|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
IP
|
$684.00
|
|
|
Service Code
|
NDC 00904750930
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$300.96 |
| Max. Negotiated Rate |
$615.60 |
| Rate for Payer: Aetna American Axle |
$444.60
|
| Rate for Payer: Aetna Commercial |
$581.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$444.60
|
| 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: 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: UMR Bronson Commercial |
$300.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$513.00
|
|
|
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
|
$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
|
$47.63
|
|
|
Service Code
|
NDC 57896091136
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.62 |
| Max. Negotiated Rate |
$42.87 |
| Rate for Payer: Aetna American Axle |
$30.96
|
| Rate for Payer: Aetna Commercial |
$40.49
|
| Rate for Payer: Aetna Medicare |
$23.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.96
|
| Rate for Payer: BCBS Complete |
$19.05
|
| Rate for Payer: Cash Price |
$38.10
|
| Rate for Payer: Cofinity Advantage |
$33.34
|
| Rate for Payer: Cofinity Commercial |
$40.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.10
|
| Rate for Payer: Healthscope Commercial |
$42.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.72
|
| Rate for Payer: PHP Commercial |
$40.49
|
| Rate for Payer: Priority Health SBD |
$30.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.96
|
| Rate for Payer: UHC Core |
$24.82
|
| Rate for Payer: UHC Exchange |
$18.72
|
| Rate for Payer: UMR Bronson Commercial |
$17.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.72
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
IP
|
$47.63
|
|
|
Service Code
|
NDC 57896091136
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.96 |
| Max. Negotiated Rate |
$42.87 |
| Rate for Payer: Aetna American Axle |
$30.96
|
| Rate for Payer: Aetna Commercial |
$40.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.96
|
| Rate for Payer: Cash Price |
$38.10
|
| Rate for Payer: Cofinity Advantage |
$33.34
|
| Rate for Payer: Cofinity Commercial |
$40.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.10
|
| Rate for Payer: Healthscope Commercial |
$42.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.72
|
| Rate for Payer: PHP Commercial |
$40.49
|
| Rate for Payer: Priority Health SBD |
$30.01
|
| Rate for Payer: UMR Bronson Commercial |
$20.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.72
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
IP
|
$684.00
|
|
|
Service Code
|
NDC 00904679430
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$300.96 |
| Max. Negotiated Rate |
$615.60 |
| Rate for Payer: Aetna American Axle |
$444.60
|
| Rate for Payer: Aetna Commercial |
$581.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$444.60
|
| 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: 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: UMR Bronson Commercial |
$300.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$513.00
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
IP
|
$676.50
|
|
|
Service Code
|
NDC 66553000201
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$297.66 |
| Max. Negotiated Rate |
$608.85 |
| Rate for Payer: Aetna American Axle |
$439.73
|
| Rate for Payer: Aetna Commercial |
$575.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$439.73
|
| Rate for Payer: Cash Price |
$541.20
|
| Rate for Payer: Cofinity Advantage |
$473.55
|
| Rate for Payer: Cofinity Commercial |
$581.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$541.20
|
| Rate for Payer: Healthscope Commercial |
$608.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$473.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$507.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$575.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$507.38
|
| Rate for Payer: PHP Commercial |
$575.02
|
| Rate for Payer: Priority Health SBD |
$426.19
|
| Rate for Payer: UMR Bronson Commercial |
$297.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$507.38
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
OP
|
$139.70
|
|
|
Service Code
|
NDC 48433012901
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.69 |
| Max. Negotiated Rate |
$125.73 |
| Rate for Payer: Aetna American Axle |
$90.81
|
| Rate for Payer: Aetna Commercial |
$118.75
|
| Rate for Payer: Aetna Medicare |
$69.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.81
|
| Rate for Payer: BCBS Complete |
$55.88
|
| Rate for Payer: Cash Price |
$111.76
|
| Rate for Payer: Cofinity Advantage |
$97.79
|
| Rate for Payer: Cofinity Commercial |
$120.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.76
|
| Rate for Payer: Healthscope Commercial |
$125.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$111.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.78
|
| Rate for Payer: PHP Commercial |
$118.75
|
| Rate for Payer: Priority Health SBD |
$88.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.81
|
| Rate for Payer: UHC Core |
$72.78
|
| Rate for Payer: UHC Exchange |
$54.90
|
| Rate for Payer: UMR Bronson Commercial |
$51.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.78
|
|
|
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
|
|
|
ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET
|
Facility
|
IP
|
$50.76
|
|
|
Service Code
|
NDC 96295013133
|
| Hospital Charge Code |
9158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.33 |
| Max. Negotiated Rate |
$45.68 |
| Rate for Payer: Aetna American Axle |
$32.99
|
| Rate for Payer: Aetna Commercial |
$43.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.99
|
| Rate for Payer: Cash Price |
$40.61
|
| Rate for Payer: Cofinity Advantage |
$35.53
|
| Rate for Payer: Cofinity Commercial |
$43.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.61
|
| Rate for Payer: Healthscope Commercial |
$45.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.07
|
| Rate for Payer: PHP Commercial |
$43.15
|
| Rate for Payer: Priority Health SBD |
$31.98
|
| Rate for Payer: UMR Bronson Commercial |
$22.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.07
|
|
|
ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET
|
Facility
|
OP
|
$65.80
|
|
|
Service Code
|
NDC 37205066978
|
| Hospital Charge Code |
9158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.35 |
| Max. Negotiated Rate |
$59.22 |
| Rate for Payer: Aetna American Axle |
$42.77
|
| Rate for Payer: Aetna Commercial |
$55.93
|
| Rate for Payer: Aetna Medicare |
$32.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.77
|
| Rate for Payer: BCBS Complete |
$26.32
|
| Rate for Payer: Cash Price |
$52.64
|
| Rate for Payer: Cofinity Advantage |
$46.06
|
| Rate for Payer: Cofinity Commercial |
$56.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.64
|
| Rate for Payer: Healthscope Commercial |
$59.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.35
|
| Rate for Payer: PHP Commercial |
$55.93
|
| Rate for Payer: Priority Health SBD |
$41.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.77
|
| Rate for Payer: UHC Core |
$34.28
|
| Rate for Payer: UHC Exchange |
$25.86
|
| Rate for Payer: UMR Bronson Commercial |
$24.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.35
|
|
|
ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET
|
Facility
|
IP
|
$70.50
|
|
|
Service Code
|
NDC 00536132601
|
| Hospital Charge Code |
9158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.02 |
| Max. Negotiated Rate |
$63.45 |
| Rate for Payer: Aetna American Axle |
$45.83
|
| Rate for Payer: Aetna Commercial |
$59.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.83
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cofinity Advantage |
$49.35
|
| Rate for Payer: Cofinity Commercial |
$60.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.40
|
| Rate for Payer: Healthscope Commercial |
$63.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.88
|
| Rate for Payer: PHP Commercial |
$59.92
|
| Rate for Payer: Priority Health SBD |
$44.41
|
| Rate for Payer: UMR Bronson Commercial |
$31.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.88
|
|
|
ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET
|
Facility
|
OP
|
$138.65
|
|
|
Service Code
|
NDC 96295013132
|
| Hospital Charge Code |
9158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.30 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna American Axle |
$90.12
|
| Rate for Payer: Aetna Commercial |
$117.85
|
| Rate for Payer: Aetna Medicare |
$69.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.12
|
| Rate for Payer: BCBS Complete |
$55.46
|
| Rate for Payer: Cash Price |
$110.92
|
| Rate for Payer: Cofinity Advantage |
$97.06
|
| Rate for Payer: Cofinity Commercial |
$119.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.92
|
| Rate for Payer: Healthscope Commercial |
$124.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.99
|
| Rate for Payer: PHP Commercial |
$117.85
|
| Rate for Payer: Priority Health SBD |
$87.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.12
|
| Rate for Payer: UHC Core |
$72.24
|
| Rate for Payer: UHC Exchange |
$54.49
|
| Rate for Payer: UMR Bronson Commercial |
$51.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.99
|
|
|
ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET
|
Facility
|
OP
|
$50.76
|
|
|
Service Code
|
NDC 96295013133
|
| Hospital Charge Code |
9158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.78 |
| Max. Negotiated Rate |
$45.68 |
| Rate for Payer: Aetna American Axle |
$32.99
|
| Rate for Payer: Aetna Commercial |
$43.15
|
| Rate for Payer: Aetna Medicare |
$25.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.99
|
| Rate for Payer: BCBS Complete |
$20.30
|
| Rate for Payer: Cash Price |
$40.61
|
| Rate for Payer: Cofinity Advantage |
$35.53
|
| Rate for Payer: Cofinity Commercial |
$43.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.61
|
| Rate for Payer: Healthscope Commercial |
$45.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.07
|
| Rate for Payer: PHP Commercial |
$43.15
|
| Rate for Payer: Priority Health SBD |
$31.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.99
|
| Rate for Payer: UHC Core |
$26.45
|
| Rate for Payer: UHC Exchange |
$19.95
|
| Rate for Payer: UMR Bronson Commercial |
$18.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.07
|
|
|
ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET
|
Facility
|
IP
|
$65.80
|
|
|
Service Code
|
NDC 37205066978
|
| Hospital Charge Code |
9158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$59.22 |
| Rate for Payer: Aetna American Axle |
$42.77
|
| Rate for Payer: Aetna Commercial |
$55.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.77
|
| Rate for Payer: Cash Price |
$52.64
|
| Rate for Payer: Cofinity Advantage |
$46.06
|
| Rate for Payer: Cofinity Commercial |
$56.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.64
|
| Rate for Payer: Healthscope Commercial |
$59.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.35
|
| Rate for Payer: PHP Commercial |
$55.93
|
| Rate for Payer: Priority Health SBD |
$41.45
|
| Rate for Payer: UMR Bronson Commercial |
$28.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.35
|
|
|
ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET
|
Facility
|
OP
|
$70.50
|
|
|
Service Code
|
NDC 00536132601
|
| Hospital Charge Code |
9158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.09 |
| Max. Negotiated Rate |
$63.45 |
| Rate for Payer: Aetna American Axle |
$45.83
|
| Rate for Payer: Aetna Commercial |
$59.92
|
| Rate for Payer: Aetna Medicare |
$35.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.83
|
| Rate for Payer: BCBS Complete |
$28.20
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cofinity Advantage |
$49.35
|
| Rate for Payer: Cofinity Commercial |
$60.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.40
|
| Rate for Payer: Healthscope Commercial |
$63.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.88
|
| Rate for Payer: PHP Commercial |
$59.92
|
| Rate for Payer: Priority Health SBD |
$44.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.83
|
| Rate for Payer: UHC Core |
$36.73
|
| Rate for Payer: UHC Exchange |
$27.71
|
| Rate for Payer: UMR Bronson Commercial |
$26.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.88
|
|
|
ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET
|
Facility
|
IP
|
$138.65
|
|
|
Service Code
|
NDC 96295013132
|
| Hospital Charge Code |
9158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.01 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna American Axle |
$90.12
|
| Rate for Payer: Aetna Commercial |
$117.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.12
|
| Rate for Payer: Cash Price |
$110.92
|
| Rate for Payer: Cofinity Advantage |
$97.06
|
| Rate for Payer: Cofinity Commercial |
$119.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.92
|
| Rate for Payer: Healthscope Commercial |
$124.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.99
|
| Rate for Payer: PHP Commercial |
$117.85
|
| Rate for Payer: Priority Health SBD |
$87.35
|
| Rate for Payer: UMR Bronson Commercial |
$61.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.99
|
|
|
ASTHMA
|
Facility
|
IP
|
$4,328.68
|
|
|
Service Code
|
APR-DRG 1412
|
| Min. Negotiated Rate |
$4,122.55 |
| Max. Negotiated Rate |
$4,328.68 |
| Rate for Payer: BCBS Complete |
$4,328.68
|
| Rate for Payer: Mclaren Medicaid |
$4,122.55
|
| Rate for Payer: Meridian Medicaid |
$4,328.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,122.55
|
| Rate for Payer: UHC Medicaid |
$4,122.55
|
| Rate for Payer: UHCCP Medicaid |
$4,122.55
|
|
|
ASTHMA
|
Facility
|
IP
|
$11,868.61
|
|
|
Service Code
|
APR-DRG 1414
|
| Min. Negotiated Rate |
$11,303.44 |
| Max. Negotiated Rate |
$11,868.61 |
| Rate for Payer: BCBS Complete |
$11,868.61
|
| Rate for Payer: Mclaren Medicaid |
$11,303.44
|
| Rate for Payer: Meridian Medicaid |
$11,868.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,303.44
|
| Rate for Payer: UHC Medicaid |
$11,303.44
|
| Rate for Payer: UHCCP Medicaid |
$11,303.44
|
|
|
ASTHMA
|
Facility
|
IP
|
$6,050.83
|
|
|
Service Code
|
APR-DRG 1413
|
| Min. Negotiated Rate |
$5,762.69 |
| Max. Negotiated Rate |
$6,050.83 |
| Rate for Payer: BCBS Complete |
$6,050.83
|
| Rate for Payer: Mclaren Medicaid |
$5,762.69
|
| Rate for Payer: Meridian Medicaid |
$6,050.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,762.69
|
| Rate for Payer: UHC Medicaid |
$5,762.69
|
| Rate for Payer: UHCCP Medicaid |
$5,762.69
|
|
|
ASTHMA
|
Facility
|
IP
|
$3,302.05
|
|
|
Service Code
|
APR-DRG 1411
|
| Min. Negotiated Rate |
$3,144.81 |
| Max. Negotiated Rate |
$3,302.05 |
| Rate for Payer: BCBS Complete |
$3,302.05
|
| Rate for Payer: Mclaren Medicaid |
$3,144.81
|
| Rate for Payer: Meridian Medicaid |
$3,302.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,144.81
|
| Rate for Payer: UHC Medicaid |
$3,144.81
|
| Rate for Payer: UHCCP Medicaid |
$3,144.81
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
|
OP
|
$354.85
|
|
|
Service Code
|
NDC 00904718761
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.29 |
| Max. Negotiated Rate |
$319.37 |
| Rate for Payer: Aetna American Axle |
$230.65
|
| Rate for Payer: Aetna Commercial |
$301.62
|
| Rate for Payer: Aetna Medicare |
$177.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.65
|
| Rate for Payer: BCBS Complete |
$141.94
|
| Rate for Payer: Cash Price |
$283.88
|
| Rate for Payer: Cofinity Advantage |
$248.40
|
| Rate for Payer: Cofinity Commercial |
$305.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.88
|
| Rate for Payer: Healthscope Commercial |
$319.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$283.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$266.14
|
| Rate for Payer: PHP Commercial |
$301.62
|
| Rate for Payer: Priority Health SBD |
$223.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.65
|
| Rate for Payer: UHC Core |
$184.88
|
| Rate for Payer: UHC Exchange |
$139.46
|
| Rate for Payer: UMR Bronson Commercial |
$131.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.14
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
|
OP
|
$75.20
|
|
|
Service Code
|
NDC 00093078701
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.82 |
| Max. Negotiated Rate |
$67.68 |
| Rate for Payer: Aetna American Axle |
$48.88
|
| Rate for Payer: Aetna Commercial |
$63.92
|
| Rate for Payer: Aetna Medicare |
$37.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.88
|
| Rate for Payer: BCBS Complete |
$30.08
|
| Rate for Payer: Cash Price |
$60.16
|
| Rate for Payer: Cofinity Advantage |
$52.64
|
| Rate for Payer: Cofinity Commercial |
$64.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.16
|
| Rate for Payer: Healthscope Commercial |
$67.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.40
|
| Rate for Payer: PHP Commercial |
$63.92
|
| Rate for Payer: Priority Health SBD |
$47.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.88
|
| Rate for Payer: UHC Core |
$39.18
|
| Rate for Payer: UHC Exchange |
$29.55
|
| Rate for Payer: UMR Bronson Commercial |
$27.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.40
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
|
OP
|
$4.05
|
|
|
Service Code
|
NDC 51079075901
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$3.65 |
| Rate for Payer: Aetna American Axle |
$2.63
|
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: Aetna Medicare |
$2.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.63
|
| Rate for Payer: BCBS Complete |
$1.62
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cofinity Advantage |
$2.83
|
| Rate for Payer: Cofinity Commercial |
$3.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.24
|
| Rate for Payer: Healthscope Commercial |
$3.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.04
|
| Rate for Payer: PHP Commercial |
$3.44
|
| Rate for Payer: Priority Health SBD |
$2.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.63
|
| Rate for Payer: UHC Core |
$2.11
|
| Rate for Payer: UHC Exchange |
$1.59
|
| Rate for Payer: UMR Bronson Commercial |
$1.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.04
|
|
