|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$308.81
|
|
|
Service Code
|
NDC 60687-753-21
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.88 |
| Max. Negotiated Rate |
$277.93 |
| Rate for Payer: Aetna American Axle |
$200.73
|
| Rate for Payer: Aetna Commercial |
$262.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.73
|
| Rate for Payer: Cash Price |
$247.05
|
| Rate for Payer: Cofinity Commercial |
$216.17
|
| Rate for Payer: Cofinity Commercial |
$265.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.05
|
| Rate for Payer: Healthscope Commercial |
$277.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$262.49
|
| Rate for Payer: PHP Commercial |
$262.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.17
|
| Rate for Payer: Priority Health SBD |
$194.55
|
| Rate for Payer: UMR Bronson Commercial |
$135.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.61
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$498.06
|
|
|
Service Code
|
NDC 50111-788-10
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$219.15 |
| Max. Negotiated Rate |
$448.25 |
| Rate for Payer: Aetna American Axle |
$323.74
|
| Rate for Payer: Aetna Commercial |
$423.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.74
|
| Rate for Payer: Cash Price |
$398.45
|
| Rate for Payer: Cofinity Commercial |
$348.64
|
| Rate for Payer: Cofinity Commercial |
$428.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.45
|
| Rate for Payer: Healthscope Commercial |
$448.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$348.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$373.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$423.35
|
| Rate for Payer: PHP Commercial |
$423.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.64
|
| Rate for Payer: Priority Health SBD |
$313.78
|
| Rate for Payer: UMR Bronson Commercial |
$219.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$373.54
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$8.35
|
|
|
Service Code
|
NDC 50268-099-11
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$7.52 |
| Rate for Payer: Aetna American Axle |
$5.43
|
| Rate for Payer: Aetna Commercial |
$7.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.43
|
| Rate for Payer: Cash Price |
$6.68
|
| Rate for Payer: Cofinity Commercial |
$5.84
|
| Rate for Payer: Cofinity Commercial |
$7.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.68
|
| Rate for Payer: Healthscope Commercial |
$7.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.10
|
| Rate for Payer: PHP Commercial |
$7.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.84
|
| Rate for Payer: Priority Health SBD |
$5.26
|
| Rate for Payer: UMR Bronson Commercial |
$3.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.26
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$121.25
|
|
|
Service Code
|
NDC 65862-642-30
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.35 |
| Max. Negotiated Rate |
$109.12 |
| Rate for Payer: Aetna American Axle |
$78.81
|
| Rate for Payer: Aetna Commercial |
$103.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.81
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cofinity Commercial |
$104.28
|
| Rate for Payer: Cofinity Commercial |
$84.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.00
|
| Rate for Payer: Healthscope Commercial |
$109.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$103.06
|
| Rate for Payer: PHP Commercial |
$103.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.88
|
| Rate for Payer: Priority Health SBD |
$76.39
|
| Rate for Payer: UMR Bronson Commercial |
$53.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.94
|
|
|
AZTREONAM 1 GM IVPB (INTRA-OP)
|
Facility
|
IP
|
$25.30
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
165983
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.13 |
| Max. Negotiated Rate |
$22.77 |
| Rate for Payer: Aetna American Axle |
$16.44
|
| Rate for Payer: Aetna Commercial |
$21.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.44
|
| Rate for Payer: Cash Price |
$20.24
|
| Rate for Payer: Cofinity Commercial |
$17.71
|
| Rate for Payer: Cofinity Commercial |
$21.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.24
|
| Rate for Payer: Healthscope Commercial |
$22.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.50
|
| Rate for Payer: PHP Commercial |
$21.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.71
|
| Rate for Payer: Priority Health SBD |
$15.94
|
| Rate for Payer: UMR Bronson Commercial |
$11.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.98
|
|
|
AZTREONAM 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$99.29
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
9185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$89.36 |
| Rate for Payer: Aetna American Axle |
$64.54
|
| Rate for Payer: Aetna Commercial |
$84.40
|
| Rate for Payer: Aetna Medicare |
$2.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.17
|
| Rate for Payer: BCBS Complete |
$1.46
|
| Rate for Payer: BCBS MAPPO |
$2.54
|
| Rate for Payer: BCBS Trust/PPO |
$8.18
|
| Rate for Payer: BCN Medicare Advantage |
$2.54
|
| Rate for Payer: Cash Price |
$79.43
|
| Rate for Payer: Cash Price |
$79.43
|
| Rate for Payer: Cofinity Commercial |
$69.50
|
| Rate for Payer: Cofinity Commercial |
$85.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.54
|
| Rate for Payer: Healthscope Commercial |
$89.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.47
|
| Rate for Payer: Mclaren Medicaid |
$1.39
|
| Rate for Payer: Mclaren Medicare |
$2.54
|
| Rate for Payer: Meridian Medicaid |
$1.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$84.40
|
| Rate for Payer: PACE Medicare |
$2.41
|
| Rate for Payer: PACE SWMI |
$2.54
|
| Rate for Payer: PHP Commercial |
$84.40
|
| Rate for Payer: PHP Medicare Advantage |
$2.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.39
|
| Rate for Payer: Priority Health Medicare |
$2.54
|
| Rate for Payer: Priority Health Narrow Network |
$5.91
|
| Rate for Payer: Priority Health SBD |
$62.55
|
| Rate for Payer: Railroad Medicare Medicare |
$2.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.54
|
| Rate for Payer: UHC Medicare Advantage |
$2.62
|
| Rate for Payer: UMR Bronson Commercial |
$36.74
|
| Rate for Payer: VA VA |
$2.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.47
|
|
|
AZTREONAM 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$99.29
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
9185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.69 |
| Max. Negotiated Rate |
$89.36 |
| Rate for Payer: Aetna American Axle |
$64.54
|
| Rate for Payer: Aetna American Axle |
$79.96
|
| Rate for Payer: Aetna Commercial |
$104.57
|
| Rate for Payer: Aetna Commercial |
$84.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.54
|
| Rate for Payer: Cash Price |
$79.43
|
| Rate for Payer: Cash Price |
$98.42
|
| Rate for Payer: Cofinity Commercial |
$105.80
|
| Rate for Payer: Cofinity Commercial |
$85.39
|
| Rate for Payer: Cofinity Commercial |
$69.50
|
| Rate for Payer: Cofinity Commercial |
$86.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.43
|
| Rate for Payer: Healthscope Commercial |
$89.36
|
| Rate for Payer: Healthscope Commercial |
$110.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$104.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$84.40
|
| Rate for Payer: PHP Commercial |
$104.57
|
| Rate for Payer: PHP Commercial |
$84.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.50
|
| Rate for Payer: Priority Health SBD |
$77.50
|
| Rate for Payer: Priority Health SBD |
$62.55
|
| Rate for Payer: UMR Bronson Commercial |
$43.69
|
| Rate for Payer: UMR Bronson Commercial |
$54.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.26
|
|
|
AZTREONAM 2 GM IVPB (INTRA-OP)
|
Facility
|
IP
|
$50.60
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
168909
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.26 |
| Max. Negotiated Rate |
$45.54 |
| Rate for Payer: Aetna American Axle |
$32.89
|
| Rate for Payer: Aetna Commercial |
$43.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.89
|
| Rate for Payer: Cash Price |
$40.48
|
| Rate for Payer: Cofinity Commercial |
$35.42
|
| Rate for Payer: Cofinity Commercial |
$43.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.48
|
| Rate for Payer: Healthscope Commercial |
$45.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.01
|
| Rate for Payer: PHP Commercial |
$43.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.42
|
| Rate for Payer: Priority Health SBD |
$31.88
|
| Rate for Payer: UMR Bronson Commercial |
$22.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.95
|
|
|
AZTREONAM 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$202.75
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
9186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$89.21 |
| Max. Negotiated Rate |
$182.48 |
| Rate for Payer: Aetna American Axle |
$131.79
|
| Rate for Payer: Aetna American Axle |
$127.58
|
| Rate for Payer: Aetna American Axle |
$131.81
|
| Rate for Payer: Aetna Commercial |
$172.34
|
| Rate for Payer: Aetna Commercial |
$172.37
|
| Rate for Payer: Aetna Commercial |
$166.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.81
|
| Rate for Payer: Cash Price |
$162.20
|
| Rate for Payer: Cash Price |
$157.02
|
| Rate for Payer: Cash Price |
$162.23
|
| Rate for Payer: Cofinity Commercial |
$174.36
|
| Rate for Payer: Cofinity Commercial |
$141.95
|
| Rate for Payer: Cofinity Commercial |
$174.40
|
| Rate for Payer: Cofinity Commercial |
$168.80
|
| Rate for Payer: Cofinity Commercial |
$137.40
|
| Rate for Payer: Cofinity Commercial |
$141.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.20
|
| Rate for Payer: Healthscope Commercial |
$182.48
|
| Rate for Payer: Healthscope Commercial |
$182.51
|
| Rate for Payer: Healthscope Commercial |
$176.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$141.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$141.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$172.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$172.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$166.84
|
| Rate for Payer: PHP Commercial |
$166.84
|
| Rate for Payer: PHP Commercial |
$172.34
|
| Rate for Payer: PHP Commercial |
$172.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.92
|
| Rate for Payer: Priority Health SBD |
$127.76
|
| Rate for Payer: Priority Health SBD |
$127.73
|
| Rate for Payer: Priority Health SBD |
$123.66
|
| Rate for Payer: UMR Bronson Commercial |
$86.36
|
| Rate for Payer: UMR Bronson Commercial |
$89.21
|
| Rate for Payer: UMR Bronson Commercial |
$89.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.06
|
|
|
BACITRACIN 500 UNIT/GRAM EYE OINTMENT
|
Facility
|
IP
|
$351.79
|
|
|
Service Code
|
NDC 0574-4022-35
|
| Hospital Charge Code |
852
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.79 |
| Max. Negotiated Rate |
$316.61 |
| Rate for Payer: Aetna American Axle |
$228.66
|
| Rate for Payer: Aetna Commercial |
$299.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.66
|
| Rate for Payer: Cash Price |
$281.43
|
| Rate for Payer: Cofinity Commercial |
$246.25
|
| Rate for Payer: Cofinity Commercial |
$302.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.43
|
| Rate for Payer: Healthscope Commercial |
$316.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$246.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$299.02
|
| Rate for Payer: PHP Commercial |
$299.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.25
|
| Rate for Payer: Priority Health SBD |
$221.63
|
| Rate for Payer: UMR Bronson Commercial |
$154.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.84
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$63.97
|
|
|
Service Code
|
NDC 1678411761
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.15 |
| Max. Negotiated Rate |
$57.57 |
| Rate for Payer: Aetna American Axle |
$41.58
|
| Rate for Payer: Aetna Commercial |
$54.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.58
|
| Rate for Payer: Cash Price |
$51.18
|
| Rate for Payer: Cofinity Commercial |
$44.78
|
| Rate for Payer: Cofinity Commercial |
$55.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.18
|
| Rate for Payer: Healthscope Commercial |
$57.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.37
|
| Rate for Payer: PHP Commercial |
$54.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.78
|
| Rate for Payer: Priority Health SBD |
$40.30
|
| Rate for Payer: UMR Bronson Commercial |
$28.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.98
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$9.85
|
|
|
Service Code
|
NDC 51672-2075-2
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.33 |
| Max. Negotiated Rate |
$8.86 |
| Rate for Payer: Aetna American Axle |
$6.40
|
| Rate for Payer: Aetna Commercial |
$8.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.40
|
| Rate for Payer: Cash Price |
$7.88
|
| Rate for Payer: Cofinity Commercial |
$6.90
|
| Rate for Payer: Cofinity Commercial |
$8.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.88
|
| Rate for Payer: Healthscope Commercial |
$8.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.37
|
| Rate for Payer: PHP Commercial |
$8.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.90
|
| Rate for Payer: Priority Health SBD |
$6.21
|
| Rate for Payer: UMR Bronson Commercial |
$4.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.39
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$65.45
|
|
|
Service Code
|
NDC 67777-220-07
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$58.90 |
| Rate for Payer: Aetna American Axle |
$42.54
|
| Rate for Payer: Aetna Commercial |
$55.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.54
|
| Rate for Payer: Cash Price |
$52.36
|
| Rate for Payer: Cofinity Commercial |
$45.82
|
| Rate for Payer: Cofinity Commercial |
$56.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.36
|
| Rate for Payer: Healthscope Commercial |
$58.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.63
|
| Rate for Payer: PHP Commercial |
$55.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.82
|
| Rate for Payer: Priority Health SBD |
$41.23
|
| Rate for Payer: UMR Bronson Commercial |
$28.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.09
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$8.82
|
|
|
Service Code
|
NDC 1442800888
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.88 |
| Max. Negotiated Rate |
$7.94 |
| Rate for Payer: Aetna American Axle |
$5.73
|
| Rate for Payer: Aetna Commercial |
$7.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.73
|
| Rate for Payer: Cash Price |
$7.06
|
| Rate for Payer: Cofinity Commercial |
$6.17
|
| Rate for Payer: Cofinity Commercial |
$7.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.06
|
| Rate for Payer: Healthscope Commercial |
$7.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.50
|
| Rate for Payer: PHP Commercial |
$7.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.17
|
| Rate for Payer: Priority Health SBD |
$5.56
|
| Rate for Payer: UMR Bronson Commercial |
$3.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.62
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$9.45
|
|
|
Service Code
|
NDC 51672-2075-1
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: Aetna American Axle |
$6.14
|
| Rate for Payer: Aetna Commercial |
$8.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.14
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: Cofinity Commercial |
$6.62
|
| Rate for Payer: Cofinity Commercial |
$8.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.56
|
| Rate for Payer: Healthscope Commercial |
$8.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.03
|
| Rate for Payer: PHP Commercial |
$8.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.62
|
| Rate for Payer: Priority Health SBD |
$5.95
|
| Rate for Payer: UMR Bronson Commercial |
$4.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.09
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$10.23
|
|
|
Service Code
|
NDC 67777-220-02
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$9.21 |
| Rate for Payer: Aetna American Axle |
$6.65
|
| Rate for Payer: Aetna Commercial |
$8.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.65
|
| Rate for Payer: Cash Price |
$8.18
|
| Rate for Payer: Cofinity Commercial |
$7.16
|
| Rate for Payer: Cofinity Commercial |
$8.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.18
|
| Rate for Payer: Healthscope Commercial |
$9.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.70
|
| Rate for Payer: PHP Commercial |
$8.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.16
|
| Rate for Payer: Priority Health SBD |
$6.44
|
| Rate for Payer: UMR Bronson Commercial |
$4.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.67
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$10.26
|
|
|
Service Code
|
NDC 1442800944
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.51 |
| Max. Negotiated Rate |
$9.23 |
| Rate for Payer: Aetna American Axle |
$6.67
|
| Rate for Payer: Aetna Commercial |
$8.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.67
|
| Rate for Payer: Cash Price |
$8.21
|
| Rate for Payer: Cofinity Commercial |
$7.18
|
| Rate for Payer: Cofinity Commercial |
$8.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.21
|
| Rate for Payer: Healthscope Commercial |
$9.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.72
|
| Rate for Payer: PHP Commercial |
$8.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.18
|
| Rate for Payer: Priority Health SBD |
$6.46
|
| Rate for Payer: UMR Bronson Commercial |
$4.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.70
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$24.79
|
|
|
Service Code
|
NDC 1678411751
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.91 |
| Max. Negotiated Rate |
$22.31 |
| Rate for Payer: Aetna American Axle |
$16.11
|
| Rate for Payer: Aetna Commercial |
$21.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.11
|
| Rate for Payer: Cash Price |
$19.83
|
| Rate for Payer: Cofinity Commercial |
$17.35
|
| Rate for Payer: Cofinity Commercial |
$21.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.83
|
| Rate for Payer: Healthscope Commercial |
$22.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.07
|
| Rate for Payer: PHP Commercial |
$21.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.35
|
| Rate for Payer: Priority Health SBD |
$15.62
|
| Rate for Payer: UMR Bronson Commercial |
$10.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.59
|
|
|
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC
|
Facility
|
IP
|
$41,302.02
|
|
|
Service Code
|
MS-DRG 519
|
| Min. Negotiated Rate |
$14,898.33 |
| Max. Negotiated Rate |
$41,302.02 |
| Rate for Payer: Aetna Medicare |
$16,309.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,603.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,603.06
|
| Rate for Payer: BCBS MAPPO |
$15,682.45
|
| Rate for Payer: BCBS Trust/PPO |
$41,302.02
|
| Rate for Payer: BCN Medicare Advantage |
$15,682.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,682.45
|
| Rate for Payer: Mclaren Medicare |
$15,682.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,466.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,034.82
|
| Rate for Payer: PACE Medicare |
$14,898.33
|
| Rate for Payer: PACE SWMI |
$15,682.45
|
| Rate for Payer: PHP Medicare Advantage |
$15,682.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28,249.25
|
| Rate for Payer: Priority Health Medicare |
$15,682.45
|
| Rate for Payer: Priority Health Narrow Network |
$22,599.40
|
| Rate for Payer: Railroad Medicare Medicare |
$15,682.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30,029.02
|
| Rate for Payer: UHC Core |
$24,623.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,682.45
|
| Rate for Payer: UHC Exchange |
$19,575.76
|
| Rate for Payer: UHC Medicare Advantage |
$16,152.92
|
| Rate for Payer: VA VA |
$15,682.45
|
|
|
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR
|
Facility
|
IP
|
$59,686.40
|
|
|
Service Code
|
MS-DRG 518
|
| Min. Negotiated Rate |
$27,220.59 |
| Max. Negotiated Rate |
$59,686.40 |
| Rate for Payer: Aetna Medicare |
$29,799.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35,816.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35,816.56
|
| Rate for Payer: BCBS MAPPO |
$28,653.25
|
| Rate for Payer: BCBS Trust/PPO |
$59,686.40
|
| Rate for Payer: BCN Medicare Advantage |
$28,653.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28,653.25
|
| Rate for Payer: Mclaren Medicare |
$28,653.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$30,085.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32,951.24
|
| Rate for Payer: PACE Medicare |
$27,220.59
|
| Rate for Payer: PACE SWMI |
$28,653.25
|
| Rate for Payer: PHP Medicare Advantage |
$28,653.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52,403.04
|
| Rate for Payer: Priority Health Medicare |
$28,653.25
|
| Rate for Payer: Priority Health Narrow Network |
$41,922.43
|
| Rate for Payer: Railroad Medicare Medicare |
$28,653.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55,704.56
|
| Rate for Payer: UHC Core |
$45,676.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$28,653.25
|
| Rate for Payer: UHC Exchange |
$36,313.50
|
| Rate for Payer: UHC Medicare Advantage |
$29,512.85
|
| Rate for Payer: VA VA |
$28,653.25
|
|
|
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC
|
Facility
|
IP
|
$32,748.11
|
|
|
Service Code
|
MS-DRG 520
|
| Min. Negotiated Rate |
$10,966.36 |
| Max. Negotiated Rate |
$32,748.11 |
| Rate for Payer: Aetna Medicare |
$12,005.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,429.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,429.42
|
| Rate for Payer: BCBS MAPPO |
$11,543.54
|
| Rate for Payer: BCBS Trust/PPO |
$32,748.11
|
| Rate for Payer: BCN Medicare Advantage |
$11,543.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,543.54
|
| Rate for Payer: Mclaren Medicare |
$11,543.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,120.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,275.07
|
| Rate for Payer: PACE Medicare |
$10,966.36
|
| Rate for Payer: PACE SWMI |
$11,543.54
|
| Rate for Payer: PHP Medicare Advantage |
$11,543.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,541.91
|
| Rate for Payer: Priority Health Medicare |
$11,543.54
|
| Rate for Payer: Priority Health Narrow Network |
$16,433.53
|
| Rate for Payer: Railroad Medicare Medicare |
$11,543.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,836.10
|
| Rate for Payer: UHC Core |
$17,905.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,543.54
|
| Rate for Payer: UHC Exchange |
$14,234.84
|
| Rate for Payer: UHC Medicare Advantage |
$11,889.85
|
| Rate for Payer: VA VA |
$11,543.54
|
|
|
BACLOFEN 10,000 MCG/20 ML (500 MCG/ML) INTRATHECAL SOLUTION
|
Facility
|
IP
|
$497.00
|
|
|
Service Code
|
HCPCS J0475
|
| Hospital Charge Code |
107799
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$218.68 |
| Max. Negotiated Rate |
$447.30 |
| Rate for Payer: Aetna American Axle |
$323.05
|
| Rate for Payer: Aetna American Axle |
$388.36
|
| Rate for Payer: Aetna Commercial |
$422.45
|
| Rate for Payer: Aetna Commercial |
$507.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$388.36
|
| Rate for Payer: Cash Price |
$477.98
|
| Rate for Payer: Cash Price |
$397.60
|
| Rate for Payer: Cofinity Commercial |
$347.90
|
| Rate for Payer: Cofinity Commercial |
$427.42
|
| Rate for Payer: Cofinity Commercial |
$418.23
|
| Rate for Payer: Cofinity Commercial |
$513.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$477.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$397.60
|
| Rate for Payer: Healthscope Commercial |
$447.30
|
| Rate for Payer: Healthscope Commercial |
$537.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$418.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$347.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$448.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$372.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$422.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$507.85
|
| Rate for Payer: PHP Commercial |
$422.45
|
| Rate for Payer: PHP Commercial |
$507.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$418.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.90
|
| Rate for Payer: Priority Health SBD |
$313.11
|
| Rate for Payer: Priority Health SBD |
$376.41
|
| Rate for Payer: UMR Bronson Commercial |
$218.68
|
| Rate for Payer: UMR Bronson Commercial |
$262.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$448.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$372.75
|
|
|
BACLOFEN 10 MG TABLET
|
Facility
|
IP
|
$331.55
|
|
|
Service Code
|
NDC 0904-6475-61
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.88 |
| Max. Negotiated Rate |
$298.40 |
| Rate for Payer: Aetna American Axle |
$215.51
|
| Rate for Payer: Aetna Commercial |
$281.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.51
|
| Rate for Payer: Cash Price |
$265.24
|
| Rate for Payer: Cofinity Commercial |
$232.08
|
| Rate for Payer: Cofinity Commercial |
$285.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.24
|
| Rate for Payer: Healthscope Commercial |
$298.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$232.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$281.82
|
| Rate for Payer: PHP Commercial |
$281.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.08
|
| Rate for Payer: Priority Health SBD |
$208.88
|
| Rate for Payer: UMR Bronson Commercial |
$145.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.66
|
|
|
BACLOFEN 10 MG TABLET
|
Facility
|
IP
|
$173.90
|
|
|
Service Code
|
NDC 0172-4096-60
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.52 |
| Max. Negotiated Rate |
$156.51 |
| Rate for Payer: Aetna American Axle |
$113.04
|
| Rate for Payer: Aetna Commercial |
$147.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.04
|
| Rate for Payer: Cash Price |
$139.12
|
| Rate for Payer: Cofinity Commercial |
$121.73
|
| Rate for Payer: Cofinity Commercial |
$149.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.12
|
| Rate for Payer: Healthscope Commercial |
$156.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.82
|
| Rate for Payer: PHP Commercial |
$147.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.73
|
| Rate for Payer: Priority Health SBD |
$109.56
|
| Rate for Payer: UMR Bronson Commercial |
$76.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.42
|
|
|
BACLOFEN 10 MG TABLET
|
Facility
|
IP
|
$408.50
|
|
|
Service Code
|
NDC 63739-479-10
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.74 |
| Max. Negotiated Rate |
$367.65 |
| Rate for Payer: Aetna American Axle |
$265.52
|
| Rate for Payer: Aetna Commercial |
$347.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.52
|
| Rate for Payer: Cash Price |
$326.80
|
| Rate for Payer: Cofinity Commercial |
$285.95
|
| Rate for Payer: Cofinity Commercial |
$351.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.80
|
| Rate for Payer: Healthscope Commercial |
$367.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$285.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$347.22
|
| Rate for Payer: PHP Commercial |
$347.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.95
|
| Rate for Payer: Priority Health SBD |
$257.36
|
| Rate for Payer: UMR Bronson Commercial |
$179.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.38
|
|
