|
CABOTEGRAVIR ER 600 MG/3 ML (200 MG/ML) IM SUSPENSION,EXTENDED RELEASE
|
Facility
|
OP
|
$10,059.43
|
|
|
Service Code
|
HCPCS J0739
|
| Hospital Charge Code |
198975
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.38 |
| 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: BCBS Complete |
$4,023.77
|
| Rate for Payer: BCBS Trust/PPO |
$21.25
|
| Rate for Payer: Cash Price |
$8,047.54
|
| Rate for Payer: Cash Price |
$8,047.54
|
| Rate for Payer: Cofinity Commercial |
$8,651.11
|
| Rate for Payer: Cofinity Commercial |
$7,041.60
|
| 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 HMO/PPO/Tiered Network |
$6.73
|
| Rate for Payer: Priority Health Narrow Network |
$5.38
|
| Rate for Payer: Priority Health SBD |
$6,337.44
|
| Rate for Payer: UMR Bronson Commercial |
$3,721.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,544.57
|
|
|
CABOTEGRAVIR ER 600 MG/3 ML-RILPIVIRINE ER 900 MG/3ML IM SUSPENSION,ER
|
Facility
|
OP
|
$16,967.03
|
|
|
Service Code
|
HCPCS J0741
|
| Hospital Charge Code |
196915
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.36 |
| Max. Negotiated Rate |
$15,270.33 |
| Rate for Payer: Aetna American Axle |
$11,028.57
|
| Rate for Payer: Aetna Commercial |
$14,421.98
|
| Rate for Payer: Aetna Medicare |
$23.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,028.57
|
| 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 |
$13,573.62
|
| Rate for Payer: Cash Price |
$13,573.62
|
| Rate for Payer: Cofinity Commercial |
$11,876.92
|
| Rate for Payer: Cofinity Commercial |
$14,591.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,573.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.60
|
| Rate for Payer: Healthscope Commercial |
$15,270.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,876.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,725.27
|
| 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 |
$14,421.98
|
| Rate for Payer: PACE Medicare |
$21.47
|
| Rate for Payer: PACE SWMI |
$22.60
|
| Rate for Payer: PHP Commercial |
$14,421.98
|
| 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 |
$11,876.92
|
| 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 |
$10,689.23
|
| 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 |
$6,277.80
|
| Rate for Payer: VA VA |
$22.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,725.27
|
|
|
CABOTEGRAVIR ER 600 MG/3 ML-RILPIVIRINE ER 900 MG/3ML IM SUSPENSION,ER
|
Facility
|
IP
|
$16,967.03
|
|
|
Service Code
|
HCPCS J0741
|
| Hospital Charge Code |
196915
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,465.49 |
| Max. Negotiated Rate |
$15,270.33 |
| Rate for Payer: Aetna American Axle |
$11,028.57
|
| Rate for Payer: Aetna Commercial |
$14,421.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,028.57
|
| Rate for Payer: Cash Price |
$13,573.62
|
| Rate for Payer: Cofinity Commercial |
$11,876.92
|
| Rate for Payer: Cofinity Commercial |
$14,591.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,573.62
|
| Rate for Payer: Healthscope Commercial |
$15,270.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,876.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,725.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,421.98
|
| Rate for Payer: PHP Commercial |
$14,421.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,876.92
|
| Rate for Payer: Priority Health SBD |
$10,689.23
|
| Rate for Payer: UMR Bronson Commercial |
$7,465.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,725.27
|
|
|
CAFFEINE 200 MG TABLET
|
Facility
|
IP
|
$33.47
|
|
|
Service Code
|
NDC 9629596325
|
| Hospital Charge Code |
1259
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.73 |
| Max. Negotiated Rate |
$30.12 |
| Rate for Payer: Aetna American Axle |
$21.76
|
| Rate for Payer: Aetna Commercial |
$28.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.76
|
| Rate for Payer: Cash Price |
$26.78
|
| Rate for Payer: Cofinity Commercial |
$23.43
|
| Rate for Payer: Cofinity Commercial |
$28.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.78
|
| Rate for Payer: Healthscope Commercial |
$30.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.45
|
| Rate for Payer: PHP Commercial |
$28.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.43
|
| Rate for Payer: Priority Health SBD |
$21.09
|
| Rate for Payer: UMR Bronson Commercial |
$14.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.10
|
|
|
CAFFEINE 200 MG TABLET
|
Facility
|
IP
|
$1.63
|
|
|
Service Code
|
NDC 9900-0008-81
|
| Hospital Charge Code |
1259
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$1.47 |
| Rate for Payer: Aetna American Axle |
$1.06
|
| Rate for Payer: Aetna Commercial |
$1.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.06
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Cofinity Commercial |
$1.14
|
| Rate for Payer: Cofinity Commercial |
$1.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.30
|
| Rate for Payer: Healthscope Commercial |
$1.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.39
|
| Rate for Payer: PHP Commercial |
$1.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.14
|
| Rate for Payer: Priority Health SBD |
$1.03
|
| Rate for Payer: UMR Bronson Commercial |
$0.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.22
|
|
|
CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) BOLUS/LOAD IV SOLUTION CUSTOM
|
Facility
|
IP
|
$44.78
|
|
|
Service Code
|
HCPCS J0706
|
| Hospital Charge Code |
163560
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.70 |
| Max. Negotiated Rate |
$40.30 |
| Rate for Payer: Aetna American Axle |
$29.11
|
| Rate for Payer: Aetna Commercial |
$38.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.11
|
| Rate for Payer: Cash Price |
$35.82
|
| Rate for Payer: Cofinity Commercial |
$31.35
|
| Rate for Payer: Cofinity Commercial |
$38.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.82
|
| Rate for Payer: Healthscope Commercial |
$40.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.06
|
| Rate for Payer: PHP Commercial |
$38.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.35
|
| Rate for Payer: Priority Health SBD |
$28.21
|
| Rate for Payer: UMR Bronson Commercial |
$19.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.58
|
|
|
CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) BOLUS/LOAD ORAL SOLUTION CUSTOM
|
Facility
|
IP
|
$37.76
|
|
|
Service Code
|
HCPCS J0706
|
| Hospital Charge Code |
301512
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$33.98 |
| Rate for Payer: Aetna American Axle |
$24.54
|
| Rate for Payer: Aetna Commercial |
$32.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.54
|
| Rate for Payer: Cash Price |
$30.21
|
| Rate for Payer: Cofinity Commercial |
$26.43
|
| Rate for Payer: Cofinity Commercial |
$32.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.21
|
| Rate for Payer: Healthscope Commercial |
$33.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.10
|
| Rate for Payer: PHP Commercial |
$32.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.43
|
| Rate for Payer: Priority Health SBD |
$23.79
|
| Rate for Payer: UMR Bronson Commercial |
$16.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.32
|
|
|
CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) MAINTENANCE INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$44.78
|
|
|
Service Code
|
HCPCS J0706
|
| Hospital Charge Code |
77412
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.70 |
| Max. Negotiated Rate |
$40.30 |
| Rate for Payer: Aetna American Axle |
$29.11
|
| Rate for Payer: Aetna American Axle |
$56.82
|
| Rate for Payer: Aetna American Axle |
$38.26
|
| Rate for Payer: Aetna American Axle |
$52.03
|
| Rate for Payer: Aetna American Axle |
$47.50
|
| Rate for Payer: Aetna Commercial |
$74.30
|
| Rate for Payer: Aetna Commercial |
$38.06
|
| Rate for Payer: Aetna Commercial |
$62.12
|
| Rate for Payer: Aetna Commercial |
$68.03
|
| Rate for Payer: Aetna Commercial |
$50.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.50
|
| Rate for Payer: Cash Price |
$69.93
|
| Rate for Payer: Cash Price |
$64.03
|
| Rate for Payer: Cash Price |
$35.82
|
| Rate for Payer: Cash Price |
$58.46
|
| Rate for Payer: Cash Price |
$47.09
|
| Rate for Payer: Cofinity Commercial |
$61.19
|
| Rate for Payer: Cofinity Commercial |
$31.35
|
| Rate for Payer: Cofinity Commercial |
$38.51
|
| Rate for Payer: Cofinity Commercial |
$41.20
|
| Rate for Payer: Cofinity Commercial |
$50.62
|
| Rate for Payer: Cofinity Commercial |
$51.16
|
| Rate for Payer: Cofinity Commercial |
$62.85
|
| Rate for Payer: Cofinity Commercial |
$56.03
|
| Rate for Payer: Cofinity Commercial |
$68.83
|
| Rate for Payer: Cofinity Commercial |
$75.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.46
|
| Rate for Payer: Healthscope Commercial |
$65.77
|
| Rate for Payer: Healthscope Commercial |
$78.67
|
| Rate for Payer: Healthscope Commercial |
$72.04
|
| Rate for Payer: Healthscope Commercial |
$40.30
|
| Rate for Payer: Healthscope Commercial |
$52.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.03
|
| Rate for Payer: PHP Commercial |
$68.03
|
| Rate for Payer: PHP Commercial |
$74.30
|
| Rate for Payer: PHP Commercial |
$62.12
|
| Rate for Payer: PHP Commercial |
$38.06
|
| Rate for Payer: PHP Commercial |
$50.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.35
|
| Rate for Payer: Priority Health SBD |
$50.43
|
| Rate for Payer: Priority Health SBD |
$37.08
|
| Rate for Payer: Priority Health SBD |
$46.04
|
| Rate for Payer: Priority Health SBD |
$28.21
|
| Rate for Payer: Priority Health SBD |
$55.07
|
| Rate for Payer: UMR Bronson Commercial |
$19.70
|
| Rate for Payer: UMR Bronson Commercial |
$25.90
|
| Rate for Payer: UMR Bronson Commercial |
$32.16
|
| Rate for Payer: UMR Bronson Commercial |
$38.46
|
| Rate for Payer: UMR Bronson Commercial |
$35.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.56
|
|
|
CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) MAINTENANCE ORAL SOLUTION
|
Facility
|
IP
|
$37.76
|
|
|
Service Code
|
HCPCS J0706
|
| Hospital Charge Code |
77411
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$33.98 |
| Rate for Payer: Aetna American Axle |
$24.54
|
| Rate for Payer: Aetna Commercial |
$32.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.54
|
| Rate for Payer: Cash Price |
$30.21
|
| Rate for Payer: Cofinity Commercial |
$26.43
|
| Rate for Payer: Cofinity Commercial |
$32.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.21
|
| Rate for Payer: Healthscope Commercial |
$33.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.10
|
| Rate for Payer: PHP Commercial |
$32.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.43
|
| Rate for Payer: Priority Health SBD |
$23.79
|
| Rate for Payer: UMR Bronson Commercial |
$16.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.32
|
|
|
CAFFEINE-SODIUM BENZOATE 250 MG/ML(125 MG/ML CAFFEINE) INJECTION SOLN
|
Facility
|
IP
|
$108.02
|
|
|
Service Code
|
NDC 0517-2502-10
|
| Hospital Charge Code |
1262
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.53 |
| Max. Negotiated Rate |
$97.22 |
| Rate for Payer: Aetna American Axle |
$70.21
|
| Rate for Payer: Aetna Commercial |
$91.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.21
|
| Rate for Payer: Cash Price |
$86.42
|
| Rate for Payer: Cofinity Commercial |
$75.61
|
| Rate for Payer: Cofinity Commercial |
$92.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.42
|
| Rate for Payer: Healthscope Commercial |
$97.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.82
|
| Rate for Payer: PHP Commercial |
$91.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.61
|
| Rate for Payer: Priority Health SBD |
$68.05
|
| Rate for Payer: UMR Bronson Commercial |
$47.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.02
|
|
|
CAFFEINE-SODIUM BENZOATE 250 MG/ML(125 MG/ML CAFFEINE) INJECTION SOLN
|
Facility
|
IP
|
$108.02
|
|
|
Service Code
|
NDC 0517-2502-01
|
| Hospital Charge Code |
1262
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.53 |
| Max. Negotiated Rate |
$97.22 |
| Rate for Payer: Aetna American Axle |
$70.21
|
| Rate for Payer: Aetna Commercial |
$91.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.21
|
| Rate for Payer: Cash Price |
$86.42
|
| Rate for Payer: Cofinity Commercial |
$75.61
|
| Rate for Payer: Cofinity Commercial |
$92.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.42
|
| Rate for Payer: Healthscope Commercial |
$97.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.82
|
| Rate for Payer: PHP Commercial |
$91.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.61
|
| Rate for Payer: Priority Health SBD |
$68.05
|
| Rate for Payer: UMR Bronson Commercial |
$47.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.02
|
|
|
CALAMINE 8 %-ZINC OXIDE 8 % LOTION
|
Facility
|
IP
|
$14.34
|
|
|
Service Code
|
NDC 0395-0413-96
|
| Hospital Charge Code |
78879
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.31 |
| Max. Negotiated Rate |
$12.91 |
| Rate for Payer: Aetna American Axle |
$9.32
|
| Rate for Payer: Aetna Commercial |
$12.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.32
|
| Rate for Payer: Cash Price |
$11.47
|
| Rate for Payer: Cofinity Commercial |
$10.04
|
| Rate for Payer: Cofinity Commercial |
$12.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.47
|
| Rate for Payer: Healthscope Commercial |
$12.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.19
|
| Rate for Payer: PHP Commercial |
$12.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.04
|
| Rate for Payer: Priority Health SBD |
$9.03
|
| Rate for Payer: UMR Bronson Commercial |
$6.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.76
|
|
|
CALAMINE 8 %-ZINC OXIDE 8 % LOTION
|
Facility
|
IP
|
$8.50
|
|
|
Service Code
|
NDC 0904-2533-21
|
| Hospital Charge Code |
78879
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna American Axle |
$5.52
|
| Rate for Payer: Aetna Commercial |
$7.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.52
|
| Rate for Payer: Cash Price |
$6.80
|
| Rate for Payer: Cofinity Commercial |
$5.95
|
| Rate for Payer: Cofinity Commercial |
$7.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.80
|
| Rate for Payer: Healthscope Commercial |
$7.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.22
|
| Rate for Payer: PHP Commercial |
$7.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.95
|
| Rate for Payer: Priority Health SBD |
$5.36
|
| Rate for Payer: UMR Bronson Commercial |
$3.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.38
|
|
|
CALASPARGASE PEGOL-MKNL 750 UNIT/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$121,559.21
|
|
|
Service Code
|
HCPCS J9118
|
| Hospital Charge Code |
191705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53,486.05 |
| Max. Negotiated Rate |
$109,403.29 |
| Rate for Payer: Aetna American Axle |
$79,013.49
|
| Rate for Payer: Aetna Commercial |
$103,325.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79,013.49
|
| Rate for Payer: Cash Price |
$97,247.37
|
| Rate for Payer: Cofinity Commercial |
$104,540.92
|
| Rate for Payer: Cofinity Commercial |
$85,091.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97,247.37
|
| Rate for Payer: Healthscope Commercial |
$109,403.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85,091.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91,169.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$103,325.33
|
| Rate for Payer: PHP Commercial |
$103,325.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85,091.45
|
| Rate for Payer: Priority Health SBD |
$76,582.30
|
| Rate for Payer: UMR Bronson Commercial |
$53,486.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91,169.41
|
|
|
CALCIPOTRIENE 0.005 % TOPICAL CREAM
|
Facility
|
IP
|
$1,150.59
|
|
|
Service Code
|
NDC 0781-7117-35
|
| Hospital Charge Code |
16034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$506.26 |
| Max. Negotiated Rate |
$1,035.53 |
| Rate for Payer: Aetna American Axle |
$747.88
|
| Rate for Payer: Aetna Commercial |
$978.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$747.88
|
| Rate for Payer: Cash Price |
$920.47
|
| Rate for Payer: Cofinity Commercial |
$805.41
|
| Rate for Payer: Cofinity Commercial |
$989.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$920.47
|
| Rate for Payer: Healthscope Commercial |
$1,035.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$805.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$862.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$978.00
|
| Rate for Payer: PHP Commercial |
$978.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$805.41
|
| Rate for Payer: Priority Health SBD |
$724.87
|
| Rate for Payer: UMR Bronson Commercial |
$506.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$862.94
|
|
|
CALCIPOTRIENE 0.005 % TOPICAL CREAM
|
Facility
|
IP
|
$683.76
|
|
|
Service Code
|
NDC 68462-501-65
|
| Hospital Charge Code |
16034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$300.85 |
| Max. Negotiated Rate |
$615.38 |
| Rate for Payer: Aetna American Axle |
$444.44
|
| Rate for Payer: Aetna Commercial |
$581.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$444.44
|
| Rate for Payer: Cash Price |
$547.01
|
| Rate for Payer: Cofinity Commercial |
$478.63
|
| Rate for Payer: Cofinity Commercial |
$588.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$547.01
|
| Rate for Payer: Healthscope Commercial |
$615.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$478.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$512.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$581.20
|
| Rate for Payer: PHP Commercial |
$581.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$478.63
|
| Rate for Payer: Priority Health SBD |
$430.77
|
| Rate for Payer: UMR Bronson Commercial |
$300.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$512.82
|
|
|
CALCIPOTRIENE 0.005 % TOPICAL CREAM
|
Facility
|
IP
|
$249.27
|
|
|
Service Code
|
NDC 66993-877-61
|
| Hospital Charge Code |
16034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.68 |
| Max. Negotiated Rate |
$224.34 |
| Rate for Payer: Aetna American Axle |
$162.03
|
| Rate for Payer: Aetna Commercial |
$211.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.03
|
| Rate for Payer: Cash Price |
$199.42
|
| Rate for Payer: Cofinity Commercial |
$174.49
|
| Rate for Payer: Cofinity Commercial |
$214.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.42
|
| Rate for Payer: Healthscope Commercial |
$224.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$211.88
|
| Rate for Payer: PHP Commercial |
$211.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.49
|
| Rate for Payer: Priority Health SBD |
$157.04
|
| Rate for Payer: UMR Bronson Commercial |
$109.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.95
|
|
|
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY
|
Facility
|
IP
|
$243.26
|
|
|
Service Code
|
NDC 49884-161-11
|
| Hospital Charge Code |
15738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.03 |
| Max. Negotiated Rate |
$218.93 |
| Rate for Payer: Aetna American Axle |
$158.12
|
| Rate for Payer: Aetna Commercial |
$206.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.12
|
| Rate for Payer: Cash Price |
$194.61
|
| Rate for Payer: Cofinity Commercial |
$209.20
|
| Rate for Payer: Cofinity Commercial |
$170.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.61
|
| Rate for Payer: Healthscope Commercial |
$218.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$170.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$206.77
|
| Rate for Payer: PHP Commercial |
$206.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.28
|
| Rate for Payer: Priority Health SBD |
$153.25
|
| Rate for Payer: UMR Bronson Commercial |
$107.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.44
|
|
|
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY
|
Facility
|
IP
|
$112.28
|
|
|
Service Code
|
NDC 60505-0823-6
|
| Hospital Charge Code |
15738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.40 |
| Max. Negotiated Rate |
$101.05 |
| Rate for Payer: Aetna American Axle |
$72.98
|
| Rate for Payer: Aetna Commercial |
$95.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.98
|
| Rate for Payer: Cash Price |
$89.82
|
| Rate for Payer: Cofinity Commercial |
$78.60
|
| Rate for Payer: Cofinity Commercial |
$96.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.82
|
| Rate for Payer: Healthscope Commercial |
$101.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$95.44
|
| Rate for Payer: PHP Commercial |
$95.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.60
|
| Rate for Payer: Priority Health SBD |
$70.74
|
| Rate for Payer: UMR Bronson Commercial |
$49.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.21
|
|
|
CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$3,392.04
|
|
|
Service Code
|
HCPCS J0630
|
| Hospital Charge Code |
9347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,492.50 |
| Max. Negotiated Rate |
$3,052.84 |
| Rate for Payer: Aetna American Axle |
$2,204.83
|
| Rate for Payer: Aetna American Axle |
$3,242.39
|
| Rate for Payer: Aetna American Axle |
$2,031.12
|
| Rate for Payer: Aetna Commercial |
$2,883.23
|
| Rate for Payer: Aetna Commercial |
$2,656.08
|
| Rate for Payer: Aetna Commercial |
$4,240.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,242.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,204.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,031.12
|
| Rate for Payer: Cash Price |
$2,499.84
|
| Rate for Payer: Cash Price |
$2,713.63
|
| Rate for Payer: Cash Price |
$3,990.63
|
| Rate for Payer: Cofinity Commercial |
$3,491.80
|
| Rate for Payer: Cofinity Commercial |
$2,687.33
|
| Rate for Payer: Cofinity Commercial |
$2,374.43
|
| Rate for Payer: Cofinity Commercial |
$2,917.15
|
| Rate for Payer: Cofinity Commercial |
$4,289.93
|
| Rate for Payer: Cofinity Commercial |
$2,187.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,499.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,990.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,713.63
|
| Rate for Payer: Healthscope Commercial |
$2,812.32
|
| Rate for Payer: Healthscope Commercial |
$4,489.46
|
| Rate for Payer: Healthscope Commercial |
$3,052.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,187.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,491.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,374.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,544.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,343.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,741.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,240.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,656.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,883.23
|
| Rate for Payer: PHP Commercial |
$2,883.23
|
| Rate for Payer: PHP Commercial |
$4,240.05
|
| Rate for Payer: PHP Commercial |
$2,656.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,374.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,187.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,491.80
|
| Rate for Payer: Priority Health SBD |
$3,142.62
|
| Rate for Payer: Priority Health SBD |
$1,968.62
|
| Rate for Payer: Priority Health SBD |
$2,136.99
|
| Rate for Payer: UMR Bronson Commercial |
$2,194.85
|
| Rate for Payer: UMR Bronson Commercial |
$1,374.91
|
| Rate for Payer: UMR Bronson Commercial |
$1,492.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,343.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,544.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,741.22
|
|
|
CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$3,392.04
|
|
|
Service Code
|
HCPCS J0630
|
| Hospital Charge Code |
9347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$585.02 |
| Max. Negotiated Rate |
$3,807.26 |
| Rate for Payer: Aetna American Axle |
$2,204.83
|
| Rate for Payer: Aetna Commercial |
$2,883.23
|
| Rate for Payer: Aetna Medicare |
$1,112.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,204.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,336.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,336.87
|
| Rate for Payer: BCBS Complete |
$614.32
|
| Rate for Payer: BCBS MAPPO |
$1,069.50
|
| Rate for Payer: BCBS Trust/PPO |
$3,456.11
|
| Rate for Payer: BCN Medicare Advantage |
$1,069.50
|
| Rate for Payer: Cash Price |
$2,713.63
|
| Rate for Payer: Cash Price |
$2,713.63
|
| Rate for Payer: Cofinity Commercial |
$2,917.15
|
| Rate for Payer: Cofinity Commercial |
$2,374.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,713.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,069.50
|
| Rate for Payer: Healthscope Commercial |
$3,052.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,374.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,544.03
|
| Rate for Payer: Mclaren Medicaid |
$585.02
|
| Rate for Payer: Mclaren Medicare |
$1,069.50
|
| Rate for Payer: Meridian Medicaid |
$614.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,122.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,229.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,883.23
|
| Rate for Payer: PACE Medicare |
$1,016.02
|
| Rate for Payer: PACE SWMI |
$1,069.50
|
| Rate for Payer: PHP Commercial |
$2,883.23
|
| Rate for Payer: PHP Medicare Advantage |
$1,069.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$585.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,374.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,807.26
|
| Rate for Payer: Priority Health Medicare |
$1,069.50
|
| Rate for Payer: Priority Health Narrow Network |
$3,045.81
|
| Rate for Payer: Priority Health SBD |
$2,136.99
|
| Rate for Payer: Railroad Medicare Medicare |
$1,069.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,069.50
|
| Rate for Payer: UHC Medicare Advantage |
$1,101.58
|
| Rate for Payer: UMR Bronson Commercial |
$1,255.05
|
| Rate for Payer: VA VA |
$1,069.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,544.03
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
IP
|
$300.80
|
|
|
Service Code
|
NDC 23155-662-01
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.35 |
| Max. Negotiated Rate |
$270.72 |
| Rate for Payer: Aetna American Axle |
$195.52
|
| Rate for Payer: Aetna Commercial |
$255.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.52
|
| Rate for Payer: Cash Price |
$240.64
|
| Rate for Payer: Cofinity Commercial |
$210.56
|
| Rate for Payer: Cofinity Commercial |
$258.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.64
|
| Rate for Payer: Healthscope Commercial |
$270.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.68
|
| Rate for Payer: PHP Commercial |
$255.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.56
|
| Rate for Payer: Priority Health SBD |
$189.50
|
| Rate for Payer: UMR Bronson Commercial |
$132.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.60
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
IP
|
$3.07
|
|
|
Service Code
|
NDC 60687-345-11
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$2.76 |
| Rate for Payer: Aetna American Axle |
$2.00
|
| Rate for Payer: Aetna Commercial |
$2.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.00
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cofinity Commercial |
$2.15
|
| Rate for Payer: Cofinity Commercial |
$2.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.46
|
| Rate for Payer: Healthscope Commercial |
$2.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.61
|
| Rate for Payer: PHP Commercial |
$2.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.15
|
| Rate for Payer: Priority Health SBD |
$1.93
|
| Rate for Payer: UMR Bronson Commercial |
$1.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.30
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
IP
|
$306.72
|
|
|
Service Code
|
NDC 60687-345-01
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.96 |
| Max. Negotiated Rate |
$276.05 |
| Rate for Payer: Aetna American Axle |
$199.37
|
| Rate for Payer: Aetna Commercial |
$260.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.37
|
| Rate for Payer: Cash Price |
$245.38
|
| Rate for Payer: Cofinity Commercial |
$214.70
|
| Rate for Payer: Cofinity Commercial |
$263.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.38
|
| Rate for Payer: Healthscope Commercial |
$276.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$260.71
|
| Rate for Payer: PHP Commercial |
$260.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.70
|
| Rate for Payer: Priority Health SBD |
$193.23
|
| Rate for Payer: UMR Bronson Commercial |
$134.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.04
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
IP
|
$71.82
|
|
|
Service Code
|
NDC 69452-207-13
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$64.64 |
| Rate for Payer: Aetna American Axle |
$46.68
|
| Rate for Payer: Aetna Commercial |
$61.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.68
|
| Rate for Payer: Cash Price |
$57.46
|
| Rate for Payer: Cofinity Commercial |
$50.27
|
| Rate for Payer: Cofinity Commercial |
$61.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.46
|
| Rate for Payer: Healthscope Commercial |
$64.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.05
|
| Rate for Payer: PHP Commercial |
$61.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.27
|
| Rate for Payer: Priority Health SBD |
$45.25
|
| Rate for Payer: UMR Bronson Commercial |
$31.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.86
|
|
