|
IRON POLYSACCH CPLX 150 MG IRON-VIT B12 25 MCG-FOLIC ACID 1 MG CAPSULE
|
Facility
|
OP
|
$2.68
|
|
|
Service Code
|
NDC 51991019899
|
| Hospital Charge Code |
28034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna American Axle |
$1.74
|
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: Aetna Medicare |
$1.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.74
|
| Rate for Payer: BCBS Complete |
$1.07
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cofinity Commercial |
$1.88
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Healthscope Commercial |
$2.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.28
|
| Rate for Payer: PHP Commercial |
$2.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.74
|
| Rate for Payer: Priority Health SBD |
$1.69
|
| Rate for Payer: UMR Bronson Commercial |
$0.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.01
|
|
|
IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$154.04
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
29132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.78 |
| Max. Negotiated Rate |
$138.64 |
| Rate for Payer: Aetna American Axle |
$100.13
|
| Rate for Payer: Aetna Commercial |
$130.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.13
|
| Rate for Payer: Cash Price |
$123.23
|
| Rate for Payer: Cofinity Commercial |
$107.83
|
| Rate for Payer: Cofinity Commercial |
$132.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.23
|
| Rate for Payer: Healthscope Commercial |
$138.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.93
|
| Rate for Payer: PHP Commercial |
$130.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.13
|
| Rate for Payer: Priority Health SBD |
$97.05
|
| Rate for Payer: UMR Bronson Commercial |
$67.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.53
|
|
|
IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$154.04
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
29132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$138.64 |
| Rate for Payer: Aetna American Axle |
$100.13
|
| Rate for Payer: Aetna Commercial |
$130.93
|
| Rate for Payer: Aetna Medicare |
$77.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.13
|
| Rate for Payer: BCBS Complete |
$61.62
|
| Rate for Payer: BCBS Trust/PPO |
$0.61
|
| Rate for Payer: BCN Commercial |
$0.61
|
| Rate for Payer: Cash Price |
$123.23
|
| Rate for Payer: Cash Price |
$123.23
|
| Rate for Payer: Cofinity Commercial |
$107.83
|
| Rate for Payer: Cofinity Commercial |
$132.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.23
|
| Rate for Payer: Healthscope Commercial |
$138.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.93
|
| Rate for Payer: PHP Commercial |
$130.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.13
|
| Rate for Payer: Priority Health SBD |
$97.05
|
| Rate for Payer: UMR Bronson Commercial |
$56.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.53
|
|
|
IRON SUCROSE 200 MG IRON/10 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$246.62
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
152314
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.51 |
| Max. Negotiated Rate |
$221.96 |
| Rate for Payer: Aetna American Axle |
$160.30
|
| Rate for Payer: Aetna Commercial |
$209.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.30
|
| Rate for Payer: Cash Price |
$197.30
|
| Rate for Payer: Cofinity Commercial |
$172.63
|
| Rate for Payer: Cofinity Commercial |
$212.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.30
|
| Rate for Payer: Healthscope Commercial |
$221.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.63
|
| Rate for Payer: PHP Commercial |
$209.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.30
|
| Rate for Payer: Priority Health SBD |
$155.37
|
| Rate for Payer: UMR Bronson Commercial |
$108.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.96
|
|
|
IRON SUCROSE 200 MG IRON/10 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$246.62
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
152314
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$221.96 |
| Rate for Payer: Aetna American Axle |
$160.30
|
| Rate for Payer: Aetna Commercial |
$209.63
|
| Rate for Payer: Aetna Medicare |
$123.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.30
|
| Rate for Payer: BCBS Complete |
$98.65
|
| Rate for Payer: BCBS Trust/PPO |
$0.61
|
| Rate for Payer: BCN Commercial |
$0.61
|
| Rate for Payer: Cash Price |
$197.30
|
| Rate for Payer: Cash Price |
$197.30
|
| Rate for Payer: Cofinity Commercial |
$172.63
|
| Rate for Payer: Cofinity Commercial |
$212.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.30
|
| Rate for Payer: Healthscope Commercial |
$221.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.63
|
| Rate for Payer: PHP Commercial |
$209.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.30
|
| Rate for Payer: Priority Health SBD |
$155.37
|
| Rate for Payer: UMR Bronson Commercial |
$91.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.96
|
|
|
IRON SUCROSE 50 MG IRON/2.5 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$82.79
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
152263
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$74.51 |
| Rate for Payer: Aetna American Axle |
$53.81
|
| Rate for Payer: Aetna Commercial |
$70.37
|
| Rate for Payer: Aetna Medicare |
$41.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.81
|
| Rate for Payer: BCBS Complete |
$33.12
|
| Rate for Payer: BCBS Trust/PPO |
$0.61
|
| Rate for Payer: BCN Commercial |
$0.61
|
| Rate for Payer: Cash Price |
$66.23
|
| Rate for Payer: Cash Price |
$66.23
|
| Rate for Payer: Cofinity Commercial |
$57.95
|
| Rate for Payer: Cofinity Commercial |
$71.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.23
|
| Rate for Payer: Healthscope Commercial |
$74.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.37
|
| Rate for Payer: PHP Commercial |
$70.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.81
|
| Rate for Payer: Priority Health SBD |
$52.16
|
| Rate for Payer: UMR Bronson Commercial |
$30.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.09
|
|
|
IRON SUCROSE 50 MG IRON/2.5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$82.79
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
152263
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.43 |
| Max. Negotiated Rate |
$74.51 |
| Rate for Payer: Aetna American Axle |
$53.81
|
| Rate for Payer: Aetna Commercial |
$70.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.81
|
| Rate for Payer: Cash Price |
$66.23
|
| Rate for Payer: Cofinity Commercial |
$57.95
|
| Rate for Payer: Cofinity Commercial |
$71.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.23
|
| Rate for Payer: Healthscope Commercial |
$74.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.37
|
| Rate for Payer: PHP Commercial |
$70.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.81
|
| Rate for Payer: Priority Health SBD |
$52.16
|
| Rate for Payer: UMR Bronson Commercial |
$36.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.09
|
|
|
ISAVUCONAZONIUM SULFATE 186 MG CAPSULE
|
Facility
|
OP
|
$386.57
|
|
|
Service Code
|
NDC 00469052001
|
| Hospital Charge Code |
174376
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.03 |
| Max. Negotiated Rate |
$347.91 |
| Rate for Payer: Aetna American Axle |
$251.27
|
| Rate for Payer: Aetna Commercial |
$328.58
|
| Rate for Payer: Aetna Medicare |
$193.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.27
|
| Rate for Payer: BCBS Complete |
$154.63
|
| Rate for Payer: Cash Price |
$309.26
|
| Rate for Payer: Cofinity Commercial |
$270.60
|
| Rate for Payer: Cofinity Commercial |
$332.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$270.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.26
|
| Rate for Payer: Healthscope Commercial |
$347.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$270.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.58
|
| Rate for Payer: PHP Commercial |
$328.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.27
|
| Rate for Payer: Priority Health SBD |
$243.54
|
| Rate for Payer: UMR Bronson Commercial |
$143.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.93
|
|
|
ISAVUCONAZONIUM SULFATE 186 MG CAPSULE
|
Facility
|
IP
|
$386.57
|
|
|
Service Code
|
NDC 00469052001
|
| Hospital Charge Code |
174376
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.09 |
| Max. Negotiated Rate |
$347.91 |
| Rate for Payer: Aetna American Axle |
$251.27
|
| Rate for Payer: Aetna Commercial |
$328.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.27
|
| Rate for Payer: Cash Price |
$309.26
|
| Rate for Payer: Cofinity Commercial |
$270.60
|
| Rate for Payer: Cofinity Commercial |
$332.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$270.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.26
|
| Rate for Payer: Healthscope Commercial |
$347.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$270.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.58
|
| Rate for Payer: PHP Commercial |
$328.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.27
|
| Rate for Payer: Priority Health SBD |
$243.54
|
| Rate for Payer: UMR Bronson Commercial |
$170.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.93
|
|
|
ISAVUCONAZONIUM SULFATE 186 MG CAPSULE
|
Facility
|
IP
|
$4,889.98
|
|
|
Service Code
|
NDC 00469052014
|
| Hospital Charge Code |
174376
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,151.59 |
| Max. Negotiated Rate |
$4,400.98 |
| Rate for Payer: Aetna American Axle |
$3,178.49
|
| Rate for Payer: Aetna Commercial |
$4,156.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,178.49
|
| Rate for Payer: Cash Price |
$3,911.98
|
| Rate for Payer: Cofinity Commercial |
$3,422.99
|
| Rate for Payer: Cofinity Commercial |
$4,205.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,422.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,911.98
|
| Rate for Payer: Healthscope Commercial |
$4,400.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,422.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,667.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,156.48
|
| Rate for Payer: PHP Commercial |
$4,156.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,178.49
|
| Rate for Payer: Priority Health SBD |
$3,080.69
|
| Rate for Payer: UMR Bronson Commercial |
$2,151.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,667.48
|
|
|
ISAVUCONAZONIUM SULFATE 186 MG CAPSULE
|
Facility
|
IP
|
$5,411.91
|
|
|
Service Code
|
NDC 00469052002
|
| Hospital Charge Code |
174376
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,381.24 |
| Max. Negotiated Rate |
$4,870.72 |
| Rate for Payer: Aetna American Axle |
$3,517.74
|
| Rate for Payer: Aetna Commercial |
$4,600.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,517.74
|
| Rate for Payer: Cash Price |
$4,329.53
|
| Rate for Payer: Cofinity Commercial |
$3,788.34
|
| Rate for Payer: Cofinity Commercial |
$4,654.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,788.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,329.53
|
| Rate for Payer: Healthscope Commercial |
$4,870.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,788.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,058.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,600.12
|
| Rate for Payer: PHP Commercial |
$4,600.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,517.74
|
| Rate for Payer: Priority Health SBD |
$3,409.50
|
| Rate for Payer: UMR Bronson Commercial |
$2,381.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,058.93
|
|
|
ISAVUCONAZONIUM SULFATE 186 MG CAPSULE
|
Facility
|
OP
|
$4,889.98
|
|
|
Service Code
|
NDC 00469052014
|
| Hospital Charge Code |
174376
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,809.29 |
| Max. Negotiated Rate |
$4,400.98 |
| Rate for Payer: Aetna American Axle |
$3,178.49
|
| Rate for Payer: Aetna Commercial |
$4,156.48
|
| Rate for Payer: Aetna Medicare |
$2,444.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,178.49
|
| Rate for Payer: BCBS Complete |
$1,955.99
|
| Rate for Payer: Cash Price |
$3,911.98
|
| Rate for Payer: Cofinity Commercial |
$3,422.99
|
| Rate for Payer: Cofinity Commercial |
$4,205.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,422.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,911.98
|
| Rate for Payer: Healthscope Commercial |
$4,400.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,422.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,667.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,156.48
|
| Rate for Payer: PHP Commercial |
$4,156.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,178.49
|
| Rate for Payer: Priority Health SBD |
$3,080.69
|
| Rate for Payer: UMR Bronson Commercial |
$1,809.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,667.48
|
|
|
ISAVUCONAZONIUM SULFATE 186 MG CAPSULE
|
Facility
|
OP
|
$5,411.91
|
|
|
Service Code
|
NDC 00469052002
|
| Hospital Charge Code |
174376
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,002.41 |
| Max. Negotiated Rate |
$4,870.72 |
| Rate for Payer: Aetna American Axle |
$3,517.74
|
| Rate for Payer: Aetna Commercial |
$4,600.12
|
| Rate for Payer: Aetna Medicare |
$2,705.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,517.74
|
| Rate for Payer: BCBS Complete |
$2,164.76
|
| Rate for Payer: Cash Price |
$4,329.53
|
| Rate for Payer: Cofinity Commercial |
$3,788.34
|
| Rate for Payer: Cofinity Commercial |
$4,654.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,788.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,329.53
|
| Rate for Payer: Healthscope Commercial |
$4,870.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,788.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,058.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,600.12
|
| Rate for Payer: PHP Commercial |
$4,600.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,517.74
|
| Rate for Payer: Priority Health SBD |
$3,409.50
|
| Rate for Payer: UMR Bronson Commercial |
$2,002.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,058.93
|
|
|
ISAVUCONAZONIUM SULFATE 74.5 MG CAPSULE
|
Facility
|
OP
|
$154.96
|
|
|
Service Code
|
NDC 00469286001
|
| Hospital Charge Code |
205375
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.34 |
| Max. Negotiated Rate |
$139.46 |
| Rate for Payer: Aetna American Axle |
$100.72
|
| Rate for Payer: Aetna Commercial |
$131.72
|
| Rate for Payer: Aetna Medicare |
$77.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.72
|
| Rate for Payer: BCBS Complete |
$61.98
|
| Rate for Payer: Cash Price |
$123.97
|
| Rate for Payer: Cofinity Commercial |
$108.47
|
| Rate for Payer: Cofinity Commercial |
$133.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.97
|
| Rate for Payer: Healthscope Commercial |
$139.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.72
|
| Rate for Payer: PHP Commercial |
$131.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.72
|
| Rate for Payer: Priority Health SBD |
$97.62
|
| Rate for Payer: UMR Bronson Commercial |
$57.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.22
|
|
|
ISAVUCONAZONIUM SULFATE 74.5 MG CAPSULE
|
Facility
|
IP
|
$5,423.34
|
|
|
Service Code
|
NDC 00469286035
|
| Hospital Charge Code |
205375
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,386.27 |
| Max. Negotiated Rate |
$4,881.01 |
| Rate for Payer: Aetna American Axle |
$3,525.17
|
| Rate for Payer: Aetna Commercial |
$4,609.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,525.17
|
| Rate for Payer: Cash Price |
$4,338.67
|
| Rate for Payer: Cofinity Commercial |
$3,796.34
|
| Rate for Payer: Cofinity Commercial |
$4,664.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,796.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,338.67
|
| Rate for Payer: Healthscope Commercial |
$4,881.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,796.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,067.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,609.84
|
| Rate for Payer: PHP Commercial |
$4,609.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,525.17
|
| Rate for Payer: Priority Health SBD |
$3,416.70
|
| Rate for Payer: UMR Bronson Commercial |
$2,386.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,067.50
|
|
|
ISAVUCONAZONIUM SULFATE 74.5 MG CAPSULE
|
Facility
|
IP
|
$154.96
|
|
|
Service Code
|
NDC 00469286001
|
| Hospital Charge Code |
205375
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.18 |
| Max. Negotiated Rate |
$139.46 |
| Rate for Payer: Aetna American Axle |
$100.72
|
| Rate for Payer: Aetna Commercial |
$131.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.72
|
| Rate for Payer: Cash Price |
$123.97
|
| Rate for Payer: Cofinity Commercial |
$108.47
|
| Rate for Payer: Cofinity Commercial |
$133.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.97
|
| Rate for Payer: Healthscope Commercial |
$139.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.72
|
| Rate for Payer: PHP Commercial |
$131.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.72
|
| Rate for Payer: Priority Health SBD |
$97.62
|
| Rate for Payer: UMR Bronson Commercial |
$68.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.22
|
|
|
ISAVUCONAZONIUM SULFATE 74.5 MG CAPSULE
|
Facility
|
OP
|
$5,423.34
|
|
|
Service Code
|
NDC 00469286035
|
| Hospital Charge Code |
205375
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,006.64 |
| Max. Negotiated Rate |
$4,881.01 |
| Rate for Payer: Cash Price |
$4,338.67
|
| Rate for Payer: Cofinity Commercial |
$3,796.34
|
| Rate for Payer: Cofinity Commercial |
$4,664.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,796.34
|
| Rate for Payer: Aetna American Axle |
$3,525.17
|
| Rate for Payer: Aetna Commercial |
$4,609.84
|
| Rate for Payer: Aetna Medicare |
$2,711.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,525.17
|
| Rate for Payer: BCBS Complete |
$2,169.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,338.67
|
| Rate for Payer: Healthscope Commercial |
$4,881.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,796.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,067.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,609.84
|
| Rate for Payer: PHP Commercial |
$4,609.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,525.17
|
| Rate for Payer: Priority Health SBD |
$3,416.70
|
| Rate for Payer: UMR Bronson Commercial |
$2,006.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,067.50
|
|
|
ISOFLURANE 99.9 % INHALATION LIQUID
|
Facility
|
OP
|
$106.38
|
|
|
Service Code
|
NDC 66794001725
|
| Hospital Charge Code |
159360
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$39.36 |
| Max. Negotiated Rate |
$95.74 |
| Rate for Payer: Aetna American Axle |
$69.15
|
| Rate for Payer: Aetna Commercial |
$90.42
|
| Rate for Payer: Aetna Medicare |
$53.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.15
|
| Rate for Payer: BCBS Complete |
$42.55
|
| Rate for Payer: Cash Price |
$85.10
|
| Rate for Payer: Cofinity Commercial |
$74.47
|
| Rate for Payer: Cofinity Commercial |
$91.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.10
|
| Rate for Payer: Healthscope Commercial |
$95.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.42
|
| Rate for Payer: PHP Commercial |
$90.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.15
|
| Rate for Payer: Priority Health SBD |
$67.02
|
| Rate for Payer: UMR Bronson Commercial |
$39.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.78
|
|
|
ISOFLURANE 99.9 % INHALATION LIQUID
|
Facility
|
IP
|
$106.38
|
|
|
Service Code
|
NDC 66794001725
|
| Hospital Charge Code |
159360
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.81 |
| Max. Negotiated Rate |
$95.74 |
| Rate for Payer: Aetna American Axle |
$69.15
|
| Rate for Payer: Aetna Commercial |
$90.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.15
|
| Rate for Payer: Cash Price |
$85.10
|
| Rate for Payer: Cofinity Commercial |
$74.47
|
| Rate for Payer: Cofinity Commercial |
$91.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.10
|
| Rate for Payer: Healthscope Commercial |
$95.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.42
|
| Rate for Payer: PHP Commercial |
$90.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.15
|
| Rate for Payer: Priority Health SBD |
$67.02
|
| Rate for Payer: UMR Bronson Commercial |
$46.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.78
|
|
|
ISOFLURANE 99.9 % INHALATION LIQUID
|
Facility
|
IP
|
$190.55
|
|
|
Service Code
|
NDC 10019036060
|
| Hospital Charge Code |
159360
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$83.84 |
| Max. Negotiated Rate |
$171.50 |
| Rate for Payer: Aetna American Axle |
$123.86
|
| Rate for Payer: Aetna Commercial |
$161.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.86
|
| Rate for Payer: Cash Price |
$152.44
|
| Rate for Payer: Cofinity Commercial |
$133.38
|
| Rate for Payer: Cofinity Commercial |
$163.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$133.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.44
|
| Rate for Payer: Healthscope Commercial |
$171.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.97
|
| Rate for Payer: PHP Commercial |
$161.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.86
|
| Rate for Payer: Priority Health SBD |
$120.05
|
| Rate for Payer: UMR Bronson Commercial |
$83.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.91
|
|
|
ISOFLURANE 99.9 % INHALATION LIQUID
|
Facility
|
OP
|
$190.55
|
|
|
Service Code
|
NDC 10019036060
|
| Hospital Charge Code |
159360
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$70.50 |
| Max. Negotiated Rate |
$171.50 |
| Rate for Payer: Aetna American Axle |
$123.86
|
| Rate for Payer: Aetna Commercial |
$161.97
|
| Rate for Payer: Aetna Medicare |
$95.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.86
|
| Rate for Payer: BCBS Complete |
$76.22
|
| Rate for Payer: Cash Price |
$152.44
|
| Rate for Payer: Cofinity Commercial |
$133.38
|
| Rate for Payer: Cofinity Commercial |
$163.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$133.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.44
|
| Rate for Payer: Healthscope Commercial |
$171.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.97
|
| Rate for Payer: PHP Commercial |
$161.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.86
|
| Rate for Payer: Priority Health SBD |
$120.05
|
| Rate for Payer: UMR Bronson Commercial |
$70.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.91
|
|
|
ISOFLURANE 99.9 % INHALATION LIQUID
|
Facility
|
OP
|
$106.38
|
|
|
Service Code
|
NDC 66794001925
|
| Hospital Charge Code |
159360
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$39.36 |
| Max. Negotiated Rate |
$95.74 |
| Rate for Payer: Aetna American Axle |
$69.15
|
| Rate for Payer: Aetna Commercial |
$90.42
|
| Rate for Payer: Aetna Medicare |
$53.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.15
|
| Rate for Payer: BCBS Complete |
$42.55
|
| Rate for Payer: Cash Price |
$85.10
|
| Rate for Payer: Cofinity Commercial |
$74.47
|
| Rate for Payer: Cofinity Commercial |
$91.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.10
|
| Rate for Payer: Healthscope Commercial |
$95.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.42
|
| Rate for Payer: PHP Commercial |
$90.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.15
|
| Rate for Payer: Priority Health SBD |
$67.02
|
| Rate for Payer: UMR Bronson Commercial |
$39.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.78
|
|
|
ISOFLURANE 99.9 % INHALATION LIQUID
|
Facility
|
IP
|
$106.38
|
|
|
Service Code
|
NDC 66794001925
|
| Hospital Charge Code |
159360
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.81 |
| Max. Negotiated Rate |
$95.74 |
| Rate for Payer: Aetna American Axle |
$69.15
|
| Rate for Payer: Aetna Commercial |
$90.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.15
|
| Rate for Payer: Cash Price |
$85.10
|
| Rate for Payer: Cofinity Commercial |
$74.47
|
| Rate for Payer: Cofinity Commercial |
$91.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.10
|
| Rate for Payer: Healthscope Commercial |
$95.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.42
|
| Rate for Payer: PHP Commercial |
$90.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.15
|
| Rate for Payer: Priority Health SBD |
$67.02
|
| Rate for Payer: UMR Bronson Commercial |
$46.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.78
|
|
|
ISONIAZID 300 MG TABLET
|
Facility
|
OP
|
$4.27
|
|
|
Service Code
|
NDC 60687055311
|
| Hospital Charge Code |
4027
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$3.84 |
| Rate for Payer: Aetna American Axle |
$2.78
|
| Rate for Payer: Aetna Commercial |
$3.63
|
| Rate for Payer: Aetna Medicare |
$2.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.78
|
| Rate for Payer: BCBS Complete |
$1.71
|
| Rate for Payer: Cash Price |
$3.42
|
| Rate for Payer: Cofinity Commercial |
$2.99
|
| Rate for Payer: Cofinity Commercial |
$3.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.42
|
| Rate for Payer: Healthscope Commercial |
$3.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.63
|
| Rate for Payer: PHP Commercial |
$3.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.78
|
| Rate for Payer: Priority Health SBD |
$2.69
|
| Rate for Payer: UMR Bronson Commercial |
$1.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.20
|
|
|
ISONIAZID 300 MG TABLET
|
Facility
|
IP
|
$426.72
|
|
|
Service Code
|
NDC 60687055301
|
| Hospital Charge Code |
4027
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$187.76 |
| Max. Negotiated Rate |
$384.05 |
| Rate for Payer: Aetna American Axle |
$277.37
|
| Rate for Payer: Aetna Commercial |
$362.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.37
|
| Rate for Payer: Cash Price |
$341.38
|
| Rate for Payer: Cofinity Commercial |
$298.70
|
| Rate for Payer: Cofinity Commercial |
$366.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$298.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$341.38
|
| Rate for Payer: Healthscope Commercial |
$384.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$298.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$320.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$362.71
|
| Rate for Payer: PHP Commercial |
$362.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.37
|
| Rate for Payer: Priority Health SBD |
$268.83
|
| Rate for Payer: UMR Bronson Commercial |
$187.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$320.04
|
|
