|
ITRACONAZOLE 100 MG CAPSULE
|
Facility
|
IP
|
$182.27
|
|
|
Service Code
|
NDC 50268045012
|
| Hospital Charge Code |
10364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.20 |
| Max. Negotiated Rate |
$164.04 |
| Rate for Payer: Aetna American Axle |
$118.48
|
| Rate for Payer: Aetna Commercial |
$154.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.48
|
| Rate for Payer: Cash Price |
$145.82
|
| Rate for Payer: Cofinity Commercial |
$127.59
|
| Rate for Payer: Cofinity Commercial |
$156.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$127.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.82
|
| Rate for Payer: Healthscope Commercial |
$164.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.93
|
| Rate for Payer: PHP Commercial |
$154.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.48
|
| Rate for Payer: Priority Health SBD |
$114.83
|
| Rate for Payer: UMR Bronson Commercial |
$80.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.70
|
|
|
ITRACONAZOLE 100 MG CAPSULE
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
NDC 67877045430
|
| Hospital Charge Code |
10364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.91 |
| Max. Negotiated Rate |
$128.70 |
| Rate for Payer: Aetna American Axle |
$92.95
|
| Rate for Payer: Aetna Commercial |
$121.55
|
| Rate for Payer: Aetna Medicare |
$71.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.95
|
| Rate for Payer: BCBS Complete |
$57.20
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cofinity Commercial |
$100.10
|
| Rate for Payer: Cofinity Commercial |
$122.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.40
|
| Rate for Payer: Healthscope Commercial |
$128.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.55
|
| Rate for Payer: PHP Commercial |
$121.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.95
|
| Rate for Payer: Priority Health SBD |
$90.09
|
| Rate for Payer: UMR Bronson Commercial |
$52.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.25
|
|
|
ITRACONAZOLE 100 MG CAPSULE
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
NDC 67877045430
|
| Hospital Charge Code |
10364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.92 |
| Max. Negotiated Rate |
$128.70 |
| Rate for Payer: Aetna American Axle |
$92.95
|
| Rate for Payer: Aetna Commercial |
$121.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.95
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cofinity Commercial |
$100.10
|
| Rate for Payer: Cofinity Commercial |
$122.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.40
|
| Rate for Payer: Healthscope Commercial |
$128.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.55
|
| Rate for Payer: PHP Commercial |
$121.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.95
|
| Rate for Payer: Priority Health SBD |
$90.09
|
| Rate for Payer: UMR Bronson Commercial |
$62.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.25
|
|
|
ITRACONAZOLE 100 MG CAPSULE
|
Facility
|
OP
|
$9.12
|
|
|
Service Code
|
NDC 50268045011
|
| Hospital Charge Code |
10364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$8.21 |
| Rate for Payer: Aetna American Axle |
$5.93
|
| Rate for Payer: Aetna Commercial |
$7.75
|
| Rate for Payer: Aetna Medicare |
$4.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.93
|
| Rate for Payer: BCBS Complete |
$3.65
|
| Rate for Payer: Cash Price |
$7.30
|
| Rate for Payer: Cofinity Commercial |
$6.38
|
| Rate for Payer: Cofinity Commercial |
$7.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.30
|
| Rate for Payer: Healthscope Commercial |
$8.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.75
|
| Rate for Payer: PHP Commercial |
$7.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.93
|
| Rate for Payer: Priority Health SBD |
$5.75
|
| Rate for Payer: UMR Bronson Commercial |
$3.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.84
|
|
|
ITRACONAZOLE 100 MG CAPSULE
|
Facility
|
IP
|
$9.12
|
|
|
Service Code
|
NDC 50268045011
|
| Hospital Charge Code |
10364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$8.21 |
| Rate for Payer: Aetna American Axle |
$5.93
|
| Rate for Payer: Aetna Commercial |
$7.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.93
|
| Rate for Payer: Cash Price |
$7.30
|
| Rate for Payer: Cofinity Commercial |
$6.38
|
| Rate for Payer: Cofinity Commercial |
$7.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.30
|
| Rate for Payer: Healthscope Commercial |
$8.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.75
|
| Rate for Payer: PHP Commercial |
$7.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.93
|
| Rate for Payer: Priority Health SBD |
$5.75
|
| Rate for Payer: UMR Bronson Commercial |
$4.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.84
|
|
|
ITRACONAZOLE 100 MG CAPSULE
|
Facility
|
IP
|
$227.96
|
|
|
Service Code
|
NDC 13668046330
|
| Hospital Charge Code |
10364
|
|
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 |
$193.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.17
|
| Rate for Payer: Cash Price |
$182.37
|
| Rate for Payer: Cofinity Commercial |
$159.57
|
| Rate for Payer: Cofinity Commercial |
$196.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$159.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.37
|
| Rate for Payer: Healthscope Commercial |
$205.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$159.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.77
|
| Rate for Payer: PHP Commercial |
$193.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.17
|
| 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 |
$170.97
|
|
|
ITRACONAZOLE 100 MG CAPSULE
|
Facility
|
OP
|
$227.96
|
|
|
Service Code
|
NDC 13668046330
|
| Hospital Charge Code |
10364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.35 |
| Max. Negotiated Rate |
$205.16 |
| Rate for Payer: Aetna American Axle |
$148.17
|
| Rate for Payer: Aetna Commercial |
$193.77
|
| Rate for Payer: Aetna Medicare |
$113.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.17
|
| Rate for Payer: BCBS Complete |
$91.18
|
| Rate for Payer: Cash Price |
$182.37
|
| Rate for Payer: Cofinity Commercial |
$159.57
|
| Rate for Payer: Cofinity Commercial |
$196.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$159.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.37
|
| Rate for Payer: Healthscope Commercial |
$205.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$159.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.77
|
| Rate for Payer: PHP Commercial |
$193.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.17
|
| Rate for Payer: Priority Health SBD |
$143.61
|
| Rate for Payer: UMR Bronson Commercial |
$84.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.97
|
|
|
ITRACONAZOLE 100 MG CAPSULE
|
Facility
|
OP
|
$766.13
|
|
|
Service Code
|
NDC 10147170003
|
| Hospital Charge Code |
10364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$283.47 |
| Max. Negotiated Rate |
$689.52 |
| Rate for Payer: Aetna American Axle |
$497.98
|
| Rate for Payer: Aetna Commercial |
$651.21
|
| Rate for Payer: Aetna Medicare |
$383.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$497.98
|
| Rate for Payer: BCBS Complete |
$306.45
|
| Rate for Payer: Cash Price |
$612.90
|
| Rate for Payer: Cofinity Commercial |
$536.29
|
| Rate for Payer: Cofinity Commercial |
$658.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$536.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$612.90
|
| Rate for Payer: Healthscope Commercial |
$689.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$536.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$574.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$651.21
|
| Rate for Payer: PHP Commercial |
$651.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.98
|
| Rate for Payer: Priority Health SBD |
$482.66
|
| Rate for Payer: UMR Bronson Commercial |
$283.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$574.60
|
|
|
ITRACONAZOLE 100 MG CAPSULE
|
Facility
|
OP
|
$182.27
|
|
|
Service Code
|
NDC 50268045012
|
| Hospital Charge Code |
10364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.44 |
| Max. Negotiated Rate |
$164.04 |
| Rate for Payer: Aetna American Axle |
$118.48
|
| Rate for Payer: Aetna Commercial |
$154.93
|
| Rate for Payer: Aetna Medicare |
$91.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.48
|
| Rate for Payer: BCBS Complete |
$72.91
|
| Rate for Payer: Cash Price |
$145.82
|
| Rate for Payer: Cofinity Commercial |
$127.59
|
| Rate for Payer: Cofinity Commercial |
$156.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$127.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.82
|
| Rate for Payer: Healthscope Commercial |
$164.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.93
|
| Rate for Payer: PHP Commercial |
$154.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.48
|
| Rate for Payer: Priority Health SBD |
$114.83
|
| Rate for Payer: UMR Bronson Commercial |
$67.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.70
|
|
|
ITRACONAZOLE 100 MG CAPSULE
|
Facility
|
IP
|
$766.13
|
|
|
Service Code
|
NDC 10147170003
|
| Hospital Charge Code |
10364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$337.10 |
| Max. Negotiated Rate |
$689.52 |
| Rate for Payer: Aetna American Axle |
$497.98
|
| Rate for Payer: Aetna Commercial |
$651.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$497.98
|
| Rate for Payer: Cash Price |
$612.90
|
| Rate for Payer: Cofinity Commercial |
$536.29
|
| Rate for Payer: Cofinity Commercial |
$658.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$536.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$612.90
|
| Rate for Payer: Healthscope Commercial |
$689.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$536.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$574.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$651.21
|
| Rate for Payer: PHP Commercial |
$651.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.98
|
| Rate for Payer: Priority Health SBD |
$482.66
|
| Rate for Payer: UMR Bronson Commercial |
$337.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$574.60
|
|
|
ITRACONAZOLE 10 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$828.00
|
|
|
Service Code
|
NDC 31722000631
|
| Hospital Charge Code |
19928
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$306.36 |
| Max. Negotiated Rate |
$745.20 |
| Rate for Payer: Aetna American Axle |
$538.20
|
| Rate for Payer: Aetna Commercial |
$703.80
|
| Rate for Payer: Aetna Medicare |
$414.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$538.20
|
| Rate for Payer: BCBS Complete |
$331.20
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cofinity Commercial |
$579.60
|
| Rate for Payer: Cofinity Commercial |
$712.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$579.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$662.40
|
| Rate for Payer: Healthscope Commercial |
$745.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$579.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$621.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$703.80
|
| Rate for Payer: PHP Commercial |
$703.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$538.20
|
| Rate for Payer: Priority Health SBD |
$521.64
|
| Rate for Payer: UMR Bronson Commercial |
$306.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$621.00
|
|
|
ITRACONAZOLE 10 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$1,181.60
|
|
|
Service Code
|
NDC 50458029515
|
| Hospital Charge Code |
19928
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$519.90 |
| Max. Negotiated Rate |
$1,063.44 |
| Rate for Payer: Aetna American Axle |
$768.04
|
| Rate for Payer: Aetna Commercial |
$1,004.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$768.04
|
| Rate for Payer: Cash Price |
$945.28
|
| Rate for Payer: Cofinity Commercial |
$1,016.18
|
| Rate for Payer: Cofinity Commercial |
$827.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$827.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$945.28
|
| Rate for Payer: Healthscope Commercial |
$1,063.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$827.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$886.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,004.36
|
| Rate for Payer: PHP Commercial |
$1,004.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$768.04
|
| Rate for Payer: Priority Health SBD |
$744.41
|
| Rate for Payer: UMR Bronson Commercial |
$519.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$886.20
|
|
|
ITRACONAZOLE 10 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$1,181.60
|
|
|
Service Code
|
NDC 50458029515
|
| Hospital Charge Code |
19928
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$437.19 |
| Max. Negotiated Rate |
$1,063.44 |
| Rate for Payer: Aetna American Axle |
$768.04
|
| Rate for Payer: Aetna Commercial |
$1,004.36
|
| Rate for Payer: Aetna Medicare |
$590.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$768.04
|
| Rate for Payer: BCBS Complete |
$472.64
|
| Rate for Payer: Cash Price |
$945.28
|
| Rate for Payer: Cofinity Commercial |
$1,016.18
|
| Rate for Payer: Cofinity Commercial |
$827.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$827.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$945.28
|
| Rate for Payer: Healthscope Commercial |
$1,063.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$827.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$886.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,004.36
|
| Rate for Payer: PHP Commercial |
$1,004.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$768.04
|
| Rate for Payer: Priority Health SBD |
$744.41
|
| Rate for Payer: UMR Bronson Commercial |
$437.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$886.20
|
|
|
ITRACONAZOLE 10 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$828.00
|
|
|
Service Code
|
NDC 31722000631
|
| Hospital Charge Code |
19928
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$364.32 |
| Max. Negotiated Rate |
$745.20 |
| Rate for Payer: Aetna American Axle |
$538.20
|
| Rate for Payer: Aetna Commercial |
$703.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$538.20
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cofinity Commercial |
$579.60
|
| Rate for Payer: Cofinity Commercial |
$712.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$579.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$662.40
|
| Rate for Payer: Healthscope Commercial |
$745.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$579.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$621.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$703.80
|
| Rate for Payer: PHP Commercial |
$703.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$538.20
|
| Rate for Payer: Priority Health SBD |
$521.64
|
| Rate for Payer: UMR Bronson Commercial |
$364.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$621.00
|
|
|
IVABRADINE 5 MG TABLET
|
Facility
|
IP
|
$499.06
|
|
|
Service Code
|
NDC 50742036260
|
| Hospital Charge Code |
161508
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$219.59 |
| Max. Negotiated Rate |
$449.15 |
| Rate for Payer: Aetna American Axle |
$324.39
|
| Rate for Payer: Aetna Commercial |
$424.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.39
|
| Rate for Payer: Cash Price |
$399.25
|
| Rate for Payer: Cofinity Commercial |
$349.34
|
| Rate for Payer: Cofinity Commercial |
$429.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$349.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.25
|
| Rate for Payer: Healthscope Commercial |
$449.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$349.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$374.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$424.20
|
| Rate for Payer: PHP Commercial |
$424.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.39
|
| Rate for Payer: Priority Health SBD |
$314.41
|
| Rate for Payer: UMR Bronson Commercial |
$219.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$374.30
|
|
|
IVABRADINE 5 MG TABLET
|
Facility
|
OP
|
$499.06
|
|
|
Service Code
|
NDC 50742036260
|
| Hospital Charge Code |
161508
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.65 |
| Max. Negotiated Rate |
$449.15 |
| Rate for Payer: Aetna American Axle |
$324.39
|
| Rate for Payer: Aetna Commercial |
$424.20
|
| Rate for Payer: Aetna Medicare |
$249.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.39
|
| Rate for Payer: BCBS Complete |
$199.62
|
| Rate for Payer: Cash Price |
$399.25
|
| Rate for Payer: Cofinity Commercial |
$349.34
|
| Rate for Payer: Cofinity Commercial |
$429.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$349.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.25
|
| Rate for Payer: Healthscope Commercial |
$449.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$349.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$374.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$424.20
|
| Rate for Payer: PHP Commercial |
$424.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.39
|
| Rate for Payer: Priority Health SBD |
$314.41
|
| Rate for Payer: UMR Bronson Commercial |
$184.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$374.30
|
|
|
IVABRADINE 5 MG TABLET
|
Facility
|
OP
|
$2,153.63
|
|
|
Service Code
|
NDC 55513080060
|
| Hospital Charge Code |
161508
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$796.84 |
| Max. Negotiated Rate |
$1,938.27 |
| Rate for Payer: Aetna American Axle |
$1,399.86
|
| Rate for Payer: Aetna Commercial |
$1,830.59
|
| Rate for Payer: Aetna Medicare |
$1,076.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,399.86
|
| Rate for Payer: BCBS Complete |
$861.45
|
| Rate for Payer: Cash Price |
$1,722.90
|
| Rate for Payer: Cofinity Commercial |
$1,507.54
|
| Rate for Payer: Cofinity Commercial |
$1,852.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,507.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,722.90
|
| Rate for Payer: Healthscope Commercial |
$1,938.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,507.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,615.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,830.59
|
| Rate for Payer: PHP Commercial |
$1,830.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,399.86
|
| Rate for Payer: Priority Health SBD |
$1,356.79
|
| Rate for Payer: UMR Bronson Commercial |
$796.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,615.22
|
|
|
IVABRADINE 5 MG TABLET
|
Facility
|
IP
|
$2,153.63
|
|
|
Service Code
|
NDC 55513080060
|
| Hospital Charge Code |
161508
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$947.60 |
| Max. Negotiated Rate |
$1,938.27 |
| Rate for Payer: Aetna American Axle |
$1,399.86
|
| Rate for Payer: Aetna Commercial |
$1,830.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,399.86
|
| Rate for Payer: Cash Price |
$1,722.90
|
| Rate for Payer: Cofinity Commercial |
$1,507.54
|
| Rate for Payer: Cofinity Commercial |
$1,852.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,507.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,722.90
|
| Rate for Payer: Healthscope Commercial |
$1,938.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,507.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,615.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,830.59
|
| Rate for Payer: PHP Commercial |
$1,830.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,399.86
|
| Rate for Payer: Priority Health SBD |
$1,356.79
|
| Rate for Payer: UMR Bronson Commercial |
$947.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,615.22
|
|
|
IVERMECTIN 3 MG TABLET
|
Facility
|
OP
|
$320.20
|
|
|
Service Code
|
NDC 00006003220
|
| Hospital Charge Code |
25820
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.47 |
| Max. Negotiated Rate |
$288.18 |
| Rate for Payer: Aetna American Axle |
$208.13
|
| Rate for Payer: Aetna Commercial |
$272.17
|
| Rate for Payer: Aetna Medicare |
$160.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.13
|
| Rate for Payer: BCBS Complete |
$128.08
|
| Rate for Payer: Cash Price |
$256.16
|
| Rate for Payer: Cofinity Commercial |
$224.14
|
| Rate for Payer: Cofinity Commercial |
$275.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$224.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.16
|
| Rate for Payer: Healthscope Commercial |
$288.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$224.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.17
|
| Rate for Payer: PHP Commercial |
$272.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.13
|
| Rate for Payer: Priority Health SBD |
$201.73
|
| Rate for Payer: UMR Bronson Commercial |
$118.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.15
|
|
|
IVERMECTIN 3 MG TABLET
|
Facility
|
IP
|
$320.20
|
|
|
Service Code
|
NDC 00006003220
|
| Hospital Charge Code |
25820
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.89 |
| Max. Negotiated Rate |
$288.18 |
| Rate for Payer: Aetna American Axle |
$208.13
|
| Rate for Payer: Aetna Commercial |
$272.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.13
|
| Rate for Payer: Cash Price |
$256.16
|
| Rate for Payer: Cofinity Commercial |
$224.14
|
| Rate for Payer: Cofinity Commercial |
$275.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$224.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.16
|
| Rate for Payer: Healthscope Commercial |
$288.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$224.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.17
|
| Rate for Payer: PHP Commercial |
$272.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.13
|
| Rate for Payer: Priority Health SBD |
$201.73
|
| Rate for Payer: UMR Bronson Commercial |
$140.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.15
|
|
|
IXABEPILONE 15 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$9,045.38
|
|
|
Service Code
|
HCPCS J9207
|
| Hospital Charge Code |
88652
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.62 |
| Max. Negotiated Rate |
$8,140.84 |
| Rate for Payer: Aetna American Axle |
$5,879.50
|
| Rate for Payer: Aetna Commercial |
$7,688.57
|
| Rate for Payer: Aetna Medicare |
$144.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,879.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$174.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$174.01
|
| Rate for Payer: BCBS Complete |
$78.35
|
| Rate for Payer: BCBS MAPPO |
$139.21
|
| Rate for Payer: BCN Medicare Advantage |
$139.21
|
| Rate for Payer: Cash Price |
$7,236.30
|
| Rate for Payer: Cash Price |
$7,236.30
|
| Rate for Payer: Cofinity Commercial |
$7,779.03
|
| Rate for Payer: Cofinity Commercial |
$6,331.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,331.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,236.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$139.21
|
| Rate for Payer: Healthscope Commercial |
$8,140.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,331.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,784.03
|
| Rate for Payer: Mclaren Medicaid |
$74.62
|
| Rate for Payer: Mclaren Medicare |
$139.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$146.17
|
| Rate for Payer: Meridian Medicaid |
$78.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$160.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,688.57
|
| Rate for Payer: PACE Medicare |
$132.25
|
| Rate for Payer: PACE SWMI |
$139.21
|
| Rate for Payer: PHP Commercial |
$7,688.57
|
| Rate for Payer: PHP Medicare Advantage |
$139.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,879.50
|
| Rate for Payer: Priority Health Medicare |
$139.21
|
| Rate for Payer: Priority Health SBD |
$5,698.59
|
| Rate for Payer: Railroad Medicare Medicare |
$139.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$391.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$139.21
|
| Rate for Payer: UHC Exchange |
$266.04
|
| Rate for Payer: UHC Medicare Advantage |
$139.21
|
| Rate for Payer: UHCCP Medicaid |
$74.62
|
| Rate for Payer: UMR Bronson Commercial |
$3,346.79
|
| Rate for Payer: VA VA |
$139.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,784.03
|
|
|
IXABEPILONE 15 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$9,045.38
|
|
|
Service Code
|
HCPCS J9207
|
| Hospital Charge Code |
88652
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,979.97 |
| Max. Negotiated Rate |
$8,140.84 |
| Rate for Payer: Aetna American Axle |
$5,879.50
|
| Rate for Payer: Aetna Commercial |
$7,688.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,879.50
|
| Rate for Payer: Cash Price |
$7,236.30
|
| Rate for Payer: Cofinity Commercial |
$6,331.77
|
| Rate for Payer: Cofinity Commercial |
$7,779.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,331.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,236.30
|
| Rate for Payer: Healthscope Commercial |
$8,140.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,331.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,784.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,688.57
|
| Rate for Payer: PHP Commercial |
$7,688.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,879.50
|
| Rate for Payer: Priority Health SBD |
$5,698.59
|
| Rate for Payer: UMR Bronson Commercial |
$3,979.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,784.03
|
|
|
J-TIP NEEDLE FREE INJECTOR 0.25 ML
|
Facility
|
OP
|
$3.99
|
|
|
Service Code
|
NDC 09900000400
|
| Hospital Charge Code |
163515
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$3.59 |
| Rate for Payer: Aetna American Axle |
$2.59
|
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Aetna Medicare |
$2.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.59
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: Cash Price |
$3.19
|
| Rate for Payer: Cofinity Commercial |
$2.79
|
| Rate for Payer: Cofinity Commercial |
$3.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.19
|
| Rate for Payer: Healthscope Commercial |
$3.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.39
|
| Rate for Payer: PHP Commercial |
$3.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.59
|
| Rate for Payer: Priority Health SBD |
$2.51
|
| Rate for Payer: UMR Bronson Commercial |
$1.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.99
|
|
|
J-TIP NEEDLE FREE INJECTOR 0.25 ML
|
Facility
|
IP
|
$3.99
|
|
|
Service Code
|
NDC 09900000400
|
| Hospital Charge Code |
163515
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$3.59 |
| Rate for Payer: Aetna American Axle |
$2.59
|
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.59
|
| Rate for Payer: Cash Price |
$3.19
|
| Rate for Payer: Cofinity Commercial |
$2.79
|
| Rate for Payer: Cofinity Commercial |
$3.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.19
|
| Rate for Payer: Healthscope Commercial |
$3.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.39
|
| Rate for Payer: PHP Commercial |
$3.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.59
|
| Rate for Payer: Priority Health SBD |
$2.51
|
| Rate for Payer: UMR Bronson Commercial |
$1.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.99
|
|
|
KATE FARMS ADULT PEPTIDE 1.5 BOLUS FEED
|
Facility
|
IP
|
$54.12
|
|
|
Service Code
|
NDC 51823000647
|
| Hospital Charge Code |
301916
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.81 |
| Max. Negotiated Rate |
$48.71 |
| Rate for Payer: Aetna American Axle |
$35.18
|
| Rate for Payer: Aetna Commercial |
$46.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.18
|
| Rate for Payer: Cash Price |
$43.30
|
| Rate for Payer: Cofinity Commercial |
$37.88
|
| Rate for Payer: Cofinity Commercial |
$46.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.30
|
| Rate for Payer: Healthscope Commercial |
$48.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.00
|
| Rate for Payer: PHP Commercial |
$46.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.18
|
| Rate for Payer: Priority Health SBD |
$34.10
|
| Rate for Payer: UMR Bronson Commercial |
$23.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.59
|
|
