|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$30.67
|
|
|
Service Code
|
NDC 63323042405
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.49 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Aetna American Axle |
$19.94
|
| Rate for Payer: Aetna Commercial |
$26.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.94
|
| Rate for Payer: Cash Price |
$24.54
|
| Rate for Payer: Cofinity Commercial |
$21.47
|
| Rate for Payer: Cofinity Commercial |
$26.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.54
|
| Rate for Payer: Healthscope Commercial |
$27.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.07
|
| Rate for Payer: PHP Commercial |
$26.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.94
|
| Rate for Payer: Priority Health SBD |
$19.32
|
| Rate for Payer: UMR Bronson Commercial |
$13.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.00
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$22.83
|
|
|
Service Code
|
NDC 36000014801
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$20.55 |
| Rate for Payer: Aetna American Axle |
$14.84
|
| Rate for Payer: Aetna Commercial |
$19.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.84
|
| Rate for Payer: Cash Price |
$18.26
|
| Rate for Payer: Cofinity Commercial |
$15.98
|
| Rate for Payer: Cofinity Commercial |
$19.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.26
|
| Rate for Payer: Healthscope Commercial |
$20.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.41
|
| Rate for Payer: PHP Commercial |
$19.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.84
|
| Rate for Payer: Priority Health SBD |
$14.38
|
| Rate for Payer: UMR Bronson Commercial |
$10.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.12
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$22.83
|
|
|
Service Code
|
NDC 36000014810
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$20.55 |
| Rate for Payer: Aetna American Axle |
$14.84
|
| Rate for Payer: Aetna Commercial |
$19.41
|
| Rate for Payer: Aetna Medicare |
$11.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.84
|
| Rate for Payer: BCBS Complete |
$9.13
|
| Rate for Payer: Cash Price |
$18.26
|
| Rate for Payer: Cofinity Commercial |
$15.98
|
| Rate for Payer: Cofinity Commercial |
$19.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.26
|
| Rate for Payer: Healthscope Commercial |
$20.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.41
|
| Rate for Payer: PHP Commercial |
$19.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.84
|
| Rate for Payer: Priority Health SBD |
$14.38
|
| Rate for Payer: UMR Bronson Commercial |
$8.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.12
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.50
|
|
|
Service Code
|
NDC 00143978401
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.84 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna American Axle |
$12.02
|
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna Medicare |
$9.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.02
|
| Rate for Payer: BCBS Complete |
$7.40
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$12.95
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.02
|
| Rate for Payer: Priority Health SBD |
$11.66
|
| Rate for Payer: UMR Bronson Commercial |
$6.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.88
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$22.83
|
|
|
Service Code
|
NDC 36000014810
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$20.55 |
| Rate for Payer: Aetna American Axle |
$14.84
|
| Rate for Payer: Aetna Commercial |
$19.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.84
|
| Rate for Payer: Cash Price |
$18.26
|
| Rate for Payer: Cofinity Commercial |
$15.98
|
| Rate for Payer: Cofinity Commercial |
$19.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.26
|
| Rate for Payer: Healthscope Commercial |
$20.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.41
|
| Rate for Payer: PHP Commercial |
$19.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.84
|
| Rate for Payer: Priority Health SBD |
$14.38
|
| Rate for Payer: UMR Bronson Commercial |
$10.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.12
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.50
|
|
|
Service Code
|
NDC 00143978410
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.84 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna American Axle |
$12.02
|
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna Medicare |
$9.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.02
|
| Rate for Payer: BCBS Complete |
$7.40
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$12.95
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.02
|
| Rate for Payer: Priority Health SBD |
$11.66
|
| Rate for Payer: UMR Bronson Commercial |
$6.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.88
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.50
|
|
|
Service Code
|
NDC 00143978401
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna American Axle |
$12.02
|
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.02
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$12.95
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.02
|
| Rate for Payer: Priority Health SBD |
$11.66
|
| Rate for Payer: UMR Bronson Commercial |
$8.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.88
|
|
|
FLUMAZENIL 0.1 MG/ML IV (CODE)
|
Facility
|
IP
|
$18.50
|
|
|
Service Code
|
NDC 00143978410
|
| Hospital Charge Code |
163712
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna American Axle |
$12.02
|
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.02
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$12.95
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.02
|
| Rate for Payer: Priority Health SBD |
$11.66
|
| Rate for Payer: UMR Bronson Commercial |
$8.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.88
|
|
|
FLUMAZENIL 0.1 MG/ML IV (CODE)
|
Facility
|
OP
|
$18.50
|
|
|
Service Code
|
NDC 00143978410
|
| Hospital Charge Code |
163712
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.84 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna American Axle |
$12.02
|
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna Medicare |
$9.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.02
|
| Rate for Payer: BCBS Complete |
$7.40
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$12.95
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.02
|
| Rate for Payer: Priority Health SBD |
$11.66
|
| Rate for Payer: UMR Bronson Commercial |
$6.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.88
|
|
|
FLUORESCEIN 0.6 MG EYE STRIPS
|
Facility
|
OP
|
$571.05
|
|
|
Service Code
|
NDC 17478040303
|
| Hospital Charge Code |
27662
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$211.29 |
| Max. Negotiated Rate |
$513.94 |
| Rate for Payer: Aetna American Axle |
$371.18
|
| Rate for Payer: Aetna Commercial |
$485.39
|
| Rate for Payer: Aetna Medicare |
$285.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$371.18
|
| Rate for Payer: BCBS Complete |
$228.42
|
| Rate for Payer: Cash Price |
$456.84
|
| Rate for Payer: Cofinity Commercial |
$399.74
|
| Rate for Payer: Cofinity Commercial |
$491.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$399.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$456.84
|
| Rate for Payer: Healthscope Commercial |
$513.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$399.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$428.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$485.39
|
| Rate for Payer: PHP Commercial |
$485.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$371.18
|
| Rate for Payer: Priority Health SBD |
$359.76
|
| Rate for Payer: UMR Bronson Commercial |
$211.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$428.29
|
|
|
FLUORESCEIN 0.6 MG EYE STRIPS
|
Facility
|
IP
|
$571.05
|
|
|
Service Code
|
NDC 17478040303
|
| Hospital Charge Code |
27662
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$251.26 |
| Max. Negotiated Rate |
$513.94 |
| Rate for Payer: Aetna American Axle |
$371.18
|
| Rate for Payer: Aetna Commercial |
$485.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$371.18
|
| Rate for Payer: Cash Price |
$456.84
|
| Rate for Payer: Cofinity Commercial |
$399.74
|
| Rate for Payer: Cofinity Commercial |
$491.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$399.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$456.84
|
| Rate for Payer: Healthscope Commercial |
$513.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$399.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$428.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$485.39
|
| Rate for Payer: PHP Commercial |
$485.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$371.18
|
| Rate for Payer: Priority Health SBD |
$359.76
|
| Rate for Payer: UMR Bronson Commercial |
$251.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$428.29
|
|
|
FLUORESCEIN 1 MG EYE STRIPS
|
Facility
|
OP
|
$2.33
|
|
|
Service Code
|
NDC 17478040401
|
| Hospital Charge Code |
27663
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: Aetna American Axle |
$1.51
|
| Rate for Payer: Aetna Commercial |
$1.98
|
| Rate for Payer: Aetna Medicare |
$1.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.51
|
| Rate for Payer: BCBS Complete |
$0.93
|
| Rate for Payer: Cash Price |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$1.63
|
| Rate for Payer: Cofinity Commercial |
$2.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.86
|
| Rate for Payer: Healthscope Commercial |
$2.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.98
|
| Rate for Payer: PHP Commercial |
$1.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.51
|
| Rate for Payer: Priority Health SBD |
$1.47
|
| Rate for Payer: UMR Bronson Commercial |
$0.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.75
|
|
|
FLUORESCEIN 1 MG EYE STRIPS
|
Facility
|
IP
|
$2.33
|
|
|
Service Code
|
NDC 17478040401
|
| Hospital Charge Code |
27663
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: Aetna American Axle |
$1.51
|
| Rate for Payer: Aetna Commercial |
$1.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.51
|
| Rate for Payer: Cash Price |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$1.63
|
| Rate for Payer: Cofinity Commercial |
$2.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.86
|
| Rate for Payer: Healthscope Commercial |
$2.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.98
|
| Rate for Payer: PHP Commercial |
$1.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.51
|
| Rate for Payer: Priority Health SBD |
$1.47
|
| Rate for Payer: UMR Bronson Commercial |
$1.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.75
|
|
|
FLUORESCEIN 1 MG EYE STRIPS
|
Facility
|
IP
|
$4.59
|
|
|
Service Code
|
NDC 17238090099
|
| Hospital Charge Code |
27663
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna American Axle |
$2.98
|
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.98
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$3.21
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.98
|
| Rate for Payer: Priority Health SBD |
$2.89
|
| Rate for Payer: UMR Bronson Commercial |
$2.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.44
|
|
|
FLUORESCEIN 1 MG EYE STRIPS
|
Facility
|
OP
|
$4.59
|
|
|
Service Code
|
NDC 17238090099
|
| Hospital Charge Code |
27663
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna American Axle |
$2.98
|
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Aetna Medicare |
$2.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.98
|
| Rate for Payer: BCBS Complete |
$1.84
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$3.21
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.98
|
| Rate for Payer: Priority Health SBD |
$2.89
|
| Rate for Payer: UMR Bronson Commercial |
$1.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.44
|
|
|
FLUORESCEIN 1 MG EYE STRIPS
|
Facility
|
OP
|
$458.25
|
|
|
Service Code
|
NDC 17238090011
|
| Hospital Charge Code |
27663
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$169.55 |
| Max. Negotiated Rate |
$412.42 |
| Rate for Payer: Aetna American Axle |
$297.86
|
| Rate for Payer: Aetna Commercial |
$389.51
|
| Rate for Payer: Aetna Medicare |
$229.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.86
|
| Rate for Payer: BCBS Complete |
$183.30
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cofinity Commercial |
$320.78
|
| Rate for Payer: Cofinity Commercial |
$394.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$320.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.60
|
| Rate for Payer: Healthscope Commercial |
$412.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.51
|
| Rate for Payer: PHP Commercial |
$389.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.86
|
| Rate for Payer: Priority Health SBD |
$288.70
|
| Rate for Payer: UMR Bronson Commercial |
$169.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.69
|
|
|
FLUORESCEIN 1 MG EYE STRIPS
|
Facility
|
IP
|
$458.25
|
|
|
Service Code
|
NDC 17238090011
|
| Hospital Charge Code |
27663
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$201.63 |
| Max. Negotiated Rate |
$412.42 |
| Rate for Payer: Aetna American Axle |
$297.86
|
| Rate for Payer: Aetna Commercial |
$389.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.86
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cofinity Commercial |
$320.78
|
| Rate for Payer: Cofinity Commercial |
$394.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$320.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.60
|
| Rate for Payer: Healthscope Commercial |
$412.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.51
|
| Rate for Payer: PHP Commercial |
$389.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.86
|
| Rate for Payer: Priority Health SBD |
$288.70
|
| Rate for Payer: UMR Bronson Commercial |
$201.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.69
|
|
|
FLUORESCEIN 500 MG/5 ML (10 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$199.57
|
|
|
Service Code
|
NDC 00065009265
|
| Hospital Charge Code |
10059
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$73.84 |
| Max. Negotiated Rate |
$179.61 |
| Rate for Payer: Aetna American Axle |
$129.72
|
| Rate for Payer: Aetna Commercial |
$169.63
|
| Rate for Payer: Aetna Medicare |
$99.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.72
|
| Rate for Payer: BCBS Complete |
$79.83
|
| Rate for Payer: Cash Price |
$159.66
|
| Rate for Payer: Cofinity Commercial |
$139.70
|
| Rate for Payer: Cofinity Commercial |
$171.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.66
|
| Rate for Payer: Healthscope Commercial |
$179.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.63
|
| Rate for Payer: PHP Commercial |
$169.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.72
|
| Rate for Payer: Priority Health SBD |
$125.73
|
| Rate for Payer: UMR Bronson Commercial |
$73.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.68
|
|
|
FLUORESCEIN 500 MG/5 ML (10 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$199.57
|
|
|
Service Code
|
NDC 00065009265
|
| Hospital Charge Code |
10059
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$87.81 |
| Max. Negotiated Rate |
$179.61 |
| Rate for Payer: Aetna American Axle |
$129.72
|
| Rate for Payer: Aetna Commercial |
$169.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.72
|
| Rate for Payer: Cash Price |
$159.66
|
| Rate for Payer: Cofinity Commercial |
$139.70
|
| Rate for Payer: Cofinity Commercial |
$171.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.66
|
| Rate for Payer: Healthscope Commercial |
$179.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.63
|
| Rate for Payer: PHP Commercial |
$169.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.72
|
| Rate for Payer: Priority Health SBD |
$125.73
|
| Rate for Payer: UMR Bronson Commercial |
$87.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.68
|
|
|
FLUORIDE 0.5 MG (1.1 MG SODIUM FLUORIDE)/ML ORAL DROPS
|
Facility
|
OP
|
$149.23
|
|
|
Service Code
|
NDC 44946103208
|
| Hospital Charge Code |
11406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.22 |
| Max. Negotiated Rate |
$134.31 |
| Rate for Payer: Aetna American Axle |
$97.00
|
| Rate for Payer: Aetna Commercial |
$126.85
|
| Rate for Payer: Aetna Medicare |
$74.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.00
|
| Rate for Payer: BCBS Complete |
$59.69
|
| Rate for Payer: Cash Price |
$119.38
|
| Rate for Payer: Cofinity Commercial |
$104.46
|
| Rate for Payer: Cofinity Commercial |
$128.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.38
|
| Rate for Payer: Healthscope Commercial |
$134.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.85
|
| Rate for Payer: PHP Commercial |
$126.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.00
|
| Rate for Payer: Priority Health SBD |
$94.01
|
| Rate for Payer: UMR Bronson Commercial |
$55.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.92
|
|
|
FLUORIDE 0.5 MG (1.1 MG SODIUM FLUORIDE)/ML ORAL DROPS
|
Facility
|
IP
|
$149.23
|
|
|
Service Code
|
NDC 44946103208
|
| Hospital Charge Code |
11406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.66 |
| Max. Negotiated Rate |
$134.31 |
| Rate for Payer: Aetna American Axle |
$97.00
|
| Rate for Payer: Aetna Commercial |
$126.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.00
|
| Rate for Payer: Cash Price |
$119.38
|
| Rate for Payer: Cofinity Commercial |
$104.46
|
| Rate for Payer: Cofinity Commercial |
$128.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.38
|
| Rate for Payer: Healthscope Commercial |
$134.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.85
|
| Rate for Payer: PHP Commercial |
$126.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.00
|
| Rate for Payer: Priority Health SBD |
$94.01
|
| Rate for Payer: UMR Bronson Commercial |
$65.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.92
|
|
|
FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
NDC 60758088005
|
| Hospital Charge Code |
3208
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.24 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Aetna American Axle |
$163.80
|
| Rate for Payer: Aetna Commercial |
$214.20
|
| Rate for Payer: Aetna Medicare |
$126.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.80
|
| Rate for Payer: BCBS Complete |
$100.80
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cofinity Commercial |
$176.40
|
| Rate for Payer: Cofinity Commercial |
$216.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$176.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.60
|
| Rate for Payer: Healthscope Commercial |
$226.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$176.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.20
|
| Rate for Payer: PHP Commercial |
$214.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.80
|
| Rate for Payer: Priority Health SBD |
$158.76
|
| Rate for Payer: UMR Bronson Commercial |
$93.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.00
|
|
|
FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$548.21
|
|
|
Service Code
|
NDC 11980021105
|
| Hospital Charge Code |
3208
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$202.84 |
| Max. Negotiated Rate |
$493.39 |
| Rate for Payer: Aetna American Axle |
$356.34
|
| Rate for Payer: Aetna Commercial |
$465.98
|
| Rate for Payer: Aetna Medicare |
$274.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$356.34
|
| Rate for Payer: BCBS Complete |
$219.28
|
| Rate for Payer: Cash Price |
$438.57
|
| Rate for Payer: Cofinity Commercial |
$383.75
|
| Rate for Payer: Cofinity Commercial |
$471.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$383.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$438.57
|
| Rate for Payer: Healthscope Commercial |
$493.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$383.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$411.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$465.98
|
| Rate for Payer: PHP Commercial |
$465.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$356.34
|
| Rate for Payer: Priority Health SBD |
$345.37
|
| Rate for Payer: UMR Bronson Commercial |
$202.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$411.16
|
|
|
FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$548.21
|
|
|
Service Code
|
NDC 11980021105
|
| Hospital Charge Code |
3208
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$241.21 |
| Max. Negotiated Rate |
$493.39 |
| Rate for Payer: Aetna American Axle |
$356.34
|
| Rate for Payer: Aetna Commercial |
$465.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$356.34
|
| Rate for Payer: Cash Price |
$438.57
|
| Rate for Payer: Cofinity Commercial |
$383.75
|
| Rate for Payer: Cofinity Commercial |
$471.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$383.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$438.57
|
| Rate for Payer: Healthscope Commercial |
$493.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$383.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$411.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$465.98
|
| Rate for Payer: PHP Commercial |
$465.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$356.34
|
| Rate for Payer: Priority Health SBD |
$345.37
|
| Rate for Payer: UMR Bronson Commercial |
$241.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$411.16
|
|
|
FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
NDC 60758088005
|
| Hospital Charge Code |
3208
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.88 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Aetna American Axle |
$163.80
|
| Rate for Payer: Aetna Commercial |
$214.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.80
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cofinity Commercial |
$176.40
|
| Rate for Payer: Cofinity Commercial |
$216.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$176.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.60
|
| Rate for Payer: Healthscope Commercial |
$226.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$176.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.20
|
| Rate for Payer: PHP Commercial |
$214.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.80
|
| Rate for Payer: Priority Health SBD |
$158.76
|
| Rate for Payer: UMR Bronson Commercial |
$110.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.00
|
|
