|
NATEGLINIDE 60 MG TABLET
|
Facility
|
IP
|
$530.88
|
|
|
Service Code
|
NDC 49884-984-01
|
| Hospital Charge Code |
29437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$233.59 |
| Max. Negotiated Rate |
$477.79 |
| Rate for Payer: Aetna American Axle |
$345.07
|
| Rate for Payer: Aetna Commercial |
$451.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$345.07
|
| Rate for Payer: Cash Price |
$424.70
|
| Rate for Payer: Cofinity Commercial |
$371.62
|
| Rate for Payer: Cofinity Commercial |
$456.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$424.70
|
| Rate for Payer: Healthscope Commercial |
$477.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$371.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$398.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$451.25
|
| Rate for Payer: PHP Commercial |
$451.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$371.62
|
| Rate for Payer: Priority Health SBD |
$334.45
|
| Rate for Payer: UMR Bronson Commercial |
$233.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$398.16
|
|
|
NECITUMUMAB 800 MG/50 ML (16 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19,440.58
|
|
|
Service Code
|
HCPCS J9295
|
| Hospital Charge Code |
176602
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$17,496.52 |
| Rate for Payer: Aetna American Axle |
$12,636.38
|
| Rate for Payer: Aetna Commercial |
$16,524.49
|
| Rate for Payer: Aetna Medicare |
$5.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,636.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.17
|
| Rate for Payer: BCBS Complete |
$3.30
|
| Rate for Payer: BCBS MAPPO |
$5.74
|
| Rate for Payer: BCBS Trust/PPO |
$18.52
|
| Rate for Payer: BCN Medicare Advantage |
$5.74
|
| Rate for Payer: Cash Price |
$15,552.46
|
| Rate for Payer: Cash Price |
$15,552.46
|
| Rate for Payer: Cofinity Commercial |
$13,608.41
|
| Rate for Payer: Cofinity Commercial |
$16,718.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,552.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.74
|
| Rate for Payer: Healthscope Commercial |
$17,496.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13,608.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,580.44
|
| Rate for Payer: Mclaren Medicaid |
$3.14
|
| Rate for Payer: Mclaren Medicare |
$5.74
|
| Rate for Payer: Meridian Medicaid |
$3.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16,524.49
|
| Rate for Payer: PACE Medicare |
$5.45
|
| Rate for Payer: PACE SWMI |
$5.74
|
| Rate for Payer: PHP Commercial |
$16,524.49
|
| Rate for Payer: PHP Medicare Advantage |
$5.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,608.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.86
|
| Rate for Payer: Priority Health Medicare |
$5.74
|
| Rate for Payer: Priority Health Narrow Network |
$13.49
|
| Rate for Payer: Priority Health SBD |
$12,247.57
|
| Rate for Payer: Railroad Medicare Medicare |
$5.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.74
|
| Rate for Payer: UHC Medicare Advantage |
$5.91
|
| Rate for Payer: UMR Bronson Commercial |
$7,193.01
|
| Rate for Payer: VA VA |
$5.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,580.44
|
|
|
NECITUMUMAB 800 MG/50 ML (16 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19,440.58
|
|
|
Service Code
|
HCPCS J9295
|
| Hospital Charge Code |
176602
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8,553.86 |
| Max. Negotiated Rate |
$17,496.52 |
| Rate for Payer: Aetna American Axle |
$12,636.38
|
| Rate for Payer: Aetna Commercial |
$16,524.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,636.38
|
| Rate for Payer: Cash Price |
$15,552.46
|
| Rate for Payer: Cofinity Commercial |
$13,608.41
|
| Rate for Payer: Cofinity Commercial |
$16,718.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,552.46
|
| Rate for Payer: Healthscope Commercial |
$17,496.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13,608.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,580.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16,524.49
|
| Rate for Payer: PHP Commercial |
$16,524.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,608.41
|
| Rate for Payer: Priority Health SBD |
$12,247.57
|
| Rate for Payer: UMR Bronson Commercial |
$8,553.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,580.44
|
|
|
NEEDLE INSERTION(S) WITHOUT INJECTION(S); 1 OR 2 MUSCLE(S)
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 20560
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14.41 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$27.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.09
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS MAPPO |
$26.47
|
| Rate for Payer: BCN Medicare Advantage |
$26.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.47
|
| Rate for Payer: Mclaren Medicaid |
$14.48
|
| Rate for Payer: Mclaren Medicare |
$26.47
|
| Rate for Payer: Meridian Medicaid |
$15.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.44
|
| Rate for Payer: PACE Medicare |
$25.15
|
| Rate for Payer: PACE SWMI |
$26.47
|
| Rate for Payer: PHP Medicare Advantage |
$26.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$83.33
|
| Rate for Payer: Priority Health Medicare |
$26.47
|
| Rate for Payer: Priority Health Narrow Network |
$66.66
|
| Rate for Payer: Railroad Medicare Medicare |
$26.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.85
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.47
|
| Rate for Payer: UHC Exchange |
$14.41
|
| Rate for Payer: UHC Medicare Advantage |
$27.26
|
| Rate for Payer: VA VA |
$26.47
|
|
|
NEGATIVE PRESSURE WOUND THERAPY, (EG, VACUUM ASSISTED DRAINAGE COLLECTION), UTILIZING DISPOSABLE, NON-DURABLE MEDICAL EQUIPMENT INCLUDING PROVISION OF EXUDATE MANAGEMENT COLLECTION SYSTEM, TOPICAL APPLICATION(S), WOUND ASSESSMENT, AND INSTRUCTIONS FOR ONGOING CARE, PER SESSION; TOTAL WOUND(S) SURFACE AREA LESS THAN OR EQUAL TO 50 SQUARE CENTIMETERS
|
Facility
|
OP
|
$443.04
|
|
|
Service Code
|
CPT 97607
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$20.35 |
| Max. Negotiated Rate |
$443.04 |
| Rate for Payer: Aetna Medicare |
$368.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$385.05
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.44
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$20.35
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.43
|
| Rate for Payer: UHC Exchange |
$20.63
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: VA VA |
$354.43
|
|
|
NEGATIVE PRESSURE WOUND THERAPY (EG, VACUUM ASSISTED DRAINAGE COLLECTION), UTILIZING DURABLE MEDICAL EQUIPMENT (DME), INCLUDING TOPICAL APPLICATION(S), WOUND ASSESSMENT, AND INSTRUCTION(S) FOR ONGOING CARE, PER SESSION; TOTAL WOUND(S) SURFACE AREA GREATER THAN 50 SQUARE CENTIMETERS
|
Facility
|
OP
|
$443.04
|
|
|
Service Code
|
CPT 97606
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$22.10 |
| Max. Negotiated Rate |
$443.04 |
| Rate for Payer: Aetna Medicare |
$368.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.63
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$22.10
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.43
|
| Rate for Payer: UHC Exchange |
$25.87
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: VA VA |
$354.43
|
|
|
NEGATIVE PRESSURE WOUND THERAPY (EG, VACUUM ASSISTED DRAINAGE COLLECTION), UTILIZING DURABLE MEDICAL EQUIPMENT (DME), INCLUDING TOPICAL APPLICATION(S), WOUND ASSESSMENT, AND INSTRUCTION(S) FOR ONGOING CARE, PER SESSION; TOTAL WOUND(S) SURFACE AREA LESS THAN OR EQUAL TO 50 SQUARE CENTIMETERS
|
Facility
|
OP
|
$222.44
|
|
|
Service Code
|
CPT 97605
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$20.38 |
| Max. Negotiated Rate |
$222.44 |
| Rate for Payer: Aetna Medicare |
$185.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.44
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$177.95
|
| Rate for Payer: BCBS Trust/PPO |
$81.42
|
| Rate for Payer: BCN Medicare Advantage |
$177.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.95
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Mclaren Medicare |
$177.95
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.64
|
| Rate for Payer: PACE Medicare |
$169.05
|
| Rate for Payer: PACE SWMI |
$177.95
|
| Rate for Payer: PHP Medicare Advantage |
$177.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.48
|
| Rate for Payer: Priority Health Medicare |
$177.95
|
| Rate for Payer: Priority Health Narrow Network |
$20.38
|
| Rate for Payer: Railroad Medicare Medicare |
$177.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.95
|
| Rate for Payer: UHC Exchange |
$23.58
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: VA VA |
$177.95
|
|
|
NELARABINE 250 MG/50 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$14,698.50
|
|
|
Service Code
|
HCPCS J9261
|
| Hospital Charge Code |
70267
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.71 |
| Max. Negotiated Rate |
$13,228.65 |
| Rate for Payer: Aetna American Axle |
$9,554.02
|
| Rate for Payer: Aetna Commercial |
$12,493.72
|
| Rate for Payer: Aetna Medicare |
$115.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,554.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$138.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$138.73
|
| Rate for Payer: BCBS Complete |
$63.75
|
| Rate for Payer: BCBS MAPPO |
$110.98
|
| Rate for Payer: BCBS Trust/PPO |
$358.62
|
| Rate for Payer: BCN Medicare Advantage |
$110.98
|
| Rate for Payer: Cash Price |
$11,758.80
|
| Rate for Payer: Cash Price |
$11,758.80
|
| Rate for Payer: Cofinity Commercial |
$10,288.95
|
| Rate for Payer: Cofinity Commercial |
$12,640.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,758.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.98
|
| Rate for Payer: Healthscope Commercial |
$13,228.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,288.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,023.88
|
| Rate for Payer: Mclaren Medicaid |
$60.71
|
| Rate for Payer: Mclaren Medicare |
$110.98
|
| Rate for Payer: Meridian Medicaid |
$63.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$116.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$127.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,493.72
|
| Rate for Payer: PACE Medicare |
$105.43
|
| Rate for Payer: PACE SWMI |
$110.98
|
| Rate for Payer: PHP Commercial |
$12,493.72
|
| Rate for Payer: PHP Medicare Advantage |
$110.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$60.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,288.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$342.58
|
| Rate for Payer: Priority Health Medicare |
$110.98
|
| Rate for Payer: Priority Health Narrow Network |
$274.06
|
| Rate for Payer: Priority Health SBD |
$9,260.06
|
| Rate for Payer: Railroad Medicare Medicare |
$110.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$110.98
|
| Rate for Payer: UHC Medicare Advantage |
$114.31
|
| Rate for Payer: UMR Bronson Commercial |
$5,438.44
|
| Rate for Payer: VA VA |
$110.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,023.88
|
|
|
NELARABINE 250 MG/50 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$5,624.18
|
|
|
Service Code
|
HCPCS J9261
|
| Hospital Charge Code |
70267
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,474.64 |
| Max. Negotiated Rate |
$5,061.76 |
| Rate for Payer: Aetna American Axle |
$3,655.72
|
| Rate for Payer: Aetna American Axle |
$6,402.10
|
| Rate for Payer: Aetna American Axle |
$9,554.02
|
| Rate for Payer: Aetna American Axle |
$4,453.54
|
| Rate for Payer: Aetna American Axle |
$4,493.58
|
| Rate for Payer: Aetna American Axle |
$6,200.79
|
| Rate for Payer: Aetna American Axle |
$5,493.23
|
| Rate for Payer: Aetna Commercial |
$8,371.97
|
| Rate for Payer: Aetna Commercial |
$4,780.55
|
| Rate for Payer: Aetna Commercial |
$8,108.73
|
| Rate for Payer: Aetna Commercial |
$5,876.22
|
| Rate for Payer: Aetna Commercial |
$5,823.86
|
| Rate for Payer: Aetna Commercial |
$7,183.46
|
| Rate for Payer: Aetna Commercial |
$12,493.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,493.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,402.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,554.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,200.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,655.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,493.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,453.54
|
| Rate for Payer: Cash Price |
$5,481.28
|
| Rate for Payer: Cash Price |
$5,530.56
|
| Rate for Payer: Cash Price |
$7,631.74
|
| Rate for Payer: Cash Price |
$7,879.50
|
| Rate for Payer: Cash Price |
$6,760.90
|
| Rate for Payer: Cash Price |
$4,499.34
|
| Rate for Payer: Cash Price |
$11,758.80
|
| Rate for Payer: Cofinity Commercial |
$5,945.35
|
| Rate for Payer: Cofinity Commercial |
$12,640.71
|
| Rate for Payer: Cofinity Commercial |
$10,288.95
|
| Rate for Payer: Cofinity Commercial |
$4,796.12
|
| Rate for Payer: Cofinity Commercial |
$5,892.38
|
| Rate for Payer: Cofinity Commercial |
$4,839.24
|
| Rate for Payer: Cofinity Commercial |
$4,836.79
|
| Rate for Payer: Cofinity Commercial |
$3,936.93
|
| Rate for Payer: Cofinity Commercial |
$8,204.12
|
| Rate for Payer: Cofinity Commercial |
$7,267.97
|
| Rate for Payer: Cofinity Commercial |
$5,915.79
|
| Rate for Payer: Cofinity Commercial |
$8,470.47
|
| Rate for Payer: Cofinity Commercial |
$6,894.57
|
| Rate for Payer: Cofinity Commercial |
$6,677.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,758.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,499.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,481.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,530.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,879.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,760.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,631.74
|
| Rate for Payer: Healthscope Commercial |
$13,228.65
|
| Rate for Payer: Healthscope Commercial |
$8,585.71
|
| Rate for Payer: Healthscope Commercial |
$7,606.02
|
| Rate for Payer: Healthscope Commercial |
$6,166.44
|
| Rate for Payer: Healthscope Commercial |
$5,061.76
|
| Rate for Payer: Healthscope Commercial |
$6,221.88
|
| Rate for Payer: Healthscope Commercial |
$8,864.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,839.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,894.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,936.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,288.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,677.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,915.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,796.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,387.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,023.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,184.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,138.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,218.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,154.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,338.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,371.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,876.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,493.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,108.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,183.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,780.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,823.86
|
| Rate for Payer: PHP Commercial |
$5,823.86
|
| Rate for Payer: PHP Commercial |
$5,876.22
|
| Rate for Payer: PHP Commercial |
$8,371.97
|
| Rate for Payer: PHP Commercial |
$4,780.55
|
| Rate for Payer: PHP Commercial |
$7,183.46
|
| Rate for Payer: PHP Commercial |
$12,493.72
|
| Rate for Payer: PHP Commercial |
$8,108.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,839.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,677.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,894.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,796.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,915.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,936.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,288.95
|
| Rate for Payer: Priority Health SBD |
$6,010.00
|
| Rate for Payer: Priority Health SBD |
$9,260.06
|
| Rate for Payer: Priority Health SBD |
$3,543.23
|
| Rate for Payer: Priority Health SBD |
$4,316.51
|
| Rate for Payer: Priority Health SBD |
$4,355.32
|
| Rate for Payer: Priority Health SBD |
$5,324.21
|
| Rate for Payer: Priority Health SBD |
$6,205.11
|
| Rate for Payer: UMR Bronson Commercial |
$4,197.46
|
| Rate for Payer: UMR Bronson Commercial |
$3,718.50
|
| Rate for Payer: UMR Bronson Commercial |
$3,041.81
|
| Rate for Payer: UMR Bronson Commercial |
$3,014.70
|
| Rate for Payer: UMR Bronson Commercial |
$2,474.64
|
| Rate for Payer: UMR Bronson Commercial |
$6,467.34
|
| Rate for Payer: UMR Bronson Commercial |
$4,333.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,387.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,218.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,154.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,338.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,138.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,184.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,023.88
|
|
|
NELFINAVIR 250 MG TABLET
|
Facility
|
IP
|
$4,380.06
|
|
|
Service Code
|
NDC 63010-010-30
|
| Hospital Charge Code |
20032
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,927.23 |
| Max. Negotiated Rate |
$3,942.05 |
| Rate for Payer: Aetna American Axle |
$2,847.04
|
| Rate for Payer: Aetna Commercial |
$3,723.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,847.04
|
| Rate for Payer: Cash Price |
$3,504.05
|
| Rate for Payer: Cofinity Commercial |
$3,766.85
|
| Rate for Payer: Cofinity Commercial |
$3,066.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,504.05
|
| Rate for Payer: Healthscope Commercial |
$3,942.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,066.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,285.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,723.05
|
| Rate for Payer: PHP Commercial |
$3,723.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,066.04
|
| Rate for Payer: Priority Health SBD |
$2,759.44
|
| Rate for Payer: UMR Bronson Commercial |
$1,927.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,285.04
|
|
|
NEOCATE JUNIOR CONTINUOUS FEED
|
Facility
|
IP
|
$201.28
|
|
|
Service Code
|
NDC 4973510627
|
| Hospital Charge Code |
301243
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.56 |
| Max. Negotiated Rate |
$181.15 |
| Rate for Payer: Aetna American Axle |
$130.83
|
| Rate for Payer: Aetna Commercial |
$171.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.83
|
| Rate for Payer: Cash Price |
$161.02
|
| Rate for Payer: Cofinity Commercial |
$140.90
|
| Rate for Payer: Cofinity Commercial |
$173.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.02
|
| Rate for Payer: Healthscope Commercial |
$181.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$171.09
|
| Rate for Payer: PHP Commercial |
$171.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.90
|
| Rate for Payer: Priority Health SBD |
$126.81
|
| Rate for Payer: UMR Bronson Commercial |
$88.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.96
|
|
|
NEOCATE JUNIOR ORAL POWDER CUSTOM
|
Facility
|
IP
|
$201.28
|
|
|
Service Code
|
NDC 4973510627
|
| Hospital Charge Code |
301244
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.56 |
| Max. Negotiated Rate |
$181.15 |
| Rate for Payer: Aetna American Axle |
$130.83
|
| Rate for Payer: Aetna Commercial |
$171.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.83
|
| Rate for Payer: Cash Price |
$161.02
|
| Rate for Payer: Cofinity Commercial |
$140.90
|
| Rate for Payer: Cofinity Commercial |
$173.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.02
|
| Rate for Payer: Healthscope Commercial |
$181.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$171.09
|
| Rate for Payer: PHP Commercial |
$171.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.90
|
| Rate for Payer: Priority Health SBD |
$126.81
|
| Rate for Payer: UMR Bronson Commercial |
$88.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.96
|
|
|
NEOMY-BACIT-POLYMYX-PRAMOXINE 3.5 MG-500 UNIT-10,000 UNIT/G TOP OINT
|
Facility
|
IP
|
$38.52
|
|
|
Service Code
|
NDC 0713-0622-31
|
| Hospital Charge Code |
21070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.95 |
| Max. Negotiated Rate |
$34.67 |
| Rate for Payer: Aetna American Axle |
$25.04
|
| Rate for Payer: Aetna Commercial |
$32.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.04
|
| Rate for Payer: Cash Price |
$30.82
|
| Rate for Payer: Cofinity Commercial |
$26.96
|
| Rate for Payer: Cofinity Commercial |
$33.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.82
|
| Rate for Payer: Healthscope Commercial |
$34.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.74
|
| Rate for Payer: PHP Commercial |
$32.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.96
|
| Rate for Payer: Priority Health SBD |
$24.27
|
| Rate for Payer: UMR Bronson Commercial |
$16.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.89
|
|
|
NEOMYCIN 1.75 MG-POLYMYXIN 10,000 UNIT-GRAMICIDIN 0.025MG/ML EYE DROPS
|
Facility
|
IP
|
$153.76
|
|
|
Service Code
|
NDC 24208-790-62
|
| Hospital Charge Code |
5474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.65 |
| Max. Negotiated Rate |
$138.38 |
| Rate for Payer: Aetna American Axle |
$99.94
|
| Rate for Payer: Aetna Commercial |
$130.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.94
|
| Rate for Payer: Cash Price |
$123.01
|
| Rate for Payer: Cofinity Commercial |
$107.63
|
| Rate for Payer: Cofinity Commercial |
$132.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.01
|
| Rate for Payer: Healthscope Commercial |
$138.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.70
|
| Rate for Payer: PHP Commercial |
$130.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.63
|
| Rate for Payer: Priority Health SBD |
$96.87
|
| Rate for Payer: UMR Bronson Commercial |
$67.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.32
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT
|
Facility
|
IP
|
$45.82
|
|
|
Service Code
|
NDC 24208-795-35
|
| Hospital Charge Code |
19495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.16 |
| Max. Negotiated Rate |
$41.24 |
| Rate for Payer: Aetna American Axle |
$29.78
|
| Rate for Payer: Aetna Commercial |
$38.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.78
|
| Rate for Payer: Cash Price |
$36.66
|
| Rate for Payer: Cofinity Commercial |
$39.41
|
| Rate for Payer: Cofinity Commercial |
$32.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.66
|
| Rate for Payer: Healthscope Commercial |
$41.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.95
|
| Rate for Payer: PHP Commercial |
$38.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.07
|
| Rate for Payer: Priority Health SBD |
$28.87
|
| Rate for Payer: UMR Bronson Commercial |
$20.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.36
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT
|
Facility
|
IP
|
$41.34
|
|
|
Service Code
|
NDC 0574-4160-35
|
| Hospital Charge Code |
19495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.19 |
| Max. Negotiated Rate |
$37.21 |
| Rate for Payer: Aetna American Axle |
$26.87
|
| Rate for Payer: Aetna Commercial |
$35.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.87
|
| Rate for Payer: Cash Price |
$33.07
|
| Rate for Payer: Cofinity Commercial |
$28.94
|
| Rate for Payer: Cofinity Commercial |
$35.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.07
|
| Rate for Payer: Healthscope Commercial |
$37.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.14
|
| Rate for Payer: PHP Commercial |
$35.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.94
|
| Rate for Payer: Priority Health SBD |
$26.04
|
| Rate for Payer: UMR Bronson Commercial |
$18.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.00
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT
|
Facility
|
IP
|
$58.60
|
|
|
Service Code
|
NDC 61314-631-36
|
| Hospital Charge Code |
19495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.78 |
| Max. Negotiated Rate |
$52.74 |
| Rate for Payer: Aetna American Axle |
$38.09
|
| Rate for Payer: Aetna Commercial |
$49.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.09
|
| Rate for Payer: Cash Price |
$46.88
|
| Rate for Payer: Cofinity Commercial |
$41.02
|
| Rate for Payer: Cofinity Commercial |
$50.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.88
|
| Rate for Payer: Healthscope Commercial |
$52.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.81
|
| Rate for Payer: PHP Commercial |
$49.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.02
|
| Rate for Payer: Priority Health SBD |
$36.92
|
| Rate for Payer: UMR Bronson Commercial |
$25.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.95
|
|
|
NEOMYCIN 40 MG-POLYMYXIN B 200,000 UNIT/ML GU IRRIGATION SOLUTION
|
Facility
|
IP
|
$27.83
|
|
|
Service Code
|
NDC 61570004701
|
| Hospital Charge Code |
70678
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$25.05 |
| Rate for Payer: Aetna American Axle |
$18.09
|
| Rate for Payer: Aetna Commercial |
$23.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.09
|
| Rate for Payer: Cash Price |
$22.26
|
| Rate for Payer: Cofinity Commercial |
$19.48
|
| Rate for Payer: Cofinity Commercial |
$23.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.26
|
| Rate for Payer: Healthscope Commercial |
$25.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.66
|
| Rate for Payer: PHP Commercial |
$23.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.48
|
| Rate for Payer: Priority Health SBD |
$17.53
|
| Rate for Payer: UMR Bronson Commercial |
$12.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.87
|
|
|
NEOMYCIN 40 MG-POLYMYXIN B 200,000 UNIT/ML GU IRRIGATION SOLUTION
|
Facility
|
IP
|
$380.12
|
|
|
Service Code
|
NDC 39822-1220-1
|
| Hospital Charge Code |
70678
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$167.25 |
| Max. Negotiated Rate |
$342.11 |
| Rate for Payer: Aetna American Axle |
$247.08
|
| Rate for Payer: Aetna Commercial |
$323.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.08
|
| Rate for Payer: Cash Price |
$304.10
|
| Rate for Payer: Cofinity Commercial |
$266.08
|
| Rate for Payer: Cofinity Commercial |
$326.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.10
|
| Rate for Payer: Healthscope Commercial |
$342.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$266.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.10
|
| Rate for Payer: PHP Commercial |
$323.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.08
|
| Rate for Payer: Priority Health SBD |
$239.48
|
| Rate for Payer: UMR Bronson Commercial |
$167.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.09
|
|
|
NEOMYCIN 40 MG-POLYMYXIN B 200,000 UNIT/ML GU IRRIGATION SOLUTION
|
Facility
|
IP
|
$45.22
|
|
|
Service Code
|
NDC 39822-1201-2
|
| Hospital Charge Code |
70678
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.90 |
| Max. Negotiated Rate |
$40.70 |
| Rate for Payer: Aetna American Axle |
$29.39
|
| Rate for Payer: Aetna Commercial |
$38.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.39
|
| Rate for Payer: Cash Price |
$36.18
|
| Rate for Payer: Cofinity Commercial |
$31.65
|
| Rate for Payer: Cofinity Commercial |
$38.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.18
|
| Rate for Payer: Healthscope Commercial |
$40.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.44
|
| Rate for Payer: PHP Commercial |
$38.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.65
|
| Rate for Payer: Priority Health SBD |
$28.49
|
| Rate for Payer: UMR Bronson Commercial |
$19.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.92
|
|
|
NEOMYCIN 40 MG-POLYMYXIN B 200,000 UNIT/ML GU IRRIGATION SOLUTION
|
Facility
|
IP
|
$45.22
|
|
|
Service Code
|
NDC 39822-1201-1
|
| Hospital Charge Code |
70678
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.90 |
| Max. Negotiated Rate |
$40.70 |
| Rate for Payer: Aetna American Axle |
$29.39
|
| Rate for Payer: Aetna Commercial |
$38.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.39
|
| Rate for Payer: Cash Price |
$36.18
|
| Rate for Payer: Cofinity Commercial |
$31.65
|
| Rate for Payer: Cofinity Commercial |
$38.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.18
|
| Rate for Payer: Healthscope Commercial |
$40.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.44
|
| Rate for Payer: PHP Commercial |
$38.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.65
|
| Rate for Payer: Priority Health SBD |
$28.49
|
| Rate for Payer: UMR Bronson Commercial |
$19.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.92
|
|
|
NEOMYCIN 500 MG TABLET
|
Facility
|
IP
|
$454.56
|
|
|
Service Code
|
NDC 50383-565-10
|
| Hospital Charge Code |
5472
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$200.01 |
| Max. Negotiated Rate |
$409.10 |
| Rate for Payer: Aetna American Axle |
$295.46
|
| Rate for Payer: Aetna Commercial |
$386.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$295.46
|
| Rate for Payer: Cash Price |
$363.65
|
| Rate for Payer: Cofinity Commercial |
$318.19
|
| Rate for Payer: Cofinity Commercial |
$390.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$363.65
|
| Rate for Payer: Healthscope Commercial |
$409.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$318.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$340.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$386.38
|
| Rate for Payer: PHP Commercial |
$386.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.19
|
| Rate for Payer: Priority Health SBD |
$286.37
|
| Rate for Payer: UMR Bronson Commercial |
$200.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$340.92
|
|
|
NEOMYCIN 500 MG TABLET
|
Facility
|
IP
|
$336.96
|
|
|
Service Code
|
NDC 0093-1177-01
|
| Hospital Charge Code |
5472
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.26 |
| Max. Negotiated Rate |
$303.26 |
| Rate for Payer: Aetna American Axle |
$219.02
|
| Rate for Payer: Aetna Commercial |
$286.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.02
|
| Rate for Payer: Cash Price |
$269.57
|
| Rate for Payer: Cofinity Commercial |
$235.87
|
| Rate for Payer: Cofinity Commercial |
$289.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.57
|
| Rate for Payer: Healthscope Commercial |
$303.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$235.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$286.42
|
| Rate for Payer: PHP Commercial |
$286.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.87
|
| Rate for Payer: Priority Health SBD |
$212.28
|
| Rate for Payer: UMR Bronson Commercial |
$148.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.72
|
|
|
NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT
|
Facility
|
IP
|
$148.34
|
|
|
Service Code
|
NDC 24208-780-55
|
| Hospital Charge Code |
38701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.27 |
| Max. Negotiated Rate |
$133.51 |
| Rate for Payer: Aetna American Axle |
$96.42
|
| Rate for Payer: Aetna Commercial |
$126.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.42
|
| Rate for Payer: Cash Price |
$118.67
|
| Rate for Payer: Cofinity Commercial |
$103.84
|
| Rate for Payer: Cofinity Commercial |
$127.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.67
|
| Rate for Payer: Healthscope Commercial |
$133.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$126.09
|
| Rate for Payer: PHP Commercial |
$126.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.84
|
| Rate for Payer: Priority Health SBD |
$93.45
|
| Rate for Payer: UMR Bronson Commercial |
$65.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.26
|
|
|
NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT
|
Facility
|
IP
|
$56.22
|
|
|
Service Code
|
NDC 16571-754-53
|
| Hospital Charge Code |
38701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.74 |
| Max. Negotiated Rate |
$50.60 |
| Rate for Payer: Aetna American Axle |
$36.54
|
| Rate for Payer: Aetna Commercial |
$47.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.54
|
| Rate for Payer: Cash Price |
$44.98
|
| Rate for Payer: Cofinity Commercial |
$39.35
|
| Rate for Payer: Cofinity Commercial |
$48.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.98
|
| Rate for Payer: Healthscope Commercial |
$50.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.79
|
| Rate for Payer: PHP Commercial |
$47.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.35
|
| Rate for Payer: Priority Health SBD |
$35.42
|
| Rate for Payer: UMR Bronson Commercial |
$24.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.16
|
|
