|
CARVEDILOL 25 MG TABLET
|
Facility
|
IP
|
$180.95
|
|
|
Service Code
|
NDC 0904-6303-61
|
| Hospital Charge Code |
15748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.62 |
| Max. Negotiated Rate |
$162.86 |
| Rate for Payer: Aetna American Axle |
$117.62
|
| Rate for Payer: Aetna Commercial |
$153.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.62
|
| Rate for Payer: Cash Price |
$144.76
|
| Rate for Payer: Cofinity Commercial |
$126.66
|
| Rate for Payer: Cofinity Commercial |
$155.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.76
|
| Rate for Payer: Healthscope Commercial |
$162.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.81
|
| Rate for Payer: PHP Commercial |
$153.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.66
|
| Rate for Payer: Priority Health SBD |
$114.00
|
| Rate for Payer: UMR Bronson Commercial |
$79.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.71
|
|
|
CARVEDILOL 25 MG TABLET
|
Facility
|
IP
|
$58.75
|
|
|
Service Code
|
NDC 68382-095-01
|
| Hospital Charge Code |
15748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.85 |
| Max. Negotiated Rate |
$52.88 |
| Rate for Payer: Aetna American Axle |
$38.19
|
| Rate for Payer: Aetna Commercial |
$49.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.19
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cofinity Commercial |
$41.12
|
| Rate for Payer: Cofinity Commercial |
$50.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.00
|
| Rate for Payer: Healthscope Commercial |
$52.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.94
|
| Rate for Payer: PHP Commercial |
$49.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.12
|
| Rate for Payer: Priority Health SBD |
$37.01
|
| Rate for Payer: UMR Bronson Commercial |
$25.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.06
|
|
|
CARVEDILOL 25 MG TABLET
|
Facility
|
IP
|
$199.75
|
|
|
Service Code
|
NDC 51079-932-20
|
| Hospital Charge Code |
15748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.89 |
| Max. Negotiated Rate |
$179.78 |
| Rate for Payer: Aetna American Axle |
$129.84
|
| Rate for Payer: Aetna Commercial |
$169.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.84
|
| Rate for Payer: Cash Price |
$159.80
|
| Rate for Payer: Cofinity Commercial |
$139.82
|
| Rate for Payer: Cofinity Commercial |
$171.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.80
|
| Rate for Payer: Healthscope Commercial |
$179.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$169.79
|
| Rate for Payer: PHP Commercial |
$169.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.82
|
| Rate for Payer: Priority Health SBD |
$125.84
|
| Rate for Payer: UMR Bronson Commercial |
$87.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.81
|
|
|
CARVEDILOL 25 MG TABLET
|
Facility
|
IP
|
$173.90
|
|
|
Service Code
|
NDC 0378-3634-01
|
| Hospital Charge Code |
15748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.52 |
| Max. Negotiated Rate |
$156.51 |
| Rate for Payer: Aetna American Axle |
$113.04
|
| Rate for Payer: Aetna Commercial |
$147.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.04
|
| Rate for Payer: Cash Price |
$139.12
|
| Rate for Payer: Cofinity Commercial |
$121.73
|
| Rate for Payer: Cofinity Commercial |
$149.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.12
|
| Rate for Payer: Healthscope Commercial |
$156.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.82
|
| Rate for Payer: PHP Commercial |
$147.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.73
|
| Rate for Payer: Priority Health SBD |
$109.56
|
| Rate for Payer: UMR Bronson Commercial |
$76.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.42
|
|
|
CARVEDILOL 25 MG TABLET
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 51079-932-01
|
| Hospital Charge Code |
15748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Aetna American Axle |
$1.30
|
| Rate for Payer: Aetna Commercial |
$1.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.30
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cofinity Commercial |
$1.40
|
| Rate for Payer: Cofinity Commercial |
$1.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.60
|
| Rate for Payer: Healthscope Commercial |
$1.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.70
|
| Rate for Payer: PHP Commercial |
$1.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.40
|
| Rate for Payer: Priority Health SBD |
$1.26
|
| Rate for Payer: UMR Bronson Commercial |
$0.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.50
|
|
|
CARVEDILOL 3.125 MG TABLET
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
NDC 68084-843-01
|
| Hospital Charge Code |
18551
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Aetna American Axle |
$152.75
|
| Rate for Payer: Aetna Commercial |
$199.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.75
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cofinity Commercial |
$164.50
|
| Rate for Payer: Cofinity Commercial |
$202.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.00
|
| Rate for Payer: Healthscope Commercial |
$211.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$199.75
|
| Rate for Payer: PHP Commercial |
$199.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.50
|
| Rate for Payer: Priority Health SBD |
$148.05
|
| Rate for Payer: UMR Bronson Commercial |
$103.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.25
|
|
|
CARVEDILOL 3.125 MG TABLET
|
Facility
|
IP
|
$173.90
|
|
|
Service Code
|
NDC 0378-3631-01
|
| Hospital Charge Code |
18551
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.52 |
| Max. Negotiated Rate |
$156.51 |
| Rate for Payer: Aetna American Axle |
$113.04
|
| Rate for Payer: Aetna Commercial |
$147.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.04
|
| Rate for Payer: Cash Price |
$139.12
|
| Rate for Payer: Cofinity Commercial |
$121.73
|
| Rate for Payer: Cofinity Commercial |
$149.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.12
|
| Rate for Payer: Healthscope Commercial |
$156.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.82
|
| Rate for Payer: PHP Commercial |
$147.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.73
|
| Rate for Payer: Priority Health SBD |
$109.56
|
| Rate for Payer: UMR Bronson Commercial |
$76.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.42
|
|
|
CARVEDILOL 3.125 MG TABLET
|
Facility
|
IP
|
$1.86
|
|
|
Service Code
|
NDC 51079-771-01
|
| Hospital Charge Code |
18551
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Aetna American Axle |
$1.21
|
| Rate for Payer: Aetna Commercial |
$1.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.21
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cofinity Commercial |
$1.30
|
| Rate for Payer: Cofinity Commercial |
$1.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.49
|
| Rate for Payer: Healthscope Commercial |
$1.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.58
|
| Rate for Payer: PHP Commercial |
$1.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.30
|
| Rate for Payer: Priority Health SBD |
$1.17
|
| Rate for Payer: UMR Bronson Commercial |
$0.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.40
|
|
|
CARVEDILOL 3.125 MG TABLET
|
Facility
|
IP
|
$35.25
|
|
|
Service Code
|
NDC 68382-092-01
|
| Hospital Charge Code |
18551
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.51 |
| Max. Negotiated Rate |
$31.72 |
| Rate for Payer: Aetna American Axle |
$22.91
|
| Rate for Payer: Aetna Commercial |
$29.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.91
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cofinity Commercial |
$24.68
|
| Rate for Payer: Cofinity Commercial |
$30.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.20
|
| Rate for Payer: Healthscope Commercial |
$31.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.96
|
| Rate for Payer: PHP Commercial |
$29.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.68
|
| Rate for Payer: Priority Health SBD |
$22.21
|
| Rate for Payer: UMR Bronson Commercial |
$15.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.44
|
|
|
CARVEDILOL 3.125 MG TABLET
|
Facility
|
IP
|
$2.35
|
|
|
Service Code
|
NDC 68084-843-11
|
| Hospital Charge Code |
18551
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Aetna American Axle |
$1.53
|
| Rate for Payer: Aetna Commercial |
$2.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.53
|
| Rate for Payer: Cash Price |
$1.88
|
| Rate for Payer: Cofinity Commercial |
$1.64
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.88
|
| Rate for Payer: Healthscope Commercial |
$2.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.00
|
| Rate for Payer: PHP Commercial |
$2.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.64
|
| Rate for Payer: Priority Health SBD |
$1.48
|
| Rate for Payer: UMR Bronson Commercial |
$1.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.76
|
|
|
CARVEDILOL 3.125 MG TABLET
|
Facility
|
IP
|
$185.65
|
|
|
Service Code
|
NDC 51079-771-20
|
| Hospital Charge Code |
18551
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.69 |
| Max. Negotiated Rate |
$167.08 |
| Rate for Payer: Aetna American Axle |
$120.67
|
| Rate for Payer: Aetna Commercial |
$157.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.67
|
| Rate for Payer: Cash Price |
$148.52
|
| Rate for Payer: Cofinity Commercial |
$129.96
|
| Rate for Payer: Cofinity Commercial |
$159.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.52
|
| Rate for Payer: Healthscope Commercial |
$167.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$157.80
|
| Rate for Payer: PHP Commercial |
$157.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.96
|
| Rate for Payer: Priority Health SBD |
$116.96
|
| Rate for Payer: UMR Bronson Commercial |
$81.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.24
|
|
|
CARVEDILOL 6.25 MG TABLET
|
Facility
|
IP
|
$2.14
|
|
|
Service Code
|
NDC 51079-930-01
|
| Hospital Charge Code |
15747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$1.93 |
| Rate for Payer: Aetna American Axle |
$1.39
|
| Rate for Payer: Aetna Commercial |
$1.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.39
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cofinity Commercial |
$1.50
|
| Rate for Payer: Cofinity Commercial |
$1.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.71
|
| Rate for Payer: Healthscope Commercial |
$1.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.82
|
| Rate for Payer: PHP Commercial |
$1.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.50
|
| Rate for Payer: Priority Health SBD |
$1.35
|
| Rate for Payer: UMR Bronson Commercial |
$0.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.60
|
|
|
CARVEDILOL 6.25 MG TABLET
|
Facility
|
IP
|
$185.65
|
|
|
Service Code
|
NDC 0904-6301-61
|
| Hospital Charge Code |
15747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.69 |
| Max. Negotiated Rate |
$167.08 |
| Rate for Payer: Aetna American Axle |
$120.67
|
| Rate for Payer: Aetna Commercial |
$157.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.67
|
| Rate for Payer: Cash Price |
$148.52
|
| Rate for Payer: Cofinity Commercial |
$129.96
|
| Rate for Payer: Cofinity Commercial |
$159.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.52
|
| Rate for Payer: Healthscope Commercial |
$167.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$157.80
|
| Rate for Payer: PHP Commercial |
$157.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.96
|
| Rate for Payer: Priority Health SBD |
$116.96
|
| Rate for Payer: UMR Bronson Commercial |
$81.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.24
|
|
|
CARVEDILOL 6.25 MG TABLET
|
Facility
|
IP
|
$213.85
|
|
|
Service Code
|
NDC 51079-930-20
|
| Hospital Charge Code |
15747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.09 |
| Max. Negotiated Rate |
$192.46 |
| Rate for Payer: Aetna American Axle |
$139.00
|
| Rate for Payer: Aetna Commercial |
$181.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.00
|
| Rate for Payer: Cash Price |
$171.08
|
| Rate for Payer: Cofinity Commercial |
$149.70
|
| Rate for Payer: Cofinity Commercial |
$183.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.08
|
| Rate for Payer: Healthscope Commercial |
$192.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$149.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$160.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$181.77
|
| Rate for Payer: PHP Commercial |
$181.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.70
|
| Rate for Payer: Priority Health SBD |
$134.73
|
| Rate for Payer: UMR Bronson Commercial |
$94.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$160.39
|
|
|
CASPOFUNGIN 50 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,005.03
|
|
|
Service Code
|
HCPCS J0637
|
| Hospital Charge Code |
29567
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.51 |
| Max. Negotiated Rate |
$904.53 |
| Rate for Payer: Aetna American Axle |
$653.27
|
| Rate for Payer: Aetna Commercial |
$854.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$653.27
|
| Rate for Payer: BCBS Complete |
$402.01
|
| Rate for Payer: BCBS Trust/PPO |
$17.51
|
| Rate for Payer: Cash Price |
$804.02
|
| Rate for Payer: Cash Price |
$804.02
|
| Rate for Payer: Cofinity Commercial |
$703.52
|
| Rate for Payer: Cofinity Commercial |
$864.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$804.02
|
| Rate for Payer: Healthscope Commercial |
$904.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$703.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$753.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$854.28
|
| Rate for Payer: PHP Commercial |
$854.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$703.52
|
| Rate for Payer: Priority Health SBD |
$633.17
|
| Rate for Payer: UMR Bronson Commercial |
$371.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$753.77
|
|
|
CASPOFUNGIN 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,005.03
|
|
|
Service Code
|
HCPCS J0637
|
| Hospital Charge Code |
29567
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$442.21 |
| Max. Negotiated Rate |
$904.53 |
| Rate for Payer: Aetna American Axle |
$653.27
|
| Rate for Payer: Aetna Commercial |
$854.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$653.27
|
| Rate for Payer: Cash Price |
$804.02
|
| Rate for Payer: Cofinity Commercial |
$703.52
|
| Rate for Payer: Cofinity Commercial |
$864.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$804.02
|
| Rate for Payer: Healthscope Commercial |
$904.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$703.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$753.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$854.28
|
| Rate for Payer: PHP Commercial |
$854.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$703.52
|
| Rate for Payer: Priority Health SBD |
$633.17
|
| Rate for Payer: UMR Bronson Commercial |
$442.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$753.77
|
|
|
CASPOFUNGIN 70 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,044.23
|
|
|
Service Code
|
HCPCS J0637
|
| Hospital Charge Code |
29568
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$459.46 |
| Max. Negotiated Rate |
$939.81 |
| Rate for Payer: Aetna American Axle |
$678.75
|
| Rate for Payer: Aetna Commercial |
$887.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$678.75
|
| Rate for Payer: Cash Price |
$835.38
|
| Rate for Payer: Cofinity Commercial |
$730.96
|
| Rate for Payer: Cofinity Commercial |
$898.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$835.38
|
| Rate for Payer: Healthscope Commercial |
$939.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$730.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$783.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$887.60
|
| Rate for Payer: PHP Commercial |
$887.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$730.96
|
| Rate for Payer: Priority Health SBD |
$657.86
|
| Rate for Payer: UMR Bronson Commercial |
$459.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$783.17
|
|
|
CASPOFUNGIN 70 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,044.23
|
|
|
Service Code
|
HCPCS J0637
|
| Hospital Charge Code |
29568
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.51 |
| Max. Negotiated Rate |
$939.81 |
| Rate for Payer: Aetna American Axle |
$678.75
|
| Rate for Payer: Aetna Commercial |
$887.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$678.75
|
| Rate for Payer: BCBS Complete |
$417.69
|
| Rate for Payer: BCBS Trust/PPO |
$17.51
|
| Rate for Payer: Cash Price |
$835.38
|
| Rate for Payer: Cash Price |
$835.38
|
| Rate for Payer: Cofinity Commercial |
$730.96
|
| Rate for Payer: Cofinity Commercial |
$898.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$835.38
|
| Rate for Payer: Healthscope Commercial |
$939.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$730.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$783.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$887.60
|
| Rate for Payer: PHP Commercial |
$887.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$730.96
|
| Rate for Payer: Priority Health SBD |
$657.86
|
| Rate for Payer: UMR Bronson Commercial |
$386.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$783.17
|
|
|
CASTOR OIL
|
Facility
|
IP
|
$8.30
|
|
|
Service Code
|
NDC 9629513775
|
| Hospital Charge Code |
15209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$7.47 |
| Rate for Payer: Aetna American Axle |
$5.40
|
| Rate for Payer: Aetna Commercial |
$7.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.40
|
| Rate for Payer: Cash Price |
$6.64
|
| Rate for Payer: Cofinity Commercial |
$5.81
|
| Rate for Payer: Cofinity Commercial |
$7.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.64
|
| Rate for Payer: Healthscope Commercial |
$7.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.06
|
| Rate for Payer: PHP Commercial |
$7.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.81
|
| Rate for Payer: Priority Health SBD |
$5.23
|
| Rate for Payer: UMR Bronson Commercial |
$3.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.22
|
|
|
CASTOR OIL
|
Facility
|
IP
|
$11.99
|
|
|
Service Code
|
NDC 0395-0515-92
|
| Hospital Charge Code |
15209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$10.79 |
| Rate for Payer: Aetna American Axle |
$7.79
|
| Rate for Payer: Aetna Commercial |
$10.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.79
|
| Rate for Payer: Cash Price |
$9.59
|
| Rate for Payer: Cofinity Commercial |
$10.31
|
| Rate for Payer: Cofinity Commercial |
$8.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.59
|
| Rate for Payer: Healthscope Commercial |
$10.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.19
|
| Rate for Payer: PHP Commercial |
$10.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.39
|
| Rate for Payer: Priority Health SBD |
$7.55
|
| Rate for Payer: UMR Bronson Commercial |
$5.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.99
|
|
|
CATHETER, BALLOON DILATATION, NON-VASCULAR
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
CPT C1726
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
|
|
CATHETERIZATION AND INTRODUCTION OF SALINE OR CONTRAST MATERIAL FOR SALINE INFUSION SONOHYSTEROGRAPHY (SIS) OR HYSTEROSALPINGOGRAPHY
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 58340
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$56.65 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: BCBS Trust/PPO |
$331.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.32
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$56.65
|
|
|
CEFAZOLIN 100 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$301.75
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
31086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$271.58 |
| Rate for Payer: Aetna American Axle |
$196.14
|
| Rate for Payer: Aetna Commercial |
$256.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.14
|
| Rate for Payer: Cash Price |
$241.40
|
| Rate for Payer: Cofinity Commercial |
$211.22
|
| Rate for Payer: Cofinity Commercial |
$259.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.40
|
| Rate for Payer: Healthscope Commercial |
$271.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$211.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$256.49
|
| Rate for Payer: PHP Commercial |
$256.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.22
|
| Rate for Payer: Priority Health SBD |
$190.10
|
| Rate for Payer: UMR Bronson Commercial |
$132.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.31
|
|
|
CEFAZOLIN 100 MG/ML FORTIFIED OPHTHALMIC DROPS
|
Facility
|
IP
|
$191.84
|
|
|
Service Code
|
NDC 9900-0001-51
|
| Hospital Charge Code |
500642
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.41 |
| Max. Negotiated Rate |
$172.66 |
| Rate for Payer: Aetna American Axle |
$124.70
|
| Rate for Payer: Aetna Commercial |
$163.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.70
|
| Rate for Payer: Cash Price |
$153.47
|
| Rate for Payer: Cofinity Commercial |
$134.29
|
| Rate for Payer: Cofinity Commercial |
$164.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.47
|
| Rate for Payer: Healthscope Commercial |
$172.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$163.06
|
| Rate for Payer: PHP Commercial |
$163.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.29
|
| Rate for Payer: Priority Health SBD |
$120.86
|
| Rate for Payer: UMR Bronson Commercial |
$84.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.88
|
|
|
CEFAZOLIN 10 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$29.07
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
1446
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$26.16 |
| Rate for Payer: Aetna American Axle |
$18.90
|
| Rate for Payer: Aetna American Axle |
$22.47
|
| Rate for Payer: Aetna Commercial |
$29.38
|
| Rate for Payer: Aetna Commercial |
$24.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.47
|
| Rate for Payer: BCBS Complete |
$11.63
|
| Rate for Payer: BCBS Complete |
$13.83
|
| Rate for Payer: BCBS Trust/PPO |
$2.44
|
| Rate for Payer: BCBS Trust/PPO |
$2.44
|
| Rate for Payer: Cash Price |
$23.26
|
| Rate for Payer: Cash Price |
$23.26
|
| Rate for Payer: Cash Price |
$27.66
|
| Rate for Payer: Cash Price |
$27.66
|
| Rate for Payer: Cofinity Commercial |
$20.35
|
| Rate for Payer: Cofinity Commercial |
$29.73
|
| Rate for Payer: Cofinity Commercial |
$24.20
|
| Rate for Payer: Cofinity Commercial |
$25.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.26
|
| Rate for Payer: Healthscope Commercial |
$26.16
|
| Rate for Payer: Healthscope Commercial |
$31.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.71
|
| Rate for Payer: PHP Commercial |
$29.38
|
| Rate for Payer: PHP Commercial |
$24.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.20
|
| Rate for Payer: Priority Health SBD |
$18.31
|
| Rate for Payer: Priority Health SBD |
$21.78
|
| Rate for Payer: UMR Bronson Commercial |
$12.79
|
| Rate for Payer: UMR Bronson Commercial |
$10.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.80
|
|
