|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$107.05
|
|
|
Service Code
|
NDC 0409-3375-04
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.10 |
| Max. Negotiated Rate |
$96.34 |
| Rate for Payer: Aetna American Axle |
$69.58
|
| Rate for Payer: Aetna Commercial |
$90.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.58
|
| Rate for Payer: Cash Price |
$85.64
|
| Rate for Payer: Cofinity Commercial |
$74.94
|
| Rate for Payer: Cofinity Commercial |
$92.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.64
|
| Rate for Payer: Healthscope Commercial |
$96.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$90.99
|
| Rate for Payer: PHP Commercial |
$90.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.94
|
| Rate for Payer: Priority Health SBD |
$67.44
|
| Rate for Payer: UMR Bronson Commercial |
$47.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.29
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$74.59
|
|
|
Service Code
|
NDC 0703-1153-01
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.82 |
| Max. Negotiated Rate |
$67.13 |
| Rate for Payer: Aetna American Axle |
$48.48
|
| Rate for Payer: Aetna Commercial |
$63.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.48
|
| Rate for Payer: Cash Price |
$59.67
|
| Rate for Payer: Cofinity Commercial |
$52.21
|
| Rate for Payer: Cofinity Commercial |
$64.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.67
|
| Rate for Payer: Healthscope Commercial |
$67.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.40
|
| Rate for Payer: PHP Commercial |
$63.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.21
|
| Rate for Payer: Priority Health SBD |
$46.99
|
| Rate for Payer: UMR Bronson Commercial |
$32.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.94
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$36.17
|
|
|
Service Code
|
NDC 47335-615-44
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$32.55 |
| Rate for Payer: Aetna American Axle |
$23.51
|
| Rate for Payer: Aetna Commercial |
$30.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.51
|
| Rate for Payer: Cash Price |
$28.94
|
| Rate for Payer: Cofinity Commercial |
$25.32
|
| Rate for Payer: Cofinity Commercial |
$31.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.94
|
| Rate for Payer: Healthscope Commercial |
$32.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.74
|
| Rate for Payer: PHP Commercial |
$30.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.32
|
| Rate for Payer: Priority Health SBD |
$22.79
|
| Rate for Payer: UMR Bronson Commercial |
$15.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.13
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$20.25
|
|
|
Service Code
|
NDC 36000-162-10
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.91 |
| Max. Negotiated Rate |
$18.22 |
| Rate for Payer: Aetna American Axle |
$13.16
|
| Rate for Payer: Aetna Commercial |
$17.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.16
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cofinity Commercial |
$14.18
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.20
|
| Rate for Payer: Healthscope Commercial |
$18.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.21
|
| Rate for Payer: PHP Commercial |
$17.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.18
|
| Rate for Payer: Priority Health SBD |
$12.76
|
| Rate for Payer: UMR Bronson Commercial |
$8.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.19
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$107.05
|
|
|
Service Code
|
NDC 0409-3375-14
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.10 |
| Max. Negotiated Rate |
$96.34 |
| Rate for Payer: Aetna American Axle |
$69.58
|
| Rate for Payer: Aetna Commercial |
$90.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.58
|
| Rate for Payer: Cash Price |
$85.64
|
| Rate for Payer: Cofinity Commercial |
$74.94
|
| Rate for Payer: Cofinity Commercial |
$92.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.64
|
| Rate for Payer: Healthscope Commercial |
$96.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$90.99
|
| Rate for Payer: PHP Commercial |
$90.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.94
|
| Rate for Payer: Priority Health SBD |
$67.44
|
| Rate for Payer: UMR Bronson Commercial |
$47.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.29
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$20.78
|
|
|
Service Code
|
NDC 63323-940-04
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.14 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Aetna American Axle |
$13.51
|
| Rate for Payer: Aetna Commercial |
$17.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.51
|
| Rate for Payer: Cash Price |
$16.62
|
| Rate for Payer: Cofinity Commercial |
$14.55
|
| Rate for Payer: Cofinity Commercial |
$17.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.62
|
| Rate for Payer: Healthscope Commercial |
$18.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.66
|
| Rate for Payer: PHP Commercial |
$17.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.55
|
| Rate for Payer: Priority Health SBD |
$13.09
|
| Rate for Payer: UMR Bronson Commercial |
$9.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.58
|
|
|
NORETHINDRONE ACETATE 5 MG TABLET
|
Facility
|
IP
|
$133.92
|
|
|
Service Code
|
NDC 68462-304-50
|
| Hospital Charge Code |
10747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.92 |
| Max. Negotiated Rate |
$120.53 |
| Rate for Payer: Aetna American Axle |
$87.05
|
| Rate for Payer: Aetna Commercial |
$113.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.05
|
| Rate for Payer: Cash Price |
$107.14
|
| Rate for Payer: Cofinity Commercial |
$115.17
|
| Rate for Payer: Cofinity Commercial |
$93.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.14
|
| Rate for Payer: Healthscope Commercial |
$120.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$113.83
|
| Rate for Payer: PHP Commercial |
$113.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.74
|
| Rate for Payer: Priority Health SBD |
$84.37
|
| Rate for Payer: UMR Bronson Commercial |
$58.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.44
|
|
|
NORGESTIMATE 0.25 MG-ETHINYL ESTRADIOL 35 MCG TABLET
|
Facility
|
IP
|
$27.67
|
|
|
Service Code
|
NDC 0555-9016-58
|
| Hospital Charge Code |
10749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.17 |
| Max. Negotiated Rate |
$24.90 |
| Rate for Payer: Aetna American Axle |
$17.99
|
| Rate for Payer: Aetna Commercial |
$23.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.99
|
| Rate for Payer: Cash Price |
$22.14
|
| Rate for Payer: Cofinity Commercial |
$19.37
|
| Rate for Payer: Cofinity Commercial |
$23.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.14
|
| Rate for Payer: Healthscope Commercial |
$24.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.52
|
| Rate for Payer: PHP Commercial |
$23.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.37
|
| Rate for Payer: Priority Health SBD |
$17.43
|
| Rate for Payer: UMR Bronson Commercial |
$12.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.75
|
|
|
NORGESTIMATE-ETHINYL ESTRADIOL 0.18 MG/0.215MG/0.25MG-35 MCG(28)TABLET
|
Facility
|
IP
|
$93.28
|
|
|
Service Code
|
NDC 0555-9018-58
|
| Hospital Charge Code |
10750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.04 |
| Max. Negotiated Rate |
$83.95 |
| Rate for Payer: Aetna American Axle |
$60.63
|
| Rate for Payer: Aetna Commercial |
$79.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.63
|
| Rate for Payer: Cash Price |
$74.62
|
| Rate for Payer: Cofinity Commercial |
$65.30
|
| Rate for Payer: Cofinity Commercial |
$80.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.62
|
| Rate for Payer: Healthscope Commercial |
$83.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$79.29
|
| Rate for Payer: PHP Commercial |
$79.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.30
|
| Rate for Payer: Priority Health SBD |
$58.77
|
| Rate for Payer: UMR Bronson Commercial |
$41.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.96
|
|
|
NORMAL NEWBORN
|
Facility
|
IP
|
$3,076.73
|
|
|
Service Code
|
MS-DRG 795
|
| Min. Negotiated Rate |
$1,963.33 |
| Max. Negotiated Rate |
$3,076.73 |
| Rate for Payer: Aetna Medicare |
$2,149.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,583.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,583.32
|
| Rate for Payer: BCBS MAPPO |
$2,066.66
|
| Rate for Payer: BCBS Trust/PPO |
$2,749.11
|
| Rate for Payer: BCN Medicare Advantage |
$2,066.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,066.66
|
| Rate for Payer: Mclaren Medicare |
$2,066.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,169.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,376.66
|
| Rate for Payer: PACE Medicare |
$1,963.33
|
| Rate for Payer: PACE SWMI |
$2,066.66
|
| Rate for Payer: PHP Medicare Advantage |
$2,066.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,894.38
|
| Rate for Payer: Priority Health Medicare |
$2,066.66
|
| Rate for Payer: Priority Health Narrow Network |
$2,315.50
|
| Rate for Payer: Railroad Medicare Medicare |
$2,066.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,076.73
|
| Rate for Payer: UHC Core |
$2,522.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,066.66
|
| Rate for Payer: UHC Exchange |
$2,005.70
|
| Rate for Payer: UHC Medicare Advantage |
$2,128.66
|
| Rate for Payer: VA VA |
$2,066.66
|
|
|
NORTRIPTYLINE 10 MG CAPSULE
|
Facility
|
IP
|
$227.95
|
|
|
Service Code
|
NDC 51672-4001-1
|
| Hospital Charge Code |
5674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.30 |
| Max. Negotiated Rate |
$205.16 |
| Rate for Payer: Aetna American Axle |
$148.17
|
| Rate for Payer: Aetna Commercial |
$193.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.17
|
| Rate for Payer: Cash Price |
$182.36
|
| Rate for Payer: Cofinity Commercial |
$159.56
|
| Rate for Payer: Cofinity Commercial |
$196.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.36
|
| Rate for Payer: Healthscope Commercial |
$205.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$159.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$193.76
|
| Rate for Payer: PHP Commercial |
$193.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.56
|
| Rate for Payer: Priority Health SBD |
$143.61
|
| Rate for Payer: UMR Bronson Commercial |
$100.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.96
|
|
|
NORTRIPTYLINE 10 MG CAPSULE
|
Facility
|
IP
|
$434.75
|
|
|
Service Code
|
NDC 51862-945-01
|
| Hospital Charge Code |
5674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$191.29 |
| Max. Negotiated Rate |
$391.28 |
| Rate for Payer: Aetna American Axle |
$282.59
|
| Rate for Payer: Aetna Commercial |
$369.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$282.59
|
| Rate for Payer: Cash Price |
$347.80
|
| Rate for Payer: Cofinity Commercial |
$304.32
|
| Rate for Payer: Cofinity Commercial |
$373.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.80
|
| Rate for Payer: Healthscope Commercial |
$391.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$304.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$326.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$369.54
|
| Rate for Payer: PHP Commercial |
$369.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$304.32
|
| Rate for Payer: Priority Health SBD |
$273.89
|
| Rate for Payer: UMR Bronson Commercial |
$191.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$326.06
|
|
|
NORTRIPTYLINE 25 MG CAPSULE
|
Facility
|
IP
|
$202.10
|
|
|
Service Code
|
NDC 51672-4002-1
|
| Hospital Charge Code |
5675
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.92 |
| Max. Negotiated Rate |
$181.89 |
| Rate for Payer: Aetna American Axle |
$131.36
|
| Rate for Payer: Aetna Commercial |
$171.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.36
|
| Rate for Payer: Cash Price |
$161.68
|
| Rate for Payer: Cofinity Commercial |
$141.47
|
| Rate for Payer: Cofinity Commercial |
$173.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.68
|
| Rate for Payer: Healthscope Commercial |
$181.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$141.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$171.78
|
| Rate for Payer: PHP Commercial |
$171.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.47
|
| Rate for Payer: Priority Health SBD |
$127.32
|
| Rate for Payer: UMR Bronson Commercial |
$88.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.58
|
|
|
NORTRIPTYLINE 25 MG CAPSULE
|
Facility
|
IP
|
$240.35
|
|
|
Service Code
|
NDC 0093-0811-01
|
| Hospital Charge Code |
5675
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.75 |
| Max. Negotiated Rate |
$216.32 |
| Rate for Payer: Aetna American Axle |
$156.23
|
| Rate for Payer: Aetna Commercial |
$204.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.23
|
| Rate for Payer: Cash Price |
$192.28
|
| Rate for Payer: Cofinity Commercial |
$168.24
|
| Rate for Payer: Cofinity Commercial |
$206.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.28
|
| Rate for Payer: Healthscope Commercial |
$216.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$168.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$204.30
|
| Rate for Payer: PHP Commercial |
$204.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.24
|
| Rate for Payer: Priority Health SBD |
$151.42
|
| Rate for Payer: UMR Bronson Commercial |
$105.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.26
|
|
|
NORTRIPTYLINE 25 MG CAPSULE
|
Facility
|
IP
|
$281.30
|
|
|
Service Code
|
NDC 51672-4002-5
|
| Hospital Charge Code |
5675
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.77 |
| Max. Negotiated Rate |
$253.17 |
| Rate for Payer: Aetna American Axle |
$182.84
|
| Rate for Payer: Aetna Commercial |
$239.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.84
|
| Rate for Payer: Cash Price |
$225.04
|
| Rate for Payer: Cofinity Commercial |
$196.91
|
| Rate for Payer: Cofinity Commercial |
$241.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.04
|
| Rate for Payer: Healthscope Commercial |
$253.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$239.10
|
| Rate for Payer: PHP Commercial |
$239.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.91
|
| Rate for Payer: Priority Health SBD |
$177.22
|
| Rate for Payer: UMR Bronson Commercial |
$123.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.98
|
|
|
NOVASOURCE RENAL BOLUS FEED
|
Facility
|
IP
|
$6.83
|
|
|
Service Code
|
NDC 4390035111
|
| Hospital Charge Code |
150853
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$6.15 |
| Rate for Payer: Aetna American Axle |
$4.44
|
| Rate for Payer: Aetna Commercial |
$5.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.44
|
| Rate for Payer: Cash Price |
$5.46
|
| Rate for Payer: Cofinity Commercial |
$4.78
|
| Rate for Payer: Cofinity Commercial |
$5.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.46
|
| Rate for Payer: Healthscope Commercial |
$6.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.81
|
| Rate for Payer: PHP Commercial |
$5.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.78
|
| Rate for Payer: Priority Health SBD |
$4.30
|
| Rate for Payer: UMR Bronson Commercial |
$3.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.12
|
|
|
NOVASOURCE RENAL CONTINUOUS FEED
|
Facility
|
IP
|
$6.83
|
|
|
Service Code
|
NDC 4390035111
|
| Hospital Charge Code |
168945
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$6.15 |
| Rate for Payer: Aetna American Axle |
$4.44
|
| Rate for Payer: Aetna Commercial |
$5.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.44
|
| Rate for Payer: Cash Price |
$5.46
|
| Rate for Payer: Cofinity Commercial |
$4.78
|
| Rate for Payer: Cofinity Commercial |
$5.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.46
|
| Rate for Payer: Healthscope Commercial |
$6.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.81
|
| Rate for Payer: PHP Commercial |
$5.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.78
|
| Rate for Payer: Priority Health SBD |
$4.30
|
| Rate for Payer: UMR Bronson Commercial |
$3.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.12
|
|
|
NOVASOURCE RENAL CYCLIC FEED
|
Facility
|
IP
|
$6.83
|
|
|
Service Code
|
NDC 4390035111
|
| Hospital Charge Code |
200087
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$6.15 |
| Rate for Payer: Aetna American Axle |
$4.44
|
| Rate for Payer: Aetna Commercial |
$5.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.44
|
| Rate for Payer: Cash Price |
$5.46
|
| Rate for Payer: Cofinity Commercial |
$4.78
|
| Rate for Payer: Cofinity Commercial |
$5.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.46
|
| Rate for Payer: Healthscope Commercial |
$6.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.81
|
| Rate for Payer: PHP Commercial |
$5.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.78
|
| Rate for Payer: Priority Health SBD |
$4.30
|
| Rate for Payer: UMR Bronson Commercial |
$3.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.12
|
|
|
NOVASOURCE RENAL INTERMITTENT FEED
|
Facility
|
IP
|
$6.83
|
|
|
Service Code
|
NDC 4390035111
|
| Hospital Charge Code |
200086
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$6.15 |
| Rate for Payer: Aetna American Axle |
$4.44
|
| Rate for Payer: Aetna Commercial |
$5.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.44
|
| Rate for Payer: Cash Price |
$5.46
|
| Rate for Payer: Cofinity Commercial |
$4.78
|
| Rate for Payer: Cofinity Commercial |
$5.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.46
|
| Rate for Payer: Healthscope Commercial |
$6.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.81
|
| Rate for Payer: PHP Commercial |
$5.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.78
|
| Rate for Payer: Priority Health SBD |
$4.30
|
| Rate for Payer: UMR Bronson Commercial |
$3.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.12
|
|
|
NURSING CASE MANAGEMENT
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
HCPCS RN001
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: BCBS Complete |
$10.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
| Rate for Payer: UMR Bronson Commercial |
$11.50
|
|
|
NUTREN 1.5 BOLUS FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 9871606220
|
| Hospital Charge Code |
180645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna American Axle |
$3.09
|
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$3.32
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.04
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.32
|
| Rate for Payer: Priority Health SBD |
$2.99
|
| Rate for Payer: UMR Bronson Commercial |
$2.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
|
NUTREN 1.5 BOLUS FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 9871616220
|
| Hospital Charge Code |
180645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna American Axle |
$3.09
|
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$3.32
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.04
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.32
|
| Rate for Payer: Priority Health SBD |
$2.99
|
| Rate for Payer: UMR Bronson Commercial |
$2.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
|
NUTREN 1.5 CONTINUOUS FEED
|
Facility
|
IP
|
$9.60
|
|
|
Service Code
|
NDC 9871616354
|
| Hospital Charge Code |
181405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna American Axle |
$6.24
|
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.24
|
| Rate for Payer: Cash Price |
$7.68
|
| Rate for Payer: Cofinity Commercial |
$6.72
|
| Rate for Payer: Cofinity Commercial |
$8.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.68
|
| Rate for Payer: Healthscope Commercial |
$8.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.16
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.72
|
| Rate for Payer: Priority Health SBD |
$6.05
|
| Rate for Payer: UMR Bronson Commercial |
$4.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.20
|
|
|
NUTREN 1.5 CYCLIC FEED
|
Facility
|
IP
|
$9.60
|
|
|
Service Code
|
NDC 9871616354
|
| Hospital Charge Code |
200083
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna American Axle |
$6.24
|
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.24
|
| Rate for Payer: Cash Price |
$7.68
|
| Rate for Payer: Cofinity Commercial |
$6.72
|
| Rate for Payer: Cofinity Commercial |
$8.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.68
|
| Rate for Payer: Healthscope Commercial |
$8.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.16
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.72
|
| Rate for Payer: Priority Health SBD |
$6.05
|
| Rate for Payer: UMR Bronson Commercial |
$4.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.20
|
|
|
NUTREN 1.5 INTERMITTENT FEED
|
Facility
|
IP
|
$9.60
|
|
|
Service Code
|
NDC 9871616354
|
| Hospital Charge Code |
200082
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna American Axle |
$6.24
|
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.24
|
| Rate for Payer: Cash Price |
$7.68
|
| Rate for Payer: Cofinity Commercial |
$6.72
|
| Rate for Payer: Cofinity Commercial |
$8.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.68
|
| Rate for Payer: Healthscope Commercial |
$8.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.16
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.72
|
| Rate for Payer: Priority Health SBD |
$6.05
|
| Rate for Payer: UMR Bronson Commercial |
$4.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.20
|
|
