|
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) INTRAOCULAR KIT
|
Facility
|
IP
|
$270.17
|
|
|
Service Code
|
NDC 24208053920
|
| Hospital Charge Code |
32559
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$118.87 |
| Max. Negotiated Rate |
$243.15 |
| Rate for Payer: Aetna American Axle |
$175.61
|
| Rate for Payer: Aetna Commercial |
$229.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.61
|
| Rate for Payer: Cash Price |
$216.14
|
| Rate for Payer: Cofinity Advantage |
$189.12
|
| Rate for Payer: Cofinity Commercial |
$232.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.14
|
| Rate for Payer: Healthscope Commercial |
$243.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$202.63
|
| Rate for Payer: PHP Commercial |
$229.64
|
| Rate for Payer: Priority Health SBD |
$170.21
|
| Rate for Payer: UMR Bronson Commercial |
$118.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.63
|
|
|
ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$78.77
|
|
|
Service Code
|
HCPCS J0132
|
| Hospital Charge Code |
38303
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$70.89 |
| Rate for Payer: Aetna American Axle |
$51.20
|
| Rate for Payer: Aetna American Axle |
$66.90
|
| Rate for Payer: Aetna American Axle |
$107.00
|
| Rate for Payer: Aetna American Axle |
$235.99
|
| Rate for Payer: Aetna American Axle |
$100.31
|
| Rate for Payer: Aetna American Axle |
$61.87
|
| Rate for Payer: Aetna American Axle |
$55.80
|
| Rate for Payer: Aetna Commercial |
$80.91
|
| Rate for Payer: Aetna Commercial |
$87.49
|
| Rate for Payer: Aetna Commercial |
$308.60
|
| Rate for Payer: Aetna Commercial |
$139.92
|
| Rate for Payer: Aetna Commercial |
$66.95
|
| Rate for Payer: Aetna Commercial |
$131.18
|
| Rate for Payer: Aetna Commercial |
$72.97
|
| Rate for Payer: Aetna Medicare |
$51.47
|
| Rate for Payer: Aetna Medicare |
$47.59
|
| Rate for Payer: Aetna Medicare |
$39.38
|
| Rate for Payer: Aetna Medicare |
$42.92
|
| Rate for Payer: Aetna Medicare |
$181.53
|
| Rate for Payer: Aetna Medicare |
$77.17
|
| Rate for Payer: Aetna Medicare |
$82.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.80
|
| Rate for Payer: BCBS Complete |
$61.73
|
| Rate for Payer: BCBS Complete |
$38.08
|
| Rate for Payer: BCBS Complete |
$145.22
|
| Rate for Payer: BCBS Complete |
$31.51
|
| Rate for Payer: BCBS Complete |
$34.34
|
| Rate for Payer: BCBS Complete |
$41.17
|
| Rate for Payer: BCBS Complete |
$65.84
|
| Rate for Payer: BCBS Trust/PPO |
$1.18
|
| Rate for Payer: BCBS Trust/PPO |
$1.18
|
| Rate for Payer: BCBS Trust/PPO |
$1.18
|
| Rate for Payer: BCBS Trust/PPO |
$1.18
|
| Rate for Payer: BCBS Trust/PPO |
$1.18
|
| Rate for Payer: BCBS Trust/PPO |
$1.18
|
| Rate for Payer: BCBS Trust/PPO |
$1.18
|
| Rate for Payer: BCN Commercial |
$1.18
|
| Rate for Payer: BCN Commercial |
$1.18
|
| Rate for Payer: BCN Commercial |
$1.18
|
| Rate for Payer: BCN Commercial |
$1.18
|
| Rate for Payer: BCN Commercial |
$1.18
|
| Rate for Payer: BCN Commercial |
$1.18
|
| Rate for Payer: BCN Commercial |
$1.18
|
| Rate for Payer: Cash Price |
$131.69
|
| Rate for Payer: Cash Price |
$76.15
|
| Rate for Payer: Cash Price |
$82.34
|
| Rate for Payer: Cash Price |
$63.02
|
| Rate for Payer: Cash Price |
$290.45
|
| Rate for Payer: Cash Price |
$290.45
|
| Rate for Payer: Cash Price |
$68.68
|
| Rate for Payer: Cash Price |
$82.34
|
| Rate for Payer: Cash Price |
$76.15
|
| Rate for Payer: Cash Price |
$123.46
|
| Rate for Payer: Cash Price |
$68.68
|
| Rate for Payer: Cash Price |
$63.02
|
| Rate for Payer: Cash Price |
$123.46
|
| Rate for Payer: Cash Price |
$131.69
|
| Rate for Payer: Cofinity Advantage |
$254.14
|
| Rate for Payer: Cofinity Advantage |
$115.23
|
| Rate for Payer: Cofinity Advantage |
$108.03
|
| Rate for Payer: Cofinity Advantage |
$72.05
|
| Rate for Payer: Cofinity Advantage |
$55.14
|
| Rate for Payer: Cofinity Advantage |
$60.09
|
| Rate for Payer: Cofinity Advantage |
$66.63
|
| Rate for Payer: Cofinity Commercial |
$67.74
|
| Rate for Payer: Cofinity Commercial |
$73.83
|
| Rate for Payer: Cofinity Commercial |
$81.86
|
| Rate for Payer: Cofinity Commercial |
$88.52
|
| Rate for Payer: Cofinity Commercial |
$132.72
|
| Rate for Payer: Cofinity Commercial |
$141.56
|
| Rate for Payer: Cofinity Commercial |
$312.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.15
|
| Rate for Payer: Healthscope Commercial |
$326.75
|
| Rate for Payer: Healthscope Commercial |
$77.27
|
| Rate for Payer: Healthscope Commercial |
$85.67
|
| Rate for Payer: Healthscope Commercial |
$70.89
|
| Rate for Payer: Healthscope Commercial |
$138.90
|
| Rate for Payer: Healthscope Commercial |
$92.64
|
| Rate for Payer: Healthscope Commercial |
$148.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$254.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$272.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$131.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$123.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$290.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$272.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$115.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.20
|
| Rate for Payer: PHP Commercial |
$308.60
|
| Rate for Payer: PHP Commercial |
$139.92
|
| Rate for Payer: PHP Commercial |
$87.49
|
| Rate for Payer: PHP Commercial |
$131.18
|
| Rate for Payer: PHP Commercial |
$66.95
|
| Rate for Payer: PHP Commercial |
$72.97
|
| Rate for Payer: PHP Commercial |
$80.91
|
| Rate for Payer: Priority Health SBD |
$54.09
|
| Rate for Payer: Priority Health SBD |
$103.70
|
| Rate for Payer: Priority Health SBD |
$49.63
|
| Rate for Payer: Priority Health SBD |
$59.97
|
| Rate for Payer: Priority Health SBD |
$97.23
|
| Rate for Payer: Priority Health SBD |
$64.85
|
| Rate for Payer: Priority Health SBD |
$228.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.61
|
| Rate for Payer: UHC Core |
$0.61
|
| Rate for Payer: UHC Core |
$0.61
|
| Rate for Payer: UHC Core |
$0.61
|
| Rate for Payer: UHC Core |
$0.61
|
| Rate for Payer: UHC Core |
$0.61
|
| Rate for Payer: UHC Core |
$0.61
|
| Rate for Payer: UHC Core |
$0.61
|
| Rate for Payer: UHC Exchange |
$0.61
|
| Rate for Payer: UHC Exchange |
$0.61
|
| Rate for Payer: UHC Exchange |
$0.61
|
| Rate for Payer: UHC Exchange |
$0.61
|
| Rate for Payer: UHC Exchange |
$0.61
|
| Rate for Payer: UHC Exchange |
$0.61
|
| Rate for Payer: UHC Exchange |
$0.61
|
| Rate for Payer: UMR Bronson Commercial |
$60.91
|
| Rate for Payer: UMR Bronson Commercial |
$134.33
|
| Rate for Payer: UMR Bronson Commercial |
$57.10
|
| Rate for Payer: UMR Bronson Commercial |
$38.08
|
| Rate for Payer: UMR Bronson Commercial |
$35.22
|
| Rate for Payer: UMR Bronson Commercial |
$31.76
|
| Rate for Payer: UMR Bronson Commercial |
$29.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$272.30
|
|
|
ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$102.93
|
|
|
Service Code
|
HCPCS J0132
|
| Hospital Charge Code |
38303
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.29 |
| Max. Negotiated Rate |
$92.64 |
| Rate for Payer: Aetna American Axle |
$66.90
|
| Rate for Payer: Aetna American Axle |
$107.00
|
| Rate for Payer: Aetna American Axle |
$235.99
|
| Rate for Payer: Aetna American Axle |
$61.87
|
| Rate for Payer: Aetna American Axle |
$55.80
|
| Rate for Payer: Aetna American Axle |
$51.20
|
| Rate for Payer: Aetna American Axle |
$100.31
|
| Rate for Payer: Aetna Commercial |
$308.60
|
| Rate for Payer: Aetna Commercial |
$131.18
|
| Rate for Payer: Aetna Commercial |
$87.49
|
| Rate for Payer: Aetna Commercial |
$139.92
|
| Rate for Payer: Aetna Commercial |
$80.91
|
| Rate for Payer: Aetna Commercial |
$66.95
|
| Rate for Payer: Aetna Commercial |
$72.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.87
|
| Rate for Payer: Cash Price |
$82.34
|
| Rate for Payer: Cash Price |
$290.45
|
| Rate for Payer: Cash Price |
$131.69
|
| Rate for Payer: Cash Price |
$123.46
|
| Rate for Payer: Cash Price |
$63.02
|
| Rate for Payer: Cash Price |
$68.68
|
| Rate for Payer: Cash Price |
$76.15
|
| Rate for Payer: Cofinity Advantage |
$60.09
|
| Rate for Payer: Cofinity Advantage |
$72.05
|
| Rate for Payer: Cofinity Advantage |
$108.03
|
| Rate for Payer: Cofinity Advantage |
$254.14
|
| Rate for Payer: Cofinity Advantage |
$115.23
|
| Rate for Payer: Cofinity Advantage |
$55.14
|
| Rate for Payer: Cofinity Advantage |
$66.63
|
| Rate for Payer: Cofinity Commercial |
$141.56
|
| Rate for Payer: Cofinity Commercial |
$81.86
|
| Rate for Payer: Cofinity Commercial |
$73.83
|
| Rate for Payer: Cofinity Commercial |
$88.52
|
| Rate for Payer: Cofinity Commercial |
$132.72
|
| Rate for Payer: Cofinity Commercial |
$67.74
|
| Rate for Payer: Cofinity Commercial |
$312.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.46
|
| Rate for Payer: Healthscope Commercial |
$85.67
|
| Rate for Payer: Healthscope Commercial |
$92.64
|
| Rate for Payer: Healthscope Commercial |
$77.27
|
| Rate for Payer: Healthscope Commercial |
$326.75
|
| Rate for Payer: Healthscope Commercial |
$138.90
|
| Rate for Payer: Healthscope Commercial |
$148.15
|
| Rate for Payer: Healthscope Commercial |
$70.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$254.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$272.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$272.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$115.75
|
| Rate for Payer: PHP Commercial |
$131.18
|
| Rate for Payer: PHP Commercial |
$72.97
|
| Rate for Payer: PHP Commercial |
$308.60
|
| Rate for Payer: PHP Commercial |
$80.91
|
| Rate for Payer: PHP Commercial |
$139.92
|
| Rate for Payer: PHP Commercial |
$87.49
|
| Rate for Payer: PHP Commercial |
$66.95
|
| Rate for Payer: Priority Health SBD |
$64.85
|
| Rate for Payer: Priority Health SBD |
$228.73
|
| Rate for Payer: Priority Health SBD |
$49.63
|
| Rate for Payer: Priority Health SBD |
$54.09
|
| Rate for Payer: Priority Health SBD |
$59.97
|
| Rate for Payer: Priority Health SBD |
$97.23
|
| Rate for Payer: Priority Health SBD |
$103.70
|
| Rate for Payer: UMR Bronson Commercial |
$41.88
|
| Rate for Payer: UMR Bronson Commercial |
$45.29
|
| Rate for Payer: UMR Bronson Commercial |
$159.75
|
| Rate for Payer: UMR Bronson Commercial |
$67.91
|
| Rate for Payer: UMR Bronson Commercial |
$34.66
|
| Rate for Payer: UMR Bronson Commercial |
$37.77
|
| Rate for Payer: UMR Bronson Commercial |
$72.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$272.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.39
|
|
|
ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION
|
Facility
|
IP
|
$77.04
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
123
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.90 |
| Max. Negotiated Rate |
$69.34 |
| Rate for Payer: Aetna American Axle |
$50.08
|
| Rate for Payer: Aetna American Axle |
$15.96
|
| Rate for Payer: Aetna American Axle |
$58.22
|
| Rate for Payer: Aetna American Axle |
$86.02
|
| Rate for Payer: Aetna Commercial |
$76.13
|
| Rate for Payer: Aetna Commercial |
$65.48
|
| Rate for Payer: Aetna Commercial |
$112.49
|
| Rate for Payer: Aetna Commercial |
$20.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.02
|
| Rate for Payer: Cash Price |
$105.87
|
| Rate for Payer: Cash Price |
$71.66
|
| Rate for Payer: Cash Price |
$19.65
|
| Rate for Payer: Cash Price |
$61.63
|
| Rate for Payer: Cofinity Advantage |
$17.19
|
| Rate for Payer: Cofinity Advantage |
$92.64
|
| Rate for Payer: Cofinity Advantage |
$53.93
|
| Rate for Payer: Cofinity Advantage |
$62.70
|
| Rate for Payer: Cofinity Commercial |
$66.25
|
| Rate for Payer: Cofinity Commercial |
$113.81
|
| Rate for Payer: Cofinity Commercial |
$21.12
|
| Rate for Payer: Cofinity Commercial |
$77.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.65
|
| Rate for Payer: Healthscope Commercial |
$22.10
|
| Rate for Payer: Healthscope Commercial |
$80.61
|
| Rate for Payer: Healthscope Commercial |
$69.34
|
| Rate for Payer: Healthscope Commercial |
$119.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.25
|
| Rate for Payer: PHP Commercial |
$112.49
|
| Rate for Payer: PHP Commercial |
$65.48
|
| Rate for Payer: PHP Commercial |
$20.88
|
| Rate for Payer: PHP Commercial |
$76.13
|
| Rate for Payer: Priority Health SBD |
$56.43
|
| Rate for Payer: Priority Health SBD |
$83.37
|
| Rate for Payer: Priority Health SBD |
$48.54
|
| Rate for Payer: Priority Health SBD |
$15.47
|
| Rate for Payer: UMR Bronson Commercial |
$10.81
|
| Rate for Payer: UMR Bronson Commercial |
$33.90
|
| Rate for Payer: UMR Bronson Commercial |
$58.23
|
| Rate for Payer: UMR Bronson Commercial |
$39.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.18
|
|
|
ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION
|
Facility
|
OP
|
$77.04
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
123
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.77 |
| Max. Negotiated Rate |
$69.34 |
| Rate for Payer: Aetna American Axle |
$50.08
|
| Rate for Payer: Aetna American Axle |
$58.22
|
| Rate for Payer: Aetna American Axle |
$86.02
|
| Rate for Payer: Aetna American Axle |
$15.96
|
| Rate for Payer: Aetna Commercial |
$112.49
|
| Rate for Payer: Aetna Commercial |
$76.13
|
| Rate for Payer: Aetna Commercial |
$20.88
|
| Rate for Payer: Aetna Commercial |
$65.48
|
| Rate for Payer: Aetna Medicare |
$44.78
|
| Rate for Payer: Aetna Medicare |
$12.28
|
| Rate for Payer: Aetna Medicare |
$66.17
|
| Rate for Payer: Aetna Medicare |
$38.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.08
|
| Rate for Payer: BCBS Complete |
$35.83
|
| Rate for Payer: BCBS Complete |
$52.94
|
| Rate for Payer: BCBS Complete |
$9.82
|
| Rate for Payer: BCBS Complete |
$30.82
|
| Rate for Payer: Cash Price |
$19.65
|
| Rate for Payer: Cash Price |
$19.65
|
| Rate for Payer: Cash Price |
$61.63
|
| Rate for Payer: Cash Price |
$105.87
|
| Rate for Payer: Cash Price |
$105.87
|
| Rate for Payer: Cash Price |
$61.63
|
| Rate for Payer: Cash Price |
$71.66
|
| Rate for Payer: Cash Price |
$71.66
|
| Rate for Payer: Cofinity Advantage |
$62.70
|
| Rate for Payer: Cofinity Advantage |
$92.64
|
| Rate for Payer: Cofinity Advantage |
$17.19
|
| Rate for Payer: Cofinity Advantage |
$53.93
|
| Rate for Payer: Cofinity Commercial |
$77.03
|
| Rate for Payer: Cofinity Commercial |
$113.81
|
| Rate for Payer: Cofinity Commercial |
$66.25
|
| Rate for Payer: Cofinity Commercial |
$21.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.87
|
| Rate for Payer: Healthscope Commercial |
$80.61
|
| Rate for Payer: Healthscope Commercial |
$119.11
|
| Rate for Payer: Healthscope Commercial |
$69.34
|
| Rate for Payer: Healthscope Commercial |
$22.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.25
|
| Rate for Payer: PHP Commercial |
$65.48
|
| Rate for Payer: PHP Commercial |
$20.88
|
| Rate for Payer: PHP Commercial |
$76.13
|
| Rate for Payer: PHP Commercial |
$112.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8.46
|
| Rate for Payer: Priority Health SBD |
$15.47
|
| Rate for Payer: Priority Health SBD |
$48.54
|
| Rate for Payer: Priority Health SBD |
$56.43
|
| Rate for Payer: Priority Health SBD |
$83.37
|
| Rate for Payer: Priority Health Tiered Network |
$6.77
|
| Rate for Payer: Priority Health Tiered Network |
$6.77
|
| Rate for Payer: Priority Health Tiered Network |
$6.77
|
| Rate for Payer: Priority Health Tiered Network |
$6.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.02
|
| Rate for Payer: UHC Core |
$46.67
|
| Rate for Payer: UHC Core |
$68.95
|
| Rate for Payer: UHC Core |
$40.14
|
| Rate for Payer: UHC Core |
$12.80
|
| Rate for Payer: UHC Exchange |
$52.01
|
| Rate for Payer: UHC Exchange |
$30.28
|
| Rate for Payer: UHC Exchange |
$35.20
|
| Rate for Payer: UHC Exchange |
$9.65
|
| Rate for Payer: UMR Bronson Commercial |
$28.50
|
| Rate for Payer: UMR Bronson Commercial |
$9.09
|
| Rate for Payer: UMR Bronson Commercial |
$48.97
|
| Rate for Payer: UMR Bronson Commercial |
$33.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.25
|
|
|
ACETYLCYSTEINE 600 MG CAPSULE
|
Facility
|
OP
|
$249.57
|
|
|
Service Code
|
NDC 27434000211
|
| Hospital Charge Code |
116999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.34 |
| Max. Negotiated Rate |
$224.61 |
| Rate for Payer: Aetna American Axle |
$162.22
|
| Rate for Payer: Aetna Commercial |
$212.13
|
| Rate for Payer: Aetna Medicare |
$124.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.22
|
| Rate for Payer: BCBS Complete |
$99.83
|
| Rate for Payer: Cash Price |
$199.66
|
| Rate for Payer: Cofinity Advantage |
$174.70
|
| Rate for Payer: Cofinity Commercial |
$214.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.66
|
| Rate for Payer: Healthscope Commercial |
$224.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.18
|
| Rate for Payer: PHP Commercial |
$212.13
|
| Rate for Payer: Priority Health SBD |
$157.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$162.22
|
| Rate for Payer: UHC Core |
$130.03
|
| Rate for Payer: UHC Exchange |
$98.08
|
| Rate for Payer: UMR Bronson Commercial |
$92.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.18
|
|
|
ACETYLCYSTEINE 600 MG CAPSULE
|
Facility
|
OP
|
$176.25
|
|
|
Service Code
|
NDC 79854004097
|
| Hospital Charge Code |
116999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.21 |
| Max. Negotiated Rate |
$158.62 |
| Rate for Payer: Aetna American Axle |
$114.56
|
| Rate for Payer: Aetna Commercial |
$149.81
|
| Rate for Payer: Aetna Medicare |
$88.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.56
|
| Rate for Payer: BCBS Complete |
$70.50
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cofinity Advantage |
$123.38
|
| Rate for Payer: Cofinity Commercial |
$151.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.00
|
| Rate for Payer: Healthscope Commercial |
$158.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$141.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.19
|
| Rate for Payer: PHP Commercial |
$149.81
|
| Rate for Payer: Priority Health SBD |
$111.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.56
|
| Rate for Payer: UHC Core |
$91.83
|
| Rate for Payer: UHC Exchange |
$69.27
|
| Rate for Payer: UMR Bronson Commercial |
$65.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.19
|
|
|
ACETYLCYSTEINE 600 MG CAPSULE
|
Facility
|
IP
|
$176.25
|
|
|
Service Code
|
NDC 79854004097
|
| Hospital Charge Code |
116999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.55 |
| Max. Negotiated Rate |
$158.62 |
| Rate for Payer: Aetna American Axle |
$114.56
|
| Rate for Payer: Aetna Commercial |
$149.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.56
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cofinity Advantage |
$123.38
|
| Rate for Payer: Cofinity Commercial |
$151.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.00
|
| Rate for Payer: Healthscope Commercial |
$158.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.19
|
| Rate for Payer: PHP Commercial |
$149.81
|
| Rate for Payer: Priority Health SBD |
$111.04
|
| Rate for Payer: UMR Bronson Commercial |
$77.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.19
|
|
|
ACETYLCYSTEINE 600 MG CAPSULE
|
Facility
|
IP
|
$249.57
|
|
|
Service Code
|
NDC 27434000211
|
| Hospital Charge Code |
116999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.81 |
| Max. Negotiated Rate |
$224.61 |
| Rate for Payer: Aetna American Axle |
$162.22
|
| Rate for Payer: Aetna Commercial |
$212.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.22
|
| Rate for Payer: Cash Price |
$199.66
|
| Rate for Payer: Cofinity Advantage |
$174.70
|
| Rate for Payer: Cofinity Commercial |
$214.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.66
|
| Rate for Payer: Healthscope Commercial |
$224.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.18
|
| Rate for Payer: PHP Commercial |
$212.13
|
| Rate for Payer: Priority Health SBD |
$157.23
|
| Rate for Payer: UMR Bronson Commercial |
$109.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.18
|
|
|
ACIDOPHILUS 25 MILLION CELL-PECTIN, CITRUS 100 MG TABLET
|
Facility
|
OP
|
$61.10
|
|
|
Service Code
|
NDC 80681002600
|
| Hospital Charge Code |
134
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.61 |
| Max. Negotiated Rate |
$54.99 |
| Rate for Payer: Aetna American Axle |
$39.72
|
| Rate for Payer: Aetna Commercial |
$51.94
|
| Rate for Payer: Aetna Medicare |
$30.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.72
|
| Rate for Payer: BCBS Complete |
$24.44
|
| Rate for Payer: Cash Price |
$48.88
|
| Rate for Payer: Cofinity Advantage |
$42.77
|
| Rate for Payer: Cofinity Commercial |
$52.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.88
|
| Rate for Payer: Healthscope Commercial |
$54.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.83
|
| Rate for Payer: PHP Commercial |
$51.94
|
| Rate for Payer: Priority Health SBD |
$38.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.72
|
| Rate for Payer: UHC Core |
$31.83
|
| Rate for Payer: UHC Exchange |
$24.01
|
| Rate for Payer: UMR Bronson Commercial |
$22.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.83
|
|
|
ACIDOPHILUS 25 MILLION CELL-PECTIN, CITRUS 100 MG TABLET
|
Facility
|
IP
|
$61.10
|
|
|
Service Code
|
NDC 80681002600
|
| Hospital Charge Code |
134
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.88 |
| Max. Negotiated Rate |
$54.99 |
| Rate for Payer: Aetna American Axle |
$39.72
|
| Rate for Payer: Aetna Commercial |
$51.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.72
|
| Rate for Payer: Cash Price |
$48.88
|
| Rate for Payer: Cofinity Advantage |
$42.77
|
| Rate for Payer: Cofinity Commercial |
$52.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.88
|
| Rate for Payer: Healthscope Commercial |
$54.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.83
|
| Rate for Payer: PHP Commercial |
$51.94
|
| Rate for Payer: Priority Health SBD |
$38.49
|
| Rate for Payer: UMR Bronson Commercial |
$26.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.83
|
|
|
ACIDOPHILUS-SPOROGENES 35 MILLION-25 MILLION CELL TABLET
|
Facility
|
OP
|
$58.75
|
|
|
Service Code
|
NDC 00536718101
|
| Hospital Charge Code |
115719
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.74 |
| Max. Negotiated Rate |
$52.88 |
| Rate for Payer: Aetna American Axle |
$38.19
|
| Rate for Payer: Aetna Commercial |
$49.94
|
| Rate for Payer: Aetna Medicare |
$29.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.19
|
| Rate for Payer: BCBS Complete |
$23.50
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cofinity Advantage |
$41.12
|
| Rate for Payer: Cofinity Commercial |
$50.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.00
|
| Rate for Payer: Healthscope Commercial |
$52.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.06
|
| Rate for Payer: PHP Commercial |
$49.94
|
| Rate for Payer: Priority Health SBD |
$37.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.19
|
| Rate for Payer: UHC Core |
$30.61
|
| Rate for Payer: UHC Exchange |
$23.09
|
| Rate for Payer: UMR Bronson Commercial |
$21.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.06
|
|
|
ACIDOPHILUS-SPOROGENES 35 MILLION-25 MILLION CELL TABLET
|
Facility
|
IP
|
$58.75
|
|
|
Service Code
|
NDC 00536718101
|
| Hospital Charge Code |
115719
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.85 |
| Max. Negotiated Rate |
$52.88 |
| Rate for Payer: Aetna American Axle |
$38.19
|
| Rate for Payer: Aetna Commercial |
$49.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.19
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cofinity Advantage |
$41.12
|
| Rate for Payer: Cofinity Commercial |
$50.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.00
|
| Rate for Payer: Healthscope Commercial |
$52.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.06
|
| Rate for Payer: PHP Commercial |
$49.94
|
| Rate for Payer: Priority Health SBD |
$37.01
|
| Rate for Payer: UMR Bronson Commercial |
$25.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.06
|
|
|
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSPENSION
|
Facility
|
OP
|
$97.44
|
|
|
Service Code
|
NDC 66689020108
|
| Hospital Charge Code |
115331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.05 |
| Max. Negotiated Rate |
$87.70 |
| Rate for Payer: Aetna American Axle |
$63.34
|
| Rate for Payer: Aetna Commercial |
$82.82
|
| Rate for Payer: Aetna Medicare |
$48.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.34
|
| Rate for Payer: BCBS Complete |
$38.98
|
| Rate for Payer: Cash Price |
$77.95
|
| Rate for Payer: Cofinity Advantage |
$68.21
|
| Rate for Payer: Cofinity Commercial |
$83.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.95
|
| Rate for Payer: Healthscope Commercial |
$87.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.08
|
| Rate for Payer: PHP Commercial |
$82.82
|
| Rate for Payer: Priority Health SBD |
$61.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.34
|
| Rate for Payer: UHC Core |
$50.77
|
| Rate for Payer: UHC Exchange |
$38.29
|
| Rate for Payer: UMR Bronson Commercial |
$36.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.08
|
|
|
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSPENSION
|
Facility
|
IP
|
$75.60
|
|
|
Service Code
|
NDC 00574052176
|
| Hospital Charge Code |
115331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.26 |
| Max. Negotiated Rate |
$68.04 |
| Rate for Payer: Aetna American Axle |
$49.14
|
| Rate for Payer: Aetna Commercial |
$64.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.14
|
| Rate for Payer: Cash Price |
$60.48
|
| Rate for Payer: Cofinity Advantage |
$52.92
|
| Rate for Payer: Cofinity Commercial |
$65.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.48
|
| Rate for Payer: Healthscope Commercial |
$68.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.70
|
| Rate for Payer: PHP Commercial |
$64.26
|
| Rate for Payer: Priority Health SBD |
$47.63
|
| Rate for Payer: UMR Bronson Commercial |
$33.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.70
|
|
|
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSPENSION
|
Facility
|
OP
|
$75.60
|
|
|
Service Code
|
NDC 00574052176
|
| Hospital Charge Code |
115331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.97 |
| Max. Negotiated Rate |
$68.04 |
| Rate for Payer: Aetna American Axle |
$49.14
|
| Rate for Payer: Aetna Commercial |
$64.26
|
| Rate for Payer: Aetna Medicare |
$37.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.14
|
| Rate for Payer: BCBS Complete |
$30.24
|
| Rate for Payer: Cash Price |
$60.48
|
| Rate for Payer: Cofinity Advantage |
$52.92
|
| Rate for Payer: Cofinity Commercial |
$65.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.48
|
| Rate for Payer: Healthscope Commercial |
$68.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.70
|
| Rate for Payer: PHP Commercial |
$64.26
|
| Rate for Payer: Priority Health SBD |
$47.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.14
|
| Rate for Payer: UHC Core |
$39.39
|
| Rate for Payer: UHC Exchange |
$29.71
|
| Rate for Payer: UMR Bronson Commercial |
$27.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.70
|
|
|
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSPENSION
|
Facility
|
IP
|
$97.44
|
|
|
Service Code
|
NDC 66689020108
|
| Hospital Charge Code |
115331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.87 |
| Max. Negotiated Rate |
$87.70 |
| Rate for Payer: Aetna American Axle |
$63.34
|
| Rate for Payer: Aetna Commercial |
$82.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.34
|
| Rate for Payer: Cash Price |
$77.95
|
| Rate for Payer: Cofinity Advantage |
$68.21
|
| Rate for Payer: Cofinity Commercial |
$83.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.95
|
| Rate for Payer: Healthscope Commercial |
$87.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.08
|
| Rate for Payer: PHP Commercial |
$82.82
|
| Rate for Payer: Priority Health SBD |
$61.39
|
| Rate for Payer: UMR Bronson Commercial |
$42.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.08
|
|
|
ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION
|
Facility
|
IP
|
$19,987.07
|
|
|
Service Code
|
MSDRG 880
|
| Min. Negotiated Rate |
$1,069.00 |
| Max. Negotiated Rate |
$19,987.07 |
| Rate for Payer: Aetna Medicare |
$8,967.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,778.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,778.52
|
| Rate for Payer: BCBS MAPPO |
$8,622.82
|
| Rate for Payer: BCBS Trust/PPO |
$19,987.07
|
| Rate for Payer: BCN Commercial |
$19,987.07
|
| Rate for Payer: BCN Medicare Advantage |
$8,622.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,622.82
|
| Rate for Payer: Mclaren Medicare |
$8,622.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,053.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,916.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,485.10
|
| Rate for Payer: Nomi Health Commercial |
$1,069.00
|
| Rate for Payer: PACE Medicare |
$8,191.68
|
| Rate for Payer: PACE SWMI |
$8,622.82
|
| Rate for Payer: PHP Medicare Advantage |
$8,622.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$15,480.48
|
| Rate for Payer: Priority Health Medicare |
$8,622.82
|
| Rate for Payer: Priority Health Tiered Network |
$12,384.38
|
| Rate for Payer: Railroad Medicare Medicare |
$8,622.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,651.26
|
| Rate for Payer: UHC Core |
$13,094.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,622.82
|
| Rate for Payer: UHC Exchange |
$10,693.75
|
| Rate for Payer: VA VA |
$8,622.82
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS
|
Facility
|
IP
|
$7,213.66
|
|
|
Service Code
|
APR-DRG 1931
|
| Min. Negotiated Rate |
$6,870.15 |
| Max. Negotiated Rate |
$7,213.66 |
| Rate for Payer: BCBS Complete |
$7,213.66
|
| Rate for Payer: Mclaren Medicaid |
$6,870.15
|
| Rate for Payer: Meridian Medicaid |
$7,213.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,870.15
|
| Rate for Payer: UHC Medicaid |
$6,870.15
|
| Rate for Payer: UHCCP Medicaid |
$6,870.15
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS
|
Facility
|
IP
|
$13,240.27
|
|
|
Service Code
|
APR-DRG 1934
|
| Min. Negotiated Rate |
$12,609.78 |
| Max. Negotiated Rate |
$13,240.27 |
| Rate for Payer: BCBS Complete |
$13,240.27
|
| Rate for Payer: Mclaren Medicaid |
$12,609.78
|
| Rate for Payer: Meridian Medicaid |
$13,240.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,609.78
|
| Rate for Payer: UHC Medicaid |
$12,609.78
|
| Rate for Payer: UHCCP Medicaid |
$12,609.78
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS
|
Facility
|
IP
|
$8,205.79
|
|
|
Service Code
|
APR-DRG 1932
|
| Min. Negotiated Rate |
$7,815.03 |
| Max. Negotiated Rate |
$8,205.79 |
| Rate for Payer: BCBS Complete |
$8,205.79
|
| Rate for Payer: Mclaren Medicaid |
$7,815.03
|
| Rate for Payer: Meridian Medicaid |
$8,205.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,815.03
|
| Rate for Payer: UHC Medicaid |
$7,815.03
|
| Rate for Payer: UHCCP Medicaid |
$7,815.03
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS
|
Facility
|
IP
|
$12,369.82
|
|
|
Service Code
|
APR-DRG 1933
|
| Min. Negotiated Rate |
$11,780.78 |
| Max. Negotiated Rate |
$12,369.82 |
| Rate for Payer: BCBS Complete |
$12,369.82
|
| Rate for Payer: Mclaren Medicaid |
$11,780.78
|
| Rate for Payer: Meridian Medicaid |
$12,369.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,780.78
|
| Rate for Payer: UHC Medicaid |
$11,780.78
|
| Rate for Payer: UHCCP Medicaid |
$11,780.78
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS WITH CC
|
Facility
|
IP
|
$27,822.47
|
|
|
Service Code
|
MSDRG 289
|
| Min. Negotiated Rate |
$14,123.90 |
| Max. Negotiated Rate |
$27,822.47 |
| Rate for Payer: Aetna Medicare |
$15,461.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,584.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,584.08
|
| Rate for Payer: BCBS MAPPO |
$14,867.26
|
| Rate for Payer: BCBS Trust/PPO |
$26,331.00
|
| Rate for Payer: BCN Commercial |
$26,331.00
|
| Rate for Payer: BCN Medicare Advantage |
$14,867.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,867.26
|
| Rate for Payer: Mclaren Medicare |
$14,867.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,610.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,097.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$16,353.99
|
| Rate for Payer: Nomi Health Commercial |
$22,019.01
|
| Rate for Payer: PACE Medicare |
$14,123.90
|
| Rate for Payer: PACE SWMI |
$14,867.26
|
| Rate for Payer: PHP Medicare Advantage |
$14,867.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$27,518.88
|
| Rate for Payer: Priority Health Medicare |
$14,867.26
|
| Rate for Payer: Priority Health Tiered Network |
$22,015.10
|
| Rate for Payer: Railroad Medicare Medicare |
$14,867.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,822.47
|
| Rate for Payer: UHC Core |
$23,277.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,867.26
|
| Rate for Payer: UHC Exchange |
$19,009.75
|
| Rate for Payer: VA VA |
$14,867.26
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC
|
Facility
|
IP
|
$74,222.01
|
|
|
Service Code
|
MSDRG 288
|
| Min. Negotiated Rate |
$22,062.89 |
| Max. Negotiated Rate |
$74,222.01 |
| Rate for Payer: Aetna Medicare |
$24,153.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29,030.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29,030.11
|
| Rate for Payer: BCBS MAPPO |
$23,224.09
|
| Rate for Payer: BCBS Trust/PPO |
$74,222.01
|
| Rate for Payer: BCN Commercial |
$74,222.01
|
| Rate for Payer: BCN Medicare Advantage |
$23,224.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23,224.09
|
| Rate for Payer: Mclaren Medicare |
$23,224.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24,385.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26,707.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$25,546.50
|
| Rate for Payer: Nomi Health Commercial |
$34,909.98
|
| Rate for Payer: PACE Medicare |
$22,062.89
|
| Rate for Payer: PACE SWMI |
$23,224.09
|
| Rate for Payer: PHP Medicare Advantage |
$23,224.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$43,629.74
|
| Rate for Payer: Priority Health Medicare |
$23,224.09
|
| Rate for Payer: Priority Health Tiered Network |
$34,903.78
|
| Rate for Payer: Railroad Medicare Medicare |
$23,224.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44,111.06
|
| Rate for Payer: UHC Core |
$36,904.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$23,224.09
|
| Rate for Payer: UHC Exchange |
$30,138.95
|
| Rate for Payer: VA VA |
$23,224.09
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$22,570.21
|
|
|
Service Code
|
MSDRG 290
|
| Min. Negotiated Rate |
$7,949.38 |
| Max. Negotiated Rate |
$22,570.21 |
| Rate for Payer: Aetna Medicare |
$8,702.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,459.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,459.71
|
| Rate for Payer: BCBS MAPPO |
$8,367.77
|
| Rate for Payer: BCBS Trust/PPO |
$22,570.21
|
| Rate for Payer: BCN Commercial |
$22,570.21
|
| Rate for Payer: BCN Medicare Advantage |
$8,367.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,367.77
|
| Rate for Payer: Mclaren Medicare |
$8,367.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,786.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,622.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,204.55
|
| Rate for Payer: Nomi Health Commercial |
$11,993.13
|
| Rate for Payer: PACE Medicare |
$7,949.38
|
| Rate for Payer: PACE SWMI |
$8,367.77
|
| Rate for Payer: PHP Medicare Advantage |
$8,367.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14,988.75
|
| Rate for Payer: Priority Health Medicare |
$8,367.77
|
| Rate for Payer: Priority Health Tiered Network |
$11,991.00
|
| Rate for Payer: Railroad Medicare Medicare |
$8,367.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,154.11
|
| Rate for Payer: UHC Core |
$12,678.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,367.77
|
| Rate for Payer: UHC Exchange |
$10,354.07
|
| Rate for Payer: VA VA |
$8,367.77
|
|
