|
ISOSOURCE HN CONTINUOUS FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 4390018457
|
| Hospital Charge Code |
168942
|
|
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 CONTINUOUS FEED
|
Facility
|
IP
|
$9.60
|
|
|
Service Code
|
NDC 4390018480
|
| Hospital Charge Code |
168942
|
|
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 CYCLIC FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 4390018457
|
| Hospital Charge Code |
200075
|
|
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 CYCLIC FEED
|
Facility
|
IP
|
$9.60
|
|
|
Service Code
|
NDC 4390018480
|
| Hospital Charge Code |
200075
|
|
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 INTERMITTENT FEED
|
Facility
|
IP
|
$9.60
|
|
|
Service Code
|
NDC 4390018480
|
| Hospital Charge Code |
200074
|
|
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 INTERMITTENT FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 4390018457
|
| Hospital Charge Code |
200074
|
|
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
|
|
|
ISOSULFAN BLUE 1 % SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$2,113.44
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
10358
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$929.91 |
| Max. Negotiated Rate |
$1,902.10 |
| Rate for Payer: Aetna American Axle |
$1,373.74
|
| Rate for Payer: Aetna American Axle |
$794.97
|
| Rate for Payer: Aetna American Axle |
$2,031.67
|
| Rate for Payer: Aetna American Axle |
$2,052.19
|
| Rate for Payer: Aetna Commercial |
$2,656.79
|
| Rate for Payer: Aetna Commercial |
$1,796.42
|
| Rate for Payer: Aetna Commercial |
$1,039.58
|
| Rate for Payer: Aetna Commercial |
$2,683.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,031.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$794.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,052.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,373.74
|
| Rate for Payer: Cash Price |
$2,525.78
|
| Rate for Payer: Cash Price |
$2,500.51
|
| Rate for Payer: Cash Price |
$978.42
|
| Rate for Payer: Cash Price |
$1,690.75
|
| Rate for Payer: Cofinity Commercial |
$2,715.21
|
| Rate for Payer: Cofinity Commercial |
$856.12
|
| Rate for Payer: Cofinity Commercial |
$1,051.81
|
| Rate for Payer: Cofinity Commercial |
$2,210.05
|
| Rate for Payer: Cofinity Commercial |
$1,479.41
|
| Rate for Payer: Cofinity Commercial |
$2,688.05
|
| Rate for Payer: Cofinity Commercial |
$2,187.95
|
| Rate for Payer: Cofinity Commercial |
$1,817.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,690.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$978.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,500.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,525.78
|
| Rate for Payer: Healthscope Commercial |
$1,100.73
|
| Rate for Payer: Healthscope Commercial |
$2,841.50
|
| Rate for Payer: Healthscope Commercial |
$1,902.10
|
| Rate for Payer: Healthscope Commercial |
$2,813.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$856.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,210.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,479.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,187.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$917.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,585.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,367.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,344.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,656.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,039.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,796.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,683.64
|
| Rate for Payer: PHP Commercial |
$1,796.42
|
| Rate for Payer: PHP Commercial |
$2,656.79
|
| Rate for Payer: PHP Commercial |
$2,683.64
|
| Rate for Payer: PHP Commercial |
$1,039.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,479.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,187.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$856.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,210.05
|
| Rate for Payer: Priority Health SBD |
$1,331.47
|
| Rate for Payer: Priority Health SBD |
$1,989.05
|
| Rate for Payer: Priority Health SBD |
$770.51
|
| Rate for Payer: Priority Health SBD |
$1,969.15
|
| Rate for Payer: UMR Bronson Commercial |
$1,375.28
|
| Rate for Payer: UMR Bronson Commercial |
$538.13
|
| Rate for Payer: UMR Bronson Commercial |
$1,389.18
|
| Rate for Payer: UMR Bronson Commercial |
$929.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,344.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$917.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,585.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,367.92
|
|
|
ISOTRETINOIN 30 MG CAPSULE
|
Facility
|
IP
|
$401.71
|
|
|
Service Code
|
NDC 61748-303-13
|
| Hospital Charge Code |
36845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.75 |
| Max. Negotiated Rate |
$361.54 |
| Rate for Payer: Aetna American Axle |
$261.11
|
| Rate for Payer: Aetna Commercial |
$341.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.11
|
| Rate for Payer: Cash Price |
$321.37
|
| Rate for Payer: Cofinity Commercial |
$281.20
|
| Rate for Payer: Cofinity Commercial |
$345.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.37
|
| Rate for Payer: Healthscope Commercial |
$361.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$281.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$341.45
|
| Rate for Payer: PHP Commercial |
$341.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.20
|
| Rate for Payer: Priority Health SBD |
$253.08
|
| Rate for Payer: UMR Bronson Commercial |
$176.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.28
|
|
|
ISOTRETINOIN 30 MG CAPSULE
|
Facility
|
IP
|
$1,528.47
|
|
|
Service Code
|
NDC 0555-1056-86
|
| Hospital Charge Code |
36845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$672.53 |
| Max. Negotiated Rate |
$1,375.62 |
| Rate for Payer: Aetna American Axle |
$993.51
|
| Rate for Payer: Aetna Commercial |
$1,299.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$993.51
|
| Rate for Payer: Cash Price |
$1,222.78
|
| Rate for Payer: Cofinity Commercial |
$1,069.93
|
| Rate for Payer: Cofinity Commercial |
$1,314.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,222.78
|
| Rate for Payer: Healthscope Commercial |
$1,375.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,069.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,146.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,299.20
|
| Rate for Payer: PHP Commercial |
$1,299.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,069.93
|
| Rate for Payer: Priority Health SBD |
$962.94
|
| Rate for Payer: UMR Bronson Commercial |
$672.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,146.35
|
|
|
ISOTRETINOIN 40 MG CAPSULE
|
Facility
|
IP
|
$720.06
|
|
|
Service Code
|
NDC 61748-304-13
|
| Hospital Charge Code |
10361
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$316.83 |
| Max. Negotiated Rate |
$648.05 |
| Rate for Payer: Aetna American Axle |
$468.04
|
| Rate for Payer: Aetna Commercial |
$612.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$468.04
|
| Rate for Payer: Cash Price |
$576.05
|
| Rate for Payer: Cofinity Commercial |
$504.04
|
| Rate for Payer: Cofinity Commercial |
$619.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$576.05
|
| Rate for Payer: Healthscope Commercial |
$648.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$504.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$540.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$612.05
|
| Rate for Payer: PHP Commercial |
$612.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$504.04
|
| Rate for Payer: Priority Health SBD |
$453.64
|
| Rate for Payer: UMR Bronson Commercial |
$316.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$540.04
|
|
|
ISRADIPINE 5 MG CAPSULE
|
Facility
|
IP
|
$867.84
|
|
|
Service Code
|
NDC 16252-540-01
|
| Hospital Charge Code |
10363
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$381.85 |
| Max. Negotiated Rate |
$781.06 |
| Rate for Payer: Aetna American Axle |
$564.10
|
| Rate for Payer: Aetna Commercial |
$737.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$564.10
|
| Rate for Payer: Cash Price |
$694.27
|
| Rate for Payer: Cofinity Commercial |
$607.49
|
| Rate for Payer: Cofinity Commercial |
$746.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$694.27
|
| Rate for Payer: Healthscope Commercial |
$781.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$607.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$650.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$737.66
|
| Rate for Payer: PHP Commercial |
$737.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$607.49
|
| Rate for Payer: Priority Health SBD |
$546.74
|
| Rate for Payer: UMR Bronson Commercial |
$381.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$650.88
|
|
|
ITRACONAZOLE 100 MG CAPSULE
|
Facility
|
IP
|
$156.96
|
|
|
Service Code
|
NDC 50268-450-12
|
| Hospital Charge Code |
10364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.06 |
| Max. Negotiated Rate |
$141.26 |
| Rate for Payer: Aetna American Axle |
$102.02
|
| Rate for Payer: Aetna Commercial |
$133.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.02
|
| Rate for Payer: Cash Price |
$125.57
|
| Rate for Payer: Cofinity Commercial |
$109.87
|
| Rate for Payer: Cofinity Commercial |
$134.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.57
|
| Rate for Payer: Healthscope Commercial |
$141.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$133.42
|
| Rate for Payer: PHP Commercial |
$133.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.87
|
| Rate for Payer: Priority Health SBD |
$98.88
|
| Rate for Payer: UMR Bronson Commercial |
$69.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.72
|
|
|
ITRACONAZOLE 100 MG CAPSULE
|
Facility
|
IP
|
$766.13
|
|
|
Service Code
|
NDC 10147-1700-3
|
| Hospital Charge Code |
10364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$337.10 |
| Max. Negotiated Rate |
$689.52 |
| Rate for Payer: Aetna American Axle |
$497.98
|
| Rate for Payer: Aetna Commercial |
$651.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$497.98
|
| Rate for Payer: Cash Price |
$612.90
|
| Rate for Payer: Cofinity Commercial |
$536.29
|
| Rate for Payer: Cofinity Commercial |
$658.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$612.90
|
| Rate for Payer: Healthscope Commercial |
$689.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$536.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$574.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$651.21
|
| Rate for Payer: PHP Commercial |
$651.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.29
|
| Rate for Payer: Priority Health SBD |
$482.66
|
| Rate for Payer: UMR Bronson Commercial |
$337.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$574.60
|
|
|
ITRACONAZOLE 100 MG CAPSULE
|
Facility
|
IP
|
$140.26
|
|
|
Service Code
|
NDC 67877-454-30
|
| Hospital Charge Code |
10364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.71 |
| Max. Negotiated Rate |
$126.23 |
| Rate for Payer: Aetna American Axle |
$91.17
|
| Rate for Payer: Aetna Commercial |
$119.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.17
|
| Rate for Payer: Cash Price |
$112.21
|
| Rate for Payer: Cofinity Commercial |
$120.62
|
| Rate for Payer: Cofinity Commercial |
$98.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.21
|
| Rate for Payer: Healthscope Commercial |
$126.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.22
|
| Rate for Payer: PHP Commercial |
$119.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.18
|
| Rate for Payer: Priority Health SBD |
$88.36
|
| Rate for Payer: UMR Bronson Commercial |
$61.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.20
|
|
|
ITRACONAZOLE 100 MG CAPSULE
|
Facility
|
IP
|
$227.96
|
|
|
Service Code
|
NDC 13668-463-30
|
| Hospital Charge Code |
10364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.30 |
| Max. Negotiated Rate |
$205.16 |
| Rate for Payer: Aetna American Axle |
$148.17
|
| Rate for Payer: Aetna Commercial |
$193.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.17
|
| Rate for Payer: Cash Price |
$182.37
|
| Rate for Payer: Cofinity Commercial |
$159.57
|
| Rate for Payer: Cofinity Commercial |
$196.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.37
|
| Rate for Payer: Healthscope Commercial |
$205.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$159.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$193.77
|
| Rate for Payer: PHP Commercial |
$193.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.57
|
| Rate for Payer: Priority Health SBD |
$143.61
|
| Rate for Payer: UMR Bronson Commercial |
$100.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.97
|
|
|
ITRACONAZOLE 100 MG CAPSULE
|
Facility
|
IP
|
$496.04
|
|
|
Service Code
|
NDC 10147-1700-7
|
| Hospital Charge Code |
10364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$218.26 |
| Max. Negotiated Rate |
$446.44 |
| Rate for Payer: Aetna American Axle |
$322.43
|
| Rate for Payer: Aetna Commercial |
$421.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$322.43
|
| Rate for Payer: Cash Price |
$396.83
|
| Rate for Payer: Cofinity Commercial |
$347.23
|
| Rate for Payer: Cofinity Commercial |
$426.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.83
|
| Rate for Payer: Healthscope Commercial |
$446.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$347.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$372.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$421.63
|
| Rate for Payer: PHP Commercial |
$421.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.23
|
| Rate for Payer: Priority Health SBD |
$312.51
|
| Rate for Payer: UMR Bronson Commercial |
$218.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$372.03
|
|
|
ITRACONAZOLE 100 MG CAPSULE
|
Facility
|
IP
|
$7.85
|
|
|
Service Code
|
NDC 50268-450-11
|
| Hospital Charge Code |
10364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$7.06 |
| Rate for Payer: Aetna American Axle |
$5.10
|
| Rate for Payer: Aetna Commercial |
$6.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.10
|
| Rate for Payer: Cash Price |
$6.28
|
| Rate for Payer: Cofinity Commercial |
$5.50
|
| Rate for Payer: Cofinity Commercial |
$6.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.28
|
| Rate for Payer: Healthscope Commercial |
$7.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.67
|
| Rate for Payer: PHP Commercial |
$6.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.50
|
| Rate for Payer: Priority Health SBD |
$4.95
|
| Rate for Payer: UMR Bronson Commercial |
$3.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.89
|
|
|
ITRACONAZOLE 10 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$1,179.38
|
|
|
Service Code
|
NDC 50458-295-15
|
| Hospital Charge Code |
19928
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$518.93 |
| Max. Negotiated Rate |
$1,061.44 |
| Rate for Payer: Aetna American Axle |
$766.60
|
| Rate for Payer: Aetna Commercial |
$1,002.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$766.60
|
| Rate for Payer: Cash Price |
$943.50
|
| Rate for Payer: Cofinity Commercial |
$1,014.27
|
| Rate for Payer: Cofinity Commercial |
$825.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$943.50
|
| Rate for Payer: Healthscope Commercial |
$1,061.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$825.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$884.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,002.47
|
| Rate for Payer: PHP Commercial |
$1,002.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$825.57
|
| Rate for Payer: Priority Health SBD |
$743.01
|
| Rate for Payer: UMR Bronson Commercial |
$518.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$884.54
|
|
|
IVABRADINE 5 MG TABLET
|
Facility
|
IP
|
$2,030.86
|
|
|
Service Code
|
NDC 55513-800-60
|
| Hospital Charge Code |
161508
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$893.58 |
| Max. Negotiated Rate |
$1,827.77 |
| Rate for Payer: Aetna American Axle |
$1,320.06
|
| Rate for Payer: Aetna Commercial |
$1,726.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,320.06
|
| Rate for Payer: Cash Price |
$1,624.69
|
| Rate for Payer: Cofinity Commercial |
$1,421.60
|
| Rate for Payer: Cofinity Commercial |
$1,746.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,624.69
|
| Rate for Payer: Healthscope Commercial |
$1,827.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,421.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,523.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,726.23
|
| Rate for Payer: PHP Commercial |
$1,726.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,421.60
|
| Rate for Payer: Priority Health SBD |
$1,279.44
|
| Rate for Payer: UMR Bronson Commercial |
$893.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,523.14
|
|
|
IVERMECTIN 0.5 % LOTION
|
Facility
|
IP
|
$888.21
|
|
|
Service Code
|
NDC 24338-183-04
|
| Hospital Charge Code |
159120
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$390.81 |
| Max. Negotiated Rate |
$799.39 |
| Rate for Payer: Aetna American Axle |
$577.34
|
| Rate for Payer: Aetna Commercial |
$754.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$577.34
|
| Rate for Payer: Cash Price |
$710.57
|
| Rate for Payer: Cofinity Commercial |
$621.75
|
| Rate for Payer: Cofinity Commercial |
$763.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$710.57
|
| Rate for Payer: Healthscope Commercial |
$799.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$621.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$666.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$754.98
|
| Rate for Payer: PHP Commercial |
$754.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$621.75
|
| Rate for Payer: Priority Health SBD |
$559.57
|
| Rate for Payer: UMR Bronson Commercial |
$390.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$666.16
|
|
|
IVERMECTIN 3 MG TABLET
|
Facility
|
IP
|
$320.20
|
|
|
Service Code
|
NDC 0006-0032-20
|
| Hospital Charge Code |
25820
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.89 |
| Max. Negotiated Rate |
$288.18 |
| Rate for Payer: Aetna American Axle |
$208.13
|
| Rate for Payer: Aetna Commercial |
$272.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.13
|
| Rate for Payer: Cash Price |
$256.16
|
| Rate for Payer: Cofinity Commercial |
$224.14
|
| Rate for Payer: Cofinity Commercial |
$275.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.16
|
| Rate for Payer: Healthscope Commercial |
$288.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$224.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$272.17
|
| Rate for Payer: PHP Commercial |
$272.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.14
|
| Rate for Payer: Priority Health SBD |
$201.73
|
| Rate for Payer: UMR Bronson Commercial |
$140.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.15
|
|
|
IXABEPILONE 15 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$8,694.13
|
|
|
Service Code
|
HCPCS J9207
|
| Hospital Charge Code |
88652
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,825.42 |
| Max. Negotiated Rate |
$7,824.72 |
| Rate for Payer: Aetna American Axle |
$5,651.18
|
| Rate for Payer: Aetna Commercial |
$7,390.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,651.18
|
| Rate for Payer: Cash Price |
$6,955.30
|
| Rate for Payer: Cofinity Commercial |
$6,085.89
|
| Rate for Payer: Cofinity Commercial |
$7,476.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,955.30
|
| Rate for Payer: Healthscope Commercial |
$7,824.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,085.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,520.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,390.01
|
| Rate for Payer: PHP Commercial |
$7,390.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,085.89
|
| Rate for Payer: Priority Health SBD |
$5,477.30
|
| Rate for Payer: UMR Bronson Commercial |
$3,825.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,520.60
|
|
|
IXABEPILONE 15 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$8,694.13
|
|
|
Service Code
|
HCPCS J9207
|
| Hospital Charge Code |
88652
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.06 |
| Max. Negotiated Rate |
$7,824.72 |
| Rate for Payer: Aetna American Axle |
$5,651.18
|
| Rate for Payer: Aetna Commercial |
$7,390.01
|
| Rate for Payer: Aetna Medicare |
$133.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,651.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$160.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$160.09
|
| Rate for Payer: BCBS Complete |
$73.57
|
| Rate for Payer: BCBS MAPPO |
$128.07
|
| Rate for Payer: BCBS Trust/PPO |
$413.88
|
| Rate for Payer: BCN Medicare Advantage |
$128.07
|
| Rate for Payer: Cash Price |
$6,955.30
|
| Rate for Payer: Cash Price |
$6,955.30
|
| Rate for Payer: Cofinity Commercial |
$6,085.89
|
| Rate for Payer: Cofinity Commercial |
$7,476.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,955.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.07
|
| Rate for Payer: Healthscope Commercial |
$7,824.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,085.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,520.60
|
| Rate for Payer: Mclaren Medicaid |
$70.06
|
| Rate for Payer: Mclaren Medicare |
$128.07
|
| Rate for Payer: Meridian Medicaid |
$73.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$134.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$147.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,390.01
|
| Rate for Payer: PACE Medicare |
$121.67
|
| Rate for Payer: PACE SWMI |
$128.07
|
| Rate for Payer: PHP Commercial |
$7,390.01
|
| Rate for Payer: PHP Medicare Advantage |
$128.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,085.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$374.68
|
| Rate for Payer: Priority Health Medicare |
$128.07
|
| Rate for Payer: Priority Health Narrow Network |
$299.74
|
| Rate for Payer: Priority Health SBD |
$5,477.30
|
| Rate for Payer: Railroad Medicare Medicare |
$128.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$128.07
|
| Rate for Payer: UHC Medicare Advantage |
$131.92
|
| Rate for Payer: UMR Bronson Commercial |
$3,216.83
|
| Rate for Payer: VA VA |
$128.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,520.60
|
|
|
J-TIP NEEDLE FREE INJECTOR 0.25 ML
|
Facility
|
OP
|
$3.99
|
|
|
Service Code
|
NDC 9900-0004-00
|
| Hospital Charge Code |
163515
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$3.59 |
| Rate for Payer: Aetna American Axle |
$2.59
|
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.59
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: Cash Price |
$3.19
|
| Rate for Payer: Cofinity Commercial |
$2.79
|
| Rate for Payer: Cofinity Commercial |
$3.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.19
|
| Rate for Payer: Healthscope Commercial |
$3.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.39
|
| Rate for Payer: PHP Commercial |
$3.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.79
|
| Rate for Payer: Priority Health SBD |
$2.51
|
| Rate for Payer: UMR Bronson Commercial |
$1.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.99
|
|
|
J-TIP NEEDLE FREE INJECTOR 0.25 ML
|
Facility
|
IP
|
$3.99
|
|
|
Service Code
|
NDC 9900-0004-00
|
| Hospital Charge Code |
163515
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$3.59 |
| Rate for Payer: Aetna American Axle |
$2.59
|
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.59
|
| Rate for Payer: Cash Price |
$3.19
|
| Rate for Payer: Cofinity Commercial |
$2.79
|
| Rate for Payer: Cofinity Commercial |
$3.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.19
|
| Rate for Payer: Healthscope Commercial |
$3.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.39
|
| Rate for Payer: PHP Commercial |
$3.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.79
|
| Rate for Payer: Priority Health SBD |
$2.51
|
| Rate for Payer: UMR Bronson Commercial |
$1.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.99
|
|
