|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$31.22
|
|
|
Service Code
|
NDC 36000014801
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.74 |
| Max. Negotiated Rate |
$28.10 |
| Rate for Payer: Aetna American Axle |
$20.29
|
| Rate for Payer: Aetna Commercial |
$26.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.29
|
| Rate for Payer: Cash Price |
$24.98
|
| Rate for Payer: Cofinity Advantage |
$21.85
|
| Rate for Payer: Cofinity Commercial |
$26.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.98
|
| Rate for Payer: Healthscope Commercial |
$28.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.41
|
| Rate for Payer: PHP Commercial |
$26.54
|
| Rate for Payer: Priority Health SBD |
$19.67
|
| Rate for Payer: UMR Bronson Commercial |
$13.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.41
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$30.67
|
|
|
Service Code
|
NDC 63323042405
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.35 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Aetna American Axle |
$19.94
|
| Rate for Payer: Aetna Commercial |
$26.07
|
| Rate for Payer: Aetna Medicare |
$15.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.94
|
| Rate for Payer: BCBS Complete |
$12.27
|
| Rate for Payer: Cash Price |
$24.54
|
| Rate for Payer: Cofinity Advantage |
$21.47
|
| Rate for Payer: Cofinity Commercial |
$26.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.54
|
| Rate for Payer: Healthscope Commercial |
$27.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.00
|
| Rate for Payer: PHP Commercial |
$26.07
|
| Rate for Payer: Priority Health SBD |
$19.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.94
|
| Rate for Payer: UHC Core |
$15.98
|
| Rate for Payer: UHC Exchange |
$12.05
|
| Rate for Payer: UMR Bronson Commercial |
$11.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.00
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.50
|
|
|
Service Code
|
NDC 143978401
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.84 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna American Axle |
$12.03
|
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna Medicare |
$9.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.03
|
| Rate for Payer: BCBS Complete |
$7.40
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Advantage |
$12.95
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.88
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: Priority Health SBD |
$11.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.03
|
| Rate for Payer: UHC Core |
$9.64
|
| Rate for Payer: UHC Exchange |
$7.27
|
| Rate for Payer: UMR Bronson Commercial |
$6.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.88
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$31.22
|
|
|
Service Code
|
NDC 36000014810
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$28.10 |
| Rate for Payer: Aetna American Axle |
$20.29
|
| Rate for Payer: Aetna Commercial |
$26.54
|
| Rate for Payer: Aetna Medicare |
$15.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.29
|
| Rate for Payer: BCBS Complete |
$12.49
|
| Rate for Payer: Cash Price |
$24.98
|
| Rate for Payer: Cofinity Advantage |
$21.85
|
| Rate for Payer: Cofinity Commercial |
$26.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.98
|
| Rate for Payer: Healthscope Commercial |
$28.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.41
|
| Rate for Payer: PHP Commercial |
$26.54
|
| Rate for Payer: Priority Health SBD |
$19.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.29
|
| Rate for Payer: UHC Core |
$16.27
|
| Rate for Payer: UHC Exchange |
$12.27
|
| Rate for Payer: UMR Bronson Commercial |
$11.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.41
|
|
|
FLUMAZENIL 0.1 MG/ML IV (CODE)
|
Facility
|
IP
|
$18.50
|
|
|
Service Code
|
NDC 00143978410
|
| Hospital Charge Code |
163712
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna American Axle |
$12.03
|
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.03
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Advantage |
$12.95
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.88
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: Priority Health SBD |
$11.65
|
| Rate for Payer: UMR Bronson Commercial |
$8.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.88
|
|
|
FLUMAZENIL 0.1 MG/ML IV (CODE)
|
Facility
|
OP
|
$18.50
|
|
|
Service Code
|
NDC 00143978410
|
| Hospital Charge Code |
163712
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.84 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna American Axle |
$12.03
|
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna Medicare |
$9.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.03
|
| Rate for Payer: BCBS Complete |
$7.40
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Advantage |
$12.95
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.88
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: Priority Health SBD |
$11.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.03
|
| Rate for Payer: UHC Core |
$9.64
|
| Rate for Payer: UHC Exchange |
$7.27
|
| Rate for Payer: UMR Bronson Commercial |
$6.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.88
|
|
|
FLUORESCEIN 0.6 MG EYE STRIPS
|
Facility
|
OP
|
$571.05
|
|
|
Service Code
|
NDC 17478040303
|
| Hospital Charge Code |
27662
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$211.29 |
| Max. Negotiated Rate |
$513.95 |
| Rate for Payer: Aetna American Axle |
$371.18
|
| Rate for Payer: Aetna Commercial |
$485.39
|
| Rate for Payer: Aetna Medicare |
$285.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$371.18
|
| Rate for Payer: BCBS Complete |
$228.42
|
| Rate for Payer: Cash Price |
$456.84
|
| Rate for Payer: Cofinity Advantage |
$399.74
|
| Rate for Payer: Cofinity Commercial |
$491.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$456.84
|
| Rate for Payer: Healthscope Commercial |
$513.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$399.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$428.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$456.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$485.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$428.29
|
| Rate for Payer: PHP Commercial |
$485.39
|
| Rate for Payer: Priority Health SBD |
$359.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$371.18
|
| Rate for Payer: UHC Core |
$297.52
|
| Rate for Payer: UHC Exchange |
$224.42
|
| Rate for Payer: UMR Bronson Commercial |
$211.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$428.29
|
|
|
FLUORESCEIN 0.6 MG EYE STRIPS
|
Facility
|
IP
|
$571.05
|
|
|
Service Code
|
NDC 17478040303
|
| Hospital Charge Code |
27662
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$251.26 |
| Max. Negotiated Rate |
$513.95 |
| Rate for Payer: Aetna American Axle |
$371.18
|
| Rate for Payer: Aetna Commercial |
$485.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$371.18
|
| Rate for Payer: Cash Price |
$456.84
|
| Rate for Payer: Cofinity Advantage |
$399.74
|
| Rate for Payer: Cofinity Commercial |
$491.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$456.84
|
| Rate for Payer: Healthscope Commercial |
$513.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$399.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$428.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$485.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$428.29
|
| Rate for Payer: PHP Commercial |
$485.39
|
| Rate for Payer: Priority Health SBD |
$359.76
|
| Rate for Payer: UMR Bronson Commercial |
$251.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$428.29
|
|
|
FLUORESCEIN 1 MG EYE STRIPS
|
Facility
|
IP
|
$2.33
|
|
|
Service Code
|
NDC 17478040401
|
| Hospital Charge Code |
27663
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: Aetna American Axle |
$1.51
|
| Rate for Payer: Aetna Commercial |
$1.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.51
|
| Rate for Payer: Cash Price |
$1.86
|
| Rate for Payer: Cofinity Advantage |
$1.63
|
| Rate for Payer: Cofinity Commercial |
$2.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.86
|
| Rate for Payer: Healthscope Commercial |
$2.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.75
|
| Rate for Payer: PHP Commercial |
$1.98
|
| Rate for Payer: Priority Health SBD |
$1.47
|
| Rate for Payer: UMR Bronson Commercial |
$1.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.75
|
|
|
FLUORESCEIN 1 MG EYE STRIPS
|
Facility
|
IP
|
$4.59
|
|
|
Service Code
|
NDC 17238090099
|
| Hospital Charge Code |
27663
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna American Axle |
$2.98
|
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.98
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Advantage |
$3.21
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.44
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: Priority Health SBD |
$2.89
|
| Rate for Payer: UMR Bronson Commercial |
$2.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.44
|
|
|
FLUORESCEIN 1 MG EYE STRIPS
|
Facility
|
OP
|
$458.25
|
|
|
Service Code
|
NDC 17238090011
|
| Hospital Charge Code |
27663
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$169.55 |
| Max. Negotiated Rate |
$412.43 |
| Rate for Payer: Aetna American Axle |
$297.86
|
| Rate for Payer: Aetna Commercial |
$389.51
|
| Rate for Payer: Aetna Medicare |
$229.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.86
|
| Rate for Payer: BCBS Complete |
$183.30
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cofinity Advantage |
$320.77
|
| Rate for Payer: Cofinity Commercial |
$394.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.60
|
| Rate for Payer: Healthscope Commercial |
$412.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$366.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$343.69
|
| Rate for Payer: PHP Commercial |
$389.51
|
| Rate for Payer: Priority Health SBD |
$288.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$297.86
|
| Rate for Payer: UHC Core |
$238.75
|
| Rate for Payer: UHC Exchange |
$180.09
|
| Rate for Payer: UMR Bronson Commercial |
$169.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.69
|
|
|
FLUORESCEIN 1 MG EYE STRIPS
|
Facility
|
IP
|
$458.25
|
|
|
Service Code
|
NDC 17238090011
|
| Hospital Charge Code |
27663
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$201.63 |
| Max. Negotiated Rate |
$412.43 |
| Rate for Payer: Aetna American Axle |
$297.86
|
| Rate for Payer: Aetna Commercial |
$389.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.86
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cofinity Advantage |
$320.77
|
| Rate for Payer: Cofinity Commercial |
$394.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.60
|
| Rate for Payer: Healthscope Commercial |
$412.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$343.69
|
| Rate for Payer: PHP Commercial |
$389.51
|
| Rate for Payer: Priority Health SBD |
$288.70
|
| Rate for Payer: UMR Bronson Commercial |
$201.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.69
|
|
|
FLUORESCEIN 1 MG EYE STRIPS
|
Facility
|
OP
|
$4.59
|
|
|
Service Code
|
NDC 17238090099
|
| Hospital Charge Code |
27663
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna American Axle |
$2.98
|
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Aetna Medicare |
$2.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.98
|
| Rate for Payer: BCBS Complete |
$1.84
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Advantage |
$3.21
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.44
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: Priority Health SBD |
$2.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.98
|
| Rate for Payer: UHC Core |
$2.39
|
| Rate for Payer: UHC Exchange |
$1.80
|
| Rate for Payer: UMR Bronson Commercial |
$1.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.44
|
|
|
FLUORESCEIN 1 MG EYE STRIPS
|
Facility
|
OP
|
$2.33
|
|
|
Service Code
|
NDC 17478040401
|
| Hospital Charge Code |
27663
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: Aetna American Axle |
$1.51
|
| Rate for Payer: Aetna Commercial |
$1.98
|
| Rate for Payer: Aetna Medicare |
$1.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.51
|
| Rate for Payer: BCBS Complete |
$0.93
|
| Rate for Payer: Cash Price |
$1.86
|
| Rate for Payer: Cofinity Advantage |
$1.63
|
| Rate for Payer: Cofinity Commercial |
$2.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.86
|
| Rate for Payer: Healthscope Commercial |
$2.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.75
|
| Rate for Payer: PHP Commercial |
$1.98
|
| Rate for Payer: Priority Health SBD |
$1.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.51
|
| Rate for Payer: UHC Core |
$1.21
|
| Rate for Payer: UHC Exchange |
$0.92
|
| Rate for Payer: UMR Bronson Commercial |
$0.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.75
|
|
|
FLUORESCEIN 500 MG/5 ML (10 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$178.84
|
|
|
Service Code
|
HCPCS A9612
|
| Hospital Charge Code |
10059
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.17 |
| Max. Negotiated Rate |
$160.96 |
| Rate for Payer: Aetna American Axle |
$116.25
|
| Rate for Payer: Aetna American Axle |
$123.17
|
| Rate for Payer: Aetna Commercial |
$152.01
|
| Rate for Payer: Aetna Commercial |
$161.07
|
| Rate for Payer: Aetna Medicare |
$89.42
|
| Rate for Payer: Aetna Medicare |
$94.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.17
|
| Rate for Payer: BCBS Complete |
$75.80
|
| Rate for Payer: BCBS Complete |
$71.54
|
| Rate for Payer: Cash Price |
$151.60
|
| Rate for Payer: Cash Price |
$143.07
|
| Rate for Payer: Cofinity Advantage |
$125.19
|
| Rate for Payer: Cofinity Advantage |
$132.65
|
| Rate for Payer: Cofinity Commercial |
$153.80
|
| Rate for Payer: Cofinity Commercial |
$162.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.07
|
| Rate for Payer: Healthscope Commercial |
$170.55
|
| Rate for Payer: Healthscope Commercial |
$160.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$125.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$134.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$143.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$151.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$134.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.12
|
| Rate for Payer: PHP Commercial |
$152.01
|
| Rate for Payer: PHP Commercial |
$161.07
|
| Rate for Payer: Priority Health SBD |
$112.67
|
| Rate for Payer: Priority Health SBD |
$119.39
|
| Rate for Payer: UMR Bronson Commercial |
$66.17
|
| Rate for Payer: UMR Bronson Commercial |
$70.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.12
|
|
|
FLUORESCEIN 500 MG/5 ML (10 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$178.84
|
|
|
Service Code
|
HCPCS A9612
|
| Hospital Charge Code |
10059
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$78.69 |
| Max. Negotiated Rate |
$160.96 |
| Rate for Payer: Aetna American Axle |
$116.25
|
| Rate for Payer: Aetna American Axle |
$123.17
|
| Rate for Payer: Aetna Commercial |
$152.01
|
| Rate for Payer: Aetna Commercial |
$161.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.17
|
| Rate for Payer: Cash Price |
$143.07
|
| Rate for Payer: Cash Price |
$151.60
|
| Rate for Payer: Cofinity Advantage |
$132.65
|
| Rate for Payer: Cofinity Advantage |
$125.19
|
| Rate for Payer: Cofinity Commercial |
$162.97
|
| Rate for Payer: Cofinity Commercial |
$153.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.60
|
| Rate for Payer: Healthscope Commercial |
$160.96
|
| Rate for Payer: Healthscope Commercial |
$170.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$125.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$134.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$134.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.12
|
| Rate for Payer: PHP Commercial |
$152.01
|
| Rate for Payer: PHP Commercial |
$161.07
|
| Rate for Payer: Priority Health SBD |
$119.39
|
| Rate for Payer: Priority Health SBD |
$112.67
|
| Rate for Payer: UMR Bronson Commercial |
$78.69
|
| Rate for Payer: UMR Bronson Commercial |
$83.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.12
|
|
|
FLUORIDE 0.5 MG (1.1 MG SODIUM FLUORIDE)/ML ORAL DROPS
|
Facility
|
OP
|
$103.08
|
|
|
Service Code
|
NDC 39328000750
|
| Hospital Charge Code |
11406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.14 |
| Max. Negotiated Rate |
$92.77 |
| Rate for Payer: Aetna American Axle |
$67.00
|
| Rate for Payer: Aetna Commercial |
$87.62
|
| Rate for Payer: Aetna Medicare |
$51.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.00
|
| Rate for Payer: BCBS Complete |
$41.23
|
| Rate for Payer: Cash Price |
$82.46
|
| Rate for Payer: Cofinity Advantage |
$72.16
|
| Rate for Payer: Cofinity Commercial |
$88.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.46
|
| Rate for Payer: Healthscope Commercial |
$92.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.31
|
| Rate for Payer: PHP Commercial |
$87.62
|
| Rate for Payer: Priority Health SBD |
$64.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.00
|
| Rate for Payer: UHC Core |
$53.70
|
| Rate for Payer: UHC Exchange |
$40.51
|
| Rate for Payer: UMR Bronson Commercial |
$38.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.31
|
|
|
FLUORIDE 0.5 MG (1.1 MG SODIUM FLUORIDE)/ML ORAL DROPS
|
Facility
|
OP
|
$149.23
|
|
|
Service Code
|
NDC 44946103208
|
| Hospital Charge Code |
11406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.22 |
| Max. Negotiated Rate |
$134.31 |
| Rate for Payer: Aetna American Axle |
$97.00
|
| Rate for Payer: Aetna Commercial |
$126.85
|
| Rate for Payer: Aetna Medicare |
$74.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.00
|
| Rate for Payer: BCBS Complete |
$59.69
|
| Rate for Payer: Cash Price |
$119.38
|
| Rate for Payer: Cofinity Advantage |
$104.46
|
| Rate for Payer: Cofinity Commercial |
$128.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.38
|
| Rate for Payer: Healthscope Commercial |
$134.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.92
|
| Rate for Payer: PHP Commercial |
$126.85
|
| Rate for Payer: Priority Health SBD |
$94.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.00
|
| Rate for Payer: UHC Core |
$77.75
|
| Rate for Payer: UHC Exchange |
$58.65
|
| Rate for Payer: UMR Bronson Commercial |
$55.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.92
|
|
|
FLUORIDE 0.5 MG (1.1 MG SODIUM FLUORIDE)/ML ORAL DROPS
|
Facility
|
IP
|
$149.23
|
|
|
Service Code
|
NDC 44946103208
|
| Hospital Charge Code |
11406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.66 |
| Max. Negotiated Rate |
$134.31 |
| Rate for Payer: Aetna American Axle |
$97.00
|
| Rate for Payer: Aetna Commercial |
$126.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.00
|
| Rate for Payer: Cash Price |
$119.38
|
| Rate for Payer: Cofinity Advantage |
$104.46
|
| Rate for Payer: Cofinity Commercial |
$128.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.38
|
| Rate for Payer: Healthscope Commercial |
$134.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.92
|
| Rate for Payer: PHP Commercial |
$126.85
|
| Rate for Payer: Priority Health SBD |
$94.01
|
| Rate for Payer: UMR Bronson Commercial |
$65.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.92
|
|
|
FLUORIDE 0.5 MG (1.1 MG SODIUM FLUORIDE)/ML ORAL DROPS
|
Facility
|
IP
|
$103.08
|
|
|
Service Code
|
NDC 39328000750
|
| Hospital Charge Code |
11406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.36 |
| Max. Negotiated Rate |
$92.77 |
| Rate for Payer: Aetna American Axle |
$67.00
|
| Rate for Payer: Aetna Commercial |
$87.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.00
|
| Rate for Payer: Cash Price |
$82.46
|
| Rate for Payer: Cofinity Advantage |
$72.16
|
| Rate for Payer: Cofinity Commercial |
$88.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.46
|
| Rate for Payer: Healthscope Commercial |
$92.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.31
|
| Rate for Payer: PHP Commercial |
$87.62
|
| Rate for Payer: Priority Health SBD |
$64.94
|
| Rate for Payer: UMR Bronson Commercial |
$45.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.31
|
|
|
FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$548.21
|
|
|
Service Code
|
NDC 11980021105
|
| Hospital Charge Code |
3208
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$202.84 |
| Max. Negotiated Rate |
$493.39 |
| Rate for Payer: Aetna American Axle |
$356.34
|
| Rate for Payer: Aetna Commercial |
$465.98
|
| Rate for Payer: Aetna Medicare |
$274.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$356.34
|
| Rate for Payer: BCBS Complete |
$219.28
|
| Rate for Payer: Cash Price |
$438.57
|
| Rate for Payer: Cofinity Advantage |
$383.75
|
| Rate for Payer: Cofinity Commercial |
$471.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$438.57
|
| Rate for Payer: Healthscope Commercial |
$493.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$383.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$411.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$438.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$465.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$411.16
|
| Rate for Payer: PHP Commercial |
$465.98
|
| Rate for Payer: Priority Health SBD |
$345.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$356.34
|
| Rate for Payer: UHC Core |
$285.62
|
| Rate for Payer: UHC Exchange |
$215.45
|
| Rate for Payer: UMR Bronson Commercial |
$202.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$411.16
|
|
|
FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$548.21
|
|
|
Service Code
|
NDC 11980021105
|
| Hospital Charge Code |
3208
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$241.21 |
| Max. Negotiated Rate |
$493.39 |
| Rate for Payer: Aetna American Axle |
$356.34
|
| Rate for Payer: Aetna Commercial |
$465.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$356.34
|
| Rate for Payer: Cash Price |
$438.57
|
| Rate for Payer: Cofinity Advantage |
$383.75
|
| Rate for Payer: Cofinity Commercial |
$471.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$438.57
|
| Rate for Payer: Healthscope Commercial |
$493.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$383.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$411.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$465.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$411.16
|
| Rate for Payer: PHP Commercial |
$465.98
|
| Rate for Payer: Priority Health SBD |
$345.37
|
| Rate for Payer: UMR Bronson Commercial |
$241.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$411.16
|
|
|
FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$256.66
|
|
|
Service Code
|
NDC 60758088005
|
| Hospital Charge Code |
3208
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.96 |
| Max. Negotiated Rate |
$230.99 |
| Rate for Payer: Aetna American Axle |
$166.83
|
| Rate for Payer: Aetna Commercial |
$218.16
|
| Rate for Payer: Aetna Medicare |
$128.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.83
|
| Rate for Payer: BCBS Complete |
$102.66
|
| Rate for Payer: Cash Price |
$205.33
|
| Rate for Payer: Cofinity Advantage |
$179.66
|
| Rate for Payer: Cofinity Commercial |
$220.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.33
|
| Rate for Payer: Healthscope Commercial |
$230.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$205.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.50
|
| Rate for Payer: PHP Commercial |
$218.16
|
| Rate for Payer: Priority Health SBD |
$161.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.83
|
| Rate for Payer: UHC Core |
$133.72
|
| Rate for Payer: UHC Exchange |
$100.87
|
| Rate for Payer: UMR Bronson Commercial |
$94.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.50
|
|
|
FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$256.66
|
|
|
Service Code
|
NDC 60758088005
|
| Hospital Charge Code |
3208
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.93 |
| Max. Negotiated Rate |
$230.99 |
| Rate for Payer: Aetna American Axle |
$166.83
|
| Rate for Payer: Aetna Commercial |
$218.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.83
|
| Rate for Payer: Cash Price |
$205.33
|
| Rate for Payer: Cofinity Advantage |
$179.66
|
| Rate for Payer: Cofinity Commercial |
$220.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.33
|
| Rate for Payer: Healthscope Commercial |
$230.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.50
|
| Rate for Payer: PHP Commercial |
$218.16
|
| Rate for Payer: Priority Health SBD |
$161.70
|
| Rate for Payer: UMR Bronson Commercial |
$112.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.50
|
|
|
FLUOROURACIL 1 GRAM/20 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$124.88
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
82204
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$112.39 |
| Rate for Payer: Aetna American Axle |
$81.17
|
| Rate for Payer: Aetna Commercial |
$106.15
|
| Rate for Payer: Aetna Medicare |
$62.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.17
|
| Rate for Payer: BCBS Complete |
$49.95
|
| Rate for Payer: BCBS Trust/PPO |
$6.17
|
| Rate for Payer: BCN Commercial |
$6.17
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cofinity Advantage |
$87.42
|
| Rate for Payer: Cofinity Commercial |
$107.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.90
|
| Rate for Payer: Healthscope Commercial |
$112.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.66
|
| Rate for Payer: PHP Commercial |
$106.15
|
| Rate for Payer: Priority Health SBD |
$78.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.20
|
| Rate for Payer: UHC Core |
$3.20
|
| Rate for Payer: UHC Exchange |
$3.20
|
| Rate for Payer: UMR Bronson Commercial |
$46.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.66
|
|
