|
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
|
|
|
ASENAPINE 5 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$1,052.95
|
|
|
Service Code
|
NDC 51991035860
|
| Hospital Charge Code |
99754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$389.59 |
| Max. Negotiated Rate |
$947.65 |
| Rate for Payer: Aetna American Axle |
$684.42
|
| Rate for Payer: Aetna Commercial |
$895.01
|
| Rate for Payer: Aetna Medicare |
$526.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$684.42
|
| Rate for Payer: BCBS Complete |
$421.18
|
| Rate for Payer: Cash Price |
$842.36
|
| Rate for Payer: Cofinity Advantage |
$737.07
|
| Rate for Payer: Cofinity Commercial |
$905.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$842.36
|
| Rate for Payer: Healthscope Commercial |
$947.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$737.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$789.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$842.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$895.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$789.71
|
| Rate for Payer: PHP Commercial |
$895.01
|
| Rate for Payer: Priority Health SBD |
$663.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$684.42
|
| Rate for Payer: UHC Core |
$548.59
|
| Rate for Payer: UHC Exchange |
$413.81
|
| Rate for Payer: UMR Bronson Commercial |
$389.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$789.71
|
|
|
ASENAPINE 5 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$109.56
|
|
|
Service Code
|
NDC 62332019810
|
| Hospital Charge Code |
99754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.21 |
| Max. Negotiated Rate |
$98.60 |
| Rate for Payer: Aetna American Axle |
$71.21
|
| Rate for Payer: Aetna Commercial |
$93.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.21
|
| 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: 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: UMR Bronson Commercial |
$48.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.17
|
|
|
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
|
OP
|
$69.29
|
|
|
Service Code
|
NDC 00456240511
|
| Hospital Charge Code |
99754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.64 |
| Max. Negotiated Rate |
$62.36 |
| Rate for Payer: Aetna American Axle |
$45.04
|
| Rate for Payer: Aetna Commercial |
$58.90
|
| Rate for Payer: Aetna Medicare |
$34.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.04
|
| Rate for Payer: BCBS Complete |
$27.72
|
| 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: MI Amish Medical Board Commercial |
$55.43
|
| 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: UHC All Payor (Choice/PPO) |
$45.04
|
| Rate for Payer: UHC Core |
$36.10
|
| Rate for Payer: UHC Exchange |
$27.23
|
| Rate for Payer: UMR Bronson Commercial |
$25.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.97
|
|
|
ASENAPINE 5 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$657.35
|
|
|
Service Code
|
NDC 62332019860
|
| Hospital Charge Code |
99754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$289.23 |
| Max. Negotiated Rate |
$591.62 |
| Rate for Payer: Aetna American Axle |
$427.28
|
| Rate for Payer: Aetna Commercial |
$558.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$427.28
|
| Rate for Payer: Cash Price |
$525.88
|
| Rate for Payer: Cofinity Advantage |
$460.14
|
| Rate for Payer: Cofinity Commercial |
$565.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$525.88
|
| Rate for Payer: Healthscope Commercial |
$591.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$460.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$493.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$558.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$493.01
|
| Rate for Payer: PHP Commercial |
$558.75
|
| Rate for Payer: Priority Health SBD |
$414.13
|
| Rate for Payer: UMR Bronson Commercial |
$289.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$493.01
|
|
|
ASENAPINE 5 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$657.35
|
|
|
Service Code
|
NDC 62332019860
|
| Hospital Charge Code |
99754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$243.22 |
| Max. Negotiated Rate |
$591.62 |
| Rate for Payer: Aetna American Axle |
$427.28
|
| Rate for Payer: Aetna Commercial |
$558.75
|
| Rate for Payer: Aetna Medicare |
$328.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$427.28
|
| Rate for Payer: BCBS Complete |
$262.94
|
| Rate for Payer: Cash Price |
$525.88
|
| Rate for Payer: Cofinity Advantage |
$460.14
|
| Rate for Payer: Cofinity Commercial |
$565.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$525.88
|
| Rate for Payer: Healthscope Commercial |
$591.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$460.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$493.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$525.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$558.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$493.01
|
| Rate for Payer: PHP Commercial |
$558.75
|
| Rate for Payer: Priority Health SBD |
$414.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$427.28
|
| Rate for Payer: UHC Core |
$342.48
|
| Rate for Payer: UHC Exchange |
$258.34
|
| Rate for Payer: UMR Bronson Commercial |
$243.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$493.01
|
|
|
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
|
|
|
ASPIRATION OF BLADDER; WITH INSERTION OF SUPRAPUBIC CATHETER
|
Facility
|
OP
|
$6,735.82
|
|
|
Service Code
|
CPT 51102
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,089.34 |
| Max. Negotiated Rate |
$6,735.82 |
| Rate for Payer: Aetna Medicare |
$2,166.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,603.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,603.59
|
| Rate for Payer: BCBS Complete |
$1,143.91
|
| Rate for Payer: BCBS MAPPO |
$2,082.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,739.40
|
| Rate for Payer: BCN Commercial |
$1,739.40
|
| Rate for Payer: BCN Medicare Advantage |
$2,082.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,082.87
|
| Rate for Payer: Mclaren Medicaid |
$2,082.87
|
| Rate for Payer: Mclaren Medicare |
$2,082.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,187.01
|
| Rate for Payer: Meridian Medicaid |
$2,187.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,395.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,291.16
|
| Rate for Payer: Nomi Health Commercial |
$6,248.61
|
| Rate for Payer: PACE Medicare |
$1,978.73
|
| Rate for Payer: PACE SWMI |
$2,082.87
|
| Rate for Payer: PHP Medicare Advantage |
$2,082.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,089.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,735.82
|
| Rate for Payer: Priority Health Medicare |
$2,082.87
|
| Rate for Payer: Priority Health Tiered Network |
$5,388.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2,082.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,082.87
|
| Rate for Payer: UHC Medicaid |
$1,089.34
|
| Rate for Payer: UHCCP Medicaid |
$1,089.34
|
| Rate for Payer: VA VA |
$2,082.87
|
|
|
ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE
|
Facility
|
IP
|
$247.40
|
|
|
Service Code
|
NDC 65162059606
|
| Hospital Charge Code |
27644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.86 |
| Max. Negotiated Rate |
$222.66 |
| Rate for Payer: Aetna American Axle |
$160.81
|
| Rate for Payer: Aetna Commercial |
$210.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.81
|
| Rate for Payer: Cash Price |
$197.92
|
| Rate for Payer: Cofinity Advantage |
$173.18
|
| Rate for Payer: Cofinity Commercial |
$212.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.92
|
| Rate for Payer: Healthscope Commercial |
$222.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.55
|
| Rate for Payer: PHP Commercial |
$210.29
|
| Rate for Payer: Priority Health SBD |
$155.86
|
| Rate for Payer: UMR Bronson Commercial |
$108.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.55
|
|
|
ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE
|
Facility
|
OP
|
$247.40
|
|
|
Service Code
|
NDC 65162059606
|
| Hospital Charge Code |
27644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.54 |
| Max. Negotiated Rate |
$222.66 |
| Rate for Payer: Aetna American Axle |
$160.81
|
| Rate for Payer: Aetna Commercial |
$210.29
|
| Rate for Payer: Aetna Medicare |
$123.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.81
|
| Rate for Payer: BCBS Complete |
$98.96
|
| Rate for Payer: Cash Price |
$197.92
|
| Rate for Payer: Cofinity Advantage |
$173.18
|
| Rate for Payer: Cofinity Commercial |
$212.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.92
|
| Rate for Payer: Healthscope Commercial |
$222.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$197.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.55
|
| Rate for Payer: PHP Commercial |
$210.29
|
| Rate for Payer: Priority Health SBD |
$155.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.81
|
| Rate for Payer: UHC Core |
$128.90
|
| Rate for Payer: UHC Exchange |
$97.23
|
| Rate for Payer: UMR Bronson Commercial |
$91.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.55
|
|
|
ASPIRIN 300 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$42.78
|
|
|
Service Code
|
NDC 00574703412
|
| Hospital Charge Code |
693
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.82 |
| Max. Negotiated Rate |
$38.50 |
| Rate for Payer: Aetna American Axle |
$27.81
|
| Rate for Payer: Aetna Commercial |
$36.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.81
|
| Rate for Payer: Cash Price |
$34.22
|
| Rate for Payer: Cofinity Advantage |
$29.95
|
| Rate for Payer: Cofinity Commercial |
$36.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.22
|
| Rate for Payer: Healthscope Commercial |
$38.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.09
|
| Rate for Payer: PHP Commercial |
$36.36
|
| Rate for Payer: Priority Health SBD |
$26.95
|
| Rate for Payer: UMR Bronson Commercial |
$18.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.09
|
|
|
ASPIRIN 300 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$42.78
|
|
|
Service Code
|
NDC 00574703412
|
| Hospital Charge Code |
693
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.83 |
| Max. Negotiated Rate |
$38.50 |
| Rate for Payer: Aetna American Axle |
$27.81
|
| Rate for Payer: Aetna Commercial |
$36.36
|
| Rate for Payer: Aetna Medicare |
$21.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.81
|
| Rate for Payer: BCBS Complete |
$17.11
|
| Rate for Payer: Cash Price |
$34.22
|
| Rate for Payer: Cofinity Advantage |
$29.95
|
| Rate for Payer: Cofinity Commercial |
$36.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.22
|
| Rate for Payer: Healthscope Commercial |
$38.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.09
|
| Rate for Payer: PHP Commercial |
$36.36
|
| Rate for Payer: Priority Health SBD |
$26.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.81
|
| Rate for Payer: UHC Core |
$22.29
|
| Rate for Payer: UHC Exchange |
$16.81
|
| Rate for Payer: UMR Bronson Commercial |
$15.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.09
|
|
|
ASPIRIN 325 MG TABLET
|
Facility
|
IP
|
$94.50
|
|
|
Service Code
|
NDC 00536105429
|
| Hospital Charge Code |
681
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.58 |
| Max. Negotiated Rate |
$85.05 |
| Rate for Payer: Aetna American Axle |
$61.42
|
| Rate for Payer: Aetna Commercial |
$80.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.42
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cofinity Advantage |
$66.15
|
| Rate for Payer: Cofinity Commercial |
$81.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.60
|
| Rate for Payer: Healthscope Commercial |
$85.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.88
|
| Rate for Payer: PHP Commercial |
$80.33
|
| Rate for Payer: Priority Health SBD |
$59.53
|
| Rate for Payer: UMR Bronson Commercial |
$41.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.88
|
|
|
ASPIRIN 325 MG TABLET
|
Facility
|
OP
|
$94.50
|
|
|
Service Code
|
NDC 00536105429
|
| Hospital Charge Code |
681
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.97 |
| Max. Negotiated Rate |
$85.05 |
| Rate for Payer: Aetna American Axle |
$61.42
|
| Rate for Payer: Aetna Commercial |
$80.33
|
| Rate for Payer: Aetna Medicare |
$47.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.42
|
| Rate for Payer: BCBS Complete |
$37.80
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cofinity Advantage |
$66.15
|
| Rate for Payer: Cofinity Commercial |
$81.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.60
|
| Rate for Payer: Healthscope Commercial |
$85.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.88
|
| Rate for Payer: PHP Commercial |
$80.33
|
| Rate for Payer: Priority Health SBD |
$59.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.42
|
| Rate for Payer: UHC Core |
$49.23
|
| Rate for Payer: UHC Exchange |
$37.14
|
| Rate for Payer: UMR Bronson Commercial |
$34.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.88
|
|
|
ASPIRIN 325 MG TABLET
|
Facility
|
OP
|
$654.50
|
|
|
Service Code
|
NDC 66553000101
|
| Hospital Charge Code |
681
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$242.16 |
| Max. Negotiated Rate |
$589.05 |
| Rate for Payer: Aetna American Axle |
$425.43
|
| Rate for Payer: Aetna Commercial |
$556.33
|
| Rate for Payer: Aetna Medicare |
$327.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$425.43
|
| Rate for Payer: BCBS Complete |
$261.80
|
| Rate for Payer: Cash Price |
$523.60
|
| Rate for Payer: Cofinity Advantage |
$458.15
|
| Rate for Payer: Cofinity Commercial |
$562.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$523.60
|
| Rate for Payer: Healthscope Commercial |
$589.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$458.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$490.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$523.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$556.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$490.88
|
| Rate for Payer: PHP Commercial |
$556.33
|
| Rate for Payer: Priority Health SBD |
$412.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$425.43
|
| Rate for Payer: UHC Core |
$340.99
|
| Rate for Payer: UHC Exchange |
$257.22
|
| Rate for Payer: UMR Bronson Commercial |
$242.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$490.88
|
|
|
ASPIRIN 325 MG TABLET
|
Facility
|
IP
|
$654.50
|
|
|
Service Code
|
NDC 66553000101
|
| Hospital Charge Code |
681
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$287.98 |
| Max. Negotiated Rate |
$589.05 |
| Rate for Payer: Aetna American Axle |
$425.43
|
| Rate for Payer: Aetna Commercial |
$556.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$425.43
|
| Rate for Payer: Cash Price |
$523.60
|
| Rate for Payer: Cofinity Advantage |
$458.15
|
| Rate for Payer: Cofinity Commercial |
$562.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$523.60
|
| Rate for Payer: Healthscope Commercial |
$589.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$458.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$490.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$556.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$490.88
|
| Rate for Payer: PHP Commercial |
$556.33
|
| Rate for Payer: Priority Health SBD |
$412.33
|
| Rate for Payer: UMR Bronson Commercial |
$287.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$490.88
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
OP
|
$45.36
|
|
|
Service Code
|
NDC 00904404073
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.78 |
| Max. Negotiated Rate |
$40.82 |
| Rate for Payer: Aetna American Axle |
$29.48
|
| Rate for Payer: Aetna Commercial |
$38.56
|
| Rate for Payer: Aetna Medicare |
$22.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.48
|
| Rate for Payer: BCBS Complete |
$18.14
|
| Rate for Payer: Cash Price |
$36.29
|
| Rate for Payer: Cofinity Advantage |
$31.75
|
| Rate for Payer: Cofinity Commercial |
$39.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.29
|
| Rate for Payer: Healthscope Commercial |
$40.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.02
|
| Rate for Payer: PHP Commercial |
$38.56
|
| Rate for Payer: Priority Health SBD |
$28.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.48
|
| Rate for Payer: UHC Core |
$23.63
|
| Rate for Payer: UHC Exchange |
$17.83
|
| Rate for Payer: UMR Bronson Commercial |
$16.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.02
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
OP
|
$504.00
|
|
|
Service Code
|
NDC 00904679480
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$186.48 |
| Max. Negotiated Rate |
$453.60 |
| Rate for Payer: Aetna American Axle |
$327.60
|
| Rate for Payer: Aetna Commercial |
$428.40
|
| Rate for Payer: Aetna Medicare |
$252.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$327.60
|
| Rate for Payer: BCBS Complete |
$201.60
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cofinity Advantage |
$352.80
|
| Rate for Payer: Cofinity Commercial |
$433.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$403.20
|
| Rate for Payer: Healthscope Commercial |
$453.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$352.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$378.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$403.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$428.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$378.00
|
| Rate for Payer: PHP Commercial |
$428.40
|
| Rate for Payer: Priority Health SBD |
$317.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$327.60
|
| Rate for Payer: UHC Core |
$262.58
|
| Rate for Payer: UHC Exchange |
$198.07
|
| Rate for Payer: UMR Bronson Commercial |
$186.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$378.00
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
IP
|
$45.36
|
|
|
Service Code
|
NDC 00904404073
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.96 |
| Max. Negotiated Rate |
$40.82 |
| Rate for Payer: Aetna American Axle |
$29.48
|
| Rate for Payer: Aetna Commercial |
$38.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.48
|
| Rate for Payer: Cash Price |
$36.29
|
| Rate for Payer: Cofinity Advantage |
$31.75
|
| Rate for Payer: Cofinity Commercial |
$39.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.29
|
| Rate for Payer: Healthscope Commercial |
$40.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.02
|
| Rate for Payer: PHP Commercial |
$38.56
|
| Rate for Payer: Priority Health SBD |
$28.58
|
| Rate for Payer: UMR Bronson Commercial |
$19.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.02
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
IP
|
$504.00
|
|
|
Service Code
|
NDC 00904679480
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$221.76 |
| Max. Negotiated Rate |
$453.60 |
| Rate for Payer: Aetna American Axle |
$327.60
|
| Rate for Payer: Aetna Commercial |
$428.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$327.60
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cofinity Advantage |
$352.80
|
| Rate for Payer: Cofinity Commercial |
$433.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$403.20
|
| Rate for Payer: Healthscope Commercial |
$453.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$352.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$378.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$428.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$378.00
|
| Rate for Payer: PHP Commercial |
$428.40
|
| Rate for Payer: Priority Health SBD |
$317.52
|
| Rate for Payer: UMR Bronson Commercial |
$221.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$378.00
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
OP
|
$684.00
|
|
|
Service Code
|
NDC 00904750930
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$253.08 |
| Max. Negotiated Rate |
$615.60 |
| Rate for Payer: Aetna American Axle |
$444.60
|
| Rate for Payer: Aetna Commercial |
$581.40
|
| Rate for Payer: Aetna Medicare |
$342.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$444.60
|
| Rate for Payer: BCBS Complete |
$273.60
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cofinity Advantage |
$478.80
|
| Rate for Payer: Cofinity Commercial |
$588.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$547.20
|
| Rate for Payer: Healthscope Commercial |
$615.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$478.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$513.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$547.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$581.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$513.00
|
| Rate for Payer: PHP Commercial |
$581.40
|
| Rate for Payer: Priority Health SBD |
$430.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$444.60
|
| Rate for Payer: UHC Core |
$356.36
|
| Rate for Payer: UHC Exchange |
$268.81
|
| Rate for Payer: UMR Bronson Commercial |
$253.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$513.00
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
OP
|
$684.00
|
|
|
Service Code
|
NDC 00904679430
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$253.08 |
| Max. Negotiated Rate |
$615.60 |
| Rate for Payer: Aetna American Axle |
$444.60
|
| Rate for Payer: Aetna Commercial |
$581.40
|
| Rate for Payer: Aetna Medicare |
$342.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$444.60
|
| Rate for Payer: BCBS Complete |
$273.60
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cofinity Advantage |
$478.80
|
| Rate for Payer: Cofinity Commercial |
$588.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$547.20
|
| Rate for Payer: Healthscope Commercial |
$615.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$478.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$513.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$547.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$581.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$513.00
|
| Rate for Payer: PHP Commercial |
$581.40
|
| Rate for Payer: Priority Health SBD |
$430.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$444.60
|
| Rate for Payer: UHC Core |
$356.36
|
| Rate for Payer: UHC Exchange |
$268.81
|
| Rate for Payer: UMR Bronson Commercial |
$253.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$513.00
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
OP
|
$90.72
|
|
|
Service Code
|
NDC 00904679489
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.57 |
| Max. Negotiated Rate |
$81.65 |
| Rate for Payer: Aetna American Axle |
$58.97
|
| Rate for Payer: Aetna Commercial |
$77.11
|
| Rate for Payer: Aetna Medicare |
$45.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.97
|
| Rate for Payer: BCBS Complete |
$36.29
|
| Rate for Payer: Cash Price |
$72.58
|
| Rate for Payer: Cofinity Advantage |
$63.50
|
| Rate for Payer: Cofinity Commercial |
$78.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.58
|
| Rate for Payer: Healthscope Commercial |
$81.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.04
|
| Rate for Payer: PHP Commercial |
$77.11
|
| Rate for Payer: Priority Health SBD |
$57.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.97
|
| Rate for Payer: UHC Core |
$47.27
|
| Rate for Payer: UHC Exchange |
$35.65
|
| Rate for Payer: UMR Bronson Commercial |
$33.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.04
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
IP
|
$50.40
|
|
|
Service Code
|
NDC 00536100836
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.18 |
| Max. Negotiated Rate |
$45.36 |
| Rate for Payer: Aetna American Axle |
$32.76
|
| Rate for Payer: Aetna Commercial |
$42.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.76
|
| Rate for Payer: Cash Price |
$40.32
|
| Rate for Payer: Cofinity Advantage |
$35.28
|
| Rate for Payer: Cofinity Commercial |
$43.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.32
|
| Rate for Payer: Healthscope Commercial |
$45.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.80
|
| Rate for Payer: PHP Commercial |
$42.84
|
| Rate for Payer: Priority Health SBD |
$31.75
|
| Rate for Payer: UMR Bronson Commercial |
$22.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.80
|
|
