|
ASPARAGINASE (ERWINIA CHRYSANTHEMI) 10,000 UNIT SOLUTION FOR INJECTION
|
Facility
IP
|
$17,571.35
|
|
|
Service Code
|
HCPCS J9019
|
| Hospital Charge Code |
155948
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,731.39 |
| Max. Negotiated Rate |
$15,814.22 |
| Rate for Payer: Aetna American Axle |
$11,421.38
|
| Rate for Payer: Aetna Commercial |
$14,935.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,421.38
|
| Rate for Payer: Cash Price |
$14,057.08
|
| Rate for Payer: Cofinity Commercial |
$12,299.94
|
| Rate for Payer: Cofinity Commercial |
$15,111.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,057.08
|
| Rate for Payer: Healthscope Commercial |
$15,814.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,299.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,178.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,935.65
|
| Rate for Payer: PHP Commercial |
$14,935.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,299.94
|
| Rate for Payer: Priority Health SBD |
$11,069.95
|
| Rate for Payer: UMR Bronson Commercial |
$7,731.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,178.51
|
|
|
ASPARAGINASE (ERWINIA CHRYSANTHEMI) 10,000 UNIT SOLUTION FOR INJECTION
|
Facility
OP
|
$17,571.35
|
|
|
Service Code
|
HCPCS J9019
|
| Hospital Charge Code |
155948
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$233.72 |
| Max. Negotiated Rate |
$15,814.22 |
| Rate for Payer: Aetna American Axle |
$11,421.38
|
| Rate for Payer: Aetna Commercial |
$14,935.65
|
| Rate for Payer: Aetna Medicare |
$444.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,421.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$534.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$534.09
|
| Rate for Payer: BCBS Complete |
$245.42
|
| Rate for Payer: BCBS MAPPO |
$427.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,373.19
|
| Rate for Payer: BCN Medicare Advantage |
$427.27
|
| Rate for Payer: Cash Price |
$14,057.08
|
| Rate for Payer: Cash Price |
$14,057.08
|
| Rate for Payer: Cofinity Commercial |
$12,299.94
|
| Rate for Payer: Cofinity Commercial |
$15,111.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,057.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$427.27
|
| Rate for Payer: Healthscope Commercial |
$15,814.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,299.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,178.51
|
| Rate for Payer: Mclaren Medicaid |
$233.72
|
| Rate for Payer: Mclaren Medicare |
$427.27
|
| Rate for Payer: Meridian Medicaid |
$245.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$448.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$491.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,935.65
|
| Rate for Payer: PACE Medicare |
$405.91
|
| Rate for Payer: PACE SWMI |
$427.27
|
| Rate for Payer: PHP Commercial |
$14,935.65
|
| Rate for Payer: PHP Medicare Advantage |
$427.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$233.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,299.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,254.84
|
| Rate for Payer: Priority Health Medicare |
$427.27
|
| Rate for Payer: Priority Health Narrow Network |
$1,003.87
|
| Rate for Payer: Priority Health SBD |
$11,069.95
|
| Rate for Payer: Railroad Medicare Medicare |
$427.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$427.27
|
| Rate for Payer: UHC Medicare Advantage |
$440.09
|
| Rate for Payer: UMR Bronson Commercial |
$6,501.40
|
| Rate for Payer: VA VA |
$427.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,178.51
|
|
|
ASPARAGINASE ERWINIA CHRYSANTHEMI-RYWN 10 MG/0.5 ML IM SOLUTION
|
Facility
IP
|
$21,686.70
|
|
|
Service Code
|
HCPCS J9021
|
| Hospital Charge Code |
197812
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,542.15 |
| Max. Negotiated Rate |
$19,518.03 |
| Rate for Payer: Aetna American Axle |
$14,096.36
|
| Rate for Payer: Aetna Commercial |
$18,433.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,096.36
|
| Rate for Payer: Cash Price |
$17,349.36
|
| Rate for Payer: Cofinity Commercial |
$15,180.69
|
| Rate for Payer: Cofinity Commercial |
$18,650.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,349.36
|
| Rate for Payer: Healthscope Commercial |
$19,518.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15,180.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16,265.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18,433.70
|
| Rate for Payer: PHP Commercial |
$18,433.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15,180.69
|
| Rate for Payer: Priority Health SBD |
$13,662.62
|
| Rate for Payer: UMR Bronson Commercial |
$9,542.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16,265.02
|
|
|
ASPIRATION OF BLADDER; WITH INSERTION OF SUPRAPUBIC CATHETER
|
Facility
OP
|
$5,699.47
|
|
|
Service Code
|
CPT 51102
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$138.18 |
| Max. Negotiated Rate |
$5,699.47 |
| Rate for Payer: Aetna Medicare |
$1,882.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,263.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,263.10
|
| Rate for Payer: BCBS Complete |
$1,039.94
|
| Rate for Payer: BCBS MAPPO |
$1,810.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,372.78
|
| Rate for Payer: BCN Medicare Advantage |
$1,810.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,810.48
|
| Rate for Payer: Mclaren Medicaid |
$990.33
|
| Rate for Payer: Mclaren Medicare |
$1,810.48
|
| Rate for Payer: Meridian Medicaid |
$1,039.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,901.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,082.05
|
| Rate for Payer: PACE Medicare |
$1,719.96
|
| Rate for Payer: PACE SWMI |
$1,810.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,810.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$990.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,699.47
|
| Rate for Payer: Priority Health Medicare |
$1,810.48
|
| Rate for Payer: Priority Health Narrow Network |
$4,559.58
|
| Rate for Payer: Railroad Medicare Medicare |
$1,810.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$152.00
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,810.48
|
| Rate for Payer: UHC Exchange |
$138.18
|
| Rate for Payer: UHC Medicare Advantage |
$1,864.79
|
| Rate for Payer: VA VA |
$1,810.48
|
|
|
ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE
|
Facility
IP
|
$267.84
|
|
|
Service Code
|
NDC 65162-596-06
|
| Hospital Charge Code |
27644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.85 |
| Max. Negotiated Rate |
$241.06 |
| Rate for Payer: Aetna American Axle |
$174.10
|
| Rate for Payer: Aetna Commercial |
$227.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.10
|
| Rate for Payer: Cash Price |
$214.27
|
| Rate for Payer: Cofinity Commercial |
$187.49
|
| Rate for Payer: Cofinity Commercial |
$230.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.27
|
| Rate for Payer: Healthscope Commercial |
$241.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$227.66
|
| Rate for Payer: PHP Commercial |
$227.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.49
|
| Rate for Payer: Priority Health SBD |
$168.74
|
| Rate for Payer: UMR Bronson Commercial |
$117.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.88
|
|
|
ASPIRIN 300 MG RECTAL SUPPOSITORY
|
Facility
IP
|
$36.43
|
|
|
Service Code
|
NDC 0574-7034-12
|
| Hospital Charge Code |
693
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.03 |
| Max. Negotiated Rate |
$32.79 |
| Rate for Payer: Aetna American Axle |
$23.68
|
| Rate for Payer: Aetna Commercial |
$30.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.68
|
| Rate for Payer: Cash Price |
$29.14
|
| Rate for Payer: Cofinity Commercial |
$25.50
|
| Rate for Payer: Cofinity Commercial |
$31.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.14
|
| Rate for Payer: Healthscope Commercial |
$32.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.97
|
| Rate for Payer: PHP Commercial |
$30.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.50
|
| Rate for Payer: Priority Health SBD |
$22.95
|
| Rate for Payer: UMR Bronson Commercial |
$16.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.32
|
|
|
ASPIRIN 325 MG TABLET
|
Facility
IP
|
$511.50
|
|
|
Service Code
|
NDC 66553-001-01
|
| Hospital Charge Code |
681
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$225.06 |
| Max. Negotiated Rate |
$460.35 |
| Rate for Payer: Aetna American Axle |
$332.48
|
| Rate for Payer: Aetna Commercial |
$434.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$332.48
|
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: Cofinity Commercial |
$358.05
|
| Rate for Payer: Cofinity Commercial |
$439.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$409.20
|
| Rate for Payer: Healthscope Commercial |
$460.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$358.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$383.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$434.78
|
| Rate for Payer: PHP Commercial |
$434.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$358.05
|
| Rate for Payer: Priority Health SBD |
$322.24
|
| Rate for Payer: UMR Bronson Commercial |
$225.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$383.62
|
|
|
ASPIRIN 600 MG RECTAL SUPPOSITORY
|
Facility
IP
|
$52.29
|
|
|
Service Code
|
NDC 0574-7036-12
|
| Hospital Charge Code |
696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.01 |
| Max. Negotiated Rate |
$47.06 |
| Rate for Payer: Aetna American Axle |
$33.99
|
| Rate for Payer: Aetna Commercial |
$44.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.99
|
| Rate for Payer: Cash Price |
$41.83
|
| Rate for Payer: Cofinity Commercial |
$36.60
|
| Rate for Payer: Cofinity Commercial |
$44.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.83
|
| Rate for Payer: Healthscope Commercial |
$47.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.45
|
| Rate for Payer: PHP Commercial |
$44.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.60
|
| Rate for Payer: Priority Health SBD |
$32.94
|
| Rate for Payer: UMR Bronson Commercial |
$23.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.22
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
IP
|
$441.00
|
|
|
Service Code
|
NDC 0904-6794-80
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.04 |
| Max. Negotiated Rate |
$396.90 |
| Rate for Payer: Aetna American Axle |
$286.65
|
| Rate for Payer: Aetna Commercial |
$374.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$286.65
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cofinity Commercial |
$308.70
|
| Rate for Payer: Cofinity Commercial |
$379.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$352.80
|
| Rate for Payer: Healthscope Commercial |
$396.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$308.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$330.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$374.85
|
| Rate for Payer: PHP Commercial |
$374.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.70
|
| Rate for Payer: Priority Health SBD |
$277.83
|
| Rate for Payer: UMR Bronson Commercial |
$194.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$330.75
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
IP
|
$47.63
|
|
|
Service Code
|
NDC 57896-911-36
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.96 |
| Max. Negotiated Rate |
$42.87 |
| Rate for Payer: Aetna American Axle |
$30.96
|
| Rate for Payer: Aetna Commercial |
$40.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.96
|
| Rate for Payer: Cash Price |
$38.10
|
| Rate for Payer: Cofinity Commercial |
$33.34
|
| Rate for Payer: Cofinity Commercial |
$40.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.10
|
| Rate for Payer: Healthscope Commercial |
$42.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.49
|
| Rate for Payer: PHP Commercial |
$40.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.34
|
| Rate for Payer: Priority Health SBD |
$30.01
|
| Rate for Payer: UMR Bronson Commercial |
$20.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.72
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
OP
|
$45.36
|
|
|
Service Code
|
NDC 0904-4040-73
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.78 |
| Max. Negotiated Rate |
$40.82 |
| Rate for Payer: Aetna American Axle |
$29.48
|
| Rate for Payer: Aetna Commercial |
$38.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.48
|
| Rate for Payer: BCBS Complete |
$18.14
|
| Rate for Payer: Cash Price |
$36.29
|
| Rate for Payer: Cofinity Commercial |
$31.75
|
| Rate for Payer: Cofinity Commercial |
$39.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.29
|
| Rate for Payer: Healthscope Commercial |
$40.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.56
|
| Rate for Payer: PHP Commercial |
$38.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.75
|
| Rate for Payer: Priority Health SBD |
$28.58
|
| Rate for Payer: UMR Bronson Commercial |
$16.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.02
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
IP
|
$90.72
|
|
|
Service Code
|
NDC 0904-6794-89
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.92 |
| Max. Negotiated Rate |
$81.65 |
| Rate for Payer: Aetna American Axle |
$58.97
|
| Rate for Payer: Aetna Commercial |
$77.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.97
|
| Rate for Payer: Cash Price |
$72.58
|
| Rate for Payer: Cofinity Commercial |
$63.50
|
| Rate for Payer: Cofinity Commercial |
$78.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.58
|
| Rate for Payer: Healthscope Commercial |
$81.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$77.11
|
| Rate for Payer: PHP Commercial |
$77.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.50
|
| Rate for Payer: Priority Health SBD |
$57.15
|
| Rate for Payer: UMR Bronson Commercial |
$39.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.04
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
IP
|
$544.50
|
|
|
Service Code
|
NDC 66553-002-01
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$239.58 |
| Max. Negotiated Rate |
$490.05 |
| Rate for Payer: Aetna American Axle |
$353.92
|
| Rate for Payer: Aetna Commercial |
$462.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$353.92
|
| Rate for Payer: Cash Price |
$435.60
|
| Rate for Payer: Cofinity Commercial |
$381.15
|
| Rate for Payer: Cofinity Commercial |
$468.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$435.60
|
| Rate for Payer: Healthscope Commercial |
$490.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$381.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$408.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$462.82
|
| Rate for Payer: PHP Commercial |
$462.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$381.15
|
| Rate for Payer: Priority Health SBD |
$343.04
|
| Rate for Payer: UMR Bronson Commercial |
$239.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$408.38
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
IP
|
$1,134.00
|
|
|
Service Code
|
NDC 63739-434-01
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$498.96 |
| Max. Negotiated Rate |
$1,020.60 |
| Rate for Payer: Aetna American Axle |
$737.10
|
| Rate for Payer: Aetna Commercial |
$963.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$737.10
|
| Rate for Payer: Cash Price |
$907.20
|
| Rate for Payer: Cofinity Commercial |
$793.80
|
| Rate for Payer: Cofinity Commercial |
$975.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$907.20
|
| Rate for Payer: Healthscope Commercial |
$1,020.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$793.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$850.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$963.90
|
| Rate for Payer: PHP Commercial |
$963.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$793.80
|
| Rate for Payer: Priority Health SBD |
$714.42
|
| Rate for Payer: UMR Bronson Commercial |
$498.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$850.50
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
IP
|
$45.36
|
|
|
Service Code
|
NDC 0904-4040-73
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.96 |
| Max. Negotiated Rate |
$40.82 |
| Rate for Payer: Aetna American Axle |
$29.48
|
| Rate for Payer: Aetna Commercial |
$38.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.48
|
| Rate for Payer: Cash Price |
$36.29
|
| Rate for Payer: Cofinity Commercial |
$31.75
|
| Rate for Payer: Cofinity Commercial |
$39.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.29
|
| Rate for Payer: Healthscope Commercial |
$40.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.56
|
| Rate for Payer: PHP Commercial |
$38.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.75
|
| Rate for Payer: Priority Health SBD |
$28.58
|
| Rate for Payer: UMR Bronson Commercial |
$19.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.02
|
|
|
ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET
|
Facility
IP
|
$44.65
|
|
|
Service Code
|
NDC 0904-5135-59
|
| Hospital Charge Code |
9158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.65 |
| Max. Negotiated Rate |
$40.18 |
| Rate for Payer: Aetna American Axle |
$29.02
|
| Rate for Payer: Aetna Commercial |
$37.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.02
|
| Rate for Payer: Cash Price |
$35.72
|
| Rate for Payer: Cofinity Commercial |
$31.26
|
| Rate for Payer: Cofinity Commercial |
$38.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.72
|
| Rate for Payer: Healthscope Commercial |
$40.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.95
|
| Rate for Payer: PHP Commercial |
$37.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.26
|
| Rate for Payer: Priority Health SBD |
$28.13
|
| Rate for Payer: UMR Bronson Commercial |
$19.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.49
|
|
|
ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET
|
Facility
IP
|
$58.75
|
|
|
Service Code
|
NDC 0536-1326-01
|
| Hospital Charge Code |
9158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.85 |
| Max. Negotiated Rate |
$52.88 |
| Rate for Payer: Aetna American Axle |
$38.19
|
| Rate for Payer: Aetna Commercial |
$49.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.19
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cofinity Commercial |
$41.12
|
| Rate for Payer: Cofinity Commercial |
$50.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.00
|
| Rate for Payer: Healthscope Commercial |
$52.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.94
|
| Rate for Payer: PHP Commercial |
$49.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.12
|
| Rate for Payer: Priority Health SBD |
$37.01
|
| Rate for Payer: UMR Bronson Commercial |
$25.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.06
|
|
|
ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET
|
Facility
IP
|
$50.76
|
|
|
Service Code
|
NDC 9629513133
|
| Hospital Charge Code |
9158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.33 |
| Max. Negotiated Rate |
$45.68 |
| Rate for Payer: Aetna American Axle |
$32.99
|
| Rate for Payer: Aetna Commercial |
$43.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.99
|
| Rate for Payer: Cash Price |
$40.61
|
| Rate for Payer: Cofinity Commercial |
$35.53
|
| Rate for Payer: Cofinity Commercial |
$43.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.61
|
| Rate for Payer: Healthscope Commercial |
$45.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.15
|
| Rate for Payer: PHP Commercial |
$43.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.53
|
| Rate for Payer: Priority Health SBD |
$31.98
|
| Rate for Payer: UMR Bronson Commercial |
$22.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.07
|
|
|
ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET
|
Facility
IP
|
$65.80
|
|
|
Service Code
|
NDC 37205-669-78
|
| Hospital Charge Code |
9158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$59.22 |
| Rate for Payer: Aetna American Axle |
$42.77
|
| Rate for Payer: Aetna Commercial |
$55.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.77
|
| Rate for Payer: Cash Price |
$52.64
|
| Rate for Payer: Cofinity Commercial |
$46.06
|
| Rate for Payer: Cofinity Commercial |
$56.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.64
|
| Rate for Payer: Healthscope Commercial |
$59.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.93
|
| Rate for Payer: PHP Commercial |
$55.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.06
|
| Rate for Payer: Priority Health SBD |
$41.45
|
| Rate for Payer: UMR Bronson Commercial |
$28.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.35
|
|
|
ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET
|
Facility
IP
|
$138.65
|
|
|
Service Code
|
NDC 9629513132
|
| Hospital Charge Code |
9158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.01 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna American Axle |
$90.12
|
| Rate for Payer: Aetna Commercial |
$117.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.12
|
| Rate for Payer: Cash Price |
$110.92
|
| Rate for Payer: Cofinity Commercial |
$119.24
|
| Rate for Payer: Cofinity Commercial |
$97.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.92
|
| Rate for Payer: Healthscope Commercial |
$124.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$117.85
|
| Rate for Payer: PHP Commercial |
$117.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.06
|
| Rate for Payer: Priority Health SBD |
$87.35
|
| Rate for Payer: UMR Bronson Commercial |
$61.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.99
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
IP
|
$3.81
|
|
|
Service Code
|
NDC 51079-759-01
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$3.43 |
| Rate for Payer: Aetna American Axle |
$2.48
|
| Rate for Payer: Aetna Commercial |
$3.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.48
|
| Rate for Payer: Cash Price |
$3.05
|
| Rate for Payer: Cofinity Commercial |
$2.67
|
| Rate for Payer: Cofinity Commercial |
$3.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.05
|
| Rate for Payer: Healthscope Commercial |
$3.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.24
|
| Rate for Payer: PHP Commercial |
$3.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.67
|
| Rate for Payer: Priority Health SBD |
$2.40
|
| Rate for Payer: UMR Bronson Commercial |
$1.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.86
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
IP
|
$75.20
|
|
|
Service Code
|
NDC 0093-0787-01
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.09 |
| Max. Negotiated Rate |
$67.68 |
| Rate for Payer: Aetna American Axle |
$48.88
|
| Rate for Payer: Aetna Commercial |
$63.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.88
|
| Rate for Payer: Cash Price |
$60.16
|
| Rate for Payer: Cofinity Commercial |
$52.64
|
| Rate for Payer: Cofinity Commercial |
$64.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.16
|
| Rate for Payer: Healthscope Commercial |
$67.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.92
|
| Rate for Payer: PHP Commercial |
$63.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.64
|
| Rate for Payer: Priority Health SBD |
$47.38
|
| Rate for Payer: UMR Bronson Commercial |
$33.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.40
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
IP
|
$380.70
|
|
|
Service Code
|
NDC 51079-759-20
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.51 |
| Max. Negotiated Rate |
$342.63 |
| Rate for Payer: Aetna American Axle |
$247.46
|
| Rate for Payer: Aetna Commercial |
$323.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.46
|
| Rate for Payer: Cash Price |
$304.56
|
| Rate for Payer: Cofinity Commercial |
$266.49
|
| Rate for Payer: Cofinity Commercial |
$327.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.56
|
| Rate for Payer: Healthscope Commercial |
$342.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$266.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.60
|
| Rate for Payer: PHP Commercial |
$323.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.49
|
| Rate for Payer: Priority Health SBD |
$239.84
|
| Rate for Payer: UMR Bronson Commercial |
$167.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.52
|
|
|
ATENOLOL 50 MG TABLET
|
Facility
IP
|
$2.00
|
|
|
Service Code
|
NDC 51079-684-01
|
| Hospital Charge Code |
718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Aetna American Axle |
$1.30
|
| Rate for Payer: Aetna Commercial |
$1.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.30
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cofinity Commercial |
$1.40
|
| Rate for Payer: Cofinity Commercial |
$1.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.60
|
| Rate for Payer: Healthscope Commercial |
$1.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.70
|
| Rate for Payer: PHP Commercial |
$1.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.40
|
| Rate for Payer: Priority Health SBD |
$1.26
|
| Rate for Payer: UMR Bronson Commercial |
$0.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.50
|
|
|
ATENOLOL 50 MG TABLET
|
Facility
IP
|
$65.80
|
|
|
Service Code
|
NDC 65862-169-01
|
| Hospital Charge Code |
718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$59.22 |
| Rate for Payer: Aetna American Axle |
$42.77
|
| Rate for Payer: Aetna Commercial |
$55.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.77
|
| Rate for Payer: Cash Price |
$52.64
|
| Rate for Payer: Cofinity Commercial |
$46.06
|
| Rate for Payer: Cofinity Commercial |
$56.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.64
|
| Rate for Payer: Healthscope Commercial |
$59.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.93
|
| Rate for Payer: PHP Commercial |
$55.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.06
|
| Rate for Payer: Priority Health SBD |
$41.45
|
| Rate for Payer: UMR Bronson Commercial |
$28.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.35
|
|
