|
ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC
|
Facility
|
IP
|
$59,528.09
|
|
|
Service Code
|
MS-DRG 061
|
| Min. Negotiated Rate |
$21,005.28 |
| Max. Negotiated Rate |
$59,528.09 |
| Rate for Payer: Aetna Medicare |
$22,995.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27,638.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27,638.52
|
| Rate for Payer: BCBS MAPPO |
$22,110.82
|
| Rate for Payer: BCBS Trust/PPO |
$59,528.09
|
| Rate for Payer: BCN Medicare Advantage |
$22,110.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22,110.82
|
| Rate for Payer: Mclaren Medicare |
$22,110.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23,216.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25,427.44
|
| Rate for Payer: PACE Medicare |
$21,005.28
|
| Rate for Payer: PACE SWMI |
$22,110.82
|
| Rate for Payer: PHP Medicare Advantage |
$22,110.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40,219.96
|
| Rate for Payer: Priority Health Medicare |
$22,110.82
|
| Rate for Payer: Priority Health Narrow Network |
$32,175.97
|
| Rate for Payer: Railroad Medicare Medicare |
$22,110.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42,753.91
|
| Rate for Payer: UHC Core |
$35,057.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$22,110.82
|
| Rate for Payer: UHC Exchange |
$27,871.04
|
| Rate for Payer: UHC Medicare Advantage |
$22,774.14
|
| Rate for Payer: VA VA |
$22,110.82
|
|
|
ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC
|
Facility
|
IP
|
$37,030.09
|
|
|
Service Code
|
MS-DRG 063
|
| Min. Negotiated Rate |
$11,371.20 |
| Max. Negotiated Rate |
$37,030.09 |
| Rate for Payer: Aetna Medicare |
$12,448.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,962.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,962.10
|
| Rate for Payer: BCBS MAPPO |
$11,969.68
|
| Rate for Payer: BCBS Trust/PPO |
$37,030.09
|
| Rate for Payer: BCN Medicare Advantage |
$11,969.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,969.68
|
| Rate for Payer: Mclaren Medicare |
$11,969.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,568.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,765.13
|
| Rate for Payer: PACE Medicare |
$11,371.20
|
| Rate for Payer: PACE SWMI |
$11,969.68
|
| Rate for Payer: PHP Medicare Advantage |
$11,969.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,335.46
|
| Rate for Payer: Priority Health Medicare |
$11,969.68
|
| Rate for Payer: Priority Health Narrow Network |
$17,068.37
|
| Rate for Payer: Railroad Medicare Medicare |
$11,969.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,679.65
|
| Rate for Payer: UHC Core |
$18,596.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,969.68
|
| Rate for Payer: UHC Exchange |
$14,784.74
|
| Rate for Payer: UHC Medicare Advantage |
$12,328.77
|
| Rate for Payer: VA VA |
$11,969.68
|
|
|
ISOFLURANE 99.9 % INHALATION LIQUID
|
Facility
|
IP
|
$190.55
|
|
|
Service Code
|
NDC 10019-360-60
|
| Hospital Charge Code |
159360
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$83.84 |
| Max. Negotiated Rate |
$171.50 |
| Rate for Payer: Aetna American Axle |
$123.86
|
| Rate for Payer: Aetna Commercial |
$161.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.86
|
| Rate for Payer: Cash Price |
$152.44
|
| Rate for Payer: Cofinity Commercial |
$133.38
|
| Rate for Payer: Cofinity Commercial |
$163.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.44
|
| Rate for Payer: Healthscope Commercial |
$171.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.97
|
| Rate for Payer: PHP Commercial |
$161.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.38
|
| Rate for Payer: Priority Health SBD |
$120.05
|
| Rate for Payer: UMR Bronson Commercial |
$83.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.91
|
|
|
ISOFLURANE 99.9 % INHALATION LIQUID
|
Facility
|
IP
|
$106.38
|
|
|
Service Code
|
NDC 66794-017-25
|
| Hospital Charge Code |
159360
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.81 |
| Max. Negotiated Rate |
$95.74 |
| Rate for Payer: Aetna American Axle |
$69.15
|
| Rate for Payer: Aetna Commercial |
$90.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.15
|
| Rate for Payer: Cash Price |
$85.10
|
| Rate for Payer: Cofinity Commercial |
$74.47
|
| Rate for Payer: Cofinity Commercial |
$91.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.10
|
| Rate for Payer: Healthscope Commercial |
$95.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$90.42
|
| Rate for Payer: PHP Commercial |
$90.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.47
|
| Rate for Payer: Priority Health SBD |
$67.02
|
| Rate for Payer: UMR Bronson Commercial |
$46.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.78
|
|
|
ISOFLURANE 99.9 % INHALATION LIQUID
|
Facility
|
IP
|
$83.25
|
|
|
Service Code
|
NDC 0409-3292-51
|
| Hospital Charge Code |
159360
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.63 |
| Max. Negotiated Rate |
$74.92 |
| Rate for Payer: Aetna American Axle |
$54.11
|
| Rate for Payer: Aetna Commercial |
$70.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.11
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cofinity Commercial |
$58.28
|
| Rate for Payer: Cofinity Commercial |
$71.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.60
|
| Rate for Payer: Healthscope Commercial |
$74.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.76
|
| Rate for Payer: PHP Commercial |
$70.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.28
|
| Rate for Payer: Priority Health SBD |
$52.45
|
| Rate for Payer: UMR Bronson Commercial |
$36.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.44
|
|
|
ISOFLURANE 99.9 % INHALATION LIQUID
|
Facility
|
IP
|
$17.58
|
|
|
Service Code
|
NDC 66794-019-25
|
| Hospital Charge Code |
159360
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.74 |
| Max. Negotiated Rate |
$15.82 |
| Rate for Payer: Aetna American Axle |
$11.43
|
| Rate for Payer: Aetna Commercial |
$14.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.43
|
| Rate for Payer: Cash Price |
$14.06
|
| Rate for Payer: Cofinity Commercial |
$12.31
|
| Rate for Payer: Cofinity Commercial |
$15.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.06
|
| Rate for Payer: Healthscope Commercial |
$15.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.94
|
| Rate for Payer: PHP Commercial |
$14.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.31
|
| Rate for Payer: Priority Health SBD |
$11.08
|
| Rate for Payer: UMR Bronson Commercial |
$7.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.18
|
|
|
ISONIAZID 300 MG TABLET
|
Facility
|
IP
|
$383.05
|
|
|
Service Code
|
NDC 0555-0071-02
|
| Hospital Charge Code |
4027
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.54 |
| Max. Negotiated Rate |
$344.74 |
| Rate for Payer: Aetna American Axle |
$248.98
|
| Rate for Payer: Aetna Commercial |
$325.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.98
|
| Rate for Payer: Cash Price |
$306.44
|
| Rate for Payer: Cofinity Commercial |
$268.14
|
| Rate for Payer: Cofinity Commercial |
$329.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.44
|
| Rate for Payer: Healthscope Commercial |
$344.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$268.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$287.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$325.59
|
| Rate for Payer: PHP Commercial |
$325.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.14
|
| Rate for Payer: Priority Health SBD |
$241.32
|
| Rate for Payer: UMR Bronson Commercial |
$168.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$287.29
|
|
|
ISOPROPYL ALCOHOL 70 % SOLUTION
|
Facility
|
IP
|
$17.03
|
|
|
Service Code
|
NDC 0869-0810-43
|
| Hospital Charge Code |
16013
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$15.33 |
| Rate for Payer: Aetna American Axle |
$11.07
|
| Rate for Payer: Aetna Commercial |
$14.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.07
|
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Cofinity Commercial |
$11.92
|
| Rate for Payer: Cofinity Commercial |
$14.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.62
|
| Rate for Payer: Healthscope Commercial |
$15.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.48
|
| Rate for Payer: PHP Commercial |
$14.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.92
|
| Rate for Payer: Priority Health SBD |
$10.73
|
| Rate for Payer: UMR Bronson Commercial |
$7.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.77
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$246.94
|
|
|
Service Code
|
NDC 70121-1604-1
|
| Hospital Charge Code |
108078
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$108.65 |
| Max. Negotiated Rate |
$222.25 |
| Rate for Payer: Aetna American Axle |
$160.51
|
| Rate for Payer: Aetna Commercial |
$209.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.51
|
| Rate for Payer: Cash Price |
$197.55
|
| Rate for Payer: Cofinity Commercial |
$172.86
|
| Rate for Payer: Cofinity Commercial |
$212.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.55
|
| Rate for Payer: Healthscope Commercial |
$222.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$209.90
|
| Rate for Payer: PHP Commercial |
$209.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.86
|
| Rate for Payer: Priority Health SBD |
$155.57
|
| Rate for Payer: UMR Bronson Commercial |
$108.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.20
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$190.63
|
|
|
Service Code
|
NDC 69918-731-10
|
| Hospital Charge Code |
108078
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$83.88 |
| Max. Negotiated Rate |
$171.57 |
| Rate for Payer: Aetna American Axle |
$123.91
|
| Rate for Payer: Aetna Commercial |
$162.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.91
|
| Rate for Payer: Cash Price |
$152.50
|
| Rate for Payer: Cofinity Commercial |
$133.44
|
| Rate for Payer: Cofinity Commercial |
$163.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.50
|
| Rate for Payer: Healthscope Commercial |
$171.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$162.04
|
| Rate for Payer: PHP Commercial |
$162.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.44
|
| Rate for Payer: Priority Health SBD |
$120.10
|
| Rate for Payer: UMR Bronson Commercial |
$83.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.97
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$479.41
|
|
|
Service Code
|
NDC 68682-433-05
|
| Hospital Charge Code |
108078
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$210.94 |
| Max. Negotiated Rate |
$431.47 |
| Rate for Payer: Aetna American Axle |
$311.62
|
| Rate for Payer: Aetna Commercial |
$407.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$311.62
|
| Rate for Payer: Cash Price |
$383.53
|
| Rate for Payer: Cofinity Commercial |
$335.59
|
| Rate for Payer: Cofinity Commercial |
$412.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$383.53
|
| Rate for Payer: Healthscope Commercial |
$431.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$335.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$359.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$407.50
|
| Rate for Payer: PHP Commercial |
$407.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$335.59
|
| Rate for Payer: Priority Health SBD |
$302.03
|
| Rate for Payer: UMR Bronson Commercial |
$210.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$359.56
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$252.93
|
|
|
Service Code
|
NDC 69097-521-31
|
| Hospital Charge Code |
108078
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$111.29 |
| Max. Negotiated Rate |
$227.64 |
| Rate for Payer: Aetna American Axle |
$164.40
|
| Rate for Payer: Aetna Commercial |
$214.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.40
|
| Rate for Payer: Cash Price |
$202.34
|
| Rate for Payer: Cofinity Commercial |
$177.05
|
| Rate for Payer: Cofinity Commercial |
$217.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.34
|
| Rate for Payer: Healthscope Commercial |
$227.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$214.99
|
| Rate for Payer: PHP Commercial |
$214.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.05
|
| Rate for Payer: Priority Health SBD |
$159.35
|
| Rate for Payer: UMR Bronson Commercial |
$111.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.70
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$190.63
|
|
|
Service Code
|
NDC 69918-731-01
|
| Hospital Charge Code |
108078
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$83.88 |
| Max. Negotiated Rate |
$171.57 |
| Rate for Payer: Aetna American Axle |
$123.91
|
| Rate for Payer: Aetna Commercial |
$162.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.91
|
| Rate for Payer: Cash Price |
$152.50
|
| Rate for Payer: Cofinity Commercial |
$133.44
|
| Rate for Payer: Cofinity Commercial |
$163.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.50
|
| Rate for Payer: Healthscope Commercial |
$171.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$162.04
|
| Rate for Payer: PHP Commercial |
$162.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.44
|
| Rate for Payer: Priority Health SBD |
$120.10
|
| Rate for Payer: UMR Bronson Commercial |
$83.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.97
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$246.94
|
|
|
Service Code
|
NDC 70121-1604-7
|
| Hospital Charge Code |
108078
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$108.65 |
| Max. Negotiated Rate |
$222.25 |
| Rate for Payer: Aetna American Axle |
$160.51
|
| Rate for Payer: Aetna Commercial |
$209.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.51
|
| Rate for Payer: Cash Price |
$197.55
|
| Rate for Payer: Cofinity Commercial |
$172.86
|
| Rate for Payer: Cofinity Commercial |
$212.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.55
|
| Rate for Payer: Healthscope Commercial |
$222.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$209.90
|
| Rate for Payer: PHP Commercial |
$209.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.86
|
| Rate for Payer: Priority Health SBD |
$155.57
|
| Rate for Payer: UMR Bronson Commercial |
$108.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.20
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$2,148.48
|
|
|
Service Code
|
NDC 0187-4330-01
|
| Hospital Charge Code |
108078
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$945.33 |
| Max. Negotiated Rate |
$1,933.63 |
| Rate for Payer: Aetna American Axle |
$1,396.51
|
| Rate for Payer: Aetna Commercial |
$1,826.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,396.51
|
| Rate for Payer: Cash Price |
$1,718.78
|
| Rate for Payer: Cofinity Commercial |
$1,503.94
|
| Rate for Payer: Cofinity Commercial |
$1,847.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,718.78
|
| Rate for Payer: Healthscope Commercial |
$1,933.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,503.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,611.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,826.21
|
| Rate for Payer: PHP Commercial |
$1,826.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,503.94
|
| Rate for Payer: Priority Health SBD |
$1,353.54
|
| Rate for Payer: UMR Bronson Commercial |
$945.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,611.36
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$220.43
|
|
|
Service Code
|
NDC 23155-660-43
|
| Hospital Charge Code |
108078
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$96.99 |
| Max. Negotiated Rate |
$198.39 |
| Rate for Payer: Aetna American Axle |
$143.28
|
| Rate for Payer: Aetna Commercial |
$187.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.28
|
| Rate for Payer: Cash Price |
$176.34
|
| Rate for Payer: Cofinity Commercial |
$154.30
|
| Rate for Payer: Cofinity Commercial |
$189.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.34
|
| Rate for Payer: Healthscope Commercial |
$198.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.37
|
| Rate for Payer: PHP Commercial |
$187.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.30
|
| Rate for Payer: Priority Health SBD |
$138.87
|
| Rate for Payer: UMR Bronson Commercial |
$96.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.32
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$192.52
|
|
|
Service Code
|
NDC 69918-735-10
|
| Hospital Charge Code |
108078
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$84.71 |
| Max. Negotiated Rate |
$173.27 |
| Rate for Payer: Aetna American Axle |
$125.14
|
| Rate for Payer: Aetna Commercial |
$163.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.14
|
| Rate for Payer: Cash Price |
$154.02
|
| Rate for Payer: Cofinity Commercial |
$165.57
|
| Rate for Payer: Cofinity Commercial |
$134.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.02
|
| Rate for Payer: Healthscope Commercial |
$173.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$163.64
|
| Rate for Payer: PHP Commercial |
$163.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.76
|
| Rate for Payer: Priority Health SBD |
$121.29
|
| Rate for Payer: UMR Bronson Commercial |
$84.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.39
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$192.52
|
|
|
Service Code
|
NDC 69918-735-01
|
| Hospital Charge Code |
108078
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$84.71 |
| Max. Negotiated Rate |
$173.27 |
| Rate for Payer: Aetna American Axle |
$125.14
|
| Rate for Payer: Aetna Commercial |
$163.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.14
|
| Rate for Payer: Cash Price |
$154.02
|
| Rate for Payer: Cofinity Commercial |
$134.76
|
| Rate for Payer: Cofinity Commercial |
$165.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.02
|
| Rate for Payer: Healthscope Commercial |
$173.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$163.64
|
| Rate for Payer: PHP Commercial |
$163.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.76
|
| Rate for Payer: Priority Health SBD |
$121.29
|
| Rate for Payer: UMR Bronson Commercial |
$84.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.39
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$220.43
|
|
|
Service Code
|
NDC 23155-660-31
|
| Hospital Charge Code |
108078
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$96.99 |
| Max. Negotiated Rate |
$198.39 |
| Rate for Payer: Aetna American Axle |
$143.28
|
| Rate for Payer: Aetna Commercial |
$187.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.28
|
| Rate for Payer: Cash Price |
$176.34
|
| Rate for Payer: Cofinity Commercial |
$189.57
|
| Rate for Payer: Cofinity Commercial |
$154.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.34
|
| Rate for Payer: Healthscope Commercial |
$198.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.37
|
| Rate for Payer: PHP Commercial |
$187.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.30
|
| Rate for Payer: Priority Health SBD |
$138.87
|
| Rate for Payer: UMR Bronson Commercial |
$96.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.32
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
IP
|
$415.15
|
|
|
Service Code
|
NDC 0904-6619-61
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$182.67 |
| Max. Negotiated Rate |
$373.64 |
| Rate for Payer: Aetna American Axle |
$269.85
|
| Rate for Payer: Aetna Commercial |
$352.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.85
|
| Rate for Payer: Cash Price |
$332.12
|
| Rate for Payer: Cofinity Commercial |
$290.60
|
| Rate for Payer: Cofinity Commercial |
$357.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.12
|
| Rate for Payer: Healthscope Commercial |
$373.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$290.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$311.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$352.88
|
| Rate for Payer: PHP Commercial |
$352.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.60
|
| Rate for Payer: Priority Health SBD |
$261.54
|
| Rate for Payer: UMR Bronson Commercial |
$182.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$311.36
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
IP
|
$386.88
|
|
|
Service Code
|
NDC 49884-021-01
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.23 |
| Max. Negotiated Rate |
$348.19 |
| Rate for Payer: Aetna American Axle |
$251.47
|
| Rate for Payer: Aetna Commercial |
$328.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.47
|
| Rate for Payer: Cash Price |
$309.50
|
| Rate for Payer: Cofinity Commercial |
$270.82
|
| Rate for Payer: Cofinity Commercial |
$332.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.50
|
| Rate for Payer: Healthscope Commercial |
$348.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$270.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$328.85
|
| Rate for Payer: PHP Commercial |
$328.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.82
|
| Rate for Payer: Priority Health SBD |
$243.73
|
| Rate for Payer: UMR Bronson Commercial |
$170.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.16
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
IP
|
$412.97
|
|
|
Service Code
|
NDC 43353-139-60
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$181.71 |
| Max. Negotiated Rate |
$371.67 |
| Rate for Payer: Aetna American Axle |
$268.43
|
| Rate for Payer: Aetna Commercial |
$351.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.43
|
| Rate for Payer: Cash Price |
$330.38
|
| Rate for Payer: Cofinity Commercial |
$289.08
|
| Rate for Payer: Cofinity Commercial |
$355.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.38
|
| Rate for Payer: Healthscope Commercial |
$371.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$289.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$351.02
|
| Rate for Payer: PHP Commercial |
$351.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.08
|
| Rate for Payer: Priority Health SBD |
$260.17
|
| Rate for Payer: UMR Bronson Commercial |
$181.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.73
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
IP
|
$2.47
|
|
|
Service Code
|
NDC 68084-082-11
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Aetna American Axle |
$1.61
|
| Rate for Payer: Aetna Commercial |
$2.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.61
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cofinity Commercial |
$1.73
|
| Rate for Payer: Cofinity Commercial |
$2.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.98
|
| Rate for Payer: Healthscope Commercial |
$2.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.10
|
| Rate for Payer: PHP Commercial |
$2.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.73
|
| Rate for Payer: Priority Health SBD |
$1.56
|
| Rate for Payer: UMR Bronson Commercial |
$1.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.85
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
IP
|
$251.04
|
|
|
Service Code
|
NDC 63739-569-10
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.46 |
| Max. Negotiated Rate |
$225.94 |
| Rate for Payer: Aetna American Axle |
$163.18
|
| Rate for Payer: Aetna Commercial |
$213.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.18
|
| Rate for Payer: Cash Price |
$200.83
|
| Rate for Payer: Cofinity Commercial |
$175.73
|
| Rate for Payer: Cofinity Commercial |
$215.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.83
|
| Rate for Payer: Healthscope Commercial |
$225.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$213.38
|
| Rate for Payer: PHP Commercial |
$213.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.73
|
| Rate for Payer: Priority Health SBD |
$158.16
|
| Rate for Payer: UMR Bronson Commercial |
$110.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.28
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
IP
|
$246.72
|
|
|
Service Code
|
NDC 68084-082-01
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.56 |
| Max. Negotiated Rate |
$222.05 |
| Rate for Payer: Aetna American Axle |
$160.37
|
| Rate for Payer: Aetna Commercial |
$209.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.37
|
| Rate for Payer: Cash Price |
$197.38
|
| Rate for Payer: Cofinity Commercial |
$172.70
|
| Rate for Payer: Cofinity Commercial |
$212.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.38
|
| Rate for Payer: Healthscope Commercial |
$222.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$209.71
|
| Rate for Payer: PHP Commercial |
$209.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.70
|
| Rate for Payer: Priority Health SBD |
$155.43
|
| Rate for Payer: UMR Bronson Commercial |
$108.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.04
|
|
