|
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
|
|
|
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 |
$6,784.04
|
| 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 |
$6,784.04
|
|
|
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 |
$73.13 |
| 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 |
$141.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,879.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$170.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$170.54
|
| Rate for Payer: BCBS Complete |
$76.78
|
| Rate for Payer: BCBS MAPPO |
$136.43
|
| Rate for Payer: BCBS Trust/PPO |
$367.85
|
| Rate for Payer: BCN Commercial |
$367.85
|
| Rate for Payer: BCN Medicare Advantage |
$136.43
|
| 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 |
$136.43
|
| 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 |
$6,784.04
|
| Rate for Payer: Mclaren Medicaid |
$73.13
|
| Rate for Payer: Mclaren Medicare |
$136.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$143.25
|
| Rate for Payer: Meridian Medicaid |
$76.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,688.57
|
| Rate for Payer: Nomi Health Commercial |
$409.29
|
| Rate for Payer: PACE Medicare |
$129.61
|
| Rate for Payer: PACE SWMI |
$136.43
|
| Rate for Payer: PHP Commercial |
$7,688.57
|
| Rate for Payer: PHP Medicare Advantage |
$136.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$73.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,879.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$385.82
|
| Rate for Payer: Priority Health Medicare |
$136.43
|
| Rate for Payer: Priority Health Narrow Network |
$308.66
|
| Rate for Payer: Priority Health SBD |
$5,698.59
|
| Rate for Payer: Railroad Medicare Medicare |
$136.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$384.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$136.43
|
| Rate for Payer: UHC Exchange |
$260.73
|
| Rate for Payer: UHC Medicare Advantage |
$136.43
|
| Rate for Payer: UHCCP Medicaid |
$73.13
|
| Rate for Payer: UMR Bronson Commercial |
$3,346.79
|
| Rate for Payer: VA VA |
$136.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,784.04
|
|
|
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
|
|
|
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
|
|
|
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
|
|
|
KATE FARMS ADULT PEPTIDE 1.5 BOLUS FEED
|
Facility
|
OP
|
$54.12
|
|
|
Service Code
|
NDC 51823000647
|
| Hospital Charge Code |
301916
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.02 |
| Max. Negotiated Rate |
$48.71 |
| Rate for Payer: Aetna American Axle |
$35.18
|
| Rate for Payer: Aetna Commercial |
$46.00
|
| Rate for Payer: Aetna Medicare |
$27.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.18
|
| Rate for Payer: BCBS Complete |
$21.65
|
| 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 |
$20.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.59
|
|
|
KATE FARMS ADULT PEPTIDE 1.5 CONTINUOUS FEED
|
Facility
|
IP
|
$177.60
|
|
|
Service Code
|
NDC 11112003039
|
| Hospital Charge Code |
301627
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.14 |
| Max. Negotiated Rate |
$159.84 |
| Rate for Payer: Aetna American Axle |
$115.44
|
| Rate for Payer: Aetna Commercial |
$150.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.44
|
| Rate for Payer: Cash Price |
$142.08
|
| Rate for Payer: Cofinity Commercial |
$124.32
|
| Rate for Payer: Cofinity Commercial |
$152.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$124.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.08
|
| Rate for Payer: Healthscope Commercial |
$159.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.96
|
| Rate for Payer: PHP Commercial |
$150.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.44
|
| Rate for Payer: Priority Health SBD |
$111.89
|
| Rate for Payer: UMR Bronson Commercial |
$78.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.20
|
|
|
KATE FARMS ADULT PEPTIDE 1.5 CONTINUOUS FEED
|
Facility
|
OP
|
$177.60
|
|
|
Service Code
|
NDC 11112003039
|
| Hospital Charge Code |
301627
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.71 |
| Max. Negotiated Rate |
$159.84 |
| Rate for Payer: Aetna American Axle |
$115.44
|
| Rate for Payer: Aetna Commercial |
$150.96
|
| Rate for Payer: Aetna Medicare |
$88.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.44
|
| Rate for Payer: BCBS Complete |
$71.04
|
| Rate for Payer: Cash Price |
$142.08
|
| Rate for Payer: Cofinity Commercial |
$124.32
|
| Rate for Payer: Cofinity Commercial |
$152.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$124.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.08
|
| Rate for Payer: Healthscope Commercial |
$159.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.96
|
| Rate for Payer: PHP Commercial |
$150.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.44
|
| Rate for Payer: Priority Health SBD |
$111.89
|
| Rate for Payer: UMR Bronson Commercial |
$65.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.20
|
|
|
KATE FARMS ADULT PEPTIDE 1.5 CYCLIC FEED
|
Facility
|
IP
|
$177.60
|
|
|
Service Code
|
NDC 11112003039
|
| Hospital Charge Code |
301628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.14 |
| Max. Negotiated Rate |
$159.84 |
| Rate for Payer: Aetna American Axle |
$115.44
|
| Rate for Payer: Aetna Commercial |
$150.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.44
|
| Rate for Payer: Cash Price |
$142.08
|
| Rate for Payer: Cofinity Commercial |
$124.32
|
| Rate for Payer: Cofinity Commercial |
$152.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$124.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.08
|
| Rate for Payer: Healthscope Commercial |
$159.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.96
|
| Rate for Payer: PHP Commercial |
$150.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.44
|
| Rate for Payer: Priority Health SBD |
$111.89
|
| Rate for Payer: UMR Bronson Commercial |
$78.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.20
|
|
|
KATE FARMS ADULT PEPTIDE 1.5 CYCLIC FEED
|
Facility
|
OP
|
$177.60
|
|
|
Service Code
|
NDC 11112003039
|
| Hospital Charge Code |
301628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.71 |
| Max. Negotiated Rate |
$159.84 |
| Rate for Payer: Aetna American Axle |
$115.44
|
| Rate for Payer: Aetna Commercial |
$150.96
|
| Rate for Payer: Aetna Medicare |
$88.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.44
|
| Rate for Payer: BCBS Complete |
$71.04
|
| Rate for Payer: Cash Price |
$142.08
|
| Rate for Payer: Cofinity Commercial |
$124.32
|
| Rate for Payer: Cofinity Commercial |
$152.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$124.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.08
|
| Rate for Payer: Healthscope Commercial |
$159.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.96
|
| Rate for Payer: PHP Commercial |
$150.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.44
|
| Rate for Payer: Priority Health SBD |
$111.89
|
| Rate for Payer: UMR Bronson Commercial |
$65.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.20
|
|
|
KATE FARMS ADULT PEPTIDE 1.5 CYCLIC FEED
|
Facility
|
IP
|
$54.12
|
|
|
Service Code
|
NDC 51823000647
|
| Hospital Charge Code |
301628
|
|
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
|
|
|
KATE FARMS ADULT PEPTIDE 1.5 CYCLIC FEED
|
Facility
|
OP
|
$54.12
|
|
|
Service Code
|
NDC 51823000647
|
| Hospital Charge Code |
301628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.02 |
| Max. Negotiated Rate |
$48.71 |
| Rate for Payer: Aetna American Axle |
$35.18
|
| Rate for Payer: Aetna Commercial |
$46.00
|
| Rate for Payer: Aetna Medicare |
$27.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.18
|
| Rate for Payer: BCBS Complete |
$21.65
|
| 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 |
$20.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.59
|
|
|
KATE FARMS ADULT PEPTIDE 1.5 INTERMITTENT FEED
|
Facility
|
IP
|
$54.12
|
|
|
Service Code
|
NDC 51823000647
|
| Hospital Charge Code |
301917
|
|
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
|
|
|
KATE FARMS ADULT PEPTIDE 1.5 INTERMITTENT FEED
|
Facility
|
OP
|
$54.12
|
|
|
Service Code
|
NDC 51823000647
|
| Hospital Charge Code |
301917
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.02 |
| Max. Negotiated Rate |
$48.71 |
| Rate for Payer: Aetna American Axle |
$35.18
|
| Rate for Payer: Aetna Commercial |
$46.00
|
| Rate for Payer: Aetna Medicare |
$27.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.18
|
| Rate for Payer: BCBS Complete |
$21.65
|
| 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 |
$20.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.59
|
|
|
KATE FARMS BOLUS FEED LIQUID 1.4 0.06 GRAM-1.4 KCAL/ML ORAL LIQUID
|
Facility
|
OP
|
$13.23
|
|
|
Service Code
|
NDC 11112003042
|
| Hospital Charge Code |
301450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$11.91 |
| Rate for Payer: Aetna American Axle |
$8.60
|
| Rate for Payer: Aetna Commercial |
$11.25
|
| Rate for Payer: Aetna Medicare |
$6.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.60
|
| Rate for Payer: BCBS Complete |
$5.29
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: Cofinity Commercial |
$11.38
|
| Rate for Payer: Cofinity Commercial |
$9.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.58
|
| Rate for Payer: Healthscope Commercial |
$11.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.25
|
| Rate for Payer: PHP Commercial |
$11.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.60
|
| Rate for Payer: Priority Health SBD |
$8.33
|
| Rate for Payer: UMR Bronson Commercial |
$4.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.92
|
|
|
KATE FARMS BOLUS FEED LIQUID 1.4 0.06 GRAM-1.4 KCAL/ML ORAL LIQUID
|
Facility
|
IP
|
$13.23
|
|
|
Service Code
|
NDC 11112003042
|
| Hospital Charge Code |
301450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$11.91 |
| Rate for Payer: Aetna American Axle |
$8.60
|
| Rate for Payer: Aetna Commercial |
$11.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.60
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: Cofinity Commercial |
$11.38
|
| Rate for Payer: Cofinity Commercial |
$9.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.58
|
| Rate for Payer: Healthscope Commercial |
$11.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.25
|
| Rate for Payer: PHP Commercial |
$11.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.60
|
| Rate for Payer: Priority Health SBD |
$8.33
|
| Rate for Payer: UMR Bronson Commercial |
$5.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.92
|
|
|
KATE FARMS CONTINUOUS FEED LIQUID 1.4 0.06 GRAM-1.4 KCAL/ML ORAL LIQUID
|
Facility
|
OP
|
$13.23
|
|
|
Service Code
|
NDC 11112003042
|
| Hospital Charge Code |
301451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$11.91 |
| Rate for Payer: Aetna American Axle |
$8.60
|
| Rate for Payer: Aetna Commercial |
$11.25
|
| Rate for Payer: Aetna Medicare |
$6.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.60
|
| Rate for Payer: BCBS Complete |
$5.29
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: Cofinity Commercial |
$11.38
|
| Rate for Payer: Cofinity Commercial |
$9.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.58
|
| Rate for Payer: Healthscope Commercial |
$11.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.25
|
| Rate for Payer: PHP Commercial |
$11.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.60
|
| Rate for Payer: Priority Health SBD |
$8.33
|
| Rate for Payer: UMR Bronson Commercial |
$4.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.92
|
|
|
KATE FARMS CONTINUOUS FEED LIQUID 1.4 0.06 GRAM-1.4 KCAL/ML ORAL LIQUID
|
Facility
|
IP
|
$13.23
|
|
|
Service Code
|
NDC 11112003042
|
| Hospital Charge Code |
301451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$11.91 |
| Rate for Payer: Aetna American Axle |
$8.60
|
| Rate for Payer: Aetna Commercial |
$11.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.60
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: Cofinity Commercial |
$11.38
|
| Rate for Payer: Cofinity Commercial |
$9.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.58
|
| Rate for Payer: Healthscope Commercial |
$11.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.25
|
| Rate for Payer: PHP Commercial |
$11.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.60
|
| Rate for Payer: Priority Health SBD |
$8.33
|
| Rate for Payer: UMR Bronson Commercial |
$5.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.92
|
|
|
KATE FARMS CYCLIC FEED LIQUID 1.4 0.06 GRAM-1.4 KCAL/ML ORAL LIQUID
|
Facility
|
IP
|
$13.23
|
|
|
Service Code
|
NDC 11112003042
|
| Hospital Charge Code |
301452
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$11.91 |
| Rate for Payer: Aetna American Axle |
$8.60
|
| Rate for Payer: Aetna Commercial |
$11.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.60
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: Cofinity Commercial |
$11.38
|
| Rate for Payer: Cofinity Commercial |
$9.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.58
|
| Rate for Payer: Healthscope Commercial |
$11.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.25
|
| Rate for Payer: PHP Commercial |
$11.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.60
|
| Rate for Payer: Priority Health SBD |
$8.33
|
| Rate for Payer: UMR Bronson Commercial |
$5.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.92
|
|
|
KATE FARMS CYCLIC FEED LIQUID 1.4 0.06 GRAM-1.4 KCAL/ML ORAL LIQUID
|
Facility
|
OP
|
$13.23
|
|
|
Service Code
|
NDC 11112003042
|
| Hospital Charge Code |
301452
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$11.91 |
| Rate for Payer: Aetna American Axle |
$8.60
|
| Rate for Payer: Aetna Commercial |
$11.25
|
| Rate for Payer: Aetna Medicare |
$6.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.60
|
| Rate for Payer: BCBS Complete |
$5.29
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: Cofinity Commercial |
$11.38
|
| Rate for Payer: Cofinity Commercial |
$9.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.58
|
| Rate for Payer: Healthscope Commercial |
$11.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.25
|
| Rate for Payer: PHP Commercial |
$11.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.60
|
| Rate for Payer: Priority Health SBD |
$8.33
|
| Rate for Payer: UMR Bronson Commercial |
$4.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.92
|
|
|
KATE FARMS INTERMITTENT FEED LIQUID 1.4 0.06 GRAM-1.4 KCAL/ML ORAL LIQUID
|
Facility
|
IP
|
$13.23
|
|
|
Service Code
|
NDC 11112003042
|
| Hospital Charge Code |
301453
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$11.91 |
| Rate for Payer: Aetna American Axle |
$8.60
|
| Rate for Payer: Aetna Commercial |
$11.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.60
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: Cofinity Commercial |
$11.38
|
| Rate for Payer: Cofinity Commercial |
$9.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.58
|
| Rate for Payer: Healthscope Commercial |
$11.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.25
|
| Rate for Payer: PHP Commercial |
$11.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.60
|
| Rate for Payer: Priority Health SBD |
$8.33
|
| Rate for Payer: UMR Bronson Commercial |
$5.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.92
|
|
|
KATE FARMS INTERMITTENT FEED LIQUID 1.4 0.06 GRAM-1.4 KCAL/ML ORAL LIQUID
|
Facility
|
OP
|
$13.23
|
|
|
Service Code
|
NDC 11112003042
|
| Hospital Charge Code |
301453
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$11.91 |
| Rate for Payer: Aetna American Axle |
$8.60
|
| Rate for Payer: Aetna Commercial |
$11.25
|
| Rate for Payer: Aetna Medicare |
$6.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.60
|
| Rate for Payer: BCBS Complete |
$5.29
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: Cofinity Commercial |
$11.38
|
| Rate for Payer: Cofinity Commercial |
$9.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.58
|
| Rate for Payer: Healthscope Commercial |
$11.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.25
|
| Rate for Payer: PHP Commercial |
$11.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.60
|
| Rate for Payer: Priority Health SBD |
$8.33
|
| Rate for Payer: UMR Bronson Commercial |
$4.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.92
|
|
|
KATE FARMS PEDIATRIC PEPTIDE BOLUS FEED VANILLA 1.5 0.05 GRAM-1.5 KCAL LIQUID
|
Facility
|
OP
|
$43.48
|
|
|
Service Code
|
NDC 11112003069
|
| Hospital Charge Code |
301447
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.09 |
| Max. Negotiated Rate |
$39.13 |
| Rate for Payer: Aetna American Axle |
$28.26
|
| Rate for Payer: Aetna Commercial |
$36.96
|
| Rate for Payer: Aetna Medicare |
$21.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.26
|
| Rate for Payer: BCBS Complete |
$17.39
|
| Rate for Payer: Cash Price |
$34.78
|
| Rate for Payer: Cofinity Commercial |
$30.44
|
| Rate for Payer: Cofinity Commercial |
$37.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.78
|
| Rate for Payer: Healthscope Commercial |
$39.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.96
|
| Rate for Payer: PHP Commercial |
$36.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.26
|
| Rate for Payer: Priority Health SBD |
$27.39
|
| Rate for Payer: UMR Bronson Commercial |
$16.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.61
|
|
|
KATE FARMS PEDIATRIC PEPTIDE BOLUS FEED VANILLA 1.5 0.05 GRAM-1.5 KCAL LIQUID
|
Facility
|
IP
|
$43.48
|
|
|
Service Code
|
NDC 11112003069
|
| Hospital Charge Code |
301447
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.13 |
| Max. Negotiated Rate |
$39.13 |
| Rate for Payer: Aetna American Axle |
$28.26
|
| Rate for Payer: Aetna Commercial |
$36.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.26
|
| Rate for Payer: Cash Price |
$34.78
|
| Rate for Payer: Cofinity Commercial |
$30.44
|
| Rate for Payer: Cofinity Commercial |
$37.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.78
|
| Rate for Payer: Healthscope Commercial |
$39.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.96
|
| Rate for Payer: PHP Commercial |
$36.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.26
|
| Rate for Payer: Priority Health SBD |
$27.39
|
| Rate for Payer: UMR Bronson Commercial |
$19.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.61
|
|
