|
BUSPIRONE 5 MG TABLET
|
Facility
|
IP
|
$119.85
|
|
|
Service Code
|
NDC 0093-0053-01
|
| Hospital Charge Code |
9324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.73 |
| Max. Negotiated Rate |
$107.86 |
| Rate for Payer: Aetna American Axle |
$77.90
|
| Rate for Payer: Aetna Commercial |
$101.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.90
|
| Rate for Payer: Cash Price |
$95.88
|
| Rate for Payer: Cofinity Commercial |
$103.07
|
| Rate for Payer: Cofinity Commercial |
$83.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.88
|
| Rate for Payer: Healthscope Commercial |
$107.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$101.87
|
| Rate for Payer: PHP Commercial |
$101.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.90
|
| Rate for Payer: Priority Health SBD |
$75.51
|
| Rate for Payer: UMR Bronson Commercial |
$52.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.89
|
|
|
BUSPIRONE 5 MG TABLET
|
Facility
|
IP
|
$105.75
|
|
|
Service Code
|
NDC 59651-389-01
|
| Hospital Charge Code |
9324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.53 |
| Max. Negotiated Rate |
$95.18 |
| Rate for Payer: Aetna American Axle |
$68.74
|
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.74
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cofinity Commercial |
$74.02
|
| Rate for Payer: Cofinity Commercial |
$90.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.60
|
| Rate for Payer: Healthscope Commercial |
$95.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.89
|
| Rate for Payer: PHP Commercial |
$89.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.02
|
| Rate for Payer: Priority Health SBD |
$66.62
|
| Rate for Payer: UMR Bronson Commercial |
$46.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.31
|
|
|
BUSPIRONE 7.5 MG TABLET
|
Facility
|
IP
|
$225.15
|
|
|
Service Code
|
NDC 64380-787-06
|
| Hospital Charge Code |
29967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.07 |
| Max. Negotiated Rate |
$202.64 |
| Rate for Payer: Aetna American Axle |
$146.35
|
| Rate for Payer: Aetna Commercial |
$191.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.35
|
| Rate for Payer: Cash Price |
$180.12
|
| Rate for Payer: Cofinity Commercial |
$157.60
|
| Rate for Payer: Cofinity Commercial |
$193.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.12
|
| Rate for Payer: Healthscope Commercial |
$202.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$191.38
|
| Rate for Payer: PHP Commercial |
$191.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.60
|
| Rate for Payer: Priority Health SBD |
$141.84
|
| Rate for Payer: UMR Bronson Commercial |
$99.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.86
|
|
|
BUSPIRONE 7.5 MG TABLET
|
Facility
|
IP
|
$408.90
|
|
|
Service Code
|
NDC 72888-063-01
|
| Hospital Charge Code |
29967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.92 |
| Max. Negotiated Rate |
$368.01 |
| Rate for Payer: Aetna American Axle |
$265.78
|
| Rate for Payer: Aetna Commercial |
$347.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.78
|
| Rate for Payer: Cash Price |
$327.12
|
| Rate for Payer: Cofinity Commercial |
$286.23
|
| Rate for Payer: Cofinity Commercial |
$351.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.12
|
| Rate for Payer: Healthscope Commercial |
$368.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$286.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$347.56
|
| Rate for Payer: PHP Commercial |
$347.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$286.23
|
| Rate for Payer: Priority Health SBD |
$257.61
|
| Rate for Payer: UMR Bronson Commercial |
$179.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.68
|
|
|
BUSPIRONE 7.5 MG TABLET
|
Facility
|
IP
|
$225.15
|
|
|
Service Code
|
NDC 16729-201-01
|
| Hospital Charge Code |
29967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.07 |
| Max. Negotiated Rate |
$202.64 |
| Rate for Payer: Aetna American Axle |
$146.35
|
| Rate for Payer: Aetna Commercial |
$191.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.35
|
| Rate for Payer: Cash Price |
$180.12
|
| Rate for Payer: Cofinity Commercial |
$157.60
|
| Rate for Payer: Cofinity Commercial |
$193.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.12
|
| Rate for Payer: Healthscope Commercial |
$202.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$191.38
|
| Rate for Payer: PHP Commercial |
$191.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.60
|
| Rate for Payer: Priority Health SBD |
$141.84
|
| Rate for Payer: UMR Bronson Commercial |
$99.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.86
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
IP
|
$302.75
|
|
|
Service Code
|
NDC 0527-1695-01
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.21 |
| Max. Negotiated Rate |
$272.48 |
| Rate for Payer: Aetna American Axle |
$196.79
|
| Rate for Payer: Aetna Commercial |
$257.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.79
|
| Rate for Payer: Cash Price |
$242.20
|
| Rate for Payer: Cofinity Commercial |
$211.92
|
| Rate for Payer: Cofinity Commercial |
$260.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.20
|
| Rate for Payer: Healthscope Commercial |
$272.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$211.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$257.34
|
| Rate for Payer: PHP Commercial |
$257.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.92
|
| Rate for Payer: Priority Health SBD |
$190.73
|
| Rate for Payer: UMR Bronson Commercial |
$133.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.06
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
IP
|
$10.65
|
|
|
Service Code
|
NDC 68084-396-11
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.69 |
| Max. Negotiated Rate |
$9.58 |
| Rate for Payer: Aetna American Axle |
$6.92
|
| Rate for Payer: Aetna Commercial |
$9.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.92
|
| Rate for Payer: Cash Price |
$8.52
|
| Rate for Payer: Cofinity Commercial |
$7.46
|
| Rate for Payer: Cofinity Commercial |
$9.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.52
|
| Rate for Payer: Healthscope Commercial |
$9.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.05
|
| Rate for Payer: PHP Commercial |
$9.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.46
|
| Rate for Payer: Priority Health SBD |
$6.71
|
| Rate for Payer: UMR Bronson Commercial |
$4.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.99
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
NDC 46672-053-10
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.68 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Aetna American Axle |
$95.55
|
| Rate for Payer: Aetna Commercial |
$124.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.55
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cofinity Commercial |
$102.90
|
| Rate for Payer: Cofinity Commercial |
$126.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.60
|
| Rate for Payer: Healthscope Commercial |
$132.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.95
|
| Rate for Payer: PHP Commercial |
$124.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.90
|
| Rate for Payer: Priority Health SBD |
$92.61
|
| Rate for Payer: UMR Bronson Commercial |
$64.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.25
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
IP
|
$434.70
|
|
|
Service Code
|
NDC 0591-3369-01
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$191.27 |
| Max. Negotiated Rate |
$391.23 |
| Rate for Payer: Aetna American Axle |
$282.56
|
| Rate for Payer: Aetna Commercial |
$369.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$282.56
|
| Rate for Payer: Cash Price |
$347.76
|
| Rate for Payer: Cofinity Commercial |
$304.29
|
| Rate for Payer: Cofinity Commercial |
$373.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.76
|
| Rate for Payer: Healthscope Commercial |
$391.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$304.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$326.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$369.50
|
| Rate for Payer: PHP Commercial |
$369.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$304.29
|
| Rate for Payer: Priority Health SBD |
$273.86
|
| Rate for Payer: UMR Bronson Commercial |
$191.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$326.02
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
IP
|
$3,472.00
|
|
|
Service Code
|
NDC 0603-2544-28
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,527.68 |
| Max. Negotiated Rate |
$3,124.80 |
| Rate for Payer: Aetna American Axle |
$2,256.80
|
| Rate for Payer: Aetna Commercial |
$2,951.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,256.80
|
| Rate for Payer: Cash Price |
$2,777.60
|
| Rate for Payer: Cofinity Commercial |
$2,430.40
|
| Rate for Payer: Cofinity Commercial |
$2,985.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,777.60
|
| Rate for Payer: Healthscope Commercial |
$3,124.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,430.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,604.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,951.20
|
| Rate for Payer: PHP Commercial |
$2,951.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,430.40
|
| Rate for Payer: Priority Health SBD |
$2,187.36
|
| Rate for Payer: UMR Bronson Commercial |
$1,527.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,604.00
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
IP
|
$735.70
|
|
|
Service Code
|
NDC 0603-2544-21
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$323.71 |
| Max. Negotiated Rate |
$662.13 |
| Rate for Payer: Aetna American Axle |
$478.20
|
| Rate for Payer: Aetna Commercial |
$625.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$478.20
|
| Rate for Payer: Cash Price |
$588.56
|
| Rate for Payer: Cofinity Commercial |
$514.99
|
| Rate for Payer: Cofinity Commercial |
$632.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$588.56
|
| Rate for Payer: Healthscope Commercial |
$662.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$514.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$551.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$625.34
|
| Rate for Payer: PHP Commercial |
$625.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$514.99
|
| Rate for Payer: Priority Health SBD |
$463.49
|
| Rate for Payer: UMR Bronson Commercial |
$323.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$551.78
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
IP
|
$302.75
|
|
|
Service Code
|
NDC 70010-149-01
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.21 |
| Max. Negotiated Rate |
$272.48 |
| Rate for Payer: Aetna American Axle |
$196.79
|
| Rate for Payer: Aetna Commercial |
$257.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.79
|
| Rate for Payer: Cash Price |
$242.20
|
| Rate for Payer: Cofinity Commercial |
$211.92
|
| Rate for Payer: Cofinity Commercial |
$260.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.20
|
| Rate for Payer: Healthscope Commercial |
$272.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$211.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$257.34
|
| Rate for Payer: PHP Commercial |
$257.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.92
|
| Rate for Payer: Priority Health SBD |
$190.73
|
| Rate for Payer: UMR Bronson Commercial |
$133.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.06
|
|
|
BUTALBITAL-ASPIRIN-CAFFEINE 50 MG-325 MG-40 MG CAPSULE
|
Facility
|
IP
|
$712.60
|
|
|
Service Code
|
NDC 0591-3219-01
|
| Hospital Charge Code |
8922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$313.54 |
| Max. Negotiated Rate |
$641.34 |
| Rate for Payer: Aetna American Axle |
$463.19
|
| Rate for Payer: Aetna Commercial |
$605.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$463.19
|
| Rate for Payer: Cash Price |
$570.08
|
| Rate for Payer: Cofinity Commercial |
$498.82
|
| Rate for Payer: Cofinity Commercial |
$612.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$570.08
|
| Rate for Payer: Healthscope Commercial |
$641.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$498.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$534.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$605.71
|
| Rate for Payer: PHP Commercial |
$605.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$498.82
|
| Rate for Payer: Priority Health SBD |
$448.94
|
| Rate for Payer: UMR Bronson Commercial |
$313.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$534.45
|
|
|
BUTALBITAL-ASPIRIN-CAFFEINE 50 MG-325 MG-40 MG CAPSULE
|
Facility
|
IP
|
$603.40
|
|
|
Service Code
|
NDC 0527-1552-01
|
| Hospital Charge Code |
8922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$265.50 |
| Max. Negotiated Rate |
$543.06 |
| Rate for Payer: Aetna American Axle |
$392.21
|
| Rate for Payer: Aetna Commercial |
$512.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$392.21
|
| Rate for Payer: Cash Price |
$482.72
|
| Rate for Payer: Cofinity Commercial |
$422.38
|
| Rate for Payer: Cofinity Commercial |
$518.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$482.72
|
| Rate for Payer: Healthscope Commercial |
$543.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$422.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$452.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$512.89
|
| Rate for Payer: PHP Commercial |
$512.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$422.38
|
| Rate for Payer: Priority Health SBD |
$380.14
|
| Rate for Payer: UMR Bronson Commercial |
$265.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$452.55
|
|
|
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOPICAL SPRAY
|
Facility
|
IP
|
$367.99
|
|
|
Service Code
|
NDC 10223-0201-3
|
| Hospital Charge Code |
9328
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.92 |
| Max. Negotiated Rate |
$331.19 |
| Rate for Payer: Aetna American Axle |
$239.19
|
| Rate for Payer: Aetna Commercial |
$312.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.19
|
| Rate for Payer: Cash Price |
$294.39
|
| Rate for Payer: Cofinity Commercial |
$257.59
|
| Rate for Payer: Cofinity Commercial |
$316.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.39
|
| Rate for Payer: Healthscope Commercial |
$331.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$257.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$275.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$312.79
|
| Rate for Payer: PHP Commercial |
$312.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.59
|
| Rate for Payer: Priority Health SBD |
$231.83
|
| Rate for Payer: UMR Bronson Commercial |
$161.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$275.99
|
|
|
BUTORPHANOL 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$14.75
|
|
|
Service Code
|
HCPCS J0595
|
| Hospital Charge Code |
9333
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.49 |
| Max. Negotiated Rate |
$13.28 |
| Rate for Payer: Aetna American Axle |
$9.59
|
| Rate for Payer: Aetna American Axle |
$26.57
|
| Rate for Payer: Aetna Commercial |
$34.75
|
| Rate for Payer: Aetna Commercial |
$12.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.57
|
| Rate for Payer: Cash Price |
$11.80
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cofinity Commercial |
$10.32
|
| Rate for Payer: Cofinity Commercial |
$12.68
|
| Rate for Payer: Cofinity Commercial |
$35.16
|
| Rate for Payer: Cofinity Commercial |
$28.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.80
|
| Rate for Payer: Healthscope Commercial |
$36.79
|
| Rate for Payer: Healthscope Commercial |
$13.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.54
|
| Rate for Payer: PHP Commercial |
$34.75
|
| Rate for Payer: PHP Commercial |
$12.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.32
|
| Rate for Payer: Priority Health SBD |
$25.75
|
| Rate for Payer: Priority Health SBD |
$9.29
|
| Rate for Payer: UMR Bronson Commercial |
$6.49
|
| Rate for Payer: UMR Bronson Commercial |
$17.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.66
|
|
|
BUTYLATED HYDROXYTOLUENE POWDER
|
Facility
|
IP
|
$338.40
|
|
|
Service Code
|
NDC 3877900655
|
| Hospital Charge Code |
17041
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.90 |
| Max. Negotiated Rate |
$304.56 |
| Rate for Payer: Aetna American Axle |
$219.96
|
| Rate for Payer: Aetna Commercial |
$287.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.96
|
| Rate for Payer: Cash Price |
$270.72
|
| Rate for Payer: Cofinity Commercial |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$291.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.72
|
| Rate for Payer: Healthscope Commercial |
$304.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$236.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$287.64
|
| Rate for Payer: PHP Commercial |
$287.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.88
|
| Rate for Payer: Priority Health SBD |
$213.19
|
| Rate for Payer: UMR Bronson Commercial |
$148.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.80
|
|
|
CABAZITAXEL 10 MG/ML (FIRST DILUTION) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$62,272.49
|
|
|
Service Code
|
HCPCS J9043
|
| Hospital Charge Code |
105644
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27,399.90 |
| Max. Negotiated Rate |
$56,045.24 |
| Rate for Payer: Aetna American Axle |
$40,477.12
|
| Rate for Payer: Aetna Commercial |
$52,931.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40,477.12
|
| Rate for Payer: Cash Price |
$49,817.99
|
| Rate for Payer: Cofinity Commercial |
$43,590.74
|
| Rate for Payer: Cofinity Commercial |
$53,554.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49,817.99
|
| Rate for Payer: Healthscope Commercial |
$56,045.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43,590.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46,704.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52,931.62
|
| Rate for Payer: PHP Commercial |
$52,931.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43,590.74
|
| Rate for Payer: Priority Health SBD |
$39,231.67
|
| Rate for Payer: UMR Bronson Commercial |
$27,399.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46,704.37
|
|
|
CABAZITAXEL 10 MG/ML (FIRST DILUTION) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$62,272.49
|
|
|
Service Code
|
HCPCS J9043
|
| Hospital Charge Code |
105644
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$115.12 |
| Max. Negotiated Rate |
$56,045.24 |
| Rate for Payer: Aetna American Axle |
$40,477.12
|
| Rate for Payer: Aetna Commercial |
$52,931.62
|
| Rate for Payer: Aetna Medicare |
$218.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40,477.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$263.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$263.07
|
| Rate for Payer: BCBS Complete |
$120.88
|
| Rate for Payer: BCBS MAPPO |
$210.45
|
| Rate for Payer: BCBS Trust/PPO |
$680.08
|
| Rate for Payer: BCN Medicare Advantage |
$210.45
|
| Rate for Payer: Cash Price |
$49,817.99
|
| Rate for Payer: Cash Price |
$49,817.99
|
| Rate for Payer: Cofinity Commercial |
$53,554.34
|
| Rate for Payer: Cofinity Commercial |
$43,590.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49,817.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$210.45
|
| Rate for Payer: Healthscope Commercial |
$56,045.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43,590.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46,704.37
|
| Rate for Payer: Mclaren Medicaid |
$115.12
|
| Rate for Payer: Mclaren Medicare |
$210.45
|
| Rate for Payer: Meridian Medicaid |
$120.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$220.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$242.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52,931.62
|
| Rate for Payer: PACE Medicare |
$199.93
|
| Rate for Payer: PACE SWMI |
$210.45
|
| Rate for Payer: PHP Commercial |
$52,931.62
|
| Rate for Payer: PHP Medicare Advantage |
$210.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$115.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43,590.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$614.81
|
| Rate for Payer: Priority Health Medicare |
$210.45
|
| Rate for Payer: Priority Health Narrow Network |
$491.85
|
| Rate for Payer: Priority Health SBD |
$39,231.67
|
| Rate for Payer: Railroad Medicare Medicare |
$210.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$210.45
|
| Rate for Payer: UHC Medicare Advantage |
$216.77
|
| Rate for Payer: UMR Bronson Commercial |
$23,040.82
|
| Rate for Payer: VA VA |
$210.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46,704.37
|
|
|
CABERGOLINE 0.5 MG TABLET
|
Facility
|
IP
|
$72.20
|
|
|
Service Code
|
NDC 50742-118-08
|
| Hospital Charge Code |
19226
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.77 |
| Max. Negotiated Rate |
$64.98 |
| Rate for Payer: Aetna American Axle |
$46.93
|
| Rate for Payer: Aetna Commercial |
$61.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.93
|
| Rate for Payer: Cash Price |
$57.76
|
| Rate for Payer: Cofinity Commercial |
$50.54
|
| Rate for Payer: Cofinity Commercial |
$62.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.76
|
| Rate for Payer: Healthscope Commercial |
$64.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.37
|
| Rate for Payer: PHP Commercial |
$61.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.54
|
| Rate for Payer: Priority Health SBD |
$45.49
|
| Rate for Payer: UMR Bronson Commercial |
$31.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.15
|
|
|
CABERGOLINE 0.5 MG TABLET
|
Facility
|
IP
|
$447.35
|
|
|
Service Code
|
NDC 0093-5420-88
|
| Hospital Charge Code |
19226
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.83 |
| Max. Negotiated Rate |
$402.62 |
| Rate for Payer: Aetna American Axle |
$290.78
|
| Rate for Payer: Aetna Commercial |
$380.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.78
|
| Rate for Payer: Cash Price |
$357.88
|
| Rate for Payer: Cofinity Commercial |
$313.14
|
| Rate for Payer: Cofinity Commercial |
$384.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.88
|
| Rate for Payer: Healthscope Commercial |
$402.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$313.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$335.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$380.25
|
| Rate for Payer: PHP Commercial |
$380.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.14
|
| Rate for Payer: Priority Health SBD |
$281.83
|
| Rate for Payer: UMR Bronson Commercial |
$196.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$335.51
|
|
|
CABERGOLINE 0.5 MG TABLET
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
NDC 59762-1005-1
|
| Hospital Charge Code |
19226
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.84 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Aetna American Axle |
$104.65
|
| Rate for Payer: Aetna Commercial |
$136.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.65
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cofinity Commercial |
$112.70
|
| Rate for Payer: Cofinity Commercial |
$138.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.80
|
| Rate for Payer: Healthscope Commercial |
$144.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$112.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$136.85
|
| Rate for Payer: PHP Commercial |
$136.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.70
|
| Rate for Payer: Priority Health SBD |
$101.43
|
| Rate for Payer: UMR Bronson Commercial |
$70.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.75
|
|
|
CABOTEGRAVIR ER 400 MG/2 ML-RILPIVIRINE ER 600 MG/2ML IM SUSPENSION,ER
|
Facility
|
IP
|
$11,311.36
|
|
|
Service Code
|
HCPCS J0741
|
| Hospital Charge Code |
196075
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,977.00 |
| Max. Negotiated Rate |
$10,180.22 |
| Rate for Payer: Aetna American Axle |
$7,352.38
|
| Rate for Payer: Aetna Commercial |
$9,614.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,352.38
|
| Rate for Payer: Cash Price |
$9,049.09
|
| Rate for Payer: Cofinity Commercial |
$7,917.95
|
| Rate for Payer: Cofinity Commercial |
$9,727.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,049.09
|
| Rate for Payer: Healthscope Commercial |
$10,180.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,917.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,483.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,614.66
|
| Rate for Payer: PHP Commercial |
$9,614.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,917.95
|
| Rate for Payer: Priority Health SBD |
$7,126.16
|
| Rate for Payer: UMR Bronson Commercial |
$4,977.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,483.52
|
|
|
CABOTEGRAVIR ER 400 MG/2 ML-RILPIVIRINE ER 600 MG/2ML IM SUSPENSION,ER
|
Facility
|
OP
|
$11,311.36
|
|
|
Service Code
|
HCPCS J0741
|
| Hospital Charge Code |
196075
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.36 |
| Max. Negotiated Rate |
$10,180.22 |
| Rate for Payer: Aetna American Axle |
$7,352.38
|
| Rate for Payer: Aetna Commercial |
$9,614.66
|
| Rate for Payer: Aetna Medicare |
$23.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,352.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.25
|
| Rate for Payer: BCBS Complete |
$12.98
|
| Rate for Payer: BCBS MAPPO |
$22.60
|
| Rate for Payer: BCBS Trust/PPO |
$73.01
|
| Rate for Payer: BCN Medicare Advantage |
$22.60
|
| Rate for Payer: Cash Price |
$9,049.09
|
| Rate for Payer: Cash Price |
$9,049.09
|
| Rate for Payer: Cofinity Commercial |
$7,917.95
|
| Rate for Payer: Cofinity Commercial |
$9,727.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,049.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.60
|
| Rate for Payer: Healthscope Commercial |
$10,180.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,917.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,483.52
|
| Rate for Payer: Mclaren Medicaid |
$12.36
|
| Rate for Payer: Mclaren Medicare |
$22.60
|
| Rate for Payer: Meridian Medicaid |
$12.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,614.66
|
| Rate for Payer: PACE Medicare |
$21.47
|
| Rate for Payer: PACE SWMI |
$22.60
|
| Rate for Payer: PHP Commercial |
$9,614.66
|
| Rate for Payer: PHP Medicare Advantage |
$22.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,917.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.44
|
| Rate for Payer: Priority Health Medicare |
$22.60
|
| Rate for Payer: Priority Health Narrow Network |
$52.35
|
| Rate for Payer: Priority Health SBD |
$7,126.16
|
| Rate for Payer: Railroad Medicare Medicare |
$22.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.60
|
| Rate for Payer: UHC Medicare Advantage |
$23.27
|
| Rate for Payer: UMR Bronson Commercial |
$4,185.20
|
| Rate for Payer: VA VA |
$22.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,483.52
|
|
|
CABOTEGRAVIR ER 600 MG/3 ML (200 MG/ML) IM SUSPENSION,EXTENDED RELEASE
|
Facility
|
IP
|
$10,059.43
|
|
|
Service Code
|
HCPCS J0739
|
| Hospital Charge Code |
198975
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,426.15 |
| Max. Negotiated Rate |
$9,053.49 |
| Rate for Payer: Aetna American Axle |
$6,538.63
|
| Rate for Payer: Aetna Commercial |
$8,550.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,538.63
|
| Rate for Payer: Cash Price |
$8,047.54
|
| Rate for Payer: Cofinity Commercial |
$7,041.60
|
| Rate for Payer: Cofinity Commercial |
$8,651.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,047.54
|
| Rate for Payer: Healthscope Commercial |
$9,053.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,041.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,544.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,550.52
|
| Rate for Payer: PHP Commercial |
$8,550.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,041.60
|
| Rate for Payer: Priority Health SBD |
$6,337.44
|
| Rate for Payer: UMR Bronson Commercial |
$4,426.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,544.57
|
|
