|
ISOSOURCE 1.5 CYCLIC FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 43900018150
|
| Hospital Charge Code |
200081
|
|
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: Cofinity Medicare Advantage |
$3.32
|
| 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 Commercial |
$4.04
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| 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
|
|
|
ISOSOURCE 1.5 INTERMITTENT FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 43900018150
|
| Hospital Charge Code |
200080
|
|
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: Cofinity Medicare Advantage |
$3.32
|
| 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 Commercial |
$4.04
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| 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
|
|
|
ISOSOURCE 1.5 INTERMITTENT FEED
|
Facility
|
OP
|
$9.60
|
|
|
Service Code
|
NDC 43900018181
|
| Hospital Charge Code |
200080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna American Axle |
$6.24
|
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Aetna Medicare |
$4.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.24
|
| Rate for Payer: BCBS Complete |
$3.84
|
| Rate for Payer: Cash Price |
$7.68
|
| Rate for Payer: Cofinity Commercial |
$6.72
|
| Rate for Payer: Cofinity Commercial |
$8.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.72
|
| 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 Commercial |
$8.16
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.24
|
| Rate for Payer: Priority Health SBD |
$6.05
|
| Rate for Payer: UMR Bronson Commercial |
$3.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.20
|
|
|
ISOSOURCE 1.5 INTERMITTENT FEED
|
Facility
|
IP
|
$9.60
|
|
|
Service Code
|
NDC 43900018181
|
| Hospital Charge Code |
200080
|
|
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: Cofinity Medicare Advantage |
$6.72
|
| 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 Commercial |
$8.16
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.24
|
| 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
|
|
|
ISOSOURCE 1.5 INTERMITTENT FEED
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 43900018150
|
| Hospital Charge Code |
200080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna American Axle |
$3.09
|
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna Medicare |
$2.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$3.32
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.32
|
| 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 Commercial |
$4.04
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health SBD |
$2.99
|
| Rate for Payer: UMR Bronson Commercial |
$1.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
|
ISOSOURCE HN BOLUS FEED
|
Facility
|
OP
|
$9.60
|
|
|
Service Code
|
NDC 43900018480
|
| Hospital Charge Code |
150769
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna American Axle |
$6.24
|
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Aetna Medicare |
$4.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.24
|
| Rate for Payer: BCBS Complete |
$3.84
|
| Rate for Payer: Cash Price |
$7.68
|
| Rate for Payer: Cofinity Commercial |
$6.72
|
| Rate for Payer: Cofinity Commercial |
$8.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.72
|
| 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 Commercial |
$8.16
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.24
|
| Rate for Payer: Priority Health SBD |
$6.05
|
| Rate for Payer: UMR Bronson Commercial |
$3.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.20
|
|
|
ISOSOURCE HN BOLUS FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 43900018457
|
| Hospital Charge Code |
150769
|
|
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: Cofinity Medicare Advantage |
$3.32
|
| 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 Commercial |
$4.04
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| 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
|
|
|
ISOSOURCE HN BOLUS FEED
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 43900018457
|
| Hospital Charge Code |
150769
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna American Axle |
$3.09
|
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna Medicare |
$2.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$3.32
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.32
|
| 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 Commercial |
$4.04
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health SBD |
$2.99
|
| Rate for Payer: UMR Bronson Commercial |
$1.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
|
ISOSOURCE HN BOLUS FEED
|
Facility
|
IP
|
$9.60
|
|
|
Service Code
|
NDC 43900018480
|
| Hospital Charge Code |
150769
|
|
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: Cofinity Medicare Advantage |
$6.72
|
| 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 Commercial |
$8.16
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.24
|
| 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
|
|
|
ISOSOURCE HN CONTINUOUS FEED
|
Facility
|
IP
|
$9.60
|
|
|
Service Code
|
NDC 43900018480
|
| Hospital Charge Code |
168942
|
|
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: Cofinity Medicare Advantage |
$6.72
|
| 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 Commercial |
$8.16
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.24
|
| 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
|
|
|
ISOSOURCE HN CONTINUOUS FEED
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 43900018457
|
| Hospital Charge Code |
168942
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna American Axle |
$3.09
|
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna Medicare |
$2.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$3.32
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.32
|
| 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 Commercial |
$4.04
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health SBD |
$2.99
|
| Rate for Payer: UMR Bronson Commercial |
$1.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
|
ISOSOURCE HN CONTINUOUS FEED
|
Facility
|
OP
|
$9.60
|
|
|
Service Code
|
NDC 43900018480
|
| Hospital Charge Code |
168942
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna American Axle |
$6.24
|
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Aetna Medicare |
$4.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.24
|
| Rate for Payer: BCBS Complete |
$3.84
|
| Rate for Payer: Cash Price |
$7.68
|
| Rate for Payer: Cofinity Commercial |
$6.72
|
| Rate for Payer: Cofinity Commercial |
$8.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.72
|
| 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 Commercial |
$8.16
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.24
|
| Rate for Payer: Priority Health SBD |
$6.05
|
| Rate for Payer: UMR Bronson Commercial |
$3.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.20
|
|
|
ISOSOURCE HN CONTINUOUS FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 43900018457
|
| Hospital Charge Code |
168942
|
|
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: Cofinity Medicare Advantage |
$3.32
|
| 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 Commercial |
$4.04
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| 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
|
|
|
ISOSOURCE HN CYCLIC FEED
|
Facility
|
OP
|
$9.60
|
|
|
Service Code
|
NDC 43900018480
|
| Hospital Charge Code |
200075
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna American Axle |
$6.24
|
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Aetna Medicare |
$4.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.24
|
| Rate for Payer: BCBS Complete |
$3.84
|
| Rate for Payer: Cash Price |
$7.68
|
| Rate for Payer: Cofinity Commercial |
$6.72
|
| Rate for Payer: Cofinity Commercial |
$8.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.72
|
| 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 Commercial |
$8.16
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.24
|
| Rate for Payer: Priority Health SBD |
$6.05
|
| Rate for Payer: UMR Bronson Commercial |
$3.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.20
|
|
|
ISOSOURCE HN CYCLIC FEED
|
Facility
|
IP
|
$9.60
|
|
|
Service Code
|
NDC 43900018480
|
| Hospital Charge Code |
200075
|
|
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: Cofinity Medicare Advantage |
$6.72
|
| 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 Commercial |
$8.16
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.24
|
| 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
|
|
|
ISOSOURCE HN CYCLIC FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 43900018457
|
| Hospital Charge Code |
200075
|
|
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: Cofinity Medicare Advantage |
$3.32
|
| 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 Commercial |
$4.04
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| 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
|
|
|
ISOSOURCE HN CYCLIC FEED
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 43900018457
|
| Hospital Charge Code |
200075
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna American Axle |
$3.09
|
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna Medicare |
$2.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$3.32
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.32
|
| 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 Commercial |
$4.04
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health SBD |
$2.99
|
| Rate for Payer: UMR Bronson Commercial |
$1.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
|
ISOSOURCE HN INTERMITTENT FEED
|
Facility
|
IP
|
$9.60
|
|
|
Service Code
|
NDC 43900018480
|
| Hospital Charge Code |
200074
|
|
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: Cofinity Medicare Advantage |
$6.72
|
| 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 Commercial |
$8.16
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.24
|
| 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
|
|
|
ISOSOURCE HN INTERMITTENT FEED
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 43900018457
|
| Hospital Charge Code |
200074
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna American Axle |
$3.09
|
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna Medicare |
$2.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$3.32
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.32
|
| 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 Commercial |
$4.04
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health SBD |
$2.99
|
| Rate for Payer: UMR Bronson Commercial |
$1.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
|
ISOSOURCE HN INTERMITTENT FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 43900018457
|
| Hospital Charge Code |
200074
|
|
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: Cofinity Medicare Advantage |
$3.32
|
| 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 Commercial |
$4.04
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| 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
|
|
|
ISOSOURCE HN INTERMITTENT FEED
|
Facility
|
OP
|
$9.60
|
|
|
Service Code
|
NDC 43900018480
|
| Hospital Charge Code |
200074
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna American Axle |
$6.24
|
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Aetna Medicare |
$4.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.24
|
| Rate for Payer: BCBS Complete |
$3.84
|
| Rate for Payer: Cash Price |
$7.68
|
| Rate for Payer: Cofinity Commercial |
$6.72
|
| Rate for Payer: Cofinity Commercial |
$8.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.72
|
| 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 Commercial |
$8.16
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.24
|
| Rate for Payer: Priority Health SBD |
$6.05
|
| Rate for Payer: UMR Bronson Commercial |
$3.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.20
|
|
|
ISOSULFAN BLUE 1 % SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$1,223.03
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
10358
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$538.13 |
| Max. Negotiated Rate |
$1,100.73 |
| Rate for Payer: Aetna American Axle |
$794.97
|
| Rate for Payer: Aetna American Axle |
$1,373.74
|
| Rate for Payer: Aetna American Axle |
$2,031.67
|
| Rate for Payer: Aetna Commercial |
$1,796.42
|
| Rate for Payer: Aetna Commercial |
$1,039.58
|
| Rate for Payer: Aetna Commercial |
$2,656.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$794.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,031.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,373.74
|
| Rate for Payer: Cash Price |
$2,500.51
|
| Rate for Payer: Cash Price |
$1,690.75
|
| Rate for Payer: Cash Price |
$978.42
|
| Rate for Payer: Cofinity Commercial |
$856.12
|
| Rate for Payer: Cofinity Commercial |
$1,817.56
|
| Rate for Payer: Cofinity Commercial |
$1,479.41
|
| Rate for Payer: Cofinity Commercial |
$2,688.05
|
| Rate for Payer: Cofinity Commercial |
$2,187.95
|
| Rate for Payer: Cofinity Commercial |
$1,051.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,479.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$856.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,187.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,500.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$978.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,690.75
|
| Rate for Payer: Healthscope Commercial |
$1,902.10
|
| Rate for Payer: Healthscope Commercial |
$1,100.73
|
| Rate for Payer: Healthscope Commercial |
$2,813.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$856.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,479.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,187.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,585.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$917.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,344.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,039.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,656.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,796.42
|
| Rate for Payer: PHP Commercial |
$2,656.79
|
| Rate for Payer: PHP Commercial |
$1,796.42
|
| Rate for Payer: PHP Commercial |
$1,039.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,373.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,031.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$794.97
|
| Rate for Payer: Priority Health SBD |
$1,969.15
|
| Rate for Payer: Priority Health SBD |
$1,331.47
|
| Rate for Payer: Priority Health SBD |
$770.51
|
| Rate for Payer: UMR Bronson Commercial |
$538.13
|
| Rate for Payer: UMR Bronson Commercial |
$1,375.28
|
| Rate for Payer: UMR Bronson Commercial |
$929.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,344.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$917.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,585.08
|
|
|
ISOSULFAN BLUE 1 % SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$1,223.03
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
10358
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.77 |
| Max. Negotiated Rate |
$1,100.73 |
| Rate for Payer: Aetna American Axle |
$794.97
|
| Rate for Payer: Aetna American Axle |
$1,373.74
|
| Rate for Payer: Aetna American Axle |
$2,031.67
|
| Rate for Payer: Aetna Commercial |
$2,656.79
|
| Rate for Payer: Aetna Commercial |
$1,039.58
|
| Rate for Payer: Aetna Commercial |
$1,796.42
|
| Rate for Payer: Aetna Medicare |
$9.26
|
| Rate for Payer: Aetna Medicare |
$9.26
|
| Rate for Payer: Aetna Medicare |
$9.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,373.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$794.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,031.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.12
|
| Rate for Payer: BCBS Complete |
$5.01
|
| Rate for Payer: BCBS Complete |
$5.01
|
| Rate for Payer: BCBS Complete |
$5.01
|
| Rate for Payer: BCBS MAPPO |
$8.90
|
| Rate for Payer: BCBS MAPPO |
$8.90
|
| Rate for Payer: BCBS MAPPO |
$8.90
|
| Rate for Payer: BCBS Trust/PPO |
$22.62
|
| Rate for Payer: BCBS Trust/PPO |
$22.62
|
| Rate for Payer: BCBS Trust/PPO |
$22.62
|
| Rate for Payer: BCN Commercial |
$22.62
|
| Rate for Payer: BCN Commercial |
$22.62
|
| Rate for Payer: BCN Commercial |
$22.62
|
| Rate for Payer: BCN Medicare Advantage |
$8.90
|
| Rate for Payer: BCN Medicare Advantage |
$8.90
|
| Rate for Payer: BCN Medicare Advantage |
$8.90
|
| Rate for Payer: Cash Price |
$2,500.51
|
| Rate for Payer: Cash Price |
$978.42
|
| Rate for Payer: Cash Price |
$978.42
|
| Rate for Payer: Cash Price |
$2,500.51
|
| Rate for Payer: Cash Price |
$1,690.75
|
| Rate for Payer: Cash Price |
$1,690.75
|
| Rate for Payer: Cofinity Commercial |
$2,688.05
|
| Rate for Payer: Cofinity Commercial |
$856.12
|
| Rate for Payer: Cofinity Commercial |
$1,051.81
|
| Rate for Payer: Cofinity Commercial |
$1,817.56
|
| Rate for Payer: Cofinity Commercial |
$1,479.41
|
| Rate for Payer: Cofinity Commercial |
$2,187.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,187.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,479.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$856.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$978.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,690.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,500.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.90
|
| Rate for Payer: Healthscope Commercial |
$1,100.73
|
| Rate for Payer: Healthscope Commercial |
$2,813.08
|
| Rate for Payer: Healthscope Commercial |
$1,902.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,187.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,479.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$856.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,344.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,585.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$917.27
|
| Rate for Payer: Mclaren Medicaid |
$4.77
|
| Rate for Payer: Mclaren Medicaid |
$4.77
|
| Rate for Payer: Mclaren Medicaid |
$4.77
|
| Rate for Payer: Mclaren Medicare |
$8.90
|
| Rate for Payer: Mclaren Medicare |
$8.90
|
| Rate for Payer: Mclaren Medicare |
$8.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.34
|
| Rate for Payer: Meridian Medicaid |
$5.01
|
| Rate for Payer: Meridian Medicaid |
$5.01
|
| Rate for Payer: Meridian Medicaid |
$5.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,656.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,039.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,796.42
|
| Rate for Payer: Nomi Health Commercial |
$26.70
|
| Rate for Payer: Nomi Health Commercial |
$26.70
|
| Rate for Payer: Nomi Health Commercial |
$26.70
|
| Rate for Payer: PACE Medicare |
$8.46
|
| Rate for Payer: PACE Medicare |
$8.46
|
| Rate for Payer: PACE Medicare |
$8.46
|
| Rate for Payer: PACE SWMI |
$8.90
|
| Rate for Payer: PACE SWMI |
$8.90
|
| Rate for Payer: PACE SWMI |
$8.90
|
| Rate for Payer: PHP Commercial |
$1,796.42
|
| Rate for Payer: PHP Commercial |
$1,039.58
|
| Rate for Payer: PHP Commercial |
$2,656.79
|
| Rate for Payer: PHP Medicare Advantage |
$8.90
|
| Rate for Payer: PHP Medicare Advantage |
$8.90
|
| Rate for Payer: PHP Medicare Advantage |
$8.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,031.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,373.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$794.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.56
|
| Rate for Payer: Priority Health Medicare |
$8.90
|
| Rate for Payer: Priority Health Medicare |
$8.90
|
| Rate for Payer: Priority Health Medicare |
$8.90
|
| Rate for Payer: Priority Health Narrow Network |
$19.65
|
| Rate for Payer: Priority Health Narrow Network |
$19.65
|
| Rate for Payer: Priority Health Narrow Network |
$19.65
|
| Rate for Payer: Priority Health SBD |
$770.51
|
| Rate for Payer: Priority Health SBD |
$1,331.47
|
| Rate for Payer: Priority Health SBD |
$1,969.15
|
| Rate for Payer: Railroad Medicare Medicare |
$8.90
|
| Rate for Payer: Railroad Medicare Medicare |
$8.90
|
| Rate for Payer: Railroad Medicare Medicare |
$8.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.90
|
| Rate for Payer: UHC Exchange |
$17.01
|
| Rate for Payer: UHC Exchange |
$17.01
|
| Rate for Payer: UHC Exchange |
$17.01
|
| Rate for Payer: UHC Medicare Advantage |
$8.90
|
| Rate for Payer: UHC Medicare Advantage |
$8.90
|
| Rate for Payer: UHC Medicare Advantage |
$8.90
|
| Rate for Payer: UHCCP Medicaid |
$4.77
|
| Rate for Payer: UHCCP Medicaid |
$4.77
|
| Rate for Payer: UHCCP Medicaid |
$4.77
|
| Rate for Payer: UMR Bronson Commercial |
$781.97
|
| Rate for Payer: UMR Bronson Commercial |
$452.52
|
| Rate for Payer: UMR Bronson Commercial |
$1,156.49
|
| Rate for Payer: VA VA |
$8.90
|
| Rate for Payer: VA VA |
$8.90
|
| Rate for Payer: VA VA |
$8.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$917.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,344.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,585.08
|
|
|
ISOTRETINOIN 30 MG CAPSULE
|
Facility
|
IP
|
$713.62
|
|
|
Service Code
|
NDC 00555105686
|
| Hospital Charge Code |
36845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$313.99 |
| Max. Negotiated Rate |
$642.26 |
| Rate for Payer: Aetna American Axle |
$463.85
|
| Rate for Payer: Aetna Commercial |
$606.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$463.85
|
| Rate for Payer: Cash Price |
$570.90
|
| Rate for Payer: Cofinity Commercial |
$499.53
|
| Rate for Payer: Cofinity Commercial |
$613.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$499.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$570.90
|
| Rate for Payer: Healthscope Commercial |
$642.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$499.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$535.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$606.58
|
| Rate for Payer: PHP Commercial |
$606.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$463.85
|
| Rate for Payer: Priority Health SBD |
$449.58
|
| Rate for Payer: UMR Bronson Commercial |
$313.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$535.22
|
|
|
ISOTRETINOIN 30 MG CAPSULE
|
Facility
|
IP
|
$401.71
|
|
|
Service Code
|
NDC 61748030313
|
| Hospital Charge Code |
36845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.75 |
| Max. Negotiated Rate |
$361.54 |
| Rate for Payer: Aetna American Axle |
$261.11
|
| Rate for Payer: Aetna Commercial |
$341.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.11
|
| Rate for Payer: Cash Price |
$321.37
|
| Rate for Payer: Cofinity Commercial |
$281.20
|
| Rate for Payer: Cofinity Commercial |
$345.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$281.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.37
|
| Rate for Payer: Healthscope Commercial |
$361.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$281.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.45
|
| Rate for Payer: PHP Commercial |
$341.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.11
|
| Rate for Payer: Priority Health SBD |
$253.08
|
| Rate for Payer: UMR Bronson Commercial |
$176.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.28
|
|
