|
ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$103.95
|
|
|
Service Code
|
NDC 45802073032
|
| Hospital Charge Code |
105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.74 |
| Max. Negotiated Rate |
$93.56 |
| Rate for Payer: Aetna American Axle |
$67.57
|
| Rate for Payer: Aetna Commercial |
$88.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.57
|
| Rate for Payer: Cash Price |
$83.16
|
| Rate for Payer: Cofinity Advantage |
$72.77
|
| Rate for Payer: Cofinity Commercial |
$89.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.16
|
| Rate for Payer: Healthscope Commercial |
$93.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.96
|
| Rate for Payer: PHP Commercial |
$88.36
|
| Rate for Payer: Priority Health SBD |
$65.49
|
| Rate for Payer: UMR Bronson Commercial |
$45.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.96
|
|
|
ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$210.10
|
|
|
Service Code
|
NDC 45802073033
|
| Hospital Charge Code |
105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.74 |
| Max. Negotiated Rate |
$189.09 |
| Rate for Payer: Aetna American Axle |
$136.56
|
| Rate for Payer: Aetna Commercial |
$178.59
|
| Rate for Payer: Aetna Medicare |
$105.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.56
|
| Rate for Payer: BCBS Complete |
$84.04
|
| Rate for Payer: Cash Price |
$168.08
|
| Rate for Payer: Cofinity Advantage |
$147.07
|
| Rate for Payer: Cofinity Commercial |
$180.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.08
|
| Rate for Payer: Healthscope Commercial |
$189.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$168.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$157.57
|
| Rate for Payer: PHP Commercial |
$178.59
|
| Rate for Payer: Priority Health SBD |
$132.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.56
|
| Rate for Payer: UHC Core |
$109.46
|
| Rate for Payer: UHC Exchange |
$82.57
|
| Rate for Payer: UMR Bronson Commercial |
$77.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.57
|
|
|
ACETAMINOPHEN 80 MG CHEWABLE TABLET
|
Facility
|
OP
|
$48.65
|
|
|
Service Code
|
NDC 00904579146
|
| Hospital Charge Code |
99
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$43.78 |
| Rate for Payer: Aetna American Axle |
$31.62
|
| Rate for Payer: Aetna Commercial |
$41.35
|
| Rate for Payer: Aetna Medicare |
$24.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.62
|
| Rate for Payer: BCBS Complete |
$19.46
|
| Rate for Payer: Cash Price |
$38.92
|
| Rate for Payer: Cofinity Advantage |
$34.05
|
| Rate for Payer: Cofinity Commercial |
$41.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.92
|
| Rate for Payer: Healthscope Commercial |
$43.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.49
|
| Rate for Payer: PHP Commercial |
$41.35
|
| Rate for Payer: Priority Health SBD |
$30.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.62
|
| Rate for Payer: UHC Core |
$25.35
|
| Rate for Payer: UHC Exchange |
$19.12
|
| Rate for Payer: UMR Bronson Commercial |
$18.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.49
|
|
|
ACETAMINOPHEN 80 MG CHEWABLE TABLET
|
Facility
|
IP
|
$48.65
|
|
|
Service Code
|
NDC 00904579146
|
| Hospital Charge Code |
99
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.41 |
| Max. Negotiated Rate |
$43.78 |
| Rate for Payer: Aetna American Axle |
$31.62
|
| Rate for Payer: Aetna Commercial |
$41.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.62
|
| Rate for Payer: Cash Price |
$38.92
|
| Rate for Payer: Cofinity Advantage |
$34.05
|
| Rate for Payer: Cofinity Commercial |
$41.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.92
|
| Rate for Payer: Healthscope Commercial |
$43.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.49
|
| Rate for Payer: PHP Commercial |
$41.35
|
| Rate for Payer: Priority Health SBD |
$30.65
|
| Rate for Payer: UMR Bronson Commercial |
$21.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.49
|
|
|
ACETAMINOPHEN 80 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$3.32
|
|
|
Service Code
|
NDC 51672211400
|
| Hospital Charge Code |
8946
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$2.99 |
| Rate for Payer: Aetna American Axle |
$2.16
|
| Rate for Payer: Aetna Commercial |
$2.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.16
|
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: Cofinity Advantage |
$2.32
|
| Rate for Payer: Cofinity Commercial |
$2.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.66
|
| Rate for Payer: Healthscope Commercial |
$2.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.49
|
| Rate for Payer: PHP Commercial |
$2.82
|
| Rate for Payer: Priority Health SBD |
$2.09
|
| Rate for Payer: UMR Bronson Commercial |
$1.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.49
|
|
|
ACETAMINOPHEN 80 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$3.32
|
|
|
Service Code
|
NDC 51672211400
|
| Hospital Charge Code |
8946
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$2.99 |
| Rate for Payer: Aetna American Axle |
$2.16
|
| Rate for Payer: Aetna Commercial |
$2.82
|
| Rate for Payer: Aetna Medicare |
$1.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.16
|
| Rate for Payer: BCBS Complete |
$1.33
|
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: Cofinity Advantage |
$2.32
|
| Rate for Payer: Cofinity Commercial |
$2.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.66
|
| Rate for Payer: Healthscope Commercial |
$2.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.49
|
| Rate for Payer: PHP Commercial |
$2.82
|
| Rate for Payer: Priority Health SBD |
$2.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.16
|
| Rate for Payer: UHC Core |
$1.73
|
| Rate for Payer: UHC Exchange |
$1.30
|
| Rate for Payer: UMR Bronson Commercial |
$1.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.49
|
|
|
ACETAMINOPHEN 80 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$107.10
|
|
|
Service Code
|
NDC 51672211404
|
| Hospital Charge Code |
8946
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.63 |
| Max. Negotiated Rate |
$96.39 |
| Rate for Payer: Aetna American Axle |
$69.61
|
| Rate for Payer: Aetna Commercial |
$91.03
|
| Rate for Payer: Aetna Medicare |
$53.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.61
|
| Rate for Payer: BCBS Complete |
$42.84
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Advantage |
$74.97
|
| Rate for Payer: Cofinity Commercial |
$92.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
| Rate for Payer: Healthscope Commercial |
$96.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.33
|
| Rate for Payer: PHP Commercial |
$91.03
|
| Rate for Payer: Priority Health SBD |
$67.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.61
|
| Rate for Payer: UHC Core |
$55.80
|
| Rate for Payer: UHC Exchange |
$42.09
|
| Rate for Payer: UMR Bronson Commercial |
$39.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.33
|
|
|
ACETAMINOPHEN 80 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$107.10
|
|
|
Service Code
|
NDC 51672211404
|
| Hospital Charge Code |
8946
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$96.39 |
| Rate for Payer: Aetna American Axle |
$69.61
|
| Rate for Payer: Aetna Commercial |
$91.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.61
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Advantage |
$74.97
|
| Rate for Payer: Cofinity Commercial |
$92.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
| Rate for Payer: Healthscope Commercial |
$96.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.33
|
| Rate for Payer: PHP Commercial |
$91.03
|
| Rate for Payer: Priority Health SBD |
$67.47
|
| Rate for Payer: UMR Bronson Commercial |
$47.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.33
|
|
|
ACETAMINOPHENÂ (NICU) 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$27.15
|
|
|
Service Code
|
HCPCS J0136
|
| Hospital Charge Code |
300386
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.95 |
| Max. Negotiated Rate |
$24.43 |
| Rate for Payer: Aetna American Axle |
$17.65
|
| Rate for Payer: Aetna Commercial |
$23.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.65
|
| Rate for Payer: Cash Price |
$21.72
|
| Rate for Payer: Cofinity Advantage |
$19.00
|
| Rate for Payer: Cofinity Commercial |
$23.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.72
|
| Rate for Payer: Healthscope Commercial |
$24.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.36
|
| Rate for Payer: PHP Commercial |
$23.08
|
| Rate for Payer: Priority Health SBD |
$17.10
|
| Rate for Payer: UMR Bronson Commercial |
$11.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.36
|
|
|
ACETAMINOPHENÂ (NICU) 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$27.15
|
|
|
Service Code
|
HCPCS J0136
|
| Hospital Charge Code |
300386
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$24.43 |
| Rate for Payer: Aetna American Axle |
$17.65
|
| Rate for Payer: Aetna Commercial |
$23.08
|
| Rate for Payer: Aetna Medicare |
$13.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.65
|
| Rate for Payer: BCBS Complete |
$10.86
|
| Rate for Payer: BCBS Trust/PPO |
$0.16
|
| Rate for Payer: BCN Commercial |
$0.16
|
| Rate for Payer: Cash Price |
$21.72
|
| Rate for Payer: Cash Price |
$21.72
|
| Rate for Payer: Cofinity Advantage |
$19.00
|
| Rate for Payer: Cofinity Commercial |
$23.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.72
|
| Rate for Payer: Healthscope Commercial |
$24.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.36
|
| Rate for Payer: PHP Commercial |
$23.08
|
| Rate for Payer: Priority Health SBD |
$17.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UMR Bronson Commercial |
$10.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.36
|
|
|
ACETAZOLAMIDE 250 MG TABLET
|
Facility
|
IP
|
$309.70
|
|
|
Service Code
|
NDC 23155028801
|
| Hospital Charge Code |
113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.27 |
| Max. Negotiated Rate |
$278.73 |
| Rate for Payer: Aetna American Axle |
$201.31
|
| Rate for Payer: Aetna Commercial |
$263.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.31
|
| Rate for Payer: Cash Price |
$247.76
|
| Rate for Payer: Cofinity Advantage |
$216.79
|
| Rate for Payer: Cofinity Commercial |
$266.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.76
|
| Rate for Payer: Healthscope Commercial |
$278.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.28
|
| Rate for Payer: PHP Commercial |
$263.25
|
| Rate for Payer: Priority Health SBD |
$195.11
|
| Rate for Payer: UMR Bronson Commercial |
$136.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.28
|
|
|
ACETAZOLAMIDE 250 MG TABLET
|
Facility
|
OP
|
$309.70
|
|
|
Service Code
|
NDC 23155028801
|
| Hospital Charge Code |
113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.59 |
| Max. Negotiated Rate |
$278.73 |
| Rate for Payer: Aetna American Axle |
$201.31
|
| Rate for Payer: Aetna Commercial |
$263.25
|
| Rate for Payer: Aetna Medicare |
$154.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.31
|
| Rate for Payer: BCBS Complete |
$123.88
|
| Rate for Payer: Cash Price |
$247.76
|
| Rate for Payer: Cofinity Advantage |
$216.79
|
| Rate for Payer: Cofinity Commercial |
$266.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.76
|
| Rate for Payer: Healthscope Commercial |
$278.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.28
|
| Rate for Payer: PHP Commercial |
$263.25
|
| Rate for Payer: Priority Health SBD |
$195.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$201.31
|
| Rate for Payer: UHC Core |
$161.35
|
| Rate for Payer: UHC Exchange |
$121.71
|
| Rate for Payer: UMR Bronson Commercial |
$114.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.28
|
|
|
ACETAZOLAMIDE 250 MG TABLET
|
Facility
|
IP
|
$7.80
|
|
|
Service Code
|
NDC 50268005411
|
| Hospital Charge Code |
113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$7.02 |
| Rate for Payer: Aetna American Axle |
$5.07
|
| Rate for Payer: Aetna Commercial |
$6.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.07
|
| Rate for Payer: Cash Price |
$6.24
|
| Rate for Payer: Cofinity Advantage |
$5.46
|
| Rate for Payer: Cofinity Commercial |
$6.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.24
|
| Rate for Payer: Healthscope Commercial |
$7.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.85
|
| Rate for Payer: PHP Commercial |
$6.63
|
| Rate for Payer: Priority Health SBD |
$4.91
|
| Rate for Payer: UMR Bronson Commercial |
$3.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.85
|
|
|
ACETAZOLAMIDE 250 MG TABLET
|
Facility
|
OP
|
$7.80
|
|
|
Service Code
|
NDC 50268005411
|
| Hospital Charge Code |
113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$7.02 |
| Rate for Payer: Aetna American Axle |
$5.07
|
| Rate for Payer: Aetna Commercial |
$6.63
|
| Rate for Payer: Aetna Medicare |
$3.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.07
|
| Rate for Payer: BCBS Complete |
$3.12
|
| Rate for Payer: Cash Price |
$6.24
|
| Rate for Payer: Cofinity Advantage |
$5.46
|
| Rate for Payer: Cofinity Commercial |
$6.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.24
|
| Rate for Payer: Healthscope Commercial |
$7.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.85
|
| Rate for Payer: PHP Commercial |
$6.63
|
| Rate for Payer: Priority Health SBD |
$4.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.07
|
| Rate for Payer: UHC Core |
$4.06
|
| Rate for Payer: UHC Exchange |
$3.07
|
| Rate for Payer: UMR Bronson Commercial |
$2.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.85
|
|
|
ACETAZOLAMIDE 250 MG TABLET
|
Facility
|
OP
|
$389.98
|
|
|
Service Code
|
NDC 50268005415
|
| Hospital Charge Code |
113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.29 |
| Max. Negotiated Rate |
$350.98 |
| Rate for Payer: Aetna American Axle |
$253.49
|
| Rate for Payer: Aetna Commercial |
$331.48
|
| Rate for Payer: Aetna Medicare |
$194.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.49
|
| Rate for Payer: BCBS Complete |
$155.99
|
| Rate for Payer: Cash Price |
$311.98
|
| Rate for Payer: Cofinity Advantage |
$272.99
|
| Rate for Payer: Cofinity Commercial |
$335.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.98
|
| Rate for Payer: Healthscope Commercial |
$350.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$272.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$311.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.49
|
| Rate for Payer: PHP Commercial |
$331.48
|
| Rate for Payer: Priority Health SBD |
$245.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$253.49
|
| Rate for Payer: UHC Core |
$203.18
|
| Rate for Payer: UHC Exchange |
$153.26
|
| Rate for Payer: UMR Bronson Commercial |
$144.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.49
|
|
|
ACETAZOLAMIDE 250 MG TABLET
|
Facility
|
IP
|
$309.70
|
|
|
Service Code
|
NDC 51672402301
|
| Hospital Charge Code |
113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.27 |
| Max. Negotiated Rate |
$278.73 |
| Rate for Payer: Aetna American Axle |
$201.31
|
| Rate for Payer: Aetna Commercial |
$263.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.31
|
| Rate for Payer: Cash Price |
$247.76
|
| Rate for Payer: Cofinity Advantage |
$216.79
|
| Rate for Payer: Cofinity Commercial |
$266.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.76
|
| Rate for Payer: Healthscope Commercial |
$278.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.28
|
| Rate for Payer: PHP Commercial |
$263.25
|
| Rate for Payer: Priority Health SBD |
$195.11
|
| Rate for Payer: UMR Bronson Commercial |
$136.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.28
|
|
|
ACETAZOLAMIDE 250 MG TABLET
|
Facility
|
OP
|
$309.70
|
|
|
Service Code
|
NDC 51672402301
|
| Hospital Charge Code |
113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.59 |
| Max. Negotiated Rate |
$278.73 |
| Rate for Payer: Aetna American Axle |
$201.31
|
| Rate for Payer: Aetna Commercial |
$263.25
|
| Rate for Payer: Aetna Medicare |
$154.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.31
|
| Rate for Payer: BCBS Complete |
$123.88
|
| Rate for Payer: Cash Price |
$247.76
|
| Rate for Payer: Cofinity Advantage |
$216.79
|
| Rate for Payer: Cofinity Commercial |
$266.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.76
|
| Rate for Payer: Healthscope Commercial |
$278.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.28
|
| Rate for Payer: PHP Commercial |
$263.25
|
| Rate for Payer: Priority Health SBD |
$195.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$201.31
|
| Rate for Payer: UHC Core |
$161.35
|
| Rate for Payer: UHC Exchange |
$121.71
|
| Rate for Payer: UMR Bronson Commercial |
$114.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.28
|
|
|
ACETAZOLAMIDE 250 MG TABLET
|
Facility
|
IP
|
$389.98
|
|
|
Service Code
|
NDC 50268005415
|
| Hospital Charge Code |
113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.59 |
| Max. Negotiated Rate |
$350.98 |
| Rate for Payer: Aetna American Axle |
$253.49
|
| Rate for Payer: Aetna Commercial |
$331.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.49
|
| Rate for Payer: Cash Price |
$311.98
|
| Rate for Payer: Cofinity Advantage |
$272.99
|
| Rate for Payer: Cofinity Commercial |
$335.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.98
|
| Rate for Payer: Healthscope Commercial |
$350.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$272.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.49
|
| Rate for Payer: PHP Commercial |
$331.48
|
| Rate for Payer: Priority Health SBD |
$245.69
|
| Rate for Payer: UMR Bronson Commercial |
$171.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.49
|
|
|
ACETAZOLAMIDE 500 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$165.50
|
|
|
Service Code
|
HCPCS J1120
|
| Hospital Charge Code |
114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.22 |
| Max. Negotiated Rate |
$148.95 |
| Rate for Payer: Aetna American Axle |
$107.58
|
| Rate for Payer: Aetna American Axle |
$65.92
|
| Rate for Payer: Aetna American Axle |
$77.75
|
| Rate for Payer: Aetna American Axle |
$78.68
|
| Rate for Payer: Aetna Commercial |
$140.68
|
| Rate for Payer: Aetna Commercial |
$102.88
|
| Rate for Payer: Aetna Commercial |
$86.21
|
| Rate for Payer: Aetna Commercial |
$101.68
|
| Rate for Payer: Aetna Medicare |
$60.52
|
| Rate for Payer: Aetna Medicare |
$59.81
|
| Rate for Payer: Aetna Medicare |
$82.75
|
| Rate for Payer: Aetna Medicare |
$50.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.68
|
| Rate for Payer: BCBS Complete |
$40.57
|
| Rate for Payer: BCBS Complete |
$47.85
|
| Rate for Payer: BCBS Complete |
$48.42
|
| Rate for Payer: BCBS Complete |
$66.20
|
| Rate for Payer: BCBS Trust/PPO |
$82.97
|
| Rate for Payer: BCBS Trust/PPO |
$82.97
|
| Rate for Payer: BCBS Trust/PPO |
$82.97
|
| Rate for Payer: BCBS Trust/PPO |
$82.97
|
| Rate for Payer: BCN Commercial |
$82.97
|
| Rate for Payer: BCN Commercial |
$82.97
|
| Rate for Payer: BCN Commercial |
$82.97
|
| Rate for Payer: BCN Commercial |
$82.97
|
| Rate for Payer: Cash Price |
$96.83
|
| Rate for Payer: Cash Price |
$132.40
|
| Rate for Payer: Cash Price |
$81.14
|
| Rate for Payer: Cash Price |
$132.40
|
| Rate for Payer: Cash Price |
$96.83
|
| Rate for Payer: Cash Price |
$95.70
|
| Rate for Payer: Cash Price |
$95.70
|
| Rate for Payer: Cash Price |
$81.14
|
| Rate for Payer: Cofinity Advantage |
$115.85
|
| Rate for Payer: Cofinity Advantage |
$84.73
|
| Rate for Payer: Cofinity Advantage |
$83.73
|
| Rate for Payer: Cofinity Advantage |
$70.99
|
| Rate for Payer: Cofinity Commercial |
$102.87
|
| Rate for Payer: Cofinity Commercial |
$104.09
|
| Rate for Payer: Cofinity Commercial |
$142.33
|
| Rate for Payer: Cofinity Commercial |
$87.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.14
|
| Rate for Payer: Healthscope Commercial |
$108.94
|
| Rate for Payer: Healthscope Commercial |
$91.28
|
| Rate for Payer: Healthscope Commercial |
$107.66
|
| Rate for Payer: Healthscope Commercial |
$148.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$132.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$90.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.12
|
| Rate for Payer: PHP Commercial |
$86.21
|
| Rate for Payer: PHP Commercial |
$102.88
|
| Rate for Payer: PHP Commercial |
$140.68
|
| Rate for Payer: PHP Commercial |
$101.68
|
| Rate for Payer: Priority Health SBD |
$76.26
|
| Rate for Payer: Priority Health SBD |
$63.89
|
| Rate for Payer: Priority Health SBD |
$75.36
|
| Rate for Payer: Priority Health SBD |
$104.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.22
|
| Rate for Payer: UHC Core |
$42.22
|
| Rate for Payer: UHC Core |
$42.22
|
| Rate for Payer: UHC Core |
$42.22
|
| Rate for Payer: UHC Core |
$42.22
|
| Rate for Payer: UHC Exchange |
$42.22
|
| Rate for Payer: UHC Exchange |
$42.22
|
| Rate for Payer: UHC Exchange |
$42.22
|
| Rate for Payer: UHC Exchange |
$42.22
|
| Rate for Payer: UMR Bronson Commercial |
$61.23
|
| Rate for Payer: UMR Bronson Commercial |
$37.53
|
| Rate for Payer: UMR Bronson Commercial |
$44.26
|
| Rate for Payer: UMR Bronson Commercial |
$44.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.12
|
|
|
ACETAZOLAMIDE 500 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$121.04
|
|
|
Service Code
|
HCPCS J1120
|
| Hospital Charge Code |
114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.26 |
| Max. Negotiated Rate |
$108.94 |
| Rate for Payer: Aetna American Axle |
$78.68
|
| Rate for Payer: Aetna American Axle |
$77.75
|
| Rate for Payer: Aetna American Axle |
$107.58
|
| Rate for Payer: Aetna American Axle |
$65.92
|
| Rate for Payer: Aetna Commercial |
$140.68
|
| Rate for Payer: Aetna Commercial |
$102.88
|
| Rate for Payer: Aetna Commercial |
$86.21
|
| Rate for Payer: Aetna Commercial |
$101.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.92
|
| Rate for Payer: Cash Price |
$81.14
|
| Rate for Payer: Cash Price |
$132.40
|
| Rate for Payer: Cash Price |
$95.70
|
| Rate for Payer: Cash Price |
$96.83
|
| Rate for Payer: Cofinity Advantage |
$83.73
|
| Rate for Payer: Cofinity Advantage |
$70.99
|
| Rate for Payer: Cofinity Advantage |
$84.73
|
| Rate for Payer: Cofinity Advantage |
$115.85
|
| Rate for Payer: Cofinity Commercial |
$104.09
|
| Rate for Payer: Cofinity Commercial |
$87.22
|
| Rate for Payer: Cofinity Commercial |
$102.87
|
| Rate for Payer: Cofinity Commercial |
$142.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.70
|
| Rate for Payer: Healthscope Commercial |
$107.66
|
| Rate for Payer: Healthscope Commercial |
$148.95
|
| Rate for Payer: Healthscope Commercial |
$108.94
|
| Rate for Payer: Healthscope Commercial |
$91.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$90.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.06
|
| Rate for Payer: PHP Commercial |
$86.21
|
| Rate for Payer: PHP Commercial |
$102.88
|
| Rate for Payer: PHP Commercial |
$101.68
|
| Rate for Payer: PHP Commercial |
$140.68
|
| Rate for Payer: Priority Health SBD |
$104.27
|
| Rate for Payer: Priority Health SBD |
$63.89
|
| Rate for Payer: Priority Health SBD |
$76.26
|
| Rate for Payer: Priority Health SBD |
$75.36
|
| Rate for Payer: UMR Bronson Commercial |
$52.63
|
| Rate for Payer: UMR Bronson Commercial |
$53.26
|
| Rate for Payer: UMR Bronson Commercial |
$44.62
|
| Rate for Payer: UMR Bronson Commercial |
$72.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.12
|
|
|
ACETIC ACID 0.25 % IRRIGATION SOLUTION
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
NDC 00264230410
|
| Hospital Charge Code |
8963
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna American Axle |
$19.50
|
| Rate for Payer: Aetna Commercial |
$25.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.50
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Advantage |
$21.00
|
| Rate for Payer: Cofinity Commercial |
$25.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.00
|
| Rate for Payer: Healthscope Commercial |
$27.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.50
|
| Rate for Payer: PHP Commercial |
$25.50
|
| Rate for Payer: Priority Health SBD |
$18.90
|
| Rate for Payer: UMR Bronson Commercial |
$13.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.50
|
|
|
ACETIC ACID 0.25 % IRRIGATION SOLUTION
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
NDC 00264230410
|
| Hospital Charge Code |
8963
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.10 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna American Axle |
$19.50
|
| Rate for Payer: Aetna Commercial |
$25.50
|
| Rate for Payer: Aetna Medicare |
$15.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.50
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Advantage |
$21.00
|
| Rate for Payer: Cofinity Commercial |
$25.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.00
|
| Rate for Payer: Healthscope Commercial |
$27.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.50
|
| Rate for Payer: PHP Commercial |
$25.50
|
| Rate for Payer: Priority Health SBD |
$18.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.50
|
| Rate for Payer: UHC Core |
$15.63
|
| Rate for Payer: UHC Exchange |
$11.79
|
| Rate for Payer: UMR Bronson Commercial |
$11.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.50
|
|
|
ACETONE LIQUID
|
Facility
|
IP
|
$105.12
|
|
|
Service Code
|
NDC 00395001994
|
| Hospital Charge Code |
121
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.25 |
| Max. Negotiated Rate |
$94.61 |
| Rate for Payer: Aetna American Axle |
$68.33
|
| Rate for Payer: Aetna Commercial |
$89.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.33
|
| Rate for Payer: Cash Price |
$84.10
|
| Rate for Payer: Cofinity Advantage |
$73.58
|
| Rate for Payer: Cofinity Commercial |
$90.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.10
|
| Rate for Payer: Healthscope Commercial |
$94.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.84
|
| Rate for Payer: PHP Commercial |
$89.35
|
| Rate for Payer: Priority Health SBD |
$66.23
|
| Rate for Payer: UMR Bronson Commercial |
$46.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.84
|
|
|
ACETONE LIQUID
|
Facility
|
OP
|
$105.12
|
|
|
Service Code
|
NDC 00395001994
|
| Hospital Charge Code |
121
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.89 |
| Max. Negotiated Rate |
$94.61 |
| Rate for Payer: Aetna American Axle |
$68.33
|
| Rate for Payer: Aetna Commercial |
$89.35
|
| Rate for Payer: Aetna Medicare |
$52.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.33
|
| Rate for Payer: BCBS Complete |
$42.05
|
| Rate for Payer: Cash Price |
$84.10
|
| Rate for Payer: Cofinity Advantage |
$73.58
|
| Rate for Payer: Cofinity Commercial |
$90.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.10
|
| Rate for Payer: Healthscope Commercial |
$94.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.84
|
| Rate for Payer: PHP Commercial |
$89.35
|
| Rate for Payer: Priority Health SBD |
$66.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.33
|
| Rate for Payer: UHC Core |
$54.77
|
| Rate for Payer: UHC Exchange |
$41.31
|
| Rate for Payer: UMR Bronson Commercial |
$38.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.84
|
|
|
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) INTRAOCULAR KIT
|
Facility
|
IP
|
$270.17
|
|
|
Service Code
|
NDC 24208053920
|
| Hospital Charge Code |
32559
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$118.87 |
| Max. Negotiated Rate |
$243.15 |
| Rate for Payer: Aetna American Axle |
$175.61
|
| Rate for Payer: Aetna Commercial |
$229.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.61
|
| Rate for Payer: Cash Price |
$216.14
|
| Rate for Payer: Cofinity Advantage |
$189.12
|
| Rate for Payer: Cofinity Commercial |
$232.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.14
|
| Rate for Payer: Healthscope Commercial |
$243.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$202.63
|
| Rate for Payer: PHP Commercial |
$229.64
|
| Rate for Payer: Priority Health SBD |
$170.21
|
| Rate for Payer: UMR Bronson Commercial |
$118.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.63
|
|
