|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
IP
|
$448.40
|
|
|
Service Code
|
NDC 0781-1556-13
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$197.30 |
| Max. Negotiated Rate |
$403.56 |
| Rate for Payer: Aetna American Axle |
$291.46
|
| Rate for Payer: Aetna Commercial |
$381.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.46
|
| Rate for Payer: Cash Price |
$358.72
|
| Rate for Payer: Cofinity Commercial |
$313.88
|
| Rate for Payer: Cofinity Commercial |
$385.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$358.72
|
| Rate for Payer: Healthscope Commercial |
$403.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$313.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$336.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$381.14
|
| Rate for Payer: PHP Commercial |
$381.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.88
|
| Rate for Payer: Priority Health SBD |
$282.49
|
| Rate for Payer: UMR Bronson Commercial |
$197.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$336.30
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
IP
|
$395.52
|
|
|
Service Code
|
NDC 0781-1556-01
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.03 |
| Max. Negotiated Rate |
$355.97 |
| Rate for Payer: Aetna American Axle |
$257.09
|
| Rate for Payer: Aetna Commercial |
$336.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.09
|
| Rate for Payer: Cash Price |
$316.42
|
| Rate for Payer: Cofinity Commercial |
$276.86
|
| Rate for Payer: Cofinity Commercial |
$340.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$316.42
|
| Rate for Payer: Healthscope Commercial |
$355.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$276.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$296.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$336.19
|
| Rate for Payer: PHP Commercial |
$336.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.86
|
| Rate for Payer: Priority Health SBD |
$249.18
|
| Rate for Payer: UMR Bronson Commercial |
$174.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$296.64
|
|
|
ISOSORBIDE DINITRATE 20 MG TABLET
|
Facility
|
IP
|
$468.35
|
|
|
Service Code
|
NDC 0904-6620-61
|
| Hospital Charge Code |
4065
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$206.07 |
| Max. Negotiated Rate |
$421.52 |
| Rate for Payer: Aetna American Axle |
$304.43
|
| Rate for Payer: Aetna Commercial |
$398.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.43
|
| Rate for Payer: Cash Price |
$374.68
|
| Rate for Payer: Cofinity Commercial |
$327.84
|
| Rate for Payer: Cofinity Commercial |
$402.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.68
|
| Rate for Payer: Healthscope Commercial |
$421.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$351.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$398.10
|
| Rate for Payer: PHP Commercial |
$398.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$327.84
|
| Rate for Payer: Priority Health SBD |
$295.06
|
| Rate for Payer: UMR Bronson Commercial |
$206.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$351.26
|
|
|
ISOSORBIDE MONONITRATE 20 MG TABLET
|
Facility
|
IP
|
$321.95
|
|
|
Service Code
|
NDC 0228-2620-11
|
| Hospital Charge Code |
10357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.66 |
| Max. Negotiated Rate |
$289.76 |
| Rate for Payer: Aetna American Axle |
$209.27
|
| Rate for Payer: Aetna Commercial |
$273.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.27
|
| Rate for Payer: Cash Price |
$257.56
|
| Rate for Payer: Cofinity Commercial |
$225.36
|
| Rate for Payer: Cofinity Commercial |
$276.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.56
|
| Rate for Payer: Healthscope Commercial |
$289.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$225.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$273.66
|
| Rate for Payer: PHP Commercial |
$273.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.36
|
| Rate for Payer: Priority Health SBD |
$202.83
|
| Rate for Payer: UMR Bronson Commercial |
$141.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.46
|
|
|
ISOSORBIDE MONONITRATE 20 MG TABLET
|
Facility
|
IP
|
$451.25
|
|
|
Service Code
|
NDC 62175-107-01
|
| Hospital Charge Code |
10357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$198.55 |
| Max. Negotiated Rate |
$406.12 |
| Rate for Payer: Aetna American Axle |
$293.31
|
| Rate for Payer: Aetna Commercial |
$383.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.31
|
| Rate for Payer: Cash Price |
$361.00
|
| Rate for Payer: Cofinity Commercial |
$388.08
|
| Rate for Payer: Cofinity Commercial |
$315.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.00
|
| Rate for Payer: Healthscope Commercial |
$406.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$315.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$338.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$383.56
|
| Rate for Payer: PHP Commercial |
$383.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.88
|
| Rate for Payer: Priority Health SBD |
$284.29
|
| Rate for Payer: UMR Bronson Commercial |
$198.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$338.44
|
|
|
ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$361.00
|
|
|
Service Code
|
NDC 13668-104-01
|
| Hospital Charge Code |
24521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.84 |
| Max. Negotiated Rate |
$324.90 |
| Rate for Payer: Aetna American Axle |
$234.65
|
| Rate for Payer: Aetna Commercial |
$306.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.65
|
| Rate for Payer: Cash Price |
$288.80
|
| Rate for Payer: Cofinity Commercial |
$252.70
|
| Rate for Payer: Cofinity Commercial |
$310.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.80
|
| Rate for Payer: Healthscope Commercial |
$324.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$252.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$306.85
|
| Rate for Payer: PHP Commercial |
$306.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.70
|
| Rate for Payer: Priority Health SBD |
$227.43
|
| Rate for Payer: UMR Bronson Commercial |
$158.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.75
|
|
|
ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$243.20
|
|
|
Service Code
|
NDC 0904-6449-61
|
| Hospital Charge Code |
24521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.01 |
| Max. Negotiated Rate |
$218.88 |
| Rate for Payer: Aetna American Axle |
$158.08
|
| Rate for Payer: Aetna Commercial |
$206.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.08
|
| Rate for Payer: Cash Price |
$194.56
|
| Rate for Payer: Cofinity Commercial |
$170.24
|
| Rate for Payer: Cofinity Commercial |
$209.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.56
|
| Rate for Payer: Healthscope Commercial |
$218.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$170.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$206.72
|
| Rate for Payer: PHP Commercial |
$206.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.24
|
| Rate for Payer: Priority Health SBD |
$153.22
|
| Rate for Payer: UMR Bronson Commercial |
$107.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.40
|
|
|
ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$453.55
|
|
|
Service Code
|
NDC 62175-128-37
|
| Hospital Charge Code |
24521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$199.56 |
| Max. Negotiated Rate |
$408.20 |
| Rate for Payer: Aetna American Axle |
$294.81
|
| Rate for Payer: Aetna Commercial |
$385.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.81
|
| Rate for Payer: Cash Price |
$362.84
|
| Rate for Payer: Cofinity Commercial |
$317.48
|
| Rate for Payer: Cofinity Commercial |
$390.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$362.84
|
| Rate for Payer: Healthscope Commercial |
$408.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$317.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$340.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$385.52
|
| Rate for Payer: PHP Commercial |
$385.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$317.48
|
| Rate for Payer: Priority Health SBD |
$285.74
|
| Rate for Payer: UMR Bronson Commercial |
$199.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$340.16
|
|
|
ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$284.35
|
|
|
Service Code
|
NDC 23155-519-01
|
| Hospital Charge Code |
24521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.11 |
| Max. Negotiated Rate |
$255.92 |
| Rate for Payer: Aetna American Axle |
$184.83
|
| Rate for Payer: Aetna Commercial |
$241.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.83
|
| Rate for Payer: Cash Price |
$227.48
|
| Rate for Payer: Cofinity Commercial |
$199.04
|
| Rate for Payer: Cofinity Commercial |
$244.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.48
|
| Rate for Payer: Healthscope Commercial |
$255.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$241.70
|
| Rate for Payer: PHP Commercial |
$241.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.04
|
| Rate for Payer: Priority Health SBD |
$179.14
|
| Rate for Payer: UMR Bronson Commercial |
$125.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.26
|
|
|
ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$464.55
|
|
|
Service Code
|
NDC 68084-591-01
|
| Hospital Charge Code |
24521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$204.40 |
| Max. Negotiated Rate |
$418.10 |
| Rate for Payer: Aetna American Axle |
$301.96
|
| Rate for Payer: Aetna Commercial |
$394.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.96
|
| Rate for Payer: Cash Price |
$371.64
|
| Rate for Payer: Cofinity Commercial |
$325.18
|
| Rate for Payer: Cofinity Commercial |
$399.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$371.64
|
| Rate for Payer: Healthscope Commercial |
$418.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$325.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$348.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$394.87
|
| Rate for Payer: PHP Commercial |
$394.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.18
|
| Rate for Payer: Priority Health SBD |
$292.67
|
| Rate for Payer: UMR Bronson Commercial |
$204.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$348.41
|
|
|
ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
NDC 23155-178-01
|
| Hospital Charge Code |
24268
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.76 |
| Max. Negotiated Rate |
$296.10 |
| Rate for Payer: Aetna American Axle |
$213.85
|
| Rate for Payer: Aetna Commercial |
$279.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.85
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$230.30
|
| Rate for Payer: Cofinity Commercial |
$282.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.20
|
| Rate for Payer: Healthscope Commercial |
$296.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$230.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$279.65
|
| Rate for Payer: PHP Commercial |
$279.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.30
|
| Rate for Payer: Priority Health SBD |
$207.27
|
| Rate for Payer: UMR Bronson Commercial |
$144.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.75
|
|
|
ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$319.20
|
|
|
Service Code
|
NDC 13668-105-01
|
| Hospital Charge Code |
24268
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.45 |
| Max. Negotiated Rate |
$287.28 |
| Rate for Payer: Aetna American Axle |
$207.48
|
| Rate for Payer: Aetna Commercial |
$271.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$207.48
|
| Rate for Payer: Cash Price |
$255.36
|
| Rate for Payer: Cofinity Commercial |
$223.44
|
| Rate for Payer: Cofinity Commercial |
$274.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$255.36
|
| Rate for Payer: Healthscope Commercial |
$287.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$223.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$239.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$271.32
|
| Rate for Payer: PHP Commercial |
$271.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$223.44
|
| Rate for Payer: Priority Health SBD |
$201.10
|
| Rate for Payer: UMR Bronson Commercial |
$140.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$239.40
|
|
|
ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$386.65
|
|
|
Service Code
|
NDC 68382-651-01
|
| Hospital Charge Code |
24268
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.13 |
| Max. Negotiated Rate |
$347.98 |
| Rate for Payer: Aetna American Axle |
$251.32
|
| Rate for Payer: Aetna Commercial |
$328.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.32
|
| Rate for Payer: Cash Price |
$309.32
|
| Rate for Payer: Cofinity Commercial |
$270.66
|
| Rate for Payer: Cofinity Commercial |
$332.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.32
|
| Rate for Payer: Healthscope Commercial |
$347.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$270.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$328.65
|
| Rate for Payer: PHP Commercial |
$328.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.66
|
| Rate for Payer: Priority Health SBD |
$243.59
|
| Rate for Payer: UMR Bronson Commercial |
$170.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.99
|
|
|
ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$192.85
|
|
|
Service Code
|
NDC 62175-119-37
|
| Hospital Charge Code |
24268
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.85 |
| Max. Negotiated Rate |
$173.56 |
| Rate for Payer: Aetna American Axle |
$125.35
|
| Rate for Payer: Aetna Commercial |
$163.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.35
|
| Rate for Payer: Cash Price |
$154.28
|
| Rate for Payer: Cofinity Commercial |
$135.00
|
| Rate for Payer: Cofinity Commercial |
$165.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.28
|
| Rate for Payer: Healthscope Commercial |
$173.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$163.92
|
| Rate for Payer: PHP Commercial |
$163.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.00
|
| Rate for Payer: Priority Health SBD |
$121.50
|
| Rate for Payer: UMR Bronson Commercial |
$84.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.64
|
|
|
ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$289.75
|
|
|
Service Code
|
NDC 0904-6450-61
|
| Hospital Charge Code |
24268
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.49 |
| Max. Negotiated Rate |
$260.78 |
| Rate for Payer: Aetna American Axle |
$188.34
|
| Rate for Payer: Aetna Commercial |
$246.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.34
|
| Rate for Payer: Cash Price |
$231.80
|
| Rate for Payer: Cofinity Commercial |
$202.82
|
| Rate for Payer: Cofinity Commercial |
$249.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.80
|
| Rate for Payer: Healthscope Commercial |
$260.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$202.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$246.29
|
| Rate for Payer: PHP Commercial |
$246.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.82
|
| Rate for Payer: Priority Health SBD |
$182.54
|
| Rate for Payer: UMR Bronson Commercial |
$127.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.31
|
|
|
ISOSOURCE 1.5 BOLUS FEED
|
Facility
|
IP
|
$11.10
|
|
|
Service Code
|
NDC 4390018182
|
| Hospital Charge Code |
150768
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$9.99 |
| Rate for Payer: Aetna American Axle |
$7.22
|
| Rate for Payer: Aetna Commercial |
$9.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.22
|
| Rate for Payer: Cash Price |
$8.88
|
| Rate for Payer: Cofinity Commercial |
$7.77
|
| Rate for Payer: Cofinity Commercial |
$9.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.88
|
| Rate for Payer: Healthscope Commercial |
$9.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.44
|
| Rate for Payer: PHP Commercial |
$9.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.77
|
| Rate for Payer: Priority Health SBD |
$6.99
|
| Rate for Payer: UMR Bronson Commercial |
$4.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.32
|
|
|
ISOSOURCE 1.5 BOLUS FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 4390018150
|
| Hospital Charge Code |
150768
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna American Axle |
$3.09
|
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$3.32
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.04
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.32
|
| Rate for Payer: Priority Health SBD |
$2.99
|
| Rate for Payer: UMR Bronson Commercial |
$2.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
|
ISOSOURCE 1.5 CONTINUOUS FEED
|
Facility
|
IP
|
$9.60
|
|
|
Service Code
|
NDC 4390018181
|
| Hospital Charge Code |
168943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna American Axle |
$6.24
|
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.24
|
| Rate for Payer: Cash Price |
$7.68
|
| Rate for Payer: Cofinity Commercial |
$6.72
|
| Rate for Payer: Cofinity Commercial |
$8.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.68
|
| Rate for Payer: Healthscope Commercial |
$8.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.16
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.72
|
| Rate for Payer: Priority Health SBD |
$6.05
|
| Rate for Payer: UMR Bronson Commercial |
$4.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.20
|
|
|
ISOSOURCE 1.5 CONTINUOUS FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 4390018150
|
| Hospital Charge Code |
168943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna American Axle |
$3.09
|
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$3.32
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.04
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.32
|
| Rate for Payer: Priority Health SBD |
$2.99
|
| Rate for Payer: UMR Bronson Commercial |
$2.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
|
ISOSOURCE 1.5 CYCLIC FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 4390018150
|
| Hospital Charge Code |
200081
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna American Axle |
$3.09
|
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$3.32
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.04
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.32
|
| Rate for Payer: Priority Health SBD |
$2.99
|
| Rate for Payer: UMR Bronson Commercial |
$2.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
|
ISOSOURCE 1.5 CYCLIC FEED
|
Facility
|
IP
|
$9.60
|
|
|
Service Code
|
NDC 4390018181
|
| Hospital Charge Code |
200081
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna American Axle |
$6.24
|
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.24
|
| Rate for Payer: Cash Price |
$7.68
|
| Rate for Payer: Cofinity Commercial |
$6.72
|
| Rate for Payer: Cofinity Commercial |
$8.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.68
|
| Rate for Payer: Healthscope Commercial |
$8.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.16
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.72
|
| Rate for Payer: Priority Health SBD |
$6.05
|
| Rate for Payer: UMR Bronson Commercial |
$4.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.20
|
|
|
ISOSOURCE 1.5 INTERMITTENT FEED
|
Facility
|
IP
|
$9.60
|
|
|
Service Code
|
NDC 4390018181
|
| Hospital Charge Code |
200080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna American Axle |
$6.24
|
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.24
|
| Rate for Payer: Cash Price |
$7.68
|
| Rate for Payer: Cofinity Commercial |
$6.72
|
| Rate for Payer: Cofinity Commercial |
$8.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.68
|
| Rate for Payer: Healthscope Commercial |
$8.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.16
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.72
|
| Rate for Payer: Priority Health SBD |
$6.05
|
| Rate for Payer: UMR Bronson Commercial |
$4.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.20
|
|
|
ISOSOURCE 1.5 INTERMITTENT FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 4390018150
|
| Hospital Charge Code |
200080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna American Axle |
$3.09
|
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$3.32
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.04
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.32
|
| Rate for Payer: Priority Health SBD |
$2.99
|
| Rate for Payer: UMR Bronson Commercial |
$2.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
|
ISOSOURCE HN BOLUS FEED
|
Facility
|
IP
|
$9.60
|
|
|
Service Code
|
NDC 4390018480
|
| Hospital Charge Code |
150769
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna American Axle |
$6.24
|
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.24
|
| Rate for Payer: Cash Price |
$7.68
|
| Rate for Payer: Cofinity Commercial |
$6.72
|
| Rate for Payer: Cofinity Commercial |
$8.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.68
|
| Rate for Payer: Healthscope Commercial |
$8.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.16
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.72
|
| Rate for Payer: Priority Health SBD |
$6.05
|
| Rate for Payer: UMR Bronson Commercial |
$4.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.20
|
|
|
ISOSOURCE HN BOLUS FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 4390018457
|
| Hospital Charge Code |
150769
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna American Axle |
$3.09
|
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$3.32
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.04
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.32
|
| Rate for Payer: Priority Health SBD |
$2.99
|
| Rate for Payer: UMR Bronson Commercial |
$2.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
