|
NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG, OPEN; OTHER THAN SPECIFIED
|
Facility
|
OP
|
$5,402.75
|
|
|
Service Code
|
CPT 64708
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$506.55 |
| Max. Negotiated Rate |
$5,402.75 |
| Rate for Payer: Aetna Medicare |
$1,784.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,145.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,145.29
|
| Rate for Payer: BCBS Complete |
$985.80
|
| Rate for Payer: BCBS MAPPO |
$1,716.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,415.61
|
| Rate for Payer: BCN Medicare Advantage |
$1,716.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,716.23
|
| Rate for Payer: Mclaren Medicaid |
$938.78
|
| Rate for Payer: Mclaren Medicare |
$1,716.23
|
| Rate for Payer: Meridian Medicaid |
$985.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,802.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,973.66
|
| Rate for Payer: PACE Medicare |
$1,630.42
|
| Rate for Payer: PACE SWMI |
$1,716.23
|
| Rate for Payer: PHP Medicare Advantage |
$1,716.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$938.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,402.75
|
| Rate for Payer: Priority Health Medicare |
$1,716.23
|
| Rate for Payer: Priority Health Narrow Network |
$4,322.20
|
| Rate for Payer: Railroad Medicare Medicare |
$1,716.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$557.20
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,716.23
|
| Rate for Payer: UHC Exchange |
$506.55
|
| Rate for Payer: UHC Medicare Advantage |
$1,767.72
|
| Rate for Payer: VA VA |
$1,716.23
|
|
|
NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG, OPEN; SCIATIC NERVE
|
Facility
|
OP
|
$5,402.75
|
|
|
Service Code
|
CPT 64712
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$591.36 |
| Max. Negotiated Rate |
$5,402.75 |
| Rate for Payer: Aetna Medicare |
$1,784.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,145.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,145.29
|
| Rate for Payer: BCBS Complete |
$985.80
|
| Rate for Payer: BCBS MAPPO |
$1,716.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,415.61
|
| Rate for Payer: BCN Medicare Advantage |
$1,716.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,716.23
|
| Rate for Payer: Mclaren Medicaid |
$938.78
|
| Rate for Payer: Mclaren Medicare |
$1,716.23
|
| Rate for Payer: Meridian Medicaid |
$985.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,802.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,973.66
|
| Rate for Payer: PACE Medicare |
$1,630.42
|
| Rate for Payer: PACE SWMI |
$1,716.23
|
| Rate for Payer: PHP Medicare Advantage |
$1,716.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$938.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,402.75
|
| Rate for Payer: Priority Health Medicare |
$1,716.23
|
| Rate for Payer: Priority Health Narrow Network |
$4,322.20
|
| Rate for Payer: Railroad Medicare Medicare |
$1,716.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$650.50
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,716.23
|
| Rate for Payer: UHC Exchange |
$591.36
|
| Rate for Payer: UHC Medicare Advantage |
$1,767.72
|
| Rate for Payer: VA VA |
$1,716.23
|
|
|
NEUROPLASTY; NERVE OF HAND OR FOOT
|
Facility
|
OP
|
$5,402.75
|
|
|
Service Code
|
CPT 64704
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$322.20 |
| Max. Negotiated Rate |
$5,402.75 |
| Rate for Payer: Aetna Medicare |
$1,784.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,145.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,145.29
|
| Rate for Payer: BCBS Complete |
$985.80
|
| Rate for Payer: BCBS MAPPO |
$1,716.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,366.80
|
| Rate for Payer: BCN Medicare Advantage |
$1,716.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,716.23
|
| Rate for Payer: Mclaren Medicaid |
$938.78
|
| Rate for Payer: Mclaren Medicare |
$1,716.23
|
| Rate for Payer: Meridian Medicaid |
$985.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,802.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,973.66
|
| Rate for Payer: PACE Medicare |
$1,630.42
|
| Rate for Payer: PACE SWMI |
$1,716.23
|
| Rate for Payer: PHP Medicare Advantage |
$1,716.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$938.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,402.75
|
| Rate for Payer: Priority Health Medicare |
$1,716.23
|
| Rate for Payer: Priority Health Narrow Network |
$4,322.20
|
| Rate for Payer: Railroad Medicare Medicare |
$1,716.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$354.42
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,716.23
|
| Rate for Payer: UHC Exchange |
$322.20
|
| Rate for Payer: UHC Medicare Advantage |
$1,767.72
|
| Rate for Payer: VA VA |
$1,716.23
|
|
|
NEUROSES EXCEPT DEPRESSIVE
|
Facility
|
IP
|
$28,054.02
|
|
|
Service Code
|
MS-DRG 882
|
| Min. Negotiated Rate |
$7,363.10 |
| Max. Negotiated Rate |
$28,054.02 |
| Rate for Payer: Aetna Medicare |
$8,060.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,688.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,688.29
|
| Rate for Payer: BCBS MAPPO |
$7,750.63
|
| Rate for Payer: BCBS Trust/PPO |
$28,054.02
|
| Rate for Payer: BCN Medicare Advantage |
$7,750.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,750.63
|
| Rate for Payer: Mclaren Medicare |
$7,750.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,138.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,913.22
|
| Rate for Payer: PACE Medicare |
$7,363.10
|
| Rate for Payer: PACE SWMI |
$7,750.63
|
| Rate for Payer: PHP Medicare Advantage |
$7,750.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,478.88
|
| Rate for Payer: Priority Health Medicare |
$7,750.63
|
| Rate for Payer: Priority Health Narrow Network |
$10,783.10
|
| Rate for Payer: Railroad Medicare Medicare |
$7,750.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,328.08
|
| Rate for Payer: UHC Core |
$11,748.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,750.63
|
| Rate for Payer: UHC Exchange |
$9,340.40
|
| Rate for Payer: UHC Medicare Advantage |
$7,983.15
|
| Rate for Payer: VA VA |
$7,750.63
|
|
|
NEVIRAPINE 200 MG TABLET
|
Facility
|
IP
|
$142.41
|
|
|
Service Code
|
NDC 31722-505-60
|
| Hospital Charge Code |
17403
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.66 |
| Max. Negotiated Rate |
$128.17 |
| Rate for Payer: Aetna American Axle |
$92.57
|
| Rate for Payer: Aetna Commercial |
$121.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.57
|
| Rate for Payer: Cash Price |
$113.93
|
| Rate for Payer: Cofinity Commercial |
$122.47
|
| Rate for Payer: Cofinity Commercial |
$99.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.93
|
| Rate for Payer: Healthscope Commercial |
$128.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$99.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$121.05
|
| Rate for Payer: PHP Commercial |
$121.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.69
|
| Rate for Payer: Priority Health SBD |
$89.72
|
| Rate for Payer: UMR Bronson Commercial |
$62.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.81
|
|
|
NEVIRAPINE 50 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$676.23
|
|
|
Service Code
|
NDC 65862-057-24
|
| Hospital Charge Code |
24119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$297.54 |
| Max. Negotiated Rate |
$608.61 |
| Rate for Payer: Aetna American Axle |
$439.55
|
| Rate for Payer: Aetna Commercial |
$574.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$439.55
|
| Rate for Payer: Cash Price |
$540.98
|
| Rate for Payer: Cofinity Commercial |
$473.36
|
| Rate for Payer: Cofinity Commercial |
$581.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$540.98
|
| Rate for Payer: Healthscope Commercial |
$608.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$473.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$507.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$574.80
|
| Rate for Payer: PHP Commercial |
$574.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$473.36
|
| Rate for Payer: Priority Health SBD |
$426.02
|
| Rate for Payer: UMR Bronson Commercial |
$297.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$507.17
|
|
|
NEVIRAPINE 50 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$918.15
|
|
|
Service Code
|
NDC 0597-0047-24
|
| Hospital Charge Code |
24119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$403.99 |
| Max. Negotiated Rate |
$826.34 |
| Rate for Payer: Aetna American Axle |
$596.80
|
| Rate for Payer: Aetna Commercial |
$780.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$596.80
|
| Rate for Payer: Cash Price |
$734.52
|
| Rate for Payer: Cofinity Commercial |
$789.61
|
| Rate for Payer: Cofinity Commercial |
$642.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$734.52
|
| Rate for Payer: Healthscope Commercial |
$826.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$642.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$688.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$780.43
|
| Rate for Payer: PHP Commercial |
$780.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$642.70
|
| Rate for Payer: Priority Health SBD |
$578.43
|
| Rate for Payer: UMR Bronson Commercial |
$403.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$688.61
|
|
|
NEVIRAPINE ER 400 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$262.30
|
|
|
Service Code
|
NDC 33342-238-07
|
| Hospital Charge Code |
152490
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.41 |
| Max. Negotiated Rate |
$236.07 |
| Rate for Payer: Aetna American Axle |
$170.50
|
| Rate for Payer: Aetna Commercial |
$222.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.50
|
| Rate for Payer: Cash Price |
$209.84
|
| Rate for Payer: Cofinity Commercial |
$183.61
|
| Rate for Payer: Cofinity Commercial |
$225.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.84
|
| Rate for Payer: Healthscope Commercial |
$236.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$222.96
|
| Rate for Payer: PHP Commercial |
$222.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.61
|
| Rate for Payer: Priority Health SBD |
$165.25
|
| Rate for Payer: UMR Bronson Commercial |
$115.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.72
|
|
|
NEVIRAPINE ER 400 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$3,031.41
|
|
|
Service Code
|
NDC 0597-0123-30
|
| Hospital Charge Code |
152490
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,333.82 |
| Max. Negotiated Rate |
$2,728.27 |
| Rate for Payer: Aetna American Axle |
$1,970.42
|
| Rate for Payer: Aetna Commercial |
$2,576.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,970.42
|
| Rate for Payer: Cash Price |
$2,425.13
|
| Rate for Payer: Cofinity Commercial |
$2,121.99
|
| Rate for Payer: Cofinity Commercial |
$2,607.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,425.13
|
| Rate for Payer: Healthscope Commercial |
$2,728.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,121.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,273.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,576.70
|
| Rate for Payer: PHP Commercial |
$2,576.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,121.99
|
| Rate for Payer: Priority Health SBD |
$1,909.79
|
| Rate for Payer: UMR Bronson Commercial |
$1,333.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,273.56
|
|
|
NEVIRAPINE ER 400 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$1,849.38
|
|
|
Service Code
|
NDC 47781-317-30
|
| Hospital Charge Code |
152490
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$813.73 |
| Max. Negotiated Rate |
$1,664.44 |
| Rate for Payer: Aetna American Axle |
$1,202.10
|
| Rate for Payer: Aetna Commercial |
$1,571.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,202.10
|
| Rate for Payer: Cash Price |
$1,479.50
|
| Rate for Payer: Cofinity Commercial |
$1,294.57
|
| Rate for Payer: Cofinity Commercial |
$1,590.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,479.50
|
| Rate for Payer: Healthscope Commercial |
$1,664.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,294.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,387.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,571.97
|
| Rate for Payer: PHP Commercial |
$1,571.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,294.57
|
| Rate for Payer: Priority Health SBD |
$1,165.11
|
| Rate for Payer: UMR Bronson Commercial |
$813.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,387.04
|
|
|
NIACIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$195.80
|
|
|
Service Code
|
NDC 65162-321-09
|
| Hospital Charge Code |
5545
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.15 |
| Max. Negotiated Rate |
$176.22 |
| Rate for Payer: Aetna American Axle |
$127.27
|
| Rate for Payer: Aetna Commercial |
$166.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.27
|
| Rate for Payer: Cash Price |
$156.64
|
| Rate for Payer: Cofinity Commercial |
$137.06
|
| Rate for Payer: Cofinity Commercial |
$168.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.64
|
| Rate for Payer: Healthscope Commercial |
$176.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$166.43
|
| Rate for Payer: PHP Commercial |
$166.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.06
|
| Rate for Payer: Priority Health SBD |
$123.35
|
| Rate for Payer: UMR Bronson Commercial |
$86.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.85
|
|
|
NIACIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$283.01
|
|
|
Service Code
|
NDC 59651-018-90
|
| Hospital Charge Code |
5545
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.52 |
| Max. Negotiated Rate |
$254.71 |
| Rate for Payer: Aetna American Axle |
$183.96
|
| Rate for Payer: Aetna Commercial |
$240.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.96
|
| Rate for Payer: Cash Price |
$226.41
|
| Rate for Payer: Cofinity Commercial |
$198.11
|
| Rate for Payer: Cofinity Commercial |
$243.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.41
|
| Rate for Payer: Healthscope Commercial |
$254.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$198.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$212.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$240.56
|
| Rate for Payer: PHP Commercial |
$240.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.11
|
| Rate for Payer: Priority Health SBD |
$178.30
|
| Rate for Payer: UMR Bronson Commercial |
$124.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$212.26
|
|
|
NICARDIPINE 10 MG/500 ML NS
|
Facility
|
IP
|
$1,830.40
|
|
|
Service Code
|
NDC 9900-0000-83
|
| Hospital Charge Code |
151055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$805.38 |
| Max. Negotiated Rate |
$1,647.36 |
| Rate for Payer: Aetna American Axle |
$1,189.76
|
| Rate for Payer: Aetna Commercial |
$1,555.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,189.76
|
| Rate for Payer: Cash Price |
$1,464.32
|
| Rate for Payer: Cofinity Commercial |
$1,281.28
|
| Rate for Payer: Cofinity Commercial |
$1,574.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,464.32
|
| Rate for Payer: Healthscope Commercial |
$1,647.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,281.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,372.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,555.84
|
| Rate for Payer: PHP Commercial |
$1,555.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,281.28
|
| Rate for Payer: Priority Health SBD |
$1,153.15
|
| Rate for Payer: UMR Bronson Commercial |
$805.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,372.80
|
|
|
NICARDIPINE 20 MG/200 ML(0.1 MG/ML) IN SOD CHLOR(ISO) INTRAVENOUS SOLN
|
Facility
|
IP
|
$201.38
|
|
|
Service Code
|
NDC 10122-313-01
|
| Hospital Charge Code |
94219
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$88.61 |
| Max. Negotiated Rate |
$181.24 |
| Rate for Payer: Aetna American Axle |
$130.90
|
| Rate for Payer: Aetna Commercial |
$171.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.90
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cofinity Commercial |
$140.97
|
| Rate for Payer: Cofinity Commercial |
$173.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.10
|
| Rate for Payer: Healthscope Commercial |
$181.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$171.17
|
| Rate for Payer: PHP Commercial |
$171.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.97
|
| Rate for Payer: Priority Health SBD |
$126.87
|
| Rate for Payer: UMR Bronson Commercial |
$88.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.04
|
|
|
NICARDIPINE 20 MG/200 ML(0.1 MG/ML) IN SOD CHLOR(ISO) INTRAVENOUS SOLN
|
Facility
|
IP
|
$201.38
|
|
|
Service Code
|
NDC 10122-313-10
|
| Hospital Charge Code |
94219
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$88.61 |
| Max. Negotiated Rate |
$181.24 |
| Rate for Payer: Aetna American Axle |
$130.90
|
| Rate for Payer: Aetna Commercial |
$171.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.90
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cofinity Commercial |
$140.97
|
| Rate for Payer: Cofinity Commercial |
$173.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.10
|
| Rate for Payer: Healthscope Commercial |
$181.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$171.17
|
| Rate for Payer: PHP Commercial |
$171.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.97
|
| Rate for Payer: Priority Health SBD |
$126.87
|
| Rate for Payer: UMR Bronson Commercial |
$88.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.04
|
|
|
NICARDIPINE 20 MG CAPSULE
|
Facility
|
IP
|
$714.96
|
|
|
Service Code
|
NDC 0378-1020-77
|
| Hospital Charge Code |
10712
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$314.58 |
| Max. Negotiated Rate |
$643.46 |
| Rate for Payer: Aetna American Axle |
$464.72
|
| Rate for Payer: Aetna Commercial |
$607.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.72
|
| Rate for Payer: Cash Price |
$571.97
|
| Rate for Payer: Cofinity Commercial |
$500.47
|
| Rate for Payer: Cofinity Commercial |
$614.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$571.97
|
| Rate for Payer: Healthscope Commercial |
$643.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$500.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$536.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$607.72
|
| Rate for Payer: PHP Commercial |
$607.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$500.47
|
| Rate for Payer: Priority Health SBD |
$450.42
|
| Rate for Payer: UMR Bronson Commercial |
$314.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$536.22
|
|
|
NICARDIPINE 20 MG CAPSULE
|
Facility
|
IP
|
$693.64
|
|
|
Service Code
|
NDC 42806-501-09
|
| Hospital Charge Code |
10712
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$305.20 |
| Max. Negotiated Rate |
$624.28 |
| Rate for Payer: Aetna American Axle |
$450.87
|
| Rate for Payer: Aetna Commercial |
$589.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$450.87
|
| Rate for Payer: Cash Price |
$554.91
|
| Rate for Payer: Cofinity Commercial |
$485.55
|
| Rate for Payer: Cofinity Commercial |
$596.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$554.91
|
| Rate for Payer: Healthscope Commercial |
$624.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$485.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$520.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$589.59
|
| Rate for Payer: PHP Commercial |
$589.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$485.55
|
| Rate for Payer: Priority Health SBD |
$436.99
|
| Rate for Payer: UMR Bronson Commercial |
$305.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$520.23
|
|
|
NICARDIPINE 25 MG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$149.26
|
|
|
Service Code
|
HCPCS J2404
|
| Hospital Charge Code |
12370
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.67 |
| Max. Negotiated Rate |
$134.33 |
| Rate for Payer: Aetna American Axle |
$97.02
|
| Rate for Payer: Aetna American Axle |
$33.09
|
| Rate for Payer: Aetna American Axle |
$42.26
|
| Rate for Payer: Aetna American Axle |
$31.33
|
| Rate for Payer: Aetna American Axle |
$61.73
|
| Rate for Payer: Aetna Commercial |
$80.72
|
| Rate for Payer: Aetna Commercial |
$126.87
|
| Rate for Payer: Aetna Commercial |
$43.27
|
| Rate for Payer: Aetna Commercial |
$55.27
|
| Rate for Payer: Aetna Commercial |
$40.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.26
|
| Rate for Payer: Cash Price |
$38.56
|
| Rate for Payer: Cash Price |
$119.41
|
| Rate for Payer: Cash Price |
$52.02
|
| Rate for Payer: Cash Price |
$75.98
|
| Rate for Payer: Cash Price |
$40.73
|
| Rate for Payer: Cofinity Commercial |
$41.45
|
| Rate for Payer: Cofinity Commercial |
$128.36
|
| Rate for Payer: Cofinity Commercial |
$104.48
|
| Rate for Payer: Cofinity Commercial |
$43.78
|
| Rate for Payer: Cofinity Commercial |
$45.51
|
| Rate for Payer: Cofinity Commercial |
$55.92
|
| Rate for Payer: Cofinity Commercial |
$66.48
|
| Rate for Payer: Cofinity Commercial |
$81.67
|
| Rate for Payer: Cofinity Commercial |
$35.64
|
| Rate for Payer: Cofinity Commercial |
$33.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.98
|
| Rate for Payer: Healthscope Commercial |
$45.82
|
| Rate for Payer: Healthscope Commercial |
$43.38
|
| Rate for Payer: Healthscope Commercial |
$58.52
|
| Rate for Payer: Healthscope Commercial |
$134.33
|
| Rate for Payer: Healthscope Commercial |
$85.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$126.87
|
| Rate for Payer: PHP Commercial |
$40.97
|
| Rate for Payer: PHP Commercial |
$55.27
|
| Rate for Payer: PHP Commercial |
$126.87
|
| Rate for Payer: PHP Commercial |
$80.72
|
| Rate for Payer: PHP Commercial |
$43.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.48
|
| Rate for Payer: Priority Health SBD |
$32.07
|
| Rate for Payer: Priority Health SBD |
$40.96
|
| Rate for Payer: Priority Health SBD |
$59.83
|
| Rate for Payer: Priority Health SBD |
$94.03
|
| Rate for Payer: Priority Health SBD |
$30.37
|
| Rate for Payer: UMR Bronson Commercial |
$41.79
|
| Rate for Payer: UMR Bronson Commercial |
$21.21
|
| Rate for Payer: UMR Bronson Commercial |
$22.40
|
| Rate for Payer: UMR Bronson Commercial |
$65.67
|
| Rate for Payer: UMR Bronson Commercial |
$28.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.15
|
|
|
NICARDIPINE 30 MG CAPSULE
|
Facility
|
IP
|
$1,104.57
|
|
|
Service Code
|
NDC 42806-502-09
|
| Hospital Charge Code |
10713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$486.01 |
| Max. Negotiated Rate |
$994.11 |
| Rate for Payer: Aetna American Axle |
$717.97
|
| Rate for Payer: Aetna Commercial |
$938.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$717.97
|
| Rate for Payer: Cash Price |
$883.66
|
| Rate for Payer: Cofinity Commercial |
$773.20
|
| Rate for Payer: Cofinity Commercial |
$949.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$883.66
|
| Rate for Payer: Healthscope Commercial |
$994.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$773.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$828.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$938.88
|
| Rate for Payer: PHP Commercial |
$938.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$773.20
|
| Rate for Payer: Priority Health SBD |
$695.88
|
| Rate for Payer: UMR Bronson Commercial |
$486.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$828.43
|
|
|
NICARDIPINE 30 MG CAPSULE
|
Facility
|
IP
|
$789.55
|
|
|
Service Code
|
NDC 0378-1430-77
|
| Hospital Charge Code |
10713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$347.40 |
| Max. Negotiated Rate |
$710.60 |
| Rate for Payer: Aetna American Axle |
$513.21
|
| Rate for Payer: Aetna Commercial |
$671.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$513.21
|
| Rate for Payer: Cash Price |
$631.64
|
| Rate for Payer: Cofinity Commercial |
$552.68
|
| Rate for Payer: Cofinity Commercial |
$679.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$631.64
|
| Rate for Payer: Healthscope Commercial |
$710.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$552.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$592.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$671.12
|
| Rate for Payer: PHP Commercial |
$671.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$552.68
|
| Rate for Payer: Priority Health SBD |
$497.42
|
| Rate for Payer: UMR Bronson Commercial |
$347.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$592.16
|
|
|
NICARDIPINE 40 MG/200 ML(0.2 MG/ML) IN SOD CHLOR(ISO) INTRAVENOUS SOLN
|
Facility
|
IP
|
$317.38
|
|
|
Service Code
|
NDC 10122-325-01
|
| Hospital Charge Code |
94576
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$139.65 |
| Max. Negotiated Rate |
$285.64 |
| Rate for Payer: Aetna American Axle |
$206.30
|
| Rate for Payer: Aetna Commercial |
$269.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.30
|
| Rate for Payer: Cash Price |
$253.90
|
| Rate for Payer: Cofinity Commercial |
$222.17
|
| Rate for Payer: Cofinity Commercial |
$272.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.90
|
| Rate for Payer: Healthscope Commercial |
$285.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$222.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$269.77
|
| Rate for Payer: PHP Commercial |
$269.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.17
|
| Rate for Payer: Priority Health SBD |
$199.95
|
| Rate for Payer: UMR Bronson Commercial |
$139.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.04
|
|
|
NICARDIPINE 40 MG/200 ML(0.2 MG/ML) IN SOD CHLOR(ISO) INTRAVENOUS SOLN
|
Facility
|
IP
|
$317.38
|
|
|
Service Code
|
NDC 10122-325-10
|
| Hospital Charge Code |
94576
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$139.65 |
| Max. Negotiated Rate |
$285.64 |
| Rate for Payer: Aetna American Axle |
$206.30
|
| Rate for Payer: Aetna Commercial |
$269.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.30
|
| Rate for Payer: Cash Price |
$253.90
|
| Rate for Payer: Cofinity Commercial |
$222.17
|
| Rate for Payer: Cofinity Commercial |
$272.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.90
|
| Rate for Payer: Healthscope Commercial |
$285.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$222.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$269.77
|
| Rate for Payer: PHP Commercial |
$269.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.17
|
| Rate for Payer: Priority Health SBD |
$199.95
|
| Rate for Payer: UMR Bronson Commercial |
$139.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.04
|
|
|
NICARDIPINE 50 MG/250 ML NS (IV PREMIX)
|
Facility
|
IP
|
$193.50
|
|
|
Service Code
|
NDC 9900-0008-64
|
| Hospital Charge Code |
180442
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$85.14 |
| Max. Negotiated Rate |
$174.15 |
| Rate for Payer: Aetna American Axle |
$125.78
|
| Rate for Payer: Aetna Commercial |
$164.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.78
|
| Rate for Payer: Cash Price |
$154.80
|
| Rate for Payer: Cofinity Commercial |
$135.45
|
| Rate for Payer: Cofinity Commercial |
$166.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.80
|
| Rate for Payer: Healthscope Commercial |
$174.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$164.48
|
| Rate for Payer: PHP Commercial |
$164.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.45
|
| Rate for Payer: Priority Health SBD |
$121.90
|
| Rate for Payer: UMR Bronson Commercial |
$85.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.12
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$88.31
|
|
|
Service Code
|
NDC 43598-447-74
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.86 |
| Max. Negotiated Rate |
$79.48 |
| Rate for Payer: Aetna American Axle |
$57.40
|
| Rate for Payer: Aetna Commercial |
$75.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.40
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cofinity Commercial |
$61.82
|
| Rate for Payer: Cofinity Commercial |
$75.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.65
|
| Rate for Payer: Healthscope Commercial |
$79.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.06
|
| Rate for Payer: PHP Commercial |
$75.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.82
|
| Rate for Payer: Priority Health SBD |
$55.64
|
| Rate for Payer: UMR Bronson Commercial |
$38.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.23
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$8.63
|
|
|
Service Code
|
NDC 60505-7062-0
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$7.77 |
| Rate for Payer: Aetna American Axle |
$5.61
|
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.61
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cofinity Commercial |
$6.04
|
| Rate for Payer: Cofinity Commercial |
$7.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.90
|
| Rate for Payer: Healthscope Commercial |
$7.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.34
|
| Rate for Payer: PHP Commercial |
$7.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.04
|
| Rate for Payer: Priority Health SBD |
$5.44
|
| Rate for Payer: UMR Bronson Commercial |
$3.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.47
|
|
