|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
IP
|
$20.72
|
|
|
Service Code
|
NDC 61314014305
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$18.65 |
| Rate for Payer: Aetna American Axle |
$13.47
|
| Rate for Payer: Aetna Commercial |
$17.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.47
|
| Rate for Payer: Cash Price |
$16.58
|
| Rate for Payer: Cofinity Advantage |
$14.50
|
| Rate for Payer: Cofinity Commercial |
$17.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.58
|
| Rate for Payer: Healthscope Commercial |
$18.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.54
|
| Rate for Payer: PHP Commercial |
$17.61
|
| Rate for Payer: Priority Health SBD |
$13.05
|
| Rate for Payer: UMR Bronson Commercial |
$9.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.54
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
IP
|
$49.92
|
|
|
Service Code
|
NDC 24208041105
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.96 |
| Max. Negotiated Rate |
$44.93 |
| Rate for Payer: Aetna American Axle |
$32.45
|
| Rate for Payer: Aetna Commercial |
$42.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.45
|
| Rate for Payer: Cash Price |
$39.94
|
| Rate for Payer: Cofinity Advantage |
$34.94
|
| Rate for Payer: Cofinity Commercial |
$42.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.94
|
| Rate for Payer: Healthscope Commercial |
$44.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.44
|
| Rate for Payer: PHP Commercial |
$42.43
|
| Rate for Payer: Priority Health SBD |
$31.45
|
| Rate for Payer: UMR Bronson Commercial |
$21.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.44
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
IP
|
$8.77
|
|
|
Service Code
|
NDC 17478071510
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$7.89 |
| Rate for Payer: Aetna American Axle |
$5.70
|
| Rate for Payer: Aetna Commercial |
$7.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.70
|
| Rate for Payer: Cash Price |
$7.02
|
| Rate for Payer: Cofinity Advantage |
$6.14
|
| Rate for Payer: Cofinity Commercial |
$7.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.02
|
| Rate for Payer: Healthscope Commercial |
$7.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.58
|
| Rate for Payer: PHP Commercial |
$7.45
|
| Rate for Payer: Priority Health SBD |
$5.53
|
| Rate for Payer: UMR Bronson Commercial |
$3.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.58
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
IP
|
$10.62
|
|
|
Service Code
|
NDC 70069023101
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.67 |
| Max. Negotiated Rate |
$9.56 |
| Rate for Payer: Aetna American Axle |
$6.90
|
| Rate for Payer: Aetna Commercial |
$9.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.90
|
| Rate for Payer: Cash Price |
$8.50
|
| Rate for Payer: Cofinity Advantage |
$7.43
|
| Rate for Payer: Cofinity Commercial |
$9.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.50
|
| Rate for Payer: Healthscope Commercial |
$9.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.96
|
| Rate for Payer: PHP Commercial |
$9.03
|
| Rate for Payer: Priority Health SBD |
$6.69
|
| Rate for Payer: UMR Bronson Commercial |
$4.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.96
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
OP
|
$20.72
|
|
|
Service Code
|
NDC 61314014305
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.67 |
| Max. Negotiated Rate |
$18.65 |
| Rate for Payer: Aetna American Axle |
$13.47
|
| Rate for Payer: Aetna Commercial |
$17.61
|
| Rate for Payer: Aetna Medicare |
$10.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.47
|
| Rate for Payer: BCBS Complete |
$8.29
|
| Rate for Payer: Cash Price |
$16.58
|
| Rate for Payer: Cofinity Advantage |
$14.50
|
| Rate for Payer: Cofinity Commercial |
$17.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.58
|
| Rate for Payer: Healthscope Commercial |
$18.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.54
|
| Rate for Payer: PHP Commercial |
$17.61
|
| Rate for Payer: Priority Health SBD |
$13.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.47
|
| Rate for Payer: UHC Core |
$10.80
|
| Rate for Payer: UHC Exchange |
$8.14
|
| Rate for Payer: UMR Bronson Commercial |
$7.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.54
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
OP
|
$10.62
|
|
|
Service Code
|
NDC 70069023101
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$9.56 |
| Rate for Payer: Aetna American Axle |
$6.90
|
| Rate for Payer: Aetna Commercial |
$9.03
|
| Rate for Payer: Aetna Medicare |
$5.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.90
|
| Rate for Payer: BCBS Complete |
$4.25
|
| Rate for Payer: Cash Price |
$8.50
|
| Rate for Payer: Cofinity Advantage |
$7.43
|
| Rate for Payer: Cofinity Commercial |
$9.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.50
|
| Rate for Payer: Healthscope Commercial |
$9.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.96
|
| Rate for Payer: PHP Commercial |
$9.03
|
| Rate for Payer: Priority Health SBD |
$6.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.90
|
| Rate for Payer: UHC Core |
$5.53
|
| Rate for Payer: UHC Exchange |
$4.17
|
| Rate for Payer: UMR Bronson Commercial |
$3.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.96
|
|
|
BRIVARACETAM 100 MG TABLET
|
Facility
|
OP
|
$5,200.35
|
|
|
Service Code
|
NDC 50474077066
|
| Hospital Charge Code |
178919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,924.13 |
| Max. Negotiated Rate |
$4,680.31 |
| Rate for Payer: Aetna American Axle |
$3,380.23
|
| Rate for Payer: Aetna Commercial |
$4,420.30
|
| Rate for Payer: Aetna Medicare |
$2,600.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,380.23
|
| Rate for Payer: BCBS Complete |
$2,080.14
|
| Rate for Payer: Cash Price |
$4,160.28
|
| Rate for Payer: Cofinity Advantage |
$3,640.24
|
| Rate for Payer: Cofinity Commercial |
$4,472.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,160.28
|
| Rate for Payer: Healthscope Commercial |
$4,680.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,640.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,900.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,160.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,420.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,900.26
|
| Rate for Payer: PHP Commercial |
$4,420.30
|
| Rate for Payer: Priority Health SBD |
$3,276.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,380.23
|
| Rate for Payer: UHC Core |
$2,709.38
|
| Rate for Payer: UHC Exchange |
$2,043.74
|
| Rate for Payer: UMR Bronson Commercial |
$1,924.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,900.26
|
|
|
BRIVARACETAM 100 MG TABLET
|
Facility
|
IP
|
$5,200.35
|
|
|
Service Code
|
NDC 50474077066
|
| Hospital Charge Code |
178919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,288.15 |
| Max. Negotiated Rate |
$4,680.31 |
| Rate for Payer: Aetna American Axle |
$3,380.23
|
| Rate for Payer: Aetna Commercial |
$4,420.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,380.23
|
| Rate for Payer: Cash Price |
$4,160.28
|
| Rate for Payer: Cofinity Advantage |
$3,640.24
|
| Rate for Payer: Cofinity Commercial |
$4,472.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,160.28
|
| Rate for Payer: Healthscope Commercial |
$4,680.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,640.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,900.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,420.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,900.26
|
| Rate for Payer: PHP Commercial |
$4,420.30
|
| Rate for Payer: Priority Health SBD |
$3,276.22
|
| Rate for Payer: UMR Bronson Commercial |
$2,288.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,900.26
|
|
|
BROMOCRIPTINE 2.5 MG TABLET
|
Facility
|
OP
|
$450.72
|
|
|
Service Code
|
NDC 00574010601
|
| Hospital Charge Code |
9297
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.77 |
| Max. Negotiated Rate |
$405.65 |
| Rate for Payer: Aetna American Axle |
$292.97
|
| Rate for Payer: Aetna Commercial |
$383.11
|
| Rate for Payer: Aetna Medicare |
$225.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.97
|
| Rate for Payer: BCBS Complete |
$180.29
|
| Rate for Payer: Cash Price |
$360.58
|
| Rate for Payer: Cofinity Advantage |
$315.50
|
| Rate for Payer: Cofinity Commercial |
$387.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.58
|
| Rate for Payer: Healthscope Commercial |
$405.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$315.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$338.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$360.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$383.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$338.04
|
| Rate for Payer: PHP Commercial |
$383.11
|
| Rate for Payer: Priority Health SBD |
$283.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$292.97
|
| Rate for Payer: UHC Core |
$234.83
|
| Rate for Payer: UHC Exchange |
$177.13
|
| Rate for Payer: UMR Bronson Commercial |
$166.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$338.04
|
|
|
BROMOCRIPTINE 2.5 MG TABLET
|
Facility
|
IP
|
$186.34
|
|
|
Service Code
|
NDC 00574010603
|
| Hospital Charge Code |
9297
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.99 |
| Max. Negotiated Rate |
$167.71 |
| Rate for Payer: Aetna American Axle |
$121.12
|
| Rate for Payer: Aetna Commercial |
$158.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.12
|
| Rate for Payer: Cash Price |
$149.07
|
| Rate for Payer: Cofinity Advantage |
$130.44
|
| Rate for Payer: Cofinity Commercial |
$160.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.07
|
| Rate for Payer: Healthscope Commercial |
$167.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$130.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.75
|
| Rate for Payer: PHP Commercial |
$158.39
|
| Rate for Payer: Priority Health SBD |
$117.39
|
| Rate for Payer: UMR Bronson Commercial |
$81.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.75
|
|
|
BROMOCRIPTINE 2.5 MG TABLET
|
Facility
|
IP
|
$450.72
|
|
|
Service Code
|
NDC 00574010601
|
| Hospital Charge Code |
9297
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$198.32 |
| Max. Negotiated Rate |
$405.65 |
| Rate for Payer: Aetna American Axle |
$292.97
|
| Rate for Payer: Aetna Commercial |
$383.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.97
|
| Rate for Payer: Cash Price |
$360.58
|
| Rate for Payer: Cofinity Advantage |
$315.50
|
| Rate for Payer: Cofinity Commercial |
$387.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.58
|
| Rate for Payer: Healthscope Commercial |
$405.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$315.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$338.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$383.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$338.04
|
| Rate for Payer: PHP Commercial |
$383.11
|
| Rate for Payer: Priority Health SBD |
$283.95
|
| Rate for Payer: UMR Bronson Commercial |
$198.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$338.04
|
|
|
BROMOCRIPTINE 2.5 MG TABLET
|
Facility
|
OP
|
$186.34
|
|
|
Service Code
|
NDC 00574010603
|
| Hospital Charge Code |
9297
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.95 |
| Max. Negotiated Rate |
$167.71 |
| Rate for Payer: Aetna American Axle |
$121.12
|
| Rate for Payer: Aetna Commercial |
$158.39
|
| Rate for Payer: Aetna Medicare |
$93.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.12
|
| Rate for Payer: BCBS Complete |
$74.54
|
| Rate for Payer: Cash Price |
$149.07
|
| Rate for Payer: Cofinity Advantage |
$130.44
|
| Rate for Payer: Cofinity Commercial |
$160.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.07
|
| Rate for Payer: Healthscope Commercial |
$167.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$130.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.75
|
| Rate for Payer: PHP Commercial |
$158.39
|
| Rate for Payer: Priority Health SBD |
$117.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.12
|
| Rate for Payer: UHC Core |
$97.08
|
| Rate for Payer: UHC Exchange |
$73.23
|
| Rate for Payer: UMR Bronson Commercial |
$68.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.75
|
|
|
BROMOCRIPTINE 5 MG CAPSULE
|
Facility
|
OP
|
$2,562.99
|
|
|
Service Code
|
NDC 00378709601
|
| Hospital Charge Code |
9296
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$948.31 |
| Max. Negotiated Rate |
$2,306.69 |
| Rate for Payer: Aetna American Axle |
$1,665.94
|
| Rate for Payer: Aetna Commercial |
$2,178.54
|
| Rate for Payer: Aetna Medicare |
$1,281.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,665.94
|
| Rate for Payer: BCBS Complete |
$1,025.20
|
| Rate for Payer: Cash Price |
$2,050.39
|
| Rate for Payer: Cofinity Advantage |
$1,794.09
|
| Rate for Payer: Cofinity Commercial |
$2,204.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,050.39
|
| Rate for Payer: Healthscope Commercial |
$2,306.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,794.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,922.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,050.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,178.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,922.24
|
| Rate for Payer: PHP Commercial |
$2,178.54
|
| Rate for Payer: Priority Health SBD |
$1,614.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,665.94
|
| Rate for Payer: UHC Core |
$1,335.32
|
| Rate for Payer: UHC Exchange |
$1,007.26
|
| Rate for Payer: UMR Bronson Commercial |
$948.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,922.24
|
|
|
BROMOCRIPTINE 5 MG CAPSULE
|
Facility
|
IP
|
$2,562.99
|
|
|
Service Code
|
NDC 00378709601
|
| Hospital Charge Code |
9296
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,127.72 |
| Max. Negotiated Rate |
$2,306.69 |
| Rate for Payer: Aetna American Axle |
$1,665.94
|
| Rate for Payer: Aetna Commercial |
$2,178.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,665.94
|
| Rate for Payer: Cash Price |
$2,050.39
|
| Rate for Payer: Cofinity Advantage |
$1,794.09
|
| Rate for Payer: Cofinity Commercial |
$2,204.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,050.39
|
| Rate for Payer: Healthscope Commercial |
$2,306.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,794.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,922.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,178.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,922.24
|
| Rate for Payer: PHP Commercial |
$2,178.54
|
| Rate for Payer: Priority Health SBD |
$1,614.68
|
| Rate for Payer: UMR Bronson Commercial |
$1,127.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,922.24
|
|
|
BROMOCRIPTINE 5 MG CAPSULE
|
Facility
|
IP
|
$1,211.01
|
|
|
Service Code
|
NDC 63304015801
|
| Hospital Charge Code |
9296
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$532.84 |
| Max. Negotiated Rate |
$1,089.91 |
| Rate for Payer: Aetna American Axle |
$787.16
|
| Rate for Payer: Aetna Commercial |
$1,029.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$787.16
|
| Rate for Payer: Cash Price |
$968.81
|
| Rate for Payer: Cofinity Advantage |
$847.71
|
| Rate for Payer: Cofinity Commercial |
$1,041.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$968.81
|
| Rate for Payer: Healthscope Commercial |
$1,089.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$847.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$908.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,029.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$908.26
|
| Rate for Payer: PHP Commercial |
$1,029.36
|
| Rate for Payer: Priority Health SBD |
$762.94
|
| Rate for Payer: UMR Bronson Commercial |
$532.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$908.26
|
|
|
BROMOCRIPTINE 5 MG CAPSULE
|
Facility
|
OP
|
$1,211.01
|
|
|
Service Code
|
NDC 63304015801
|
| Hospital Charge Code |
9296
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$448.07 |
| Max. Negotiated Rate |
$1,089.91 |
| Rate for Payer: Aetna American Axle |
$787.16
|
| Rate for Payer: Aetna Commercial |
$1,029.36
|
| Rate for Payer: Aetna Medicare |
$605.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$787.16
|
| Rate for Payer: BCBS Complete |
$484.40
|
| Rate for Payer: Cash Price |
$968.81
|
| Rate for Payer: Cofinity Advantage |
$847.71
|
| Rate for Payer: Cofinity Commercial |
$1,041.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$968.81
|
| Rate for Payer: Healthscope Commercial |
$1,089.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$847.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$908.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$968.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,029.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$908.26
|
| Rate for Payer: PHP Commercial |
$1,029.36
|
| Rate for Payer: Priority Health SBD |
$762.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$787.16
|
| Rate for Payer: UHC Core |
$630.94
|
| Rate for Payer: UHC Exchange |
$475.93
|
| Rate for Payer: UMR Bronson Commercial |
$448.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$908.26
|
|
|
BROMOCRIPTINE 5 MG CAPSULE
|
Facility
|
OP
|
$313.14
|
|
|
Service Code
|
NDC 68382011006
|
| Hospital Charge Code |
9296
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.86 |
| Max. Negotiated Rate |
$281.83 |
| Rate for Payer: Aetna American Axle |
$203.54
|
| Rate for Payer: Aetna Commercial |
$266.17
|
| Rate for Payer: Aetna Medicare |
$156.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.54
|
| Rate for Payer: BCBS Complete |
$125.26
|
| Rate for Payer: Cash Price |
$250.51
|
| Rate for Payer: Cofinity Advantage |
$219.20
|
| Rate for Payer: Cofinity Commercial |
$269.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.51
|
| Rate for Payer: Healthscope Commercial |
$281.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$219.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$266.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.85
|
| Rate for Payer: PHP Commercial |
$266.17
|
| Rate for Payer: Priority Health SBD |
$197.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.54
|
| Rate for Payer: UHC Core |
$163.15
|
| Rate for Payer: UHC Exchange |
$123.06
|
| Rate for Payer: UMR Bronson Commercial |
$115.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.85
|
|
|
BROMOCRIPTINE 5 MG CAPSULE
|
Facility
|
IP
|
$313.14
|
|
|
Service Code
|
NDC 68382011006
|
| Hospital Charge Code |
9296
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.78 |
| Max. Negotiated Rate |
$281.83 |
| Rate for Payer: Aetna American Axle |
$203.54
|
| Rate for Payer: Aetna Commercial |
$266.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.54
|
| Rate for Payer: Cash Price |
$250.51
|
| Rate for Payer: Cofinity Advantage |
$219.20
|
| Rate for Payer: Cofinity Commercial |
$269.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.51
|
| Rate for Payer: Healthscope Commercial |
$281.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$219.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$266.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.85
|
| Rate for Payer: PHP Commercial |
$266.17
|
| Rate for Payer: Priority Health SBD |
$197.28
|
| Rate for Payer: UMR Bronson Commercial |
$137.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.85
|
|
|
BRONCHIOLITIS AND RSV PNEUMONIA
|
Facility
|
IP
|
$4,326.26
|
|
|
Service Code
|
APR-DRG 1382
|
| Min. Negotiated Rate |
$4,120.25 |
| Max. Negotiated Rate |
$4,326.26 |
| Rate for Payer: BCBS Complete |
$4,326.26
|
| Rate for Payer: Mclaren Medicaid |
$4,120.25
|
| Rate for Payer: Meridian Medicaid |
$4,326.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,120.25
|
| Rate for Payer: UHC Medicaid |
$4,120.25
|
| Rate for Payer: UHCCP Medicaid |
$4,120.25
|
|
|
BRONCHIOLITIS AND RSV PNEUMONIA
|
Facility
|
IP
|
$9,602.27
|
|
|
Service Code
|
APR-DRG 1384
|
| Min. Negotiated Rate |
$9,145.02 |
| Max. Negotiated Rate |
$9,602.27 |
| Rate for Payer: BCBS Complete |
$9,602.27
|
| Rate for Payer: Mclaren Medicaid |
$9,145.02
|
| Rate for Payer: Meridian Medicaid |
$9,602.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,145.02
|
| Rate for Payer: UHC Medicaid |
$9,145.02
|
| Rate for Payer: UHCCP Medicaid |
$9,145.02
|
|
|
BRONCHIOLITIS AND RSV PNEUMONIA
|
Facility
|
IP
|
$7,268.14
|
|
|
Service Code
|
APR-DRG 1383
|
| Min. Negotiated Rate |
$6,922.04 |
| Max. Negotiated Rate |
$7,268.14 |
| Rate for Payer: BCBS Complete |
$7,268.14
|
| Rate for Payer: Mclaren Medicaid |
$6,922.04
|
| Rate for Payer: Meridian Medicaid |
$7,268.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,922.04
|
| Rate for Payer: UHC Medicaid |
$6,922.04
|
| Rate for Payer: UHCCP Medicaid |
$6,922.04
|
|
|
BRONCHIOLITIS AND RSV PNEUMONIA
|
Facility
|
IP
|
$3,205.20
|
|
|
Service Code
|
APR-DRG 1381
|
| Min. Negotiated Rate |
$3,052.57 |
| Max. Negotiated Rate |
$3,205.20 |
| Rate for Payer: BCBS Complete |
$3,205.20
|
| Rate for Payer: Mclaren Medicaid |
$3,052.57
|
| Rate for Payer: Meridian Medicaid |
$3,205.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,052.57
|
| Rate for Payer: UHC Medicaid |
$3,052.57
|
| Rate for Payer: UHCCP Medicaid |
$3,052.57
|
|
|
BRONCHITIS AND ASTHMA WITH CC/MCC
|
Facility
|
IP
|
$15,830.56
|
|
|
Service Code
|
MSDRG 202
|
| Min. Negotiated Rate |
$8,279.07 |
| Max. Negotiated Rate |
$15,830.56 |
| Rate for Payer: Aetna Medicare |
$9,063.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,893.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,893.51
|
| Rate for Payer: BCBS MAPPO |
$8,714.81
|
| Rate for Payer: BCBS Trust/PPO |
$13,612.95
|
| Rate for Payer: BCN Commercial |
$13,612.95
|
| Rate for Payer: BCN Medicare Advantage |
$8,714.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,714.81
|
| Rate for Payer: Mclaren Medicare |
$8,714.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,150.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,022.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,586.29
|
| Rate for Payer: Nomi Health Commercial |
$12,528.48
|
| Rate for Payer: PACE Medicare |
$8,279.07
|
| Rate for Payer: PACE SWMI |
$8,714.81
|
| Rate for Payer: PHP Medicare Advantage |
$8,714.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$15,657.82
|
| Rate for Payer: Priority Health Medicare |
$8,714.81
|
| Rate for Payer: Priority Health Tiered Network |
$12,526.26
|
| Rate for Payer: Railroad Medicare Medicare |
$8,714.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,830.56
|
| Rate for Payer: UHC Core |
$13,244.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,714.81
|
| Rate for Payer: UHC Exchange |
$10,816.25
|
| Rate for Payer: VA VA |
$8,714.81
|
|
|
BRONCHITIS AND ASTHMA WITHOUT CC/MCC
|
Facility
|
IP
|
$10,921.00
|
|
|
Service Code
|
MSDRG 203
|
| Min. Negotiated Rate |
$5,886.17 |
| Max. Negotiated Rate |
$10,921.00 |
| Rate for Payer: Aetna Medicare |
$6,443.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,744.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,744.96
|
| Rate for Payer: BCBS MAPPO |
$6,195.97
|
| Rate for Payer: BCBS Trust/PPO |
$7,466.67
|
| Rate for Payer: BCN Commercial |
$7,466.67
|
| Rate for Payer: BCN Medicare Advantage |
$6,195.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,195.97
|
| Rate for Payer: Mclaren Medicare |
$6,195.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,505.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,125.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,815.57
|
| Rate for Payer: Nomi Health Commercial |
$8,643.00
|
| Rate for Payer: PACE Medicare |
$5,886.17
|
| Rate for Payer: PACE SWMI |
$6,195.97
|
| Rate for Payer: PHP Medicare Advantage |
$6,195.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,801.83
|
| Rate for Payer: Priority Health Medicare |
$6,195.97
|
| Rate for Payer: Priority Health Tiered Network |
$8,641.47
|
| Rate for Payer: Railroad Medicare Medicare |
$6,195.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,921.00
|
| Rate for Payer: UHC Core |
$9,136.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,195.97
|
| Rate for Payer: UHC Exchange |
$7,461.79
|
| Rate for Payer: VA VA |
$6,195.97
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; DIAGNOSTIC, WITH CELL WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$5,735.32
|
|
|
Service Code
|
CPT 31622
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$927.54 |
| Max. Negotiated Rate |
$5,735.32 |
| Rate for Payer: Aetna Medicare |
$1,844.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,216.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,216.88
|
| Rate for Payer: BCBS Complete |
$974.01
|
| Rate for Payer: BCBS MAPPO |
$1,773.50
|
| Rate for Payer: BCBS Trust/PPO |
$3,090.86
|
| Rate for Payer: BCN Commercial |
$3,090.86
|
| Rate for Payer: BCN Medicare Advantage |
$1,773.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,773.50
|
| Rate for Payer: Mclaren Medicaid |
$1,773.50
|
| Rate for Payer: Mclaren Medicare |
$1,773.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,862.17
|
| Rate for Payer: Meridian Medicaid |
$1,862.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,039.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,950.85
|
| Rate for Payer: Nomi Health Commercial |
$5,320.50
|
| Rate for Payer: PACE Medicare |
$1,684.83
|
| Rate for Payer: PACE SWMI |
$1,773.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,773.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$927.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,735.32
|
| Rate for Payer: Priority Health Medicare |
$1,773.50
|
| Rate for Payer: Priority Health Tiered Network |
$4,588.26
|
| Rate for Payer: Railroad Medicare Medicare |
$1,773.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,773.50
|
| Rate for Payer: UHC Medicaid |
$927.54
|
| Rate for Payer: UHCCP Medicaid |
$927.54
|
| Rate for Payer: VA VA |
$1,773.50
|
|
