|
ARTIFICIAL TEARS (HYPROMELLOSE) 0.3 % EYE GEL
|
Facility
|
OP
|
$31.75
|
|
|
Service Code
|
NDC 00065806401
|
| Hospital Charge Code |
21058
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.75 |
| Max. Negotiated Rate |
$28.57 |
| Rate for Payer: Aetna American Axle |
$20.64
|
| Rate for Payer: Aetna Commercial |
$26.99
|
| Rate for Payer: Aetna Medicare |
$15.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.64
|
| Rate for Payer: BCBS Complete |
$12.70
|
| Rate for Payer: Cash Price |
$25.40
|
| Rate for Payer: Cofinity Advantage |
$22.23
|
| Rate for Payer: Cofinity Commercial |
$27.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.40
|
| Rate for Payer: Healthscope Commercial |
$28.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.81
|
| Rate for Payer: PHP Commercial |
$26.99
|
| Rate for Payer: Priority Health SBD |
$20.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.64
|
| Rate for Payer: UHC Core |
$16.54
|
| Rate for Payer: UHC Exchange |
$12.48
|
| Rate for Payer: UMR Bronson Commercial |
$11.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.81
|
|
|
ARTIFICIAL TEARS (HYPROMELLOSE) 0.3 % EYE GEL
|
Facility
|
OP
|
$43.51
|
|
|
Service Code
|
NDC 00065047401
|
| Hospital Charge Code |
21058
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.10 |
| Max. Negotiated Rate |
$39.16 |
| Rate for Payer: Aetna American Axle |
$28.28
|
| Rate for Payer: Aetna Commercial |
$36.98
|
| Rate for Payer: Aetna Medicare |
$21.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.28
|
| Rate for Payer: BCBS Complete |
$17.40
|
| Rate for Payer: Cash Price |
$34.81
|
| Rate for Payer: Cofinity Advantage |
$30.46
|
| Rate for Payer: Cofinity Commercial |
$37.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.81
|
| Rate for Payer: Healthscope Commercial |
$39.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.63
|
| Rate for Payer: PHP Commercial |
$36.98
|
| Rate for Payer: Priority Health SBD |
$27.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.28
|
| Rate for Payer: UHC Core |
$22.67
|
| Rate for Payer: UHC Exchange |
$17.10
|
| Rate for Payer: UMR Bronson Commercial |
$16.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.63
|
|
|
ARTIFICIAL TEARS (HYPROMELLOSE) 0.3 % EYE GEL
|
Facility
|
IP
|
$43.51
|
|
|
Service Code
|
NDC 00065047401
|
| Hospital Charge Code |
21058
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.14 |
| Max. Negotiated Rate |
$39.16 |
| Rate for Payer: Aetna American Axle |
$28.28
|
| Rate for Payer: Aetna Commercial |
$36.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.28
|
| Rate for Payer: Cash Price |
$34.81
|
| Rate for Payer: Cofinity Advantage |
$30.46
|
| Rate for Payer: Cofinity Commercial |
$37.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.81
|
| Rate for Payer: Healthscope Commercial |
$39.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.63
|
| Rate for Payer: PHP Commercial |
$36.98
|
| Rate for Payer: Priority Health SBD |
$27.41
|
| Rate for Payer: UMR Bronson Commercial |
$19.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.63
|
|
|
ASCORBIC ACID (VITAMIN C) 250 MG TABLET
|
Facility
|
IP
|
$105.05
|
|
|
Service Code
|
NDC 50268086015
|
| Hospital Charge Code |
663
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.22 |
| Max. Negotiated Rate |
$94.55 |
| Rate for Payer: Aetna American Axle |
$68.28
|
| Rate for Payer: Aetna Commercial |
$89.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.28
|
| Rate for Payer: Cash Price |
$84.04
|
| Rate for Payer: Cofinity Advantage |
$73.53
|
| Rate for Payer: Cofinity Commercial |
$90.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.04
|
| Rate for Payer: Healthscope Commercial |
$94.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.79
|
| Rate for Payer: PHP Commercial |
$89.29
|
| Rate for Payer: Priority Health SBD |
$66.18
|
| Rate for Payer: UMR Bronson Commercial |
$46.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.79
|
|
|
ASCORBIC ACID (VITAMIN C) 250 MG TABLET
|
Facility
|
OP
|
$2.11
|
|
|
Service Code
|
NDC 50268086011
|
| Hospital Charge Code |
663
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Aetna American Axle |
$1.37
|
| Rate for Payer: Aetna Commercial |
$1.79
|
| Rate for Payer: Aetna Medicare |
$1.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.37
|
| Rate for Payer: BCBS Complete |
$0.84
|
| Rate for Payer: Cash Price |
$1.69
|
| Rate for Payer: Cofinity Advantage |
$1.48
|
| Rate for Payer: Cofinity Commercial |
$1.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.69
|
| Rate for Payer: Healthscope Commercial |
$1.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.58
|
| Rate for Payer: PHP Commercial |
$1.79
|
| Rate for Payer: Priority Health SBD |
$1.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.37
|
| Rate for Payer: UHC Core |
$1.10
|
| Rate for Payer: UHC Exchange |
$0.83
|
| Rate for Payer: UMR Bronson Commercial |
$0.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.58
|
|
|
ASCORBIC ACID (VITAMIN C) 250 MG TABLET
|
Facility
|
IP
|
$2.11
|
|
|
Service Code
|
NDC 50268086011
|
| Hospital Charge Code |
663
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Aetna American Axle |
$1.37
|
| Rate for Payer: Aetna Commercial |
$1.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.37
|
| Rate for Payer: Cash Price |
$1.69
|
| Rate for Payer: Cofinity Advantage |
$1.48
|
| Rate for Payer: Cofinity Commercial |
$1.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.69
|
| Rate for Payer: Healthscope Commercial |
$1.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.58
|
| Rate for Payer: PHP Commercial |
$1.79
|
| Rate for Payer: Priority Health SBD |
$1.33
|
| Rate for Payer: UMR Bronson Commercial |
$0.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.58
|
|
|
ASCORBIC ACID (VITAMIN C) 250 MG TABLET
|
Facility
|
OP
|
$113.40
|
|
|
Service Code
|
NDC 20555000100
|
| Hospital Charge Code |
663
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.96 |
| Max. Negotiated Rate |
$102.06 |
| Rate for Payer: Aetna American Axle |
$73.71
|
| Rate for Payer: Aetna Commercial |
$96.39
|
| Rate for Payer: Aetna Medicare |
$56.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.71
|
| Rate for Payer: BCBS Complete |
$45.36
|
| Rate for Payer: Cash Price |
$90.72
|
| Rate for Payer: Cofinity Advantage |
$79.38
|
| Rate for Payer: Cofinity Commercial |
$97.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.72
|
| Rate for Payer: Healthscope Commercial |
$102.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.05
|
| Rate for Payer: PHP Commercial |
$96.39
|
| Rate for Payer: Priority Health SBD |
$71.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.71
|
| Rate for Payer: UHC Core |
$59.08
|
| Rate for Payer: UHC Exchange |
$44.57
|
| Rate for Payer: UMR Bronson Commercial |
$41.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.05
|
|
|
ASCORBIC ACID (VITAMIN C) 250 MG TABLET
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
NDC 96295012843
|
| Hospital Charge Code |
663
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.62 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: Aetna American Axle |
$81.90
|
| Rate for Payer: Aetna Commercial |
$107.10
|
| Rate for Payer: Aetna Medicare |
$63.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.90
|
| Rate for Payer: BCBS Complete |
$50.40
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cofinity Advantage |
$88.20
|
| Rate for Payer: Cofinity Commercial |
$108.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.80
|
| Rate for Payer: Healthscope Commercial |
$113.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$100.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.50
|
| Rate for Payer: PHP Commercial |
$107.10
|
| Rate for Payer: Priority Health SBD |
$79.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.90
|
| Rate for Payer: UHC Core |
$65.65
|
| Rate for Payer: UHC Exchange |
$49.52
|
| Rate for Payer: UMR Bronson Commercial |
$46.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.50
|
|
|
ASCORBIC ACID (VITAMIN C) 250 MG TABLET
|
Facility
|
IP
|
$113.40
|
|
|
Service Code
|
NDC 20555000100
|
| Hospital Charge Code |
663
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.90 |
| Max. Negotiated Rate |
$102.06 |
| Rate for Payer: Aetna American Axle |
$73.71
|
| Rate for Payer: Aetna Commercial |
$96.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.71
|
| Rate for Payer: Cash Price |
$90.72
|
| Rate for Payer: Cofinity Advantage |
$79.38
|
| Rate for Payer: Cofinity Commercial |
$97.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.72
|
| Rate for Payer: Healthscope Commercial |
$102.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.05
|
| Rate for Payer: PHP Commercial |
$96.39
|
| Rate for Payer: Priority Health SBD |
$71.44
|
| Rate for Payer: UMR Bronson Commercial |
$49.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.05
|
|
|
ASCORBIC ACID (VITAMIN C) 250 MG TABLET
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
NDC 96295012843
|
| Hospital Charge Code |
663
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.44 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: Aetna American Axle |
$81.90
|
| Rate for Payer: Aetna Commercial |
$107.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.90
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cofinity Advantage |
$88.20
|
| Rate for Payer: Cofinity Commercial |
$108.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.80
|
| Rate for Payer: Healthscope Commercial |
$113.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.50
|
| Rate for Payer: PHP Commercial |
$107.10
|
| Rate for Payer: Priority Health SBD |
$79.38
|
| Rate for Payer: UMR Bronson Commercial |
$55.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.50
|
|
|
ASCORBIC ACID (VITAMIN C) 250 MG TABLET
|
Facility
|
OP
|
$105.05
|
|
|
Service Code
|
NDC 50268086015
|
| Hospital Charge Code |
663
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.87 |
| Max. Negotiated Rate |
$94.55 |
| Rate for Payer: Aetna American Axle |
$68.28
|
| Rate for Payer: Aetna Commercial |
$89.29
|
| Rate for Payer: Aetna Medicare |
$52.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.28
|
| Rate for Payer: BCBS Complete |
$42.02
|
| Rate for Payer: Cash Price |
$84.04
|
| Rate for Payer: Cofinity Advantage |
$73.53
|
| Rate for Payer: Cofinity Commercial |
$90.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.04
|
| Rate for Payer: Healthscope Commercial |
$94.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.79
|
| Rate for Payer: PHP Commercial |
$89.29
|
| Rate for Payer: Priority Health SBD |
$66.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.28
|
| Rate for Payer: UHC Core |
$54.73
|
| Rate for Payer: UHC Exchange |
$41.28
|
| Rate for Payer: UMR Bronson Commercial |
$38.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.79
|
|
|
ASCORBIC ACID (VITAMIN C) 250 MG TABLET
|
Facility
|
OP
|
$138.60
|
|
|
Service Code
|
NDC 57896083101
|
| Hospital Charge Code |
663
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.28 |
| Max. Negotiated Rate |
$124.74 |
| Rate for Payer: Aetna American Axle |
$90.09
|
| Rate for Payer: Aetna Commercial |
$117.81
|
| Rate for Payer: Aetna Medicare |
$69.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.09
|
| Rate for Payer: BCBS Complete |
$55.44
|
| Rate for Payer: Cash Price |
$110.88
|
| Rate for Payer: Cofinity Advantage |
$97.02
|
| Rate for Payer: Cofinity Commercial |
$119.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.88
|
| Rate for Payer: Healthscope Commercial |
$124.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.95
|
| Rate for Payer: PHP Commercial |
$117.81
|
| Rate for Payer: Priority Health SBD |
$87.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.09
|
| Rate for Payer: UHC Core |
$72.21
|
| Rate for Payer: UHC Exchange |
$54.47
|
| Rate for Payer: UMR Bronson Commercial |
$51.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.95
|
|
|
ASCORBIC ACID (VITAMIN C) 250 MG TABLET
|
Facility
|
IP
|
$138.60
|
|
|
Service Code
|
NDC 57896083101
|
| Hospital Charge Code |
663
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.98 |
| Max. Negotiated Rate |
$124.74 |
| Rate for Payer: Aetna American Axle |
$90.09
|
| Rate for Payer: Aetna Commercial |
$117.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.09
|
| Rate for Payer: Cash Price |
$110.88
|
| Rate for Payer: Cofinity Advantage |
$97.02
|
| Rate for Payer: Cofinity Commercial |
$119.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.88
|
| Rate for Payer: Healthscope Commercial |
$124.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.95
|
| Rate for Payer: PHP Commercial |
$117.81
|
| Rate for Payer: Priority Health SBD |
$87.32
|
| Rate for Payer: UMR Bronson Commercial |
$60.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.95
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$292.17
|
|
|
Service Code
|
NDC 71414011501
|
| Hospital Charge Code |
654
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$128.55 |
| Max. Negotiated Rate |
$262.95 |
| Rate for Payer: Aetna American Axle |
$189.91
|
| Rate for Payer: Aetna Commercial |
$248.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.91
|
| Rate for Payer: Cash Price |
$233.74
|
| Rate for Payer: Cofinity Advantage |
$204.52
|
| Rate for Payer: Cofinity Commercial |
$251.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.74
|
| Rate for Payer: Healthscope Commercial |
$262.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$204.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$219.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$219.13
|
| Rate for Payer: PHP Commercial |
$248.34
|
| Rate for Payer: Priority Health SBD |
$184.07
|
| Rate for Payer: UMR Bronson Commercial |
$128.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$219.13
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$292.17
|
|
|
Service Code
|
NDC 71414011501
|
| Hospital Charge Code |
654
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$108.10 |
| Max. Negotiated Rate |
$262.95 |
| Rate for Payer: Aetna American Axle |
$189.91
|
| Rate for Payer: Aetna Commercial |
$248.34
|
| Rate for Payer: Aetna Medicare |
$146.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.91
|
| Rate for Payer: BCBS Complete |
$116.87
|
| Rate for Payer: Cash Price |
$233.74
|
| Rate for Payer: Cofinity Advantage |
$204.52
|
| Rate for Payer: Cofinity Commercial |
$251.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.74
|
| Rate for Payer: Healthscope Commercial |
$262.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$204.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$219.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$233.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$219.13
|
| Rate for Payer: PHP Commercial |
$248.34
|
| Rate for Payer: Priority Health SBD |
$184.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.91
|
| Rate for Payer: UHC Core |
$152.22
|
| Rate for Payer: UHC Exchange |
$114.82
|
| Rate for Payer: UMR Bronson Commercial |
$108.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$219.13
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,119.85
|
|
|
Service Code
|
NDC 67157010150
|
| Hospital Charge Code |
186102
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$414.34 |
| Max. Negotiated Rate |
$1,007.87 |
| Rate for Payer: Aetna American Axle |
$727.90
|
| Rate for Payer: Aetna Commercial |
$951.87
|
| Rate for Payer: Aetna Medicare |
$559.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$727.90
|
| Rate for Payer: BCBS Complete |
$447.94
|
| Rate for Payer: Cash Price |
$895.88
|
| Rate for Payer: Cofinity Advantage |
$783.89
|
| Rate for Payer: Cofinity Commercial |
$963.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$895.88
|
| Rate for Payer: Healthscope Commercial |
$1,007.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$783.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$839.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$895.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$951.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$839.89
|
| Rate for Payer: PHP Commercial |
$951.87
|
| Rate for Payer: Priority Health SBD |
$705.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$727.90
|
| Rate for Payer: UHC Core |
$583.44
|
| Rate for Payer: UHC Exchange |
$440.10
|
| Rate for Payer: UMR Bronson Commercial |
$414.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$839.89
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,119.85
|
|
|
Service Code
|
NDC 67157010151
|
| Hospital Charge Code |
186102
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$414.34 |
| Max. Negotiated Rate |
$1,007.87 |
| Rate for Payer: Aetna American Axle |
$727.90
|
| Rate for Payer: Aetna Commercial |
$951.87
|
| Rate for Payer: Aetna Medicare |
$559.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$727.90
|
| Rate for Payer: BCBS Complete |
$447.94
|
| Rate for Payer: Cash Price |
$895.88
|
| Rate for Payer: Cofinity Advantage |
$783.89
|
| Rate for Payer: Cofinity Commercial |
$963.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$895.88
|
| Rate for Payer: Healthscope Commercial |
$1,007.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$783.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$839.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$895.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$951.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$839.89
|
| Rate for Payer: PHP Commercial |
$951.87
|
| Rate for Payer: Priority Health SBD |
$705.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$727.90
|
| Rate for Payer: UHC Core |
$583.44
|
| Rate for Payer: UHC Exchange |
$440.10
|
| Rate for Payer: UMR Bronson Commercial |
$414.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$839.89
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG TABLET
|
Facility
|
OP
|
$72.85
|
|
|
Service Code
|
NDC 00904052361
|
| Hospital Charge Code |
664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$65.56 |
| Rate for Payer: Aetna American Axle |
$47.35
|
| Rate for Payer: Aetna Commercial |
$61.92
|
| Rate for Payer: Aetna Medicare |
$36.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.35
|
| Rate for Payer: BCBS Complete |
$29.14
|
| Rate for Payer: Cash Price |
$58.28
|
| Rate for Payer: Cofinity Advantage |
$50.99
|
| Rate for Payer: Cofinity Commercial |
$62.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.28
|
| Rate for Payer: Healthscope Commercial |
$65.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.64
|
| Rate for Payer: PHP Commercial |
$61.92
|
| Rate for Payer: Priority Health SBD |
$45.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.35
|
| Rate for Payer: UHC Core |
$37.95
|
| Rate for Payer: UHC Exchange |
$28.63
|
| Rate for Payer: UMR Bronson Commercial |
$26.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.64
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG TABLET
|
Facility
|
IP
|
$86.95
|
|
|
Service Code
|
NDC 00904052360
|
| Hospital Charge Code |
664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.26 |
| Max. Negotiated Rate |
$78.25 |
| Rate for Payer: Aetna American Axle |
$56.52
|
| Rate for Payer: Aetna Commercial |
$73.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.52
|
| Rate for Payer: Cash Price |
$69.56
|
| Rate for Payer: Cofinity Advantage |
$60.87
|
| Rate for Payer: Cofinity Commercial |
$74.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.56
|
| Rate for Payer: Healthscope Commercial |
$78.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.21
|
| Rate for Payer: PHP Commercial |
$73.91
|
| Rate for Payer: Priority Health SBD |
$54.78
|
| Rate for Payer: UMR Bronson Commercial |
$38.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.21
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG TABLET
|
Facility
|
OP
|
$86.95
|
|
|
Service Code
|
NDC 00904052360
|
| Hospital Charge Code |
664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.17 |
| Max. Negotiated Rate |
$78.25 |
| Rate for Payer: Aetna American Axle |
$56.52
|
| Rate for Payer: Aetna Commercial |
$73.91
|
| Rate for Payer: Aetna Medicare |
$43.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.52
|
| Rate for Payer: BCBS Complete |
$34.78
|
| Rate for Payer: Cash Price |
$69.56
|
| Rate for Payer: Cofinity Advantage |
$60.87
|
| Rate for Payer: Cofinity Commercial |
$74.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.56
|
| Rate for Payer: Healthscope Commercial |
$78.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.21
|
| Rate for Payer: PHP Commercial |
$73.91
|
| Rate for Payer: Priority Health SBD |
$54.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.52
|
| Rate for Payer: UHC Core |
$45.30
|
| Rate for Payer: UHC Exchange |
$34.17
|
| Rate for Payer: UMR Bronson Commercial |
$32.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.21
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG TABLET
|
Facility
|
IP
|
$72.85
|
|
|
Service Code
|
NDC 00904052361
|
| Hospital Charge Code |
664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.05 |
| Max. Negotiated Rate |
$65.56 |
| Rate for Payer: Aetna American Axle |
$47.35
|
| Rate for Payer: Aetna Commercial |
$61.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.35
|
| Rate for Payer: Cash Price |
$58.28
|
| Rate for Payer: Cofinity Advantage |
$50.99
|
| Rate for Payer: Cofinity Commercial |
$62.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.28
|
| Rate for Payer: Healthscope Commercial |
$65.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.64
|
| Rate for Payer: PHP Commercial |
$61.92
|
| Rate for Payer: Priority Health SBD |
$45.90
|
| Rate for Payer: UMR Bronson Commercial |
$32.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.64
|
|
|
ASENAPINE 5 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$109.56
|
|
|
Service Code
|
NDC 62332019810
|
| Hospital Charge Code |
99754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.54 |
| Max. Negotiated Rate |
$98.60 |
| Rate for Payer: Aetna American Axle |
$71.21
|
| Rate for Payer: Aetna Commercial |
$93.13
|
| Rate for Payer: Aetna Medicare |
$54.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.21
|
| Rate for Payer: BCBS Complete |
$43.82
|
| Rate for Payer: Cash Price |
$87.65
|
| Rate for Payer: Cofinity Advantage |
$76.69
|
| Rate for Payer: Cofinity Commercial |
$94.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.65
|
| Rate for Payer: Healthscope Commercial |
$98.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.17
|
| Rate for Payer: PHP Commercial |
$93.13
|
| Rate for Payer: Priority Health SBD |
$69.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.21
|
| Rate for Payer: UHC Core |
$57.08
|
| Rate for Payer: UHC Exchange |
$43.06
|
| Rate for Payer: UMR Bronson Commercial |
$40.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.17
|
|
|
ASENAPINE 5 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$758.87
|
|
|
Service Code
|
NDC 00456240506
|
| Hospital Charge Code |
99754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$333.90 |
| Max. Negotiated Rate |
$682.98 |
| Rate for Payer: Aetna American Axle |
$493.27
|
| Rate for Payer: Aetna Commercial |
$645.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$493.27
|
| Rate for Payer: Cash Price |
$607.10
|
| Rate for Payer: Cofinity Advantage |
$531.21
|
| Rate for Payer: Cofinity Commercial |
$652.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$607.10
|
| Rate for Payer: Healthscope Commercial |
$682.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$531.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$569.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$645.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$569.15
|
| Rate for Payer: PHP Commercial |
$645.04
|
| Rate for Payer: Priority Health SBD |
$478.09
|
| Rate for Payer: UMR Bronson Commercial |
$333.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$569.15
|
|
|
ASENAPINE 5 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$758.87
|
|
|
Service Code
|
NDC 00456240506
|
| Hospital Charge Code |
99754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$280.78 |
| Max. Negotiated Rate |
$682.98 |
| Rate for Payer: Aetna American Axle |
$493.27
|
| Rate for Payer: Aetna Commercial |
$645.04
|
| Rate for Payer: Aetna Medicare |
$379.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$493.27
|
| Rate for Payer: BCBS Complete |
$303.55
|
| Rate for Payer: Cash Price |
$607.10
|
| Rate for Payer: Cofinity Advantage |
$531.21
|
| Rate for Payer: Cofinity Commercial |
$652.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$607.10
|
| Rate for Payer: Healthscope Commercial |
$682.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$531.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$569.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$607.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$645.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$569.15
|
| Rate for Payer: PHP Commercial |
$645.04
|
| Rate for Payer: Priority Health SBD |
$478.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$493.27
|
| Rate for Payer: UHC Core |
$395.37
|
| Rate for Payer: UHC Exchange |
$298.24
|
| Rate for Payer: UMR Bronson Commercial |
$280.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$569.15
|
|
|
ASENAPINE 5 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$69.29
|
|
|
Service Code
|
NDC 00456240511
|
| Hospital Charge Code |
99754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.49 |
| Max. Negotiated Rate |
$62.36 |
| Rate for Payer: Aetna American Axle |
$45.04
|
| Rate for Payer: Aetna Commercial |
$58.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.04
|
| Rate for Payer: Cash Price |
$55.43
|
| Rate for Payer: Cofinity Advantage |
$48.50
|
| Rate for Payer: Cofinity Commercial |
$59.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.43
|
| Rate for Payer: Healthscope Commercial |
$62.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.97
|
| Rate for Payer: PHP Commercial |
$58.90
|
| Rate for Payer: Priority Health SBD |
$43.65
|
| Rate for Payer: UMR Bronson Commercial |
$30.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.97
|
|
