|
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
|
$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
|
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
|
$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 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-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
|
$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
|
$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 |
$43.65
|
| Rate for Payer: Cofinity Commercial |
$35.53
|
| 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
|
$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
|
|
|
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
|
|
|
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 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
|
$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 50 MG TABLET
|
Facility
|
IP
|
$199.75
|
|
|
Service Code
|
NDC 51079-684-20
|
| Hospital Charge Code |
718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.89 |
| Max. Negotiated Rate |
$179.78 |
| Rate for Payer: Aetna American Axle |
$129.84
|
| Rate for Payer: Aetna Commercial |
$169.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.84
|
| Rate for Payer: Cash Price |
$159.80
|
| Rate for Payer: Cofinity Commercial |
$139.82
|
| Rate for Payer: Cofinity Commercial |
$171.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.80
|
| Rate for Payer: Healthscope Commercial |
$179.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$169.79
|
| Rate for Payer: PHP Commercial |
$169.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.82
|
| Rate for Payer: Priority Health SBD |
$125.84
|
| Rate for Payer: UMR Bronson Commercial |
$87.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.81
|
|
|
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
|
|
|
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
|
|
|
ATEZOLIZUMAB 1,200 MG/20 ML (60 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$47,620.59
|
|
|
Service Code
|
HCPCS J9022
|
| Hospital Charge Code |
179035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.50 |
| Max. Negotiated Rate |
$42,858.53 |
| Rate for Payer: Aetna American Axle |
$30,953.38
|
| Rate for Payer: Aetna Commercial |
$40,477.50
|
| Rate for Payer: Aetna Medicare |
$88.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30,953.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$106.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$106.26
|
| Rate for Payer: BCBS Complete |
$48.83
|
| Rate for Payer: BCBS MAPPO |
$85.01
|
| Rate for Payer: BCBS Trust/PPO |
$274.70
|
| Rate for Payer: BCN Medicare Advantage |
$85.01
|
| Rate for Payer: Cash Price |
$38,096.47
|
| Rate for Payer: Cash Price |
$38,096.47
|
| Rate for Payer: Cofinity Commercial |
$33,334.41
|
| Rate for Payer: Cofinity Commercial |
$40,953.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38,096.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.01
|
| Rate for Payer: Healthscope Commercial |
$42,858.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33,334.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35,715.44
|
| Rate for Payer: Mclaren Medicaid |
$46.50
|
| Rate for Payer: Mclaren Medicare |
$85.01
|
| Rate for Payer: Meridian Medicaid |
$48.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$89.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40,477.50
|
| Rate for Payer: PACE Medicare |
$80.76
|
| Rate for Payer: PACE SWMI |
$85.01
|
| Rate for Payer: PHP Commercial |
$40,477.50
|
| Rate for Payer: PHP Medicare Advantage |
$85.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33,334.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$242.64
|
| Rate for Payer: Priority Health Medicare |
$85.01
|
| Rate for Payer: Priority Health Narrow Network |
$194.11
|
| Rate for Payer: Priority Health SBD |
$30,000.97
|
| Rate for Payer: Railroad Medicare Medicare |
$85.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.01
|
| Rate for Payer: UHC Medicare Advantage |
$87.56
|
| Rate for Payer: UMR Bronson Commercial |
$17,619.62
|
| Rate for Payer: VA VA |
$85.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35,715.44
|
|
|
ATEZOLIZUMAB 1,200 MG/20 ML (60 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$47,620.59
|
|
|
Service Code
|
HCPCS J9022
|
| Hospital Charge Code |
179035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20,953.06 |
| Max. Negotiated Rate |
$42,858.53 |
| Rate for Payer: Aetna American Axle |
$30,953.38
|
| Rate for Payer: Aetna Commercial |
$40,477.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30,953.38
|
| Rate for Payer: Cash Price |
$38,096.47
|
| Rate for Payer: Cofinity Commercial |
$33,334.41
|
| Rate for Payer: Cofinity Commercial |
$40,953.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38,096.47
|
| Rate for Payer: Healthscope Commercial |
$42,858.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33,334.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35,715.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40,477.50
|
| Rate for Payer: PHP Commercial |
$40,477.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33,334.41
|
| Rate for Payer: Priority Health SBD |
$30,000.97
|
| Rate for Payer: UMR Bronson Commercial |
$20,953.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35,715.44
|
|
|
ATHEROSCLEROSIS WITH MCC
|
Facility
|
IP
|
$30,205.06
|
|
|
Service Code
|
MS-DRG 302
|
| Min. Negotiated Rate |
$8,694.01 |
| Max. Negotiated Rate |
$30,205.06 |
| Rate for Payer: Aetna Medicare |
$9,517.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,439.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,439.49
|
| Rate for Payer: BCBS MAPPO |
$9,151.59
|
| Rate for Payer: BCBS Trust/PPO |
$30,205.06
|
| Rate for Payer: BCN Medicare Advantage |
$9,151.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,151.59
|
| Rate for Payer: Mclaren Medicare |
$9,151.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,609.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,524.33
|
| Rate for Payer: PACE Medicare |
$8,694.01
|
| Rate for Payer: PACE SWMI |
$9,151.59
|
| Rate for Payer: PHP Medicare Advantage |
$9,151.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,087.70
|
| Rate for Payer: Priority Health Medicare |
$9,151.59
|
| Rate for Payer: Priority Health Narrow Network |
$12,870.16
|
| Rate for Payer: Railroad Medicare Medicare |
$9,151.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,101.26
|
| Rate for Payer: UHC Core |
$14,022.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,151.59
|
| Rate for Payer: UHC Exchange |
$11,148.22
|
| Rate for Payer: UHC Medicare Advantage |
$9,426.14
|
| Rate for Payer: VA VA |
$9,151.59
|
|
|
ATHEROSCLEROSIS WITHOUT MCC
|
Facility
|
IP
|
$13,881.26
|
|
|
Service Code
|
MS-DRG 303
|
| Min. Negotiated Rate |
$5,304.51 |
| Max. Negotiated Rate |
$13,881.26 |
| Rate for Payer: Aetna Medicare |
$5,807.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,979.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,979.61
|
| Rate for Payer: BCBS MAPPO |
$5,583.69
|
| Rate for Payer: BCBS Trust/PPO |
$13,881.26
|
| Rate for Payer: BCN Medicare Advantage |
$5,583.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,583.69
|
| Rate for Payer: Mclaren Medicare |
$5,583.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,862.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,421.24
|
| Rate for Payer: PACE Medicare |
$5,304.51
|
| Rate for Payer: PACE SWMI |
$5,583.69
|
| Rate for Payer: PHP Medicare Advantage |
$5,583.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,443.68
|
| Rate for Payer: Priority Health Medicare |
$5,583.69
|
| Rate for Payer: Priority Health Narrow Network |
$7,554.94
|
| Rate for Payer: Railroad Medicare Medicare |
$5,583.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,038.66
|
| Rate for Payer: UHC Core |
$8,231.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,583.69
|
| Rate for Payer: UHC Exchange |
$6,544.15
|
| Rate for Payer: UHC Medicare Advantage |
$5,751.20
|
| Rate for Payer: VA VA |
$5,583.69
|
|
|
ATOMOXETINE 10 MG CAPSULE
|
Facility
|
IP
|
$309.96
|
|
|
Service Code
|
NDC 68462-265-30
|
| Hospital Charge Code |
34444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.38 |
| Max. Negotiated Rate |
$278.96 |
| Rate for Payer: Aetna American Axle |
$201.47
|
| Rate for Payer: Aetna Commercial |
$263.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.47
|
| Rate for Payer: Cash Price |
$247.97
|
| Rate for Payer: Cofinity Commercial |
$216.97
|
| Rate for Payer: Cofinity Commercial |
$266.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.97
|
| Rate for Payer: Healthscope Commercial |
$278.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$263.47
|
| Rate for Payer: PHP Commercial |
$263.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.97
|
| Rate for Payer: Priority Health SBD |
$195.27
|
| Rate for Payer: UMR Bronson Commercial |
$136.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.47
|
|
|
ATOMOXETINE 10 MG CAPSULE
|
Facility
|
IP
|
$1,213.45
|
|
|
Service Code
|
NDC 0002-3227-30
|
| Hospital Charge Code |
34444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$533.92 |
| Max. Negotiated Rate |
$1,092.10 |
| Rate for Payer: Aetna American Axle |
$788.74
|
| Rate for Payer: Aetna Commercial |
$1,031.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$788.74
|
| Rate for Payer: Cash Price |
$970.76
|
| Rate for Payer: Cofinity Commercial |
$1,043.57
|
| Rate for Payer: Cofinity Commercial |
$849.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$970.76
|
| Rate for Payer: Healthscope Commercial |
$1,092.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$849.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$910.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,031.43
|
| Rate for Payer: PHP Commercial |
$1,031.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$849.42
|
| Rate for Payer: Priority Health SBD |
$764.47
|
| Rate for Payer: UMR Bronson Commercial |
$533.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$910.09
|
|
|
ATOMOXETINE 18 MG CAPSULE
|
Facility
|
IP
|
$1,213.45
|
|
|
Service Code
|
NDC 0002-3238-30
|
| Hospital Charge Code |
34445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$533.92 |
| Max. Negotiated Rate |
$1,092.10 |
| Rate for Payer: Aetna American Axle |
$788.74
|
| Rate for Payer: Aetna Commercial |
$1,031.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$788.74
|
| Rate for Payer: Cash Price |
$970.76
|
| Rate for Payer: Cofinity Commercial |
$1,043.57
|
| Rate for Payer: Cofinity Commercial |
$849.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$970.76
|
| Rate for Payer: Healthscope Commercial |
$1,092.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$849.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$910.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,031.43
|
| Rate for Payer: PHP Commercial |
$1,031.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$849.42
|
| Rate for Payer: Priority Health SBD |
$764.47
|
| Rate for Payer: UMR Bronson Commercial |
$533.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$910.09
|
|
