|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
NDC 63323082005
|
| Hospital Charge Code |
179808
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.83 |
| Max. Negotiated Rate |
$53.10 |
| Rate for Payer: Aetna American Axle |
$38.35
|
| Rate for Payer: Aetna Commercial |
$50.15
|
| Rate for Payer: Aetna Medicare |
$29.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.35
|
| Rate for Payer: BCBS Complete |
$23.60
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cofinity Commercial |
$41.30
|
| Rate for Payer: Cofinity Commercial |
$50.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.20
|
| Rate for Payer: Healthscope Commercial |
$53.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.15
|
| Rate for Payer: PHP Commercial |
$50.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.35
|
| Rate for Payer: Priority Health SBD |
$37.17
|
| Rate for Payer: UMR Bronson Commercial |
$21.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.25
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
NDC 63323082050
|
| Hospital Charge Code |
179808
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.96 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna American Axle |
$22.10
|
| Rate for Payer: Aetna Commercial |
$28.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.10
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cofinity Commercial |
$23.80
|
| Rate for Payer: Cofinity Commercial |
$29.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.20
|
| Rate for Payer: Healthscope Commercial |
$30.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.90
|
| Rate for Payer: PHP Commercial |
$28.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.10
|
| Rate for Payer: Priority Health SBD |
$21.42
|
| Rate for Payer: UMR Bronson Commercial |
$14.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.50
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
NDC 63323082074
|
| Hospital Charge Code |
179808
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.88 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna American Axle |
$15.60
|
| Rate for Payer: Aetna Commercial |
$20.40
|
| Rate for Payer: Aetna Medicare |
$12.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.60
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$20.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.20
|
| Rate for Payer: Healthscope Commercial |
$21.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.40
|
| Rate for Payer: PHP Commercial |
$20.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.60
|
| Rate for Payer: Priority Health SBD |
$15.12
|
| Rate for Payer: UMR Bronson Commercial |
$8.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.00
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20% NEONATAL SYRINGE
|
Facility
|
IP
|
$93.09
|
|
|
Service Code
|
NDC 09900001021
|
| Hospital Charge Code |
200053
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.96 |
| Max. Negotiated Rate |
$83.78 |
| Rate for Payer: Aetna American Axle |
$60.51
|
| Rate for Payer: Aetna Commercial |
$79.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.51
|
| Rate for Payer: Cash Price |
$74.47
|
| Rate for Payer: Cofinity Commercial |
$65.16
|
| Rate for Payer: Cofinity Commercial |
$80.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.47
|
| Rate for Payer: Healthscope Commercial |
$83.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.13
|
| Rate for Payer: PHP Commercial |
$79.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.51
|
| Rate for Payer: Priority Health SBD |
$58.65
|
| Rate for Payer: UMR Bronson Commercial |
$40.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.82
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20% NEONATAL SYRINGE
|
Facility
|
IP
|
$53.92
|
|
|
Service Code
|
NDC 09900001017
|
| Hospital Charge Code |
200053
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.72 |
| Max. Negotiated Rate |
$48.53 |
| Rate for Payer: Aetna American Axle |
$35.05
|
| Rate for Payer: Aetna Commercial |
$45.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.05
|
| Rate for Payer: Cash Price |
$43.14
|
| Rate for Payer: Cofinity Commercial |
$37.74
|
| Rate for Payer: Cofinity Commercial |
$46.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.14
|
| Rate for Payer: Healthscope Commercial |
$48.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.83
|
| Rate for Payer: PHP Commercial |
$45.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.05
|
| Rate for Payer: Priority Health SBD |
$33.97
|
| Rate for Payer: UMR Bronson Commercial |
$23.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.44
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20% NEONATAL SYRINGE
|
Facility
|
IP
|
$107.83
|
|
|
Service Code
|
NDC 09900001019
|
| Hospital Charge Code |
200053
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.45 |
| Max. Negotiated Rate |
$97.05 |
| Rate for Payer: Aetna American Axle |
$70.09
|
| Rate for Payer: Aetna Commercial |
$91.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.09
|
| Rate for Payer: Cash Price |
$86.26
|
| Rate for Payer: Cofinity Commercial |
$75.48
|
| Rate for Payer: Cofinity Commercial |
$92.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.26
|
| Rate for Payer: Healthscope Commercial |
$97.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.66
|
| Rate for Payer: PHP Commercial |
$91.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.09
|
| Rate for Payer: Priority Health SBD |
$67.93
|
| Rate for Payer: UMR Bronson Commercial |
$47.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.87
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20% NEONATAL SYRINGE
|
Facility
|
IP
|
$59.09
|
|
|
Service Code
|
NDC 09900001016
|
| Hospital Charge Code |
200053
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$53.18 |
| Rate for Payer: Aetna American Axle |
$38.41
|
| Rate for Payer: Aetna Commercial |
$50.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.41
|
| Rate for Payer: Cash Price |
$47.27
|
| Rate for Payer: Cofinity Commercial |
$41.36
|
| Rate for Payer: Cofinity Commercial |
$50.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.27
|
| Rate for Payer: Healthscope Commercial |
$53.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.23
|
| Rate for Payer: PHP Commercial |
$50.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.41
|
| Rate for Payer: Priority Health SBD |
$37.23
|
| Rate for Payer: UMR Bronson Commercial |
$26.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.32
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20% NEONATAL SYRINGE
|
Facility
|
OP
|
$53.92
|
|
|
Service Code
|
NDC 09900001017
|
| Hospital Charge Code |
200053
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.95 |
| Max. Negotiated Rate |
$48.53 |
| Rate for Payer: Aetna American Axle |
$35.05
|
| Rate for Payer: Aetna Commercial |
$45.83
|
| Rate for Payer: Aetna Medicare |
$26.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.05
|
| Rate for Payer: BCBS Complete |
$21.57
|
| Rate for Payer: Cash Price |
$43.14
|
| Rate for Payer: Cofinity Commercial |
$37.74
|
| Rate for Payer: Cofinity Commercial |
$46.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.14
|
| Rate for Payer: Healthscope Commercial |
$48.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.83
|
| Rate for Payer: PHP Commercial |
$45.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.05
|
| Rate for Payer: Priority Health SBD |
$33.97
|
| Rate for Payer: UMR Bronson Commercial |
$19.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.44
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20% NEONATAL SYRINGE
|
Facility
|
OP
|
$93.09
|
|
|
Service Code
|
NDC 09900001021
|
| Hospital Charge Code |
200053
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.44 |
| Max. Negotiated Rate |
$83.78 |
| Rate for Payer: Aetna American Axle |
$60.51
|
| Rate for Payer: Aetna Commercial |
$79.13
|
| Rate for Payer: Aetna Medicare |
$46.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.51
|
| Rate for Payer: BCBS Complete |
$37.24
|
| Rate for Payer: Cash Price |
$74.47
|
| Rate for Payer: Cofinity Commercial |
$65.16
|
| Rate for Payer: Cofinity Commercial |
$80.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.47
|
| Rate for Payer: Healthscope Commercial |
$83.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.13
|
| Rate for Payer: PHP Commercial |
$79.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.51
|
| Rate for Payer: Priority Health SBD |
$58.65
|
| Rate for Payer: UMR Bronson Commercial |
$34.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.82
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20% NEONATAL SYRINGE
|
Facility
|
IP
|
$77.58
|
|
|
Service Code
|
NDC 09900001020
|
| Hospital Charge Code |
200053
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.14 |
| Max. Negotiated Rate |
$69.82 |
| Rate for Payer: Cofinity Commercial |
$54.31
|
| Rate for Payer: Cofinity Commercial |
$66.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.31
|
| Rate for Payer: Aetna American Axle |
$50.43
|
| Rate for Payer: Aetna Commercial |
$65.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.43
|
| Rate for Payer: Cash Price |
$62.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.06
|
| Rate for Payer: Healthscope Commercial |
$69.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.94
|
| Rate for Payer: PHP Commercial |
$65.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.43
|
| Rate for Payer: Priority Health SBD |
$48.88
|
| Rate for Payer: UMR Bronson Commercial |
$34.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.18
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20% NEONATAL SYRINGE
|
Facility
|
OP
|
$59.09
|
|
|
Service Code
|
NDC 09900001016
|
| Hospital Charge Code |
200053
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.86 |
| Max. Negotiated Rate |
$53.18 |
| Rate for Payer: Aetna American Axle |
$38.41
|
| Rate for Payer: Aetna Commercial |
$50.23
|
| Rate for Payer: Aetna Medicare |
$29.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.41
|
| Rate for Payer: BCBS Complete |
$23.64
|
| Rate for Payer: Cash Price |
$47.27
|
| Rate for Payer: Cofinity Commercial |
$41.36
|
| Rate for Payer: Cofinity Commercial |
$50.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.27
|
| Rate for Payer: Healthscope Commercial |
$53.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.23
|
| Rate for Payer: PHP Commercial |
$50.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.41
|
| Rate for Payer: Priority Health SBD |
$37.23
|
| Rate for Payer: UMR Bronson Commercial |
$21.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.32
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20% NEONATAL SYRINGE
|
Facility
|
OP
|
$107.83
|
|
|
Service Code
|
NDC 09900001019
|
| Hospital Charge Code |
200053
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$39.90 |
| Max. Negotiated Rate |
$97.05 |
| Rate for Payer: Aetna American Axle |
$70.09
|
| Rate for Payer: Aetna Commercial |
$91.66
|
| Rate for Payer: Aetna Medicare |
$53.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.09
|
| Rate for Payer: BCBS Complete |
$43.13
|
| Rate for Payer: Cash Price |
$86.26
|
| Rate for Payer: Cofinity Commercial |
$75.48
|
| Rate for Payer: Cofinity Commercial |
$92.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.26
|
| Rate for Payer: Healthscope Commercial |
$97.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.66
|
| Rate for Payer: PHP Commercial |
$91.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.09
|
| Rate for Payer: Priority Health SBD |
$67.93
|
| Rate for Payer: UMR Bronson Commercial |
$39.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.87
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20% NEONATAL SYRINGE
|
Facility
|
OP
|
$77.58
|
|
|
Service Code
|
NDC 09900001020
|
| Hospital Charge Code |
200053
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.70 |
| Max. Negotiated Rate |
$69.82 |
| Rate for Payer: Aetna American Axle |
$50.43
|
| Rate for Payer: Aetna Commercial |
$65.94
|
| Rate for Payer: Aetna Medicare |
$38.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.43
|
| Rate for Payer: BCBS Complete |
$31.03
|
| Rate for Payer: Cash Price |
$62.06
|
| Rate for Payer: Cofinity Commercial |
$54.31
|
| Rate for Payer: Cofinity Commercial |
$66.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.06
|
| Rate for Payer: Healthscope Commercial |
$69.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.94
|
| Rate for Payer: PHP Commercial |
$65.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.43
|
| Rate for Payer: Priority Health SBD |
$48.88
|
| Rate for Payer: UMR Bronson Commercial |
$28.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.18
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20% NEONATAL SYRINGE
|
Facility
|
OP
|
$80.87
|
|
|
Service Code
|
NDC 09900001018
|
| Hospital Charge Code |
200053
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.92 |
| Max. Negotiated Rate |
$72.78 |
| Rate for Payer: Aetna American Axle |
$52.57
|
| Rate for Payer: Aetna Commercial |
$68.74
|
| Rate for Payer: Aetna Medicare |
$40.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.57
|
| Rate for Payer: BCBS Complete |
$32.35
|
| Rate for Payer: Cash Price |
$64.70
|
| Rate for Payer: Cofinity Commercial |
$56.61
|
| Rate for Payer: Cofinity Commercial |
$69.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.70
|
| Rate for Payer: Healthscope Commercial |
$72.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.74
|
| Rate for Payer: PHP Commercial |
$68.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.57
|
| Rate for Payer: Priority Health SBD |
$50.95
|
| Rate for Payer: UMR Bronson Commercial |
$29.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.65
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20% NEONATAL SYRINGE
|
Facility
|
OP
|
$53.32
|
|
|
Service Code
|
NDC 09900001015
|
| Hospital Charge Code |
200053
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$47.99 |
| Rate for Payer: Aetna American Axle |
$34.66
|
| Rate for Payer: Aetna Commercial |
$45.32
|
| Rate for Payer: Aetna Medicare |
$26.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.66
|
| Rate for Payer: BCBS Complete |
$21.33
|
| Rate for Payer: Cash Price |
$42.66
|
| Rate for Payer: Cofinity Commercial |
$37.32
|
| Rate for Payer: Cofinity Commercial |
$45.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.66
|
| Rate for Payer: Healthscope Commercial |
$47.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.32
|
| Rate for Payer: PHP Commercial |
$45.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.66
|
| Rate for Payer: Priority Health SBD |
$33.59
|
| Rate for Payer: UMR Bronson Commercial |
$19.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.99
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20% NEONATAL SYRINGE
|
Facility
|
IP
|
$80.87
|
|
|
Service Code
|
NDC 09900001018
|
| Hospital Charge Code |
200053
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.58 |
| Max. Negotiated Rate |
$72.78 |
| Rate for Payer: Aetna American Axle |
$52.57
|
| Rate for Payer: Aetna Commercial |
$68.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.57
|
| Rate for Payer: Cash Price |
$64.70
|
| Rate for Payer: Cofinity Commercial |
$56.61
|
| Rate for Payer: Cofinity Commercial |
$69.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.70
|
| Rate for Payer: Healthscope Commercial |
$72.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.74
|
| Rate for Payer: PHP Commercial |
$68.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.57
|
| Rate for Payer: Priority Health SBD |
$50.95
|
| Rate for Payer: UMR Bronson Commercial |
$35.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.65
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20% NEONATAL SYRINGE
|
Facility
|
IP
|
$53.32
|
|
|
Service Code
|
NDC 09900001015
|
| Hospital Charge Code |
200053
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.46 |
| Max. Negotiated Rate |
$47.99 |
| Rate for Payer: Aetna American Axle |
$34.66
|
| Rate for Payer: Aetna Commercial |
$45.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.66
|
| Rate for Payer: Cash Price |
$42.66
|
| Rate for Payer: Cofinity Commercial |
$37.32
|
| Rate for Payer: Cofinity Commercial |
$45.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.66
|
| Rate for Payer: Healthscope Commercial |
$47.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.32
|
| Rate for Payer: PHP Commercial |
$45.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.66
|
| Rate for Payer: Priority Health SBD |
$33.59
|
| Rate for Payer: UMR Bronson Commercial |
$23.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.99
|
|
|
FATTY ACID NO.6-FISH OIL-GLYCERIN-PHOSPHOLIPIDS, EGG 10 % IV EMULSION
|
Facility
|
OP
|
$26.10
|
|
|
Service Code
|
HCPCS B4187
|
| Hospital Charge Code |
188923
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.66 |
| Max. Negotiated Rate |
$320.11 |
| Rate for Payer: Aetna American Axle |
$16.96
|
| Rate for Payer: Aetna American Axle |
$101.79
|
| Rate for Payer: Aetna American Axle |
$8.48
|
| Rate for Payer: Aetna American Axle |
$169.65
|
| Rate for Payer: Aetna American Axle |
$67.86
|
| Rate for Payer: Aetna American Axle |
$33.93
|
| Rate for Payer: Aetna American Axle |
$118.30
|
| Rate for Payer: Aetna American Axle |
$50.90
|
| Rate for Payer: Aetna American Axle |
$84.82
|
| Rate for Payer: Aetna Commercial |
$44.37
|
| Rate for Payer: Aetna Commercial |
$22.18
|
| Rate for Payer: Aetna Commercial |
$88.74
|
| Rate for Payer: Aetna Commercial |
$110.92
|
| Rate for Payer: Aetna Commercial |
$11.09
|
| Rate for Payer: Aetna Commercial |
$221.85
|
| Rate for Payer: Aetna Commercial |
$66.56
|
| Rate for Payer: Aetna Commercial |
$154.70
|
| Rate for Payer: Aetna Commercial |
$133.11
|
| Rate for Payer: Aetna Medicare |
$39.15
|
| Rate for Payer: Aetna Medicare |
$26.10
|
| Rate for Payer: Aetna Medicare |
$78.30
|
| Rate for Payer: Aetna Medicare |
$52.20
|
| Rate for Payer: Aetna Medicare |
$65.25
|
| Rate for Payer: Aetna Medicare |
$6.52
|
| Rate for Payer: Aetna Medicare |
$91.00
|
| Rate for Payer: Aetna Medicare |
$13.05
|
| Rate for Payer: Aetna Medicare |
$130.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.90
|
| Rate for Payer: BCBS Complete |
$62.64
|
| Rate for Payer: BCBS Complete |
$41.76
|
| Rate for Payer: BCBS Complete |
$52.20
|
| Rate for Payer: BCBS Complete |
$5.22
|
| Rate for Payer: BCBS Complete |
$31.32
|
| Rate for Payer: BCBS Complete |
$20.88
|
| Rate for Payer: BCBS Complete |
$104.40
|
| Rate for Payer: BCBS Complete |
$10.44
|
| Rate for Payer: BCBS Complete |
$72.80
|
| Rate for Payer: BCBS Trust/PPO |
$320.11
|
| Rate for Payer: BCBS Trust/PPO |
$320.11
|
| Rate for Payer: BCBS Trust/PPO |
$320.11
|
| Rate for Payer: BCBS Trust/PPO |
$320.11
|
| Rate for Payer: BCBS Trust/PPO |
$320.11
|
| Rate for Payer: BCBS Trust/PPO |
$320.11
|
| Rate for Payer: BCBS Trust/PPO |
$320.11
|
| Rate for Payer: BCBS Trust/PPO |
$320.11
|
| Rate for Payer: BCBS Trust/PPO |
$320.11
|
| Rate for Payer: BCN Commercial |
$320.11
|
| Rate for Payer: BCN Commercial |
$320.11
|
| Rate for Payer: BCN Commercial |
$320.11
|
| Rate for Payer: BCN Commercial |
$320.11
|
| Rate for Payer: BCN Commercial |
$320.11
|
| Rate for Payer: BCN Commercial |
$320.11
|
| Rate for Payer: BCN Commercial |
$320.11
|
| Rate for Payer: BCN Commercial |
$320.11
|
| Rate for Payer: BCN Commercial |
$320.11
|
| Rate for Payer: Cash Price |
$41.76
|
| Rate for Payer: Cash Price |
$83.52
|
| Rate for Payer: Cash Price |
$41.76
|
| Rate for Payer: Cash Price |
$20.88
|
| Rate for Payer: Cash Price |
$62.64
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$125.28
|
| Rate for Payer: Cash Price |
$10.44
|
| Rate for Payer: Cash Price |
$83.52
|
| Rate for Payer: Cash Price |
$62.64
|
| Rate for Payer: Cash Price |
$125.28
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$10.44
|
| Rate for Payer: Cash Price |
$20.88
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cofinity Commercial |
$9.14
|
| Rate for Payer: Cofinity Commercial |
$73.08
|
| Rate for Payer: Cofinity Commercial |
$91.35
|
| Rate for Payer: Cofinity Commercial |
$11.22
|
| Rate for Payer: Cofinity Commercial |
$112.23
|
| Rate for Payer: Cofinity Commercial |
$89.78
|
| Rate for Payer: Cofinity Commercial |
$109.62
|
| Rate for Payer: Cofinity Commercial |
$134.68
|
| Rate for Payer: Cofinity Commercial |
$127.40
|
| Rate for Payer: Cofinity Commercial |
$156.52
|
| Rate for Payer: Cofinity Commercial |
$18.27
|
| Rate for Payer: Cofinity Commercial |
$22.45
|
| Rate for Payer: Cofinity Commercial |
$182.70
|
| Rate for Payer: Cofinity Commercial |
$224.46
|
| Rate for Payer: Cofinity Commercial |
$36.54
|
| Rate for Payer: Cofinity Commercial |
$44.89
|
| Rate for Payer: Cofinity Commercial |
$54.81
|
| Rate for Payer: Cofinity Commercial |
$67.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$127.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$182.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$91.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.76
|
| Rate for Payer: Healthscope Commercial |
$93.96
|
| Rate for Payer: Healthscope Commercial |
$140.94
|
| Rate for Payer: Healthscope Commercial |
$70.47
|
| Rate for Payer: Healthscope Commercial |
$163.80
|
| Rate for Payer: Healthscope Commercial |
$46.98
|
| Rate for Payer: Healthscope Commercial |
$23.49
|
| Rate for Payer: Healthscope Commercial |
$234.90
|
| Rate for Payer: Healthscope Commercial |
$11.74
|
| Rate for Payer: Healthscope Commercial |
$117.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.85
|
| Rate for Payer: PHP Commercial |
$133.11
|
| Rate for Payer: PHP Commercial |
$221.85
|
| Rate for Payer: PHP Commercial |
$66.56
|
| Rate for Payer: PHP Commercial |
$22.18
|
| Rate for Payer: PHP Commercial |
$154.70
|
| Rate for Payer: PHP Commercial |
$110.92
|
| Rate for Payer: PHP Commercial |
$88.74
|
| Rate for Payer: PHP Commercial |
$44.37
|
| Rate for Payer: PHP Commercial |
$11.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.29
|
| Rate for Payer: Priority Health Narrow Network |
$13.03
|
| Rate for Payer: Priority Health Narrow Network |
$13.03
|
| Rate for Payer: Priority Health Narrow Network |
$13.03
|
| Rate for Payer: Priority Health Narrow Network |
$13.03
|
| Rate for Payer: Priority Health Narrow Network |
$13.03
|
| Rate for Payer: Priority Health Narrow Network |
$13.03
|
| Rate for Payer: Priority Health Narrow Network |
$13.03
|
| Rate for Payer: Priority Health Narrow Network |
$13.03
|
| Rate for Payer: Priority Health Narrow Network |
$13.03
|
| Rate for Payer: Priority Health SBD |
$49.33
|
| Rate for Payer: Priority Health SBD |
$164.43
|
| Rate for Payer: Priority Health SBD |
$8.22
|
| Rate for Payer: Priority Health SBD |
$32.89
|
| Rate for Payer: Priority Health SBD |
$16.44
|
| Rate for Payer: Priority Health SBD |
$65.77
|
| Rate for Payer: Priority Health SBD |
$114.66
|
| Rate for Payer: Priority Health SBD |
$82.22
|
| Rate for Payer: Priority Health SBD |
$98.66
|
| Rate for Payer: UMR Bronson Commercial |
$28.97
|
| Rate for Payer: UMR Bronson Commercial |
$96.57
|
| Rate for Payer: UMR Bronson Commercial |
$48.28
|
| Rate for Payer: UMR Bronson Commercial |
$38.63
|
| Rate for Payer: UMR Bronson Commercial |
$9.66
|
| Rate for Payer: UMR Bronson Commercial |
$57.94
|
| Rate for Payer: UMR Bronson Commercial |
$19.31
|
| Rate for Payer: UMR Bronson Commercial |
$67.34
|
| Rate for Payer: UMR Bronson Commercial |
$4.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.15
|
|
|
FATTY ACID NO.6-FISH OIL-GLYCERIN-PHOSPHOLIPIDS, EGG 10 % IV EMULSION
|
Facility
|
IP
|
$156.60
|
|
|
Service Code
|
HCPCS B4187
|
| Hospital Charge Code |
188923
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.90 |
| Max. Negotiated Rate |
$140.94 |
| Rate for Payer: Aetna American Axle |
$101.79
|
| Rate for Payer: Aetna American Axle |
$50.90
|
| Rate for Payer: Aetna American Axle |
$84.82
|
| Rate for Payer: Aetna American Axle |
$33.93
|
| Rate for Payer: Aetna American Axle |
$118.30
|
| Rate for Payer: Aetna American Axle |
$169.65
|
| Rate for Payer: Aetna American Axle |
$16.96
|
| Rate for Payer: Aetna American Axle |
$67.86
|
| Rate for Payer: Aetna American Axle |
$8.48
|
| Rate for Payer: Aetna Commercial |
$66.56
|
| Rate for Payer: Aetna Commercial |
$11.09
|
| Rate for Payer: Aetna Commercial |
$88.74
|
| Rate for Payer: Aetna Commercial |
$110.92
|
| Rate for Payer: Aetna Commercial |
$44.37
|
| Rate for Payer: Aetna Commercial |
$22.18
|
| Rate for Payer: Aetna Commercial |
$154.70
|
| Rate for Payer: Aetna Commercial |
$133.11
|
| Rate for Payer: Aetna Commercial |
$221.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.30
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$125.28
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$41.76
|
| Rate for Payer: Cash Price |
$83.52
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cash Price |
$10.44
|
| Rate for Payer: Cash Price |
$20.88
|
| Rate for Payer: Cash Price |
$62.64
|
| Rate for Payer: Cofinity Commercial |
$91.35
|
| Rate for Payer: Cofinity Commercial |
$73.08
|
| Rate for Payer: Cofinity Commercial |
$134.68
|
| Rate for Payer: Cofinity Commercial |
$109.62
|
| Rate for Payer: Cofinity Commercial |
$112.23
|
| Rate for Payer: Cofinity Commercial |
$11.22
|
| Rate for Payer: Cofinity Commercial |
$9.14
|
| Rate for Payer: Cofinity Commercial |
$22.45
|
| Rate for Payer: Cofinity Commercial |
$89.78
|
| Rate for Payer: Cofinity Commercial |
$67.34
|
| Rate for Payer: Cofinity Commercial |
$54.81
|
| Rate for Payer: Cofinity Commercial |
$44.89
|
| Rate for Payer: Cofinity Commercial |
$36.54
|
| Rate for Payer: Cofinity Commercial |
$127.40
|
| Rate for Payer: Cofinity Commercial |
$156.52
|
| Rate for Payer: Cofinity Commercial |
$224.46
|
| Rate for Payer: Cofinity Commercial |
$182.70
|
| Rate for Payer: Cofinity Commercial |
$18.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$182.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$127.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$91.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.28
|
| Rate for Payer: Healthscope Commercial |
$117.45
|
| Rate for Payer: Healthscope Commercial |
$234.90
|
| Rate for Payer: Healthscope Commercial |
$70.47
|
| Rate for Payer: Healthscope Commercial |
$93.96
|
| Rate for Payer: Healthscope Commercial |
$23.49
|
| Rate for Payer: Healthscope Commercial |
$163.80
|
| Rate for Payer: Healthscope Commercial |
$46.98
|
| Rate for Payer: Healthscope Commercial |
$140.94
|
| Rate for Payer: Healthscope Commercial |
$11.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.18
|
| Rate for Payer: PHP Commercial |
$154.70
|
| Rate for Payer: PHP Commercial |
$44.37
|
| Rate for Payer: PHP Commercial |
$66.56
|
| Rate for Payer: PHP Commercial |
$22.18
|
| Rate for Payer: PHP Commercial |
$221.85
|
| Rate for Payer: PHP Commercial |
$110.92
|
| Rate for Payer: PHP Commercial |
$133.11
|
| Rate for Payer: PHP Commercial |
$88.74
|
| Rate for Payer: PHP Commercial |
$11.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.90
|
| Rate for Payer: Priority Health SBD |
$65.77
|
| Rate for Payer: Priority Health SBD |
$114.66
|
| Rate for Payer: Priority Health SBD |
$98.66
|
| Rate for Payer: Priority Health SBD |
$49.33
|
| Rate for Payer: Priority Health SBD |
$164.43
|
| Rate for Payer: Priority Health SBD |
$82.22
|
| Rate for Payer: Priority Health SBD |
$8.22
|
| Rate for Payer: Priority Health SBD |
$16.44
|
| Rate for Payer: Priority Health SBD |
$32.89
|
| Rate for Payer: UMR Bronson Commercial |
$11.48
|
| Rate for Payer: UMR Bronson Commercial |
$22.97
|
| Rate for Payer: UMR Bronson Commercial |
$34.45
|
| Rate for Payer: UMR Bronson Commercial |
$5.74
|
| Rate for Payer: UMR Bronson Commercial |
$57.42
|
| Rate for Payer: UMR Bronson Commercial |
$45.94
|
| Rate for Payer: UMR Bronson Commercial |
$114.84
|
| Rate for Payer: UMR Bronson Commercial |
$68.90
|
| Rate for Payer: UMR Bronson Commercial |
$80.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.75
|
|
|
FEBUXOSTAT 40 MG TABLET
|
Facility
|
IP
|
$1,135.65
|
|
|
Service Code
|
NDC 64764091830
|
| Hospital Charge Code |
97133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$499.69 |
| Max. Negotiated Rate |
$1,022.08 |
| Rate for Payer: Aetna American Axle |
$738.17
|
| Rate for Payer: Aetna Commercial |
$965.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$738.17
|
| Rate for Payer: Cash Price |
$908.52
|
| Rate for Payer: Cofinity Commercial |
$794.96
|
| Rate for Payer: Cofinity Commercial |
$976.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$794.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$908.52
|
| Rate for Payer: Healthscope Commercial |
$1,022.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$794.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$851.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$965.30
|
| Rate for Payer: PHP Commercial |
$965.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$738.17
|
| Rate for Payer: Priority Health SBD |
$715.46
|
| Rate for Payer: UMR Bronson Commercial |
$499.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$851.74
|
|
|
FEBUXOSTAT 40 MG TABLET
|
Facility
|
OP
|
$137.94
|
|
|
Service Code
|
NDC 00527224432
|
| Hospital Charge Code |
97133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.04 |
| Max. Negotiated Rate |
$124.15 |
| Rate for Payer: Aetna American Axle |
$89.66
|
| Rate for Payer: Aetna Commercial |
$117.25
|
| Rate for Payer: Aetna Medicare |
$68.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.66
|
| Rate for Payer: BCBS Complete |
$55.18
|
| Rate for Payer: Cash Price |
$110.35
|
| Rate for Payer: Cofinity Commercial |
$118.63
|
| Rate for Payer: Cofinity Commercial |
$96.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$96.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.35
|
| Rate for Payer: Healthscope Commercial |
$124.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.25
|
| Rate for Payer: PHP Commercial |
$117.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.66
|
| Rate for Payer: Priority Health SBD |
$86.90
|
| Rate for Payer: UMR Bronson Commercial |
$51.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.46
|
|
|
FEBUXOSTAT 40 MG TABLET
|
Facility
|
IP
|
$137.94
|
|
|
Service Code
|
NDC 00527224432
|
| Hospital Charge Code |
97133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.69 |
| Max. Negotiated Rate |
$124.15 |
| Rate for Payer: Aetna American Axle |
$89.66
|
| Rate for Payer: Aetna Commercial |
$117.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.66
|
| Rate for Payer: Cash Price |
$110.35
|
| Rate for Payer: Cofinity Commercial |
$118.63
|
| Rate for Payer: Cofinity Commercial |
$96.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$96.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.35
|
| Rate for Payer: Healthscope Commercial |
$124.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.25
|
| Rate for Payer: PHP Commercial |
$117.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.66
|
| Rate for Payer: Priority Health SBD |
$86.90
|
| Rate for Payer: UMR Bronson Commercial |
$60.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.46
|
|
|
FEBUXOSTAT 40 MG TABLET
|
Facility
|
OP
|
$1,135.65
|
|
|
Service Code
|
NDC 64764091830
|
| Hospital Charge Code |
97133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$420.19 |
| Max. Negotiated Rate |
$1,022.08 |
| Rate for Payer: Aetna American Axle |
$738.17
|
| Rate for Payer: Aetna Commercial |
$965.30
|
| Rate for Payer: Aetna Medicare |
$567.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$738.17
|
| Rate for Payer: BCBS Complete |
$454.26
|
| Rate for Payer: Cash Price |
$908.52
|
| Rate for Payer: Cofinity Commercial |
$794.96
|
| Rate for Payer: Cofinity Commercial |
$976.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$794.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$908.52
|
| Rate for Payer: Healthscope Commercial |
$1,022.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$794.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$851.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$965.30
|
| Rate for Payer: PHP Commercial |
$965.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$738.17
|
| Rate for Payer: Priority Health SBD |
$715.46
|
| Rate for Payer: UMR Bronson Commercial |
$420.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$851.74
|
|
|
FECAL MICROBIOTA PRODUCT
|
Facility
|
OP
|
$2,499.70
|
|
|
Service Code
|
NDC 09900001129
|
| Hospital Charge Code |
300149
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$924.89 |
| Max. Negotiated Rate |
$2,249.73 |
| Rate for Payer: Aetna American Axle |
$1,624.80
|
| Rate for Payer: Aetna Commercial |
$2,124.74
|
| Rate for Payer: Aetna Medicare |
$1,249.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,624.80
|
| Rate for Payer: BCBS Complete |
$999.88
|
| Rate for Payer: Cash Price |
$1,999.76
|
| Rate for Payer: Cofinity Commercial |
$1,749.79
|
| Rate for Payer: Cofinity Commercial |
$2,149.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,749.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,999.76
|
| Rate for Payer: Healthscope Commercial |
$2,249.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,749.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,874.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,124.74
|
| Rate for Payer: PHP Commercial |
$2,124.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,624.80
|
| Rate for Payer: Priority Health SBD |
$1,574.81
|
| Rate for Payer: UMR Bronson Commercial |
$924.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,874.78
|
|
|
FECAL MICROBIOTA PRODUCT
|
Facility
|
IP
|
$2,499.70
|
|
|
Service Code
|
NDC 09900001129
|
| Hospital Charge Code |
300149
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,099.87 |
| Max. Negotiated Rate |
$2,249.73 |
| Rate for Payer: Aetna American Axle |
$1,624.80
|
| Rate for Payer: Aetna Commercial |
$2,124.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,624.80
|
| Rate for Payer: Cash Price |
$1,999.76
|
| Rate for Payer: Cofinity Commercial |
$1,749.79
|
| Rate for Payer: Cofinity Commercial |
$2,149.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,749.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,999.76
|
| Rate for Payer: Healthscope Commercial |
$2,249.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,749.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,874.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,124.74
|
| Rate for Payer: PHP Commercial |
$2,124.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,624.80
|
| Rate for Payer: Priority Health SBD |
$1,574.81
|
| Rate for Payer: UMR Bronson Commercial |
$1,099.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,874.78
|
|
