|
FERROUS SULFATE 15 MG IRON (75 MG)/ML ORAL DROPS
|
Facility
|
IP
|
$89.30
|
|
|
Service Code
|
NDC 39328005750
|
| Hospital Charge Code |
95693
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.29 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna American Axle |
$58.05
|
| Rate for Payer: Aetna Commercial |
$75.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.05
|
| Rate for Payer: Cash Price |
$71.44
|
| Rate for Payer: Cofinity Commercial |
$62.51
|
| Rate for Payer: Cofinity Commercial |
$76.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.44
|
| Rate for Payer: Healthscope Commercial |
$80.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.91
|
| Rate for Payer: PHP Commercial |
$75.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.05
|
| Rate for Payer: Priority Health SBD |
$56.26
|
| Rate for Payer: UMR Bronson Commercial |
$39.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.97
|
|
|
FERROUS SULFATE 15 MG IRON (75 MG)/ML ORAL DROPS
|
Facility
|
OP
|
$89.30
|
|
|
Service Code
|
NDC 39328005750
|
| Hospital Charge Code |
95693
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.04 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna American Axle |
$58.05
|
| Rate for Payer: Aetna Commercial |
$75.91
|
| Rate for Payer: Aetna Medicare |
$44.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.05
|
| Rate for Payer: BCBS Complete |
$35.72
|
| Rate for Payer: Cash Price |
$71.44
|
| Rate for Payer: Cofinity Commercial |
$62.51
|
| Rate for Payer: Cofinity Commercial |
$76.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.44
|
| Rate for Payer: Healthscope Commercial |
$80.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.91
|
| Rate for Payer: PHP Commercial |
$75.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.05
|
| Rate for Payer: Priority Health SBD |
$56.26
|
| Rate for Payer: UMR Bronson Commercial |
$33.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.97
|
|
|
FERROUS SULFATE 15 MG IRON (75 MG)/ML ORAL DROPS
|
Facility
|
OP
|
$91.65
|
|
|
Service Code
|
NDC 54838001150
|
| Hospital Charge Code |
95693
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.91 |
| Max. Negotiated Rate |
$82.48 |
| Rate for Payer: Aetna American Axle |
$59.57
|
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: Aetna Medicare |
$45.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.57
|
| Rate for Payer: BCBS Complete |
$36.66
|
| Rate for Payer: Cash Price |
$73.32
|
| Rate for Payer: Cofinity Commercial |
$64.16
|
| Rate for Payer: Cofinity Commercial |
$78.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.32
|
| Rate for Payer: Healthscope Commercial |
$82.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.90
|
| Rate for Payer: PHP Commercial |
$77.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.57
|
| Rate for Payer: Priority Health SBD |
$57.74
|
| Rate for Payer: UMR Bronson Commercial |
$33.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.74
|
|
|
FERROUS SULFATE 220 MG (44 MG IRON)/5 ML ORAL ELIXIR
|
Facility
|
IP
|
$73.79
|
|
|
Service Code
|
NDC 50383077816
|
| Hospital Charge Code |
179529
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.47 |
| Max. Negotiated Rate |
$66.41 |
| Rate for Payer: Aetna American Axle |
$47.96
|
| Rate for Payer: Aetna Commercial |
$62.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.96
|
| Rate for Payer: Cash Price |
$59.03
|
| Rate for Payer: Cofinity Commercial |
$51.65
|
| Rate for Payer: Cofinity Commercial |
$63.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.03
|
| Rate for Payer: Healthscope Commercial |
$66.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.72
|
| Rate for Payer: PHP Commercial |
$62.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.96
|
| Rate for Payer: Priority Health SBD |
$46.49
|
| Rate for Payer: UMR Bronson Commercial |
$32.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.34
|
|
|
FERROUS SULFATE 220 MG (44 MG IRON)/5 ML ORAL ELIXIR
|
Facility
|
OP
|
$73.79
|
|
|
Service Code
|
NDC 50383077816
|
| Hospital Charge Code |
179529
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$66.41 |
| Rate for Payer: Aetna American Axle |
$47.96
|
| Rate for Payer: Aetna Commercial |
$62.72
|
| Rate for Payer: Aetna Medicare |
$36.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.96
|
| Rate for Payer: BCBS Complete |
$29.52
|
| Rate for Payer: Cash Price |
$59.03
|
| Rate for Payer: Cofinity Commercial |
$51.65
|
| Rate for Payer: Cofinity Commercial |
$63.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.03
|
| Rate for Payer: Healthscope Commercial |
$66.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.72
|
| Rate for Payer: PHP Commercial |
$62.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.96
|
| Rate for Payer: Priority Health SBD |
$46.49
|
| Rate for Payer: UMR Bronson Commercial |
$27.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.34
|
|
|
FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID
|
Facility
|
OP
|
$10.62
|
|
|
Service Code
|
NDC 00121053005
|
| Hospital Charge Code |
3071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$9.56 |
| Rate for Payer: Aetna American Axle |
$6.90
|
| Rate for Payer: Aetna Commercial |
$9.03
|
| Rate for Payer: Aetna Medicare |
$5.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.90
|
| Rate for Payer: BCBS Complete |
$4.25
|
| Rate for Payer: Cash Price |
$8.50
|
| Rate for Payer: Cofinity Commercial |
$7.43
|
| Rate for Payer: Cofinity Commercial |
$9.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.50
|
| Rate for Payer: Healthscope Commercial |
$9.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.03
|
| Rate for Payer: PHP Commercial |
$9.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.90
|
| Rate for Payer: Priority Health SBD |
$6.69
|
| Rate for Payer: UMR Bronson Commercial |
$3.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.96
|
|
|
FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID
|
Facility
|
IP
|
$10.62
|
|
|
Service Code
|
NDC 00121053005
|
| Hospital Charge Code |
3071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.67 |
| Max. Negotiated Rate |
$9.56 |
| Rate for Payer: Aetna American Axle |
$6.90
|
| Rate for Payer: Aetna Commercial |
$9.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.90
|
| Rate for Payer: Cash Price |
$8.50
|
| Rate for Payer: Cofinity Commercial |
$7.43
|
| Rate for Payer: Cofinity Commercial |
$9.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.50
|
| Rate for Payer: Healthscope Commercial |
$9.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.03
|
| Rate for Payer: PHP Commercial |
$9.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.90
|
| Rate for Payer: Priority Health SBD |
$6.69
|
| Rate for Payer: UMR Bronson Commercial |
$4.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.96
|
|
|
FERROUS SULFATE 325 MG (65 MG IRON) TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
NDC 69367016620
|
| Hospital Charge Code |
3077
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.26 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna American Axle |
$128.70
|
| Rate for Payer: Aetna Commercial |
$168.30
|
| Rate for Payer: Aetna Medicare |
$99.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.70
|
| Rate for Payer: BCBS Complete |
$79.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cofinity Commercial |
$138.60
|
| Rate for Payer: Cofinity Commercial |
$170.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$138.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.40
|
| Rate for Payer: Healthscope Commercial |
$178.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$138.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.30
|
| Rate for Payer: PHP Commercial |
$168.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.70
|
| Rate for Payer: Priority Health SBD |
$124.74
|
| Rate for Payer: UMR Bronson Commercial |
$73.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.50
|
|
|
FERROUS SULFATE 325 MG (65 MG IRON) TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$149.80
|
|
|
Service Code
|
NDC 00245010801
|
| Hospital Charge Code |
3077
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.91 |
| Max. Negotiated Rate |
$134.82 |
| Rate for Payer: Aetna American Axle |
$97.37
|
| Rate for Payer: Aetna Commercial |
$127.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.37
|
| Rate for Payer: Cash Price |
$119.84
|
| Rate for Payer: Cofinity Commercial |
$104.86
|
| Rate for Payer: Cofinity Commercial |
$128.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.84
|
| Rate for Payer: Healthscope Commercial |
$134.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.33
|
| Rate for Payer: PHP Commercial |
$127.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.37
|
| Rate for Payer: Priority Health SBD |
$94.37
|
| Rate for Payer: UMR Bronson Commercial |
$65.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.35
|
|
|
FERROUS SULFATE 325 MG (65 MG IRON) TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$149.80
|
|
|
Service Code
|
NDC 00245010801
|
| Hospital Charge Code |
3077
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.43 |
| Max. Negotiated Rate |
$134.82 |
| Rate for Payer: Aetna American Axle |
$97.37
|
| Rate for Payer: Aetna Commercial |
$127.33
|
| Rate for Payer: Aetna Medicare |
$74.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.37
|
| Rate for Payer: BCBS Complete |
$59.92
|
| Rate for Payer: Cash Price |
$119.84
|
| Rate for Payer: Cofinity Commercial |
$104.86
|
| Rate for Payer: Cofinity Commercial |
$128.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.84
|
| Rate for Payer: Healthscope Commercial |
$134.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.33
|
| Rate for Payer: PHP Commercial |
$127.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.37
|
| Rate for Payer: Priority Health SBD |
$94.37
|
| Rate for Payer: UMR Bronson Commercial |
$55.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.35
|
|
|
FERROUS SULFATE 325 MG (65 MG IRON) TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$119.90
|
|
|
Service Code
|
NDC 00245010811
|
| Hospital Charge Code |
3077
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.36 |
| Max. Negotiated Rate |
$107.91 |
| Rate for Payer: Aetna American Axle |
$77.94
|
| Rate for Payer: Aetna Commercial |
$101.92
|
| Rate for Payer: Aetna Medicare |
$59.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.94
|
| Rate for Payer: BCBS Complete |
$47.96
|
| Rate for Payer: Cash Price |
$95.92
|
| Rate for Payer: Cofinity Commercial |
$103.11
|
| Rate for Payer: Cofinity Commercial |
$83.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$83.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.92
|
| Rate for Payer: Healthscope Commercial |
$107.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.92
|
| Rate for Payer: PHP Commercial |
$101.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.94
|
| Rate for Payer: Priority Health SBD |
$75.54
|
| Rate for Payer: UMR Bronson Commercial |
$44.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.92
|
|
|
FERROUS SULFATE 325 MG (65 MG IRON) TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$1.50
|
|
|
Service Code
|
NDC 00245010889
|
| Hospital Charge Code |
3077
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$1.35 |
| Rate for Payer: Aetna American Axle |
$0.98
|
| Rate for Payer: Aetna Commercial |
$1.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.98
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cofinity Commercial |
$1.05
|
| Rate for Payer: Cofinity Commercial |
$1.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.20
|
| Rate for Payer: Healthscope Commercial |
$1.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.27
|
| Rate for Payer: PHP Commercial |
$1.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.98
|
| Rate for Payer: Priority Health SBD |
$0.95
|
| Rate for Payer: UMR Bronson Commercial |
$0.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.12
|
|
|
FERROUS SULFATE 325 MG (65 MG IRON) TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
NDC 69367016620
|
| Hospital Charge Code |
3077
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.12 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna American Axle |
$128.70
|
| Rate for Payer: Aetna Commercial |
$168.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.70
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cofinity Commercial |
$138.60
|
| Rate for Payer: Cofinity Commercial |
$170.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$138.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.40
|
| Rate for Payer: Healthscope Commercial |
$178.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$138.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.30
|
| Rate for Payer: PHP Commercial |
$168.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.70
|
| Rate for Payer: Priority Health SBD |
$124.74
|
| Rate for Payer: UMR Bronson Commercial |
$87.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.50
|
|
|
FERROUS SULFATE 325 MG (65 MG IRON) TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$119.90
|
|
|
Service Code
|
NDC 00245010811
|
| Hospital Charge Code |
3077
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.76 |
| Max. Negotiated Rate |
$107.91 |
| Rate for Payer: Aetna American Axle |
$77.94
|
| Rate for Payer: Aetna Commercial |
$101.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.94
|
| Rate for Payer: Cash Price |
$95.92
|
| Rate for Payer: Cofinity Commercial |
$103.11
|
| Rate for Payer: Cofinity Commercial |
$83.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$83.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.92
|
| Rate for Payer: Healthscope Commercial |
$107.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.92
|
| Rate for Payer: PHP Commercial |
$101.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.94
|
| Rate for Payer: Priority Health SBD |
$75.54
|
| Rate for Payer: UMR Bronson Commercial |
$52.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.92
|
|
|
FERROUS SULFATE 325 MG (65 MG IRON) TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$1.50
|
|
|
Service Code
|
NDC 00245010889
|
| Hospital Charge Code |
3077
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$1.35 |
| Rate for Payer: Aetna American Axle |
$0.98
|
| Rate for Payer: Aetna Commercial |
$1.27
|
| Rate for Payer: Aetna Medicare |
$0.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.98
|
| Rate for Payer: BCBS Complete |
$0.60
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cofinity Commercial |
$1.05
|
| Rate for Payer: Cofinity Commercial |
$1.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.20
|
| Rate for Payer: Healthscope Commercial |
$1.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.27
|
| Rate for Payer: PHP Commercial |
$1.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.98
|
| Rate for Payer: Priority Health SBD |
$0.95
|
| Rate for Payer: UMR Bronson Commercial |
$0.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.12
|
|
|
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,000.31
|
|
|
Service Code
|
HCPCS Q0138
|
| Hospital Charge Code |
98312
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$900.28 |
| Rate for Payer: Aetna American Axle |
$650.20
|
| Rate for Payer: Aetna American Axle |
$392.83
|
| Rate for Payer: Aetna Commercial |
$850.26
|
| Rate for Payer: Aetna Commercial |
$513.70
|
| Rate for Payer: Aetna Medicare |
$0.33
|
| Rate for Payer: Aetna Medicare |
$0.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$392.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$650.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.40
|
| Rate for Payer: BCBS Complete |
$0.18
|
| Rate for Payer: BCBS Complete |
$0.18
|
| Rate for Payer: BCBS MAPPO |
$0.32
|
| Rate for Payer: BCBS MAPPO |
$0.32
|
| Rate for Payer: BCN Medicare Advantage |
$0.32
|
| Rate for Payer: BCN Medicare Advantage |
$0.32
|
| Rate for Payer: Cash Price |
$800.25
|
| Rate for Payer: Cash Price |
$800.25
|
| Rate for Payer: Cash Price |
$483.48
|
| Rate for Payer: Cash Price |
$483.48
|
| Rate for Payer: Cofinity Commercial |
$700.22
|
| Rate for Payer: Cofinity Commercial |
$860.27
|
| Rate for Payer: Cofinity Commercial |
$423.05
|
| Rate for Payer: Cofinity Commercial |
$519.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$700.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$423.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$483.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.32
|
| Rate for Payer: Healthscope Commercial |
$543.91
|
| Rate for Payer: Healthscope Commercial |
$900.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$700.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$423.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$453.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$750.23
|
| Rate for Payer: Mclaren Medicaid |
$0.17
|
| Rate for Payer: Mclaren Medicaid |
$0.17
|
| Rate for Payer: Mclaren Medicare |
$0.32
|
| Rate for Payer: Mclaren Medicare |
$0.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.34
|
| Rate for Payer: Meridian Medicaid |
$0.18
|
| Rate for Payer: Meridian Medicaid |
$0.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$513.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$850.26
|
| Rate for Payer: PACE Medicare |
$0.30
|
| Rate for Payer: PACE Medicare |
$0.30
|
| Rate for Payer: PACE SWMI |
$0.32
|
| Rate for Payer: PACE SWMI |
$0.32
|
| Rate for Payer: PHP Commercial |
$513.70
|
| Rate for Payer: PHP Commercial |
$850.26
|
| Rate for Payer: PHP Medicare Advantage |
$0.32
|
| Rate for Payer: PHP Medicare Advantage |
$0.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$392.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$650.20
|
| Rate for Payer: Priority Health Medicare |
$0.32
|
| Rate for Payer: Priority Health Medicare |
$0.32
|
| Rate for Payer: Priority Health SBD |
$380.74
|
| Rate for Payer: Priority Health SBD |
$630.20
|
| Rate for Payer: Railroad Medicare Medicare |
$0.32
|
| Rate for Payer: Railroad Medicare Medicare |
$0.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.32
|
| Rate for Payer: UHC Exchange |
$0.61
|
| Rate for Payer: UHC Exchange |
$0.61
|
| Rate for Payer: UHC Medicare Advantage |
$0.32
|
| Rate for Payer: UHC Medicare Advantage |
$0.32
|
| Rate for Payer: UHCCP Medicaid |
$0.17
|
| Rate for Payer: UHCCP Medicaid |
$0.17
|
| Rate for Payer: UMR Bronson Commercial |
$370.11
|
| Rate for Payer: UMR Bronson Commercial |
$223.61
|
| Rate for Payer: VA VA |
$0.32
|
| Rate for Payer: VA VA |
$0.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$453.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$750.23
|
|
|
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,000.31
|
|
|
Service Code
|
HCPCS Q0138
|
| Hospital Charge Code |
98312
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$440.14 |
| Max. Negotiated Rate |
$900.28 |
| Rate for Payer: Aetna American Axle |
$650.20
|
| Rate for Payer: Aetna Commercial |
$850.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$650.20
|
| Rate for Payer: Cash Price |
$800.25
|
| Rate for Payer: Cofinity Commercial |
$700.22
|
| Rate for Payer: Cofinity Commercial |
$860.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$700.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.25
|
| Rate for Payer: Healthscope Commercial |
$900.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$700.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$750.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$850.26
|
| Rate for Payer: PHP Commercial |
$850.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$650.20
|
| Rate for Payer: Priority Health SBD |
$630.20
|
| Rate for Payer: UMR Bronson Commercial |
$440.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$750.23
|
|
|
FETAL NON-STRESS TEST
|
Facility
|
OP
|
$552.28
|
|
|
Service Code
|
CPT 59025
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$105.16 |
| Max. Negotiated Rate |
$552.28 |
| Rate for Payer: Aetna Medicare |
$204.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$245.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$245.25
|
| Rate for Payer: BCBS Complete |
$110.42
|
| Rate for Payer: BCBS MAPPO |
$196.20
|
| Rate for Payer: BCN Medicare Advantage |
$196.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$196.20
|
| Rate for Payer: Mclaren Medicaid |
$105.16
|
| Rate for Payer: Mclaren Medicare |
$196.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.01
|
| Rate for Payer: Meridian Medicaid |
$110.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$225.63
|
| Rate for Payer: PACE Medicare |
$186.39
|
| Rate for Payer: PACE SWMI |
$196.20
|
| Rate for Payer: PHP Medicare Advantage |
$196.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.16
|
| Rate for Payer: Priority Health Medicare |
$196.20
|
| Rate for Payer: Railroad Medicare Medicare |
$196.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$552.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$196.20
|
| Rate for Payer: UHC Exchange |
$374.96
|
| Rate for Payer: UHC Medicare Advantage |
$196.20
|
| Rate for Payer: UHCCP Medicaid |
$105.16
|
| Rate for Payer: VA VA |
$196.20
|
|
|
FIBERSOURCE HN BOLUS FEED
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 43900018555
|
| Hospital Charge Code |
161567
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna American Axle |
$3.09
|
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna Medicare |
$2.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health SBD |
$2.99
|
| Rate for Payer: UMR Bronson Commercial |
$1.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
|
FIBERSOURCE HN BOLUS FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 43900018555
|
| Hospital Charge Code |
161567
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna American Axle |
$3.09
|
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health SBD |
$2.99
|
| Rate for Payer: UMR Bronson Commercial |
$2.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
|
FIBERSOURCE HN CONTINUOUS FEED
|
Facility
|
IP
|
$9.60
|
|
|
Service Code
|
NDC 43900018588
|
| Hospital Charge Code |
168938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna American Axle |
$6.24
|
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.24
|
| Rate for Payer: Cash Price |
$7.68
|
| Rate for Payer: Cofinity Commercial |
$6.72
|
| Rate for Payer: Cofinity Commercial |
$8.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.68
|
| Rate for Payer: Healthscope Commercial |
$8.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.16
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.24
|
| Rate for Payer: Priority Health SBD |
$6.05
|
| Rate for Payer: UMR Bronson Commercial |
$4.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.20
|
|
|
FIBERSOURCE HN CONTINUOUS FEED
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 43900018555
|
| Hospital Charge Code |
168938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna American Axle |
$3.09
|
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna Medicare |
$2.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health SBD |
$2.99
|
| Rate for Payer: UMR Bronson Commercial |
$1.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
|
FIBERSOURCE HN CONTINUOUS FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 43900018555
|
| Hospital Charge Code |
168938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna American Axle |
$3.09
|
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health SBD |
$2.99
|
| Rate for Payer: UMR Bronson Commercial |
$2.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
|
FIBERSOURCE HN CONTINUOUS FEED
|
Facility
|
OP
|
$9.60
|
|
|
Service Code
|
NDC 43900018588
|
| Hospital Charge Code |
168938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna American Axle |
$6.24
|
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Aetna Medicare |
$4.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.24
|
| Rate for Payer: BCBS Complete |
$3.84
|
| Rate for Payer: Cash Price |
$7.68
|
| Rate for Payer: Cofinity Commercial |
$6.72
|
| Rate for Payer: Cofinity Commercial |
$8.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.68
|
| Rate for Payer: Healthscope Commercial |
$8.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.16
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.24
|
| Rate for Payer: Priority Health SBD |
$6.05
|
| Rate for Payer: UMR Bronson Commercial |
$3.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.20
|
|
|
FIBERSOURCE HN CYCLIC FEED
|
Facility
|
OP
|
$9.60
|
|
|
Service Code
|
NDC 43900018588
|
| Hospital Charge Code |
200077
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna American Axle |
$6.24
|
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Aetna Medicare |
$4.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.24
|
| Rate for Payer: BCBS Complete |
$3.84
|
| Rate for Payer: Cash Price |
$7.68
|
| Rate for Payer: Cofinity Commercial |
$6.72
|
| Rate for Payer: Cofinity Commercial |
$8.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.68
|
| Rate for Payer: Healthscope Commercial |
$8.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.16
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.24
|
| Rate for Payer: Priority Health SBD |
$6.05
|
| Rate for Payer: UMR Bronson Commercial |
$3.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.20
|
|
