$262.95 |
| Rate for Payer: Aetna American Axle |
$189.91
|
| Rate for Payer: Aetna Commercial |
$248.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.91
|
| Rate for Payer: Cash Price |
$233.74
|
| Rate for Payer: Cofinity Commercial |
$204.52
|
| Rate for Payer: Cofinity Commercial |
$251.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.74
|
| Rate for Payer: Healthscope Commercial |
$262.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$204.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$219.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$248.34
|
| Rate for Payer: PHP Commercial |
$248.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.52
|
| Rate for Payer: Priority Health SBD |
$184.07
|
| Rate for Payer: UMR Bronson Commercial |
$128.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$219.13
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG/ML INTRAVENOUS SOLUTION
|
Facility
OP
|
$1,119.85
|
|
|
Service Code
|
NDC 67157-101-50
|
| Hospital Charge Code |
186102
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$414.34 |
| Max. Negotiated Rate |
$1,007.86 |
| Rate for Payer: Aetna American Axle |
$727.90
|
| Rate for Payer: Aetna Commercial |
$951.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$727.90
|
| Rate for Payer: BCBS Complete |
$447.94
|
| Rate for Payer: Cash Price |
$895.88
|
| Rate for Payer: Cofinity Commercial |
$783.90
|
| Rate for Payer: Cofinity Commercial |
$963.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$895.88
|
| Rate for Payer: Healthscope Commercial |
$1,007.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$783.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$839.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$951.87
|
| Rate for Payer: PHP Commercial |
$951.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$783.90
|
| Rate for Payer: Priority Health SBD |
$705.51
|
| Rate for Payer: UMR Bronson Commercial |
$414.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$839.89
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG/ML INTRAVENOUS SOLUTION
|
Facility
OP
|
$1,106.27
|
|
|
Service Code
|
NDC 67157-101-51
|
| Hospital Charge Code |
186102
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$409.32 |
| Max. Negotiated Rate |
$995.64 |
| Rate for Payer: Aetna American Axle |
$719.08
|
| Rate for Payer: Aetna Commercial |
$940.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$719.08
|
| Rate for Payer: BCBS Complete |
$442.51
|
| Rate for Payer: Cash Price |
$885.02
|
| Rate for Payer: Cofinity Commercial |
$774.39
|
| Rate for Payer: Cofinity Commercial |
$951.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$885.02
|
| Rate for Payer: Healthscope Commercial |
$995.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$774.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$829.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$940.33
|
| Rate for Payer: PHP Commercial |
$940.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$774.39
|
| Rate for Payer: Priority Health SBD |
$696.95
|
| Rate for Payer: UMR Bronson Commercial |
$409.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$829.70
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG TABLET
|
Facility
IP
|
$72.85
|
|
|
Service Code
|
NDC 904052360
|
| Hospital Charge Code |
664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.05 |
| Max. Negotiated Rate |
$65.56 |
| Rate for Payer: Aetna American Axle |
$47.35
|
| Rate for Payer: Aetna Commercial |
$61.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.35
|
| Rate for Payer: Cash Price |
$58.28
|
| Rate for Payer: Cofinity Commercial |
$51.00
|
| Rate for Payer: Cofinity Commercial |
$62.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.28
|
| Rate for Payer: Healthscope Commercial |
$65.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.92
|
| Rate for Payer: PHP Commercial |
$61.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.00
|
| Rate for Payer: Priority Health SBD |
$45.90
|
| Rate for Payer: UMR Bronson Commercial |
$32.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.64
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG TABLET
|
Facility
IP
|
$68.15
|
|
|
Service Code
|
NDC 904052361
|
| Hospital Charge Code |
664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.99 |
| Max. Negotiated Rate |
$61.34 |
| Rate for Payer: Aetna American Axle |
$44.30
|
| Rate for Payer: Aetna Commercial |
$57.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.30
|
| Rate for Payer: Cash Price |
$54.52
|
| Rate for Payer: Cofinity Commercial |
$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: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.93
|
| Rate for Payer: PHP Commercial |
$57.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.70
|
| Rate for Payer: Priority Health SBD |
$42.93
|
| Rate for Payer: UMR Bronson Commercial |
$29.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.11
|
|
|
ASENAPINE 5 MG SUBLINGUAL TABLET
|
Facility
IP
|
$4,129.87
|
|
|
Service Code
|
NDC 0456-2405-60
|
| Hospital Charge Code |
99754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,817.14 |
| Max. Negotiated Rate |
$3,716.88 |
| Rate for Payer: Aetna American Axle |
$2,684.42
|
| Rate for Payer: Aetna Commercial |
$3,510.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,684.42
|
| Rate for Payer: Cash Price |
$3,303.90
|
| Rate for Payer: Cofinity Commercial |
$2,890.91
|
| Rate for Payer: Cofinity Commercial |
$3,551.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,303.90
|
| Rate for Payer: Healthscope Commercial |
$3,716.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,890.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,097.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,510.39
|
| Rate for Payer: PHP Commercial |
$3,510.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,890.91
|
| Rate for Payer: Priority Health SBD |
$2,601.82
|
| Rate for Payer: UMR Bronson Commercial |
$1,817.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,097.40
|
|
|
ASENAPINE 5 MG SUBLINGUAL TABLET
|
Facility
IP
|
$69.29
|
|
|
Service Code
|
NDC 0456-2405-11
|
| Hospital Charge Code |
99754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.49 |
| Max. Negotiated Rate |
$62.36 |
| Rate for Payer: Aetna American Axle |
$45.04
|
| Rate for Payer: Aetna Commercial |
$58.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.04
|
| Rate for Payer: Cash Price |
$55.43
|
| Rate for Payer: Cofinity Commercial |
$48.50
|
| Rate for Payer: Cofinity Commercial |
$59.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.43
|
| Rate for Payer: Healthscope Commercial |
$62.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.90
|
| Rate for Payer: PHP Commercial |
$58.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.50
|
| Rate for Payer: Priority Health SBD |
$43.65
|
| Rate for Payer: UMR Bronson Commercial |
$30.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.97
|
|
|
ASENAPINE 5 MG SUBLINGUAL TABLET
|
Facility
IP
|
$688.32
|
|
|
Service Code
|
NDC 0456-2405-06
|
| Hospital Charge Code |
99754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$302.86 |
| Max. Negotiated Rate |
$619.49 |
| Rate for Payer: Aetna American Axle |
$447.41
|
| Rate for Payer: Aetna Commercial |
$585.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.41
|
| Rate for Payer: Cash Price |
$550.66
|
| Rate for Payer: Cofinity Commercial |
$481.82
|
| Rate for Payer: Cofinity Commercial |
$591.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.66
|
| Rate for Payer: Healthscope Commercial |
$619.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$481.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$516.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$585.07
|
| Rate for Payer: PHP Commercial |
$585.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$481.82
|
| Rate for Payer: Priority Health SBD |
$433.64
|
| Rate for Payer: UMR Bronson Commercial |
$302.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$516.24
|
|
|
ASENAPINE 5 MG SUBLINGUAL TABLET
|
Facility
IP
|
$1,052.95
|
|
|
Service Code
|
NDC 51991-358-60
|
| Hospital Charge Code |
99754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$463.30 |
| Max. Negotiated Rate |
$947.66 |
| Rate for Payer: Aetna American Axle |
$684.42
|
| Rate for Payer: Aetna Commercial |
$895.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$684.42
|
| Rate for Payer: Cash Price |
$842.36
|
| Rate for Payer: Cofinity Commercial |
$737.06
|
| Rate for Payer: Cofinity Commercial |
$905.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$842.36
|
| Rate for Payer: Healthscope Commercial |
$947.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$737.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$789.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$895.01
|
| Rate for Payer: PHP Commercial |
$895.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$737.06
|
| Rate for Payer: Priority Health SBD |
$663.36
|
| Rate for Payer: UMR Bronson Commercial |
$463.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$789.71
|
|
