|
ACETAMINOPHEN (NICU) 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$26.70
|
|
|
Service Code
|
HCPCS J0136
|
| Hospital Charge Code |
300386
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$24.03 |
| Rate for Payer: Aetna American Axle |
$17.36
|
| Rate for Payer: Aetna Commercial |
$22.70
|
| Rate for Payer: Aetna Medicare |
$13.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.36
|
| Rate for Payer: BCBS Complete |
$10.68
|
| Rate for Payer: BCBS Trust/PPO |
$0.11
|
| Rate for Payer: BCN Commercial |
$0.11
|
| Rate for Payer: Cash Price |
$21.36
|
| Rate for Payer: Cash Price |
$21.36
|
| Rate for Payer: Cofinity Commercial |
$18.69
|
| Rate for Payer: Cofinity Commercial |
$22.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.36
|
| Rate for Payer: Healthscope Commercial |
$24.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.70
|
| Rate for Payer: PHP Commercial |
$22.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.36
|
| Rate for Payer: Priority Health SBD |
$16.82
|
| Rate for Payer: UMR Bronson Commercial |
$9.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.02
|
|
|
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 |
$201.30
|
| Rate for Payer: Aetna Commercial |
$263.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.30
|
| Rate for Payer: Cash Price |
$247.76
|
| Rate for Payer: Cofinity Commercial |
$216.79
|
| Rate for Payer: Cofinity Commercial |
$266.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$216.79
|
| 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 |
$263.24
|
| Rate for Payer: PHP Commercial |
$263.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.30
|
| 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
|
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 |
$201.30
|
| Rate for Payer: Aetna Commercial |
$263.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.30
|
| Rate for Payer: Cash Price |
$247.76
|
| Rate for Payer: Cofinity Commercial |
$216.79
|
| Rate for Payer: Cofinity Commercial |
$266.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$216.79
|
| 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 |
$263.24
|
| Rate for Payer: PHP Commercial |
$263.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.30
|
| 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
|
IP
|
$9.35
|
|
|
Service Code
|
NDC 50268005411
|
| Hospital Charge Code |
113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.11 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Aetna American Axle |
$6.08
|
| Rate for Payer: Aetna Commercial |
$7.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.08
|
| Rate for Payer: Cash Price |
$7.48
|
| Rate for Payer: Cofinity Commercial |
$6.54
|
| Rate for Payer: Cofinity Commercial |
$8.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.48
|
| Rate for Payer: Healthscope Commercial |
$8.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.95
|
| Rate for Payer: PHP Commercial |
$7.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.08
|
| Rate for Payer: Priority Health SBD |
$5.89
|
| Rate for Payer: UMR Bronson Commercial |
$4.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.01
|
|
|
ACETAZOLAMIDE 250 MG TABLET
|
Facility
|
OP
|
$9.35
|
|
|
Service Code
|
NDC 50268005411
|
| Hospital Charge Code |
113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Aetna American Axle |
$6.08
|
| Rate for Payer: Aetna Commercial |
$7.95
|
| Rate for Payer: Aetna Medicare |
$4.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.08
|
| Rate for Payer: BCBS Complete |
$3.74
|
| Rate for Payer: Cash Price |
$7.48
|
| Rate for Payer: Cofinity Commercial |
$6.54
|
| Rate for Payer: Cofinity Commercial |
$8.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.48
|
| Rate for Payer: Healthscope Commercial |
$8.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.95
|
| Rate for Payer: PHP Commercial |
$7.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.08
|
| Rate for Payer: Priority Health SBD |
$5.89
|
| Rate for Payer: UMR Bronson Commercial |
$3.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.01
|
|
|
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 |
$201.30
|
| Rate for Payer: Aetna Commercial |
$263.24
|
| Rate for Payer: Aetna Medicare |
$154.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.30
|
| Rate for Payer: BCBS Complete |
$123.88
|
| Rate for Payer: Cash Price |
$247.76
|
| Rate for Payer: Cofinity Commercial |
$216.79
|
| Rate for Payer: Cofinity Commercial |
$266.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$216.79
|
| 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 |
$263.24
|
| Rate for Payer: PHP Commercial |
$263.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.30
|
| Rate for Payer: Priority Health SBD |
$195.11
|
| 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
|
$467.04
|
|
|
Service Code
|
NDC 50268005415
|
| Hospital Charge Code |
113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$205.50 |
| Max. Negotiated Rate |
$420.34 |
| Rate for Payer: Aetna American Axle |
$303.58
|
| Rate for Payer: Aetna Commercial |
$396.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.58
|
| Rate for Payer: Cash Price |
$373.63
|
| Rate for Payer: Cofinity Commercial |
$326.93
|
| Rate for Payer: Cofinity Commercial |
$401.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$326.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$373.63
|
| Rate for Payer: Healthscope Commercial |
$420.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$326.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$396.98
|
| Rate for Payer: PHP Commercial |
$396.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$303.58
|
| Rate for Payer: Priority Health SBD |
$294.24
|
| Rate for Payer: UMR Bronson Commercial |
$205.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.28
|
|
|
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 |
$201.30
|
| Rate for Payer: Aetna Commercial |
$263.24
|
| Rate for Payer: Aetna Medicare |
$154.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.30
|
| Rate for Payer: BCBS Complete |
$123.88
|
| Rate for Payer: Cash Price |
$247.76
|
| Rate for Payer: Cofinity Commercial |
$216.79
|
| Rate for Payer: Cofinity Commercial |
$266.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$216.79
|
| 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 |
$263.24
|
| Rate for Payer: PHP Commercial |
$263.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.30
|
| Rate for Payer: Priority Health SBD |
$195.11
|
| Rate for Payer: UMR Bronson Commercial |
$114.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.28
|
|
|
ACETAZOLAMIDE 250 MG TABLET
|
Facility
|
OP
|
$467.04
|
|
|
Service Code
|
NDC 50268005415
|
| Hospital Charge Code |
113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.80 |
| Max. Negotiated Rate |
$420.34 |
| Rate for Payer: Aetna American Axle |
$303.58
|
| Rate for Payer: Aetna Commercial |
$396.98
|
| Rate for Payer: Aetna Medicare |
$233.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.58
|
| Rate for Payer: BCBS Complete |
$186.82
|
| Rate for Payer: Cash Price |
$373.63
|
| Rate for Payer: Cofinity Commercial |
$326.93
|
| Rate for Payer: Cofinity Commercial |
$401.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$326.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$373.63
|
| Rate for Payer: Healthscope Commercial |
$420.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$326.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$396.98
|
| Rate for Payer: PHP Commercial |
$396.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$303.58
|
| Rate for Payer: Priority Health SBD |
$294.24
|
| Rate for Payer: UMR Bronson Commercial |
$172.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.28
|
|
|
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 |
$76.74
|
| Rate for Payer: Aetna American Axle |
$65.92
|
| Rate for Payer: Aetna American Axle |
$107.58
|
| Rate for Payer: Aetna Commercial |
$102.88
|
| Rate for Payer: Aetna Commercial |
$140.68
|
| Rate for Payer: Aetna Commercial |
$100.35
|
| Rate for Payer: Aetna Commercial |
$86.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.68
|
| Rate for Payer: Cash Price |
$94.45
|
| Rate for Payer: Cash Price |
$96.83
|
| Rate for Payer: Cash Price |
$81.14
|
| Rate for Payer: Cash Price |
$132.40
|
| Rate for Payer: Cofinity Commercial |
$70.99
|
| Rate for Payer: Cofinity Commercial |
$142.33
|
| Rate for Payer: Cofinity Commercial |
$115.85
|
| Rate for Payer: Cofinity Commercial |
$104.09
|
| Rate for Payer: Cofinity Commercial |
$101.53
|
| Rate for Payer: Cofinity Commercial |
$82.64
|
| Rate for Payer: Cofinity Commercial |
$84.73
|
| Rate for Payer: Cofinity Commercial |
$87.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$84.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.99
|
| 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 |
$96.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.45
|
| Rate for Payer: Healthscope Commercial |
$108.94
|
| Rate for Payer: Healthscope Commercial |
$91.28
|
| Rate for Payer: Healthscope Commercial |
$106.25
|
| Rate for Payer: Healthscope Commercial |
$148.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$82.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.12
|
| 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 |
$100.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.88
|
| Rate for Payer: PHP Commercial |
$102.88
|
| Rate for Payer: PHP Commercial |
$140.68
|
| Rate for Payer: PHP Commercial |
$86.21
|
| Rate for Payer: PHP Commercial |
$100.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.92
|
| Rate for Payer: Priority Health SBD |
$104.26
|
| Rate for Payer: Priority Health SBD |
$63.89
|
| Rate for Payer: Priority Health SBD |
$74.38
|
| Rate for Payer: Priority Health SBD |
$76.26
|
| Rate for Payer: UMR Bronson Commercial |
$53.26
|
| Rate for Payer: UMR Bronson Commercial |
$72.82
|
| Rate for Payer: UMR Bronson Commercial |
$51.95
|
| Rate for Payer: UMR Bronson Commercial |
$44.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.78
|
|
|
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 |
$61.24 |
| Max. Negotiated Rate |
$148.95 |
| Rate for Payer: Aetna American Axle |
$107.58
|
| Rate for Payer: Aetna American Axle |
$78.68
|
| Rate for Payer: Aetna American Axle |
$65.92
|
| Rate for Payer: Aetna American Axle |
$76.74
|
| Rate for Payer: Aetna Commercial |
$140.68
|
| Rate for Payer: Aetna Commercial |
$100.35
|
| Rate for Payer: Aetna Commercial |
$86.21
|
| Rate for Payer: Aetna Commercial |
$102.88
|
| Rate for Payer: Aetna Medicare |
$60.52
|
| Rate for Payer: Aetna Medicare |
$59.03
|
| Rate for Payer: Aetna Medicare |
$50.71
|
| Rate for Payer: Aetna Medicare |
$82.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.74
|
| Rate for Payer: BCBS Complete |
$48.42
|
| Rate for Payer: BCBS Complete |
$40.57
|
| Rate for Payer: BCBS Complete |
$66.20
|
| Rate for Payer: BCBS Complete |
$47.22
|
| Rate for Payer: BCBS Trust/PPO |
$63.75
|
| Rate for Payer: BCBS Trust/PPO |
$63.75
|
| Rate for Payer: BCBS Trust/PPO |
$63.75
|
| Rate for Payer: BCBS Trust/PPO |
$63.75
|
| Rate for Payer: BCN Commercial |
$63.75
|
| Rate for Payer: BCN Commercial |
$63.75
|
| Rate for Payer: BCN Commercial |
$63.75
|
| Rate for Payer: BCN Commercial |
$63.75
|
| Rate for Payer: Cash Price |
$94.45
|
| Rate for Payer: Cash Price |
$132.40
|
| Rate for Payer: Cash Price |
$96.83
|
| Rate for Payer: Cash Price |
$94.45
|
| Rate for Payer: Cash Price |
$81.14
|
| Rate for Payer: Cash Price |
$81.14
|
| Rate for Payer: Cash Price |
$96.83
|
| Rate for Payer: Cash Price |
$132.40
|
| Rate for Payer: Cofinity Commercial |
$142.33
|
| Rate for Payer: Cofinity Commercial |
$82.64
|
| Rate for Payer: Cofinity Commercial |
$70.99
|
| Rate for Payer: Cofinity Commercial |
$87.22
|
| Rate for Payer: Cofinity Commercial |
$101.53
|
| Rate for Payer: Cofinity Commercial |
$104.09
|
| Rate for Payer: Cofinity Commercial |
$84.73
|
| Rate for Payer: Cofinity Commercial |
$115.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$84.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.14
|
| Rate for Payer: Healthscope Commercial |
$91.28
|
| Rate for Payer: Healthscope Commercial |
$148.95
|
| Rate for Payer: Healthscope Commercial |
$108.94
|
| Rate for Payer: Healthscope Commercial |
$106.25
|
| 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 |
$82.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.35
|
| 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 |
$86.21
|
| Rate for Payer: PHP Commercial |
$140.68
|
| Rate for Payer: PHP Commercial |
$100.35
|
| Rate for Payer: PHP Commercial |
$86.21
|
| Rate for Payer: PHP Commercial |
$102.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.68
|
| Rate for Payer: Priority Health SBD |
$63.89
|
| Rate for Payer: Priority Health SBD |
$76.26
|
| Rate for Payer: Priority Health SBD |
$74.38
|
| Rate for Payer: Priority Health SBD |
$104.26
|
| Rate for Payer: UMR Bronson Commercial |
$37.53
|
| Rate for Payer: UMR Bronson Commercial |
$44.78
|
| Rate for Payer: UMR Bronson Commercial |
$61.24
|
| Rate for Payer: UMR Bronson Commercial |
$43.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.12
|
|
|
ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE
|
Facility
|
OP
|
$555.84
|
|
|
Service Code
|
NDC 23155012001
|
| Hospital Charge Code |
8962
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$205.66 |
| Max. Negotiated Rate |
$500.26 |
| Rate for Payer: Aetna American Axle |
$361.30
|
| Rate for Payer: Aetna Commercial |
$472.46
|
| Rate for Payer: Aetna Medicare |
$277.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$361.30
|
| Rate for Payer: BCBS Complete |
$222.34
|
| Rate for Payer: Cash Price |
$444.67
|
| Rate for Payer: Cofinity Commercial |
$389.09
|
| Rate for Payer: Cofinity Commercial |
$478.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$389.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$444.67
|
| Rate for Payer: Healthscope Commercial |
$500.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$389.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$416.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$472.46
|
| Rate for Payer: PHP Commercial |
$472.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$361.30
|
| Rate for Payer: Priority Health SBD |
$350.18
|
| Rate for Payer: UMR Bronson Commercial |
$205.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$416.88
|
|
|
ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE
|
Facility
|
IP
|
$555.84
|
|
|
Service Code
|
NDC 23155012001
|
| Hospital Charge Code |
8962
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$244.57 |
| Max. Negotiated Rate |
$500.26 |
| Rate for Payer: Aetna American Axle |
$361.30
|
| Rate for Payer: Aetna Commercial |
$472.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$361.30
|
| Rate for Payer: Cash Price |
$444.67
|
| Rate for Payer: Cofinity Commercial |
$389.09
|
| Rate for Payer: Cofinity Commercial |
$478.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$389.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$444.67
|
| Rate for Payer: Healthscope Commercial |
$500.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$389.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$416.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$472.46
|
| Rate for Payer: PHP Commercial |
$472.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$361.30
|
| Rate for Payer: Priority Health SBD |
$350.18
|
| Rate for Payer: UMR Bronson Commercial |
$244.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$416.88
|
|
|
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 Commercial |
$21.00
|
| Rate for Payer: Cofinity Commercial |
$25.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.00
|
| 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: PHP Commercial |
$25.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.50
|
| Rate for Payer: Priority Health SBD |
$18.90
|
| Rate for Payer: UMR Bronson Commercial |
$11.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.50
|
|
|
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 Commercial |
$21.00
|
| Rate for Payer: Cofinity Commercial |
$25.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.00
|
| 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: PHP Commercial |
$25.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.50
|
| 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
|
|
|
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 Commercial |
$73.58
|
| Rate for Payer: Cofinity Commercial |
$90.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.58
|
| 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: PHP Commercial |
$89.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.33
|
| Rate for Payer: Priority Health SBD |
$66.23
|
| Rate for Payer: UMR Bronson Commercial |
$38.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.84
|
|
|
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 Commercial |
$73.58
|
| Rate for Payer: Cofinity Commercial |
$90.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.58
|
| 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: PHP Commercial |
$89.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.33
|
| 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
|
|
|
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) INTRAOCULAR KIT
|
Facility
|
OP
|
$270.17
|
|
|
Service Code
|
NDC 24208053920
|
| Hospital Charge Code |
32559
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$99.96 |
| Max. Negotiated Rate |
$243.15 |
| Rate for Payer: Aetna American Axle |
$175.61
|
| Rate for Payer: Aetna Commercial |
$229.64
|
| Rate for Payer: Aetna Medicare |
$135.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.61
|
| Rate for Payer: BCBS Complete |
$108.07
|
| Rate for Payer: Cash Price |
$216.14
|
| Rate for Payer: Cofinity Commercial |
$189.12
|
| Rate for Payer: Cofinity Commercial |
$232.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$189.12
|
| 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: PHP Commercial |
$229.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.61
|
| Rate for Payer: Priority Health SBD |
$170.21
|
| Rate for Payer: UMR Bronson Commercial |
$99.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.63
|
|
|
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 Commercial |
$189.12
|
| Rate for Payer: Cofinity Commercial |
$232.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$189.12
|
| 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: PHP Commercial |
$229.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.61
|
| 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
|
|
|
ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$130.43
|
|
|
Service Code
|
HCPCS J0132
|
| Hospital Charge Code |
38303
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$117.39 |
| Rate for Payer: Aetna American Axle |
$84.78
|
| Rate for Payer: Aetna American Axle |
$101.79
|
| Rate for Payer: Aetna American Axle |
$440.07
|
| Rate for Payer: Aetna American Axle |
$61.87
|
| Rate for Payer: Aetna American Axle |
$107.00
|
| Rate for Payer: Aetna American Axle |
$236.06
|
| Rate for Payer: Aetna American Axle |
$111.68
|
| Rate for Payer: Aetna Commercial |
$146.05
|
| Rate for Payer: Aetna Commercial |
$80.91
|
| Rate for Payer: Aetna Commercial |
$308.69
|
| Rate for Payer: Aetna Commercial |
$575.48
|
| Rate for Payer: Aetna Commercial |
$139.92
|
| Rate for Payer: Aetna Commercial |
$110.87
|
| Rate for Payer: Aetna Commercial |
$133.11
|
| Rate for Payer: Aetna Medicare |
$85.91
|
| Rate for Payer: Aetna Medicare |
$181.58
|
| Rate for Payer: Aetna Medicare |
$78.30
|
| Rate for Payer: Aetna Medicare |
$338.52
|
| Rate for Payer: Aetna Medicare |
$82.30
|
| Rate for Payer: Aetna Medicare |
$65.22
|
| Rate for Payer: Aetna Medicare |
$47.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$440.07
|
| Rate for Payer: BCBS Complete |
$145.27
|
| Rate for Payer: BCBS Complete |
$62.64
|
| Rate for Payer: BCBS Complete |
$65.84
|
| Rate for Payer: BCBS Complete |
$52.17
|
| Rate for Payer: BCBS Complete |
$38.08
|
| Rate for Payer: BCBS Complete |
$270.81
|
| Rate for Payer: BCBS Complete |
$68.73
|
| Rate for Payer: BCBS Trust/PPO |
$1.51
|
| Rate for Payer: BCBS Trust/PPO |
$1.51
|
| Rate for Payer: BCBS Trust/PPO |
$1.51
|
| Rate for Payer: BCBS Trust/PPO |
$1.51
|
| Rate for Payer: BCBS Trust/PPO |
$1.51
|
| Rate for Payer: BCBS Trust/PPO |
$1.51
|
| Rate for Payer: BCBS Trust/PPO |
$1.51
|
| Rate for Payer: BCN Commercial |
$1.51
|
| Rate for Payer: BCN Commercial |
$1.51
|
| Rate for Payer: BCN Commercial |
$1.51
|
| Rate for Payer: BCN Commercial |
$1.51
|
| Rate for Payer: BCN Commercial |
$1.51
|
| Rate for Payer: BCN Commercial |
$1.51
|
| Rate for Payer: BCN Commercial |
$1.51
|
| Rate for Payer: Cash Price |
$76.15
|
| Rate for Payer: Cash Price |
$125.28
|
| Rate for Payer: Cash Price |
$131.69
|
| Rate for Payer: Cash Price |
$104.34
|
| Rate for Payer: Cash Price |
$125.28
|
| Rate for Payer: Cash Price |
$104.34
|
| Rate for Payer: Cash Price |
$131.69
|
| Rate for Payer: Cash Price |
$137.46
|
| Rate for Payer: Cash Price |
$137.46
|
| Rate for Payer: Cash Price |
$290.54
|
| Rate for Payer: Cash Price |
$290.54
|
| Rate for Payer: Cash Price |
$541.62
|
| Rate for Payer: Cash Price |
$541.62
|
| Rate for Payer: Cash Price |
$76.15
|
| Rate for Payer: Cofinity Commercial |
$109.62
|
| Rate for Payer: Cofinity Commercial |
$81.86
|
| Rate for Payer: Cofinity Commercial |
$254.22
|
| Rate for Payer: Cofinity Commercial |
$91.30
|
| Rate for Payer: Cofinity Commercial |
$141.56
|
| Rate for Payer: Cofinity Commercial |
$66.63
|
| Rate for Payer: Cofinity Commercial |
$112.17
|
| Rate for Payer: Cofinity Commercial |
$312.33
|
| Rate for Payer: Cofinity Commercial |
$115.23
|
| Rate for Payer: Cofinity Commercial |
$582.25
|
| Rate for Payer: Cofinity Commercial |
$473.92
|
| Rate for Payer: Cofinity Commercial |
$134.68
|
| Rate for Payer: Cofinity Commercial |
$120.27
|
| Rate for Payer: Cofinity Commercial |
$147.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$254.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$91.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$473.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$120.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$541.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.69
|
| Rate for Payer: Healthscope Commercial |
$154.64
|
| Rate for Payer: Healthscope Commercial |
$85.67
|
| Rate for Payer: Healthscope Commercial |
$326.85
|
| Rate for Payer: Healthscope Commercial |
$117.39
|
| Rate for Payer: Healthscope Commercial |
$140.94
|
| Rate for Payer: Healthscope Commercial |
$148.15
|
| Rate for Payer: Healthscope Commercial |
$609.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$473.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$120.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$254.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$272.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$128.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$507.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$575.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.91
|
| Rate for Payer: PHP Commercial |
$133.11
|
| Rate for Payer: PHP Commercial |
$146.05
|
| Rate for Payer: PHP Commercial |
$80.91
|
| Rate for Payer: PHP Commercial |
$139.92
|
| Rate for Payer: PHP Commercial |
$110.87
|
| Rate for Payer: PHP Commercial |
$308.69
|
| Rate for Payer: PHP Commercial |
$575.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$440.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.87
|
| Rate for Payer: Priority Health SBD |
$108.25
|
| Rate for Payer: Priority Health SBD |
$228.80
|
| Rate for Payer: Priority Health SBD |
$59.97
|
| Rate for Payer: Priority Health SBD |
$426.53
|
| Rate for Payer: Priority Health SBD |
$98.66
|
| Rate for Payer: Priority Health SBD |
$103.70
|
| Rate for Payer: Priority Health SBD |
$82.17
|
| Rate for Payer: UMR Bronson Commercial |
$134.37
|
| Rate for Payer: UMR Bronson Commercial |
$60.91
|
| Rate for Payer: UMR Bronson Commercial |
$48.26
|
| Rate for Payer: UMR Bronson Commercial |
$57.94
|
| Rate for Payer: UMR Bronson Commercial |
$63.57
|
| Rate for Payer: UMR Bronson Commercial |
$250.50
|
| Rate for Payer: UMR Bronson Commercial |
$35.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$272.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$128.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$507.77
|
|
|
ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$130.43
|
|
|
Service Code
|
HCPCS J0132
|
| Hospital Charge Code |
38303
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.39 |
| Max. Negotiated Rate |
$117.39 |
| Rate for Payer: Aetna American Axle |
$84.78
|
| Rate for Payer: Aetna American Axle |
$440.07
|
| Rate for Payer: Aetna American Axle |
$236.06
|
| Rate for Payer: Aetna American Axle |
$107.00
|
| Rate for Payer: Aetna American Axle |
$101.79
|
| Rate for Payer: Aetna American Axle |
$111.68
|
| Rate for Payer: Aetna American Axle |
$61.87
|
| Rate for Payer: Aetna Commercial |
$575.48
|
| Rate for Payer: Aetna Commercial |
$133.11
|
| Rate for Payer: Aetna Commercial |
$146.05
|
| Rate for Payer: Aetna Commercial |
$308.69
|
| Rate for Payer: Aetna Commercial |
$80.91
|
| Rate for Payer: Aetna Commercial |
$139.92
|
| Rate for Payer: Aetna Commercial |
$110.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$440.07
|
| Rate for Payer: Cash Price |
$137.46
|
| Rate for Payer: Cash Price |
$541.62
|
| Rate for Payer: Cash Price |
$125.28
|
| Rate for Payer: Cash Price |
$104.34
|
| Rate for Payer: Cash Price |
$131.69
|
| Rate for Payer: Cash Price |
$290.54
|
| Rate for Payer: Cash Price |
$76.15
|
| Rate for Payer: Cofinity Commercial |
$582.25
|
| Rate for Payer: Cofinity Commercial |
$112.17
|
| Rate for Payer: Cofinity Commercial |
$147.77
|
| Rate for Payer: Cofinity Commercial |
$120.27
|
| Rate for Payer: Cofinity Commercial |
$115.23
|
| Rate for Payer: Cofinity Commercial |
$109.62
|
| Rate for Payer: Cofinity Commercial |
$134.68
|
| Rate for Payer: Cofinity Commercial |
$141.56
|
| Rate for Payer: Cofinity Commercial |
$91.30
|
| Rate for Payer: Cofinity Commercial |
$254.22
|
| Rate for Payer: Cofinity Commercial |
$312.33
|
| Rate for Payer: Cofinity Commercial |
$473.92
|
| Rate for Payer: Cofinity Commercial |
$66.63
|
| Rate for Payer: Cofinity Commercial |
$81.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$120.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$91.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$473.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$254.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$541.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.34
|
| Rate for Payer: Healthscope Commercial |
$85.67
|
| Rate for Payer: Healthscope Commercial |
$326.85
|
| Rate for Payer: Healthscope Commercial |
$148.15
|
| Rate for Payer: Healthscope Commercial |
$154.64
|
| Rate for Payer: Healthscope Commercial |
$140.94
|
| Rate for Payer: Healthscope Commercial |
$117.39
|
| Rate for Payer: Healthscope Commercial |
$609.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$120.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$254.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$473.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$272.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$128.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$507.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$575.48
|
| Rate for Payer: PHP Commercial |
$308.69
|
| Rate for Payer: PHP Commercial |
$139.92
|
| Rate for Payer: PHP Commercial |
$146.05
|
| Rate for Payer: PHP Commercial |
$110.87
|
| Rate for Payer: PHP Commercial |
$133.11
|
| Rate for Payer: PHP Commercial |
$80.91
|
| Rate for Payer: PHP Commercial |
$575.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$440.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.06
|
| Rate for Payer: Priority Health SBD |
$103.70
|
| Rate for Payer: Priority Health SBD |
$98.66
|
| Rate for Payer: Priority Health SBD |
$82.17
|
| Rate for Payer: Priority Health SBD |
$59.97
|
| Rate for Payer: Priority Health SBD |
$426.53
|
| Rate for Payer: Priority Health SBD |
$228.80
|
| Rate for Payer: Priority Health SBD |
$108.25
|
| Rate for Payer: UMR Bronson Commercial |
$75.60
|
| Rate for Payer: UMR Bronson Commercial |
$41.88
|
| Rate for Payer: UMR Bronson Commercial |
$159.79
|
| Rate for Payer: UMR Bronson Commercial |
$297.89
|
| Rate for Payer: UMR Bronson Commercial |
$57.39
|
| Rate for Payer: UMR Bronson Commercial |
$72.43
|
| Rate for Payer: UMR Bronson Commercial |
$68.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$128.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$507.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$272.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.82
|
|
|
ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION
|
Facility
|
IP
|
$116.07
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
123
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$51.07 |
| Max. Negotiated Rate |
$104.46 |
| Rate for Payer: Aetna American Axle |
$75.45
|
| Rate for Payer: Aetna American Axle |
$15.96
|
| Rate for Payer: Aetna American Axle |
$43.97
|
| Rate for Payer: Aetna Commercial |
$20.88
|
| Rate for Payer: Aetna Commercial |
$98.66
|
| Rate for Payer: Aetna Commercial |
$57.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.96
|
| Rate for Payer: Cash Price |
$54.11
|
| Rate for Payer: Cash Price |
$19.65
|
| Rate for Payer: Cash Price |
$92.86
|
| Rate for Payer: Cofinity Commercial |
$99.82
|
| Rate for Payer: Cofinity Commercial |
$21.12
|
| Rate for Payer: Cofinity Commercial |
$17.19
|
| Rate for Payer: Cofinity Commercial |
$58.17
|
| Rate for Payer: Cofinity Commercial |
$47.35
|
| Rate for Payer: Cofinity Commercial |
$81.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.65
|
| Rate for Payer: Healthscope Commercial |
$22.10
|
| Rate for Payer: Healthscope Commercial |
$104.46
|
| Rate for Payer: Healthscope Commercial |
$60.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.88
|
| Rate for Payer: PHP Commercial |
$57.49
|
| Rate for Payer: PHP Commercial |
$20.88
|
| Rate for Payer: PHP Commercial |
$98.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.45
|
| Rate for Payer: Priority Health SBD |
$42.61
|
| Rate for Payer: Priority Health SBD |
$15.47
|
| Rate for Payer: Priority Health SBD |
$73.12
|
| Rate for Payer: UMR Bronson Commercial |
$51.07
|
| Rate for Payer: UMR Bronson Commercial |
$29.76
|
| Rate for Payer: UMR Bronson Commercial |
$10.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.42
|
|
|
ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION
|
Facility
|
OP
|
$24.56
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
123
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$22.10 |
| Rate for Payer: Aetna American Axle |
$15.96
|
| Rate for Payer: Aetna American Axle |
$75.45
|
| Rate for Payer: Aetna American Axle |
$43.97
|
| Rate for Payer: Aetna Commercial |
$57.49
|
| Rate for Payer: Aetna Commercial |
$98.66
|
| Rate for Payer: Aetna Commercial |
$20.88
|
| Rate for Payer: Aetna Medicare |
$12.28
|
| Rate for Payer: Aetna Medicare |
$58.04
|
| Rate for Payer: Aetna Medicare |
$33.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.97
|
| Rate for Payer: BCBS Complete |
$46.43
|
| Rate for Payer: BCBS Complete |
$27.06
|
| Rate for Payer: BCBS Complete |
$9.82
|
| Rate for Payer: Cash Price |
$54.11
|
| Rate for Payer: Cash Price |
$92.86
|
| Rate for Payer: Cash Price |
$92.86
|
| Rate for Payer: Cash Price |
$19.65
|
| Rate for Payer: Cash Price |
$54.11
|
| Rate for Payer: Cash Price |
$19.65
|
| Rate for Payer: Cofinity Commercial |
$81.25
|
| Rate for Payer: Cofinity Commercial |
$47.35
|
| Rate for Payer: Cofinity Commercial |
$58.17
|
| Rate for Payer: Cofinity Commercial |
$21.12
|
| Rate for Payer: Cofinity Commercial |
$17.19
|
| Rate for Payer: Cofinity Commercial |
$99.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.65
|
| Rate for Payer: Healthscope Commercial |
$22.10
|
| Rate for Payer: Healthscope Commercial |
$104.46
|
| Rate for Payer: Healthscope Commercial |
$60.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: PHP Commercial |
$57.49
|
| Rate for Payer: PHP Commercial |
$20.88
|
| Rate for Payer: PHP Commercial |
$98.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.15
|
| Rate for Payer: Priority Health Narrow Network |
$6.52
|
| Rate for Payer: Priority Health Narrow Network |
$6.52
|
| Rate for Payer: Priority Health Narrow Network |
$6.52
|
| Rate for Payer: Priority Health SBD |
$15.47
|
| Rate for Payer: Priority Health SBD |
$73.12
|
| Rate for Payer: Priority Health SBD |
$42.61
|
| Rate for Payer: UMR Bronson Commercial |
$42.95
|
| Rate for Payer: UMR Bronson Commercial |
$9.09
|
| Rate for Payer: UMR Bronson Commercial |
$25.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.73
|
|
|
ACETYLCYSTEINE 600 MG CAPSULE
|
Facility
|
OP
|
$249.57
|
|
|
Service Code
|
NDC 27434000211
|
| Hospital Charge Code |
116999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.34 |
| Max. Negotiated Rate |
$224.61 |
| Rate for Payer: Aetna American Axle |
$162.22
|
| Rate for Payer: Aetna Commercial |
$212.13
|
| Rate for Payer: Aetna Medicare |
$124.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.22
|
| Rate for Payer: BCBS Complete |
$99.83
|
| Rate for Payer: Cash Price |
$199.66
|
| Rate for Payer: Cofinity Commercial |
$174.70
|
| Rate for Payer: Cofinity Commercial |
$214.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.66
|
| Rate for Payer: Healthscope Commercial |
$224.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.13
|
| Rate for Payer: PHP Commercial |
$212.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.22
|
| Rate for Payer: Priority Health SBD |
$157.23
|
| Rate for Payer: UMR Bronson Commercial |
$92.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.18
|
|
|
ACETYLCYSTEINE 600 MG CAPSULE
|
Facility
|
IP
|
$176.25
|
|
|
Service Code
|
NDC 79854004097
|
| Hospital Charge Code |
116999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.55 |
| Max. Negotiated Rate |
$158.62 |
| Rate for Payer: Aetna American Axle |
$114.56
|
| Rate for Payer: Aetna Commercial |
$149.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.56
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cofinity Commercial |
$123.38
|
| Rate for Payer: Cofinity Commercial |
$151.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.00
|
| Rate for Payer: Healthscope Commercial |
$158.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.81
|
| Rate for Payer: PHP Commercial |
$149.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.56
|
| Rate for Payer: Priority Health SBD |
$111.04
|
| Rate for Payer: UMR Bronson Commercial |
$77.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.19
|
|
