|
CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE
|
Facility
|
IP
|
$159.80
|
|
|
Service Code
|
NDC 7985409098
|
| Hospital Charge Code |
15636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.31 |
| Max. Negotiated Rate |
$143.82 |
| Rate for Payer: Aetna American Axle |
$103.87
|
| Rate for Payer: Aetna Commercial |
$135.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.87
|
| Rate for Payer: Cash Price |
$127.84
|
| Rate for Payer: Cofinity Commercial |
$111.86
|
| Rate for Payer: Cofinity Commercial |
$137.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.84
|
| Rate for Payer: Healthscope Commercial |
$143.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$135.83
|
| Rate for Payer: PHP Commercial |
$135.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.86
|
| Rate for Payer: Priority Health SBD |
$100.67
|
| Rate for Payer: UMR Bronson Commercial |
$70.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.85
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE
|
Facility
|
IP
|
$133.95
|
|
|
Service Code
|
NDC 5026886815
|
| Hospital Charge Code |
15636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.94 |
| Max. Negotiated Rate |
$120.56 |
| Rate for Payer: Aetna American Axle |
$87.07
|
| Rate for Payer: Aetna Commercial |
$113.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.07
|
| Rate for Payer: Cash Price |
$107.16
|
| Rate for Payer: Cofinity Commercial |
$115.20
|
| Rate for Payer: Cofinity Commercial |
$93.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.16
|
| Rate for Payer: Healthscope Commercial |
$120.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$113.86
|
| Rate for Payer: PHP Commercial |
$113.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.76
|
| Rate for Payer: Priority Health SBD |
$84.39
|
| Rate for Payer: UMR Bronson Commercial |
$58.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.46
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET
|
Facility
|
IP
|
$35.25
|
|
|
Service Code
|
NDC 536333401
|
| Hospital Charge Code |
82639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.51 |
| Max. Negotiated Rate |
$31.72 |
| Rate for Payer: Aetna American Axle |
$22.91
|
| Rate for Payer: Aetna Commercial |
$29.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.91
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cofinity Commercial |
$24.68
|
| Rate for Payer: Cofinity Commercial |
$30.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.20
|
| Rate for Payer: Healthscope Commercial |
$31.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.96
|
| Rate for Payer: PHP Commercial |
$29.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.68
|
| Rate for Payer: Priority Health SBD |
$22.21
|
| Rate for Payer: UMR Bronson Commercial |
$15.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.44
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET
|
Facility
|
IP
|
$84.60
|
|
|
Service Code
|
NDC 2055503300
|
| Hospital Charge Code |
82639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.22 |
| Max. Negotiated Rate |
$76.14 |
| Rate for Payer: Aetna American Axle |
$54.99
|
| Rate for Payer: Aetna Commercial |
$71.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.99
|
| Rate for Payer: Cash Price |
$67.68
|
| Rate for Payer: Cofinity Commercial |
$59.22
|
| Rate for Payer: Cofinity Commercial |
$72.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.68
|
| Rate for Payer: Healthscope Commercial |
$76.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.91
|
| Rate for Payer: PHP Commercial |
$71.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.22
|
| Rate for Payer: Priority Health SBD |
$53.30
|
| Rate for Payer: UMR Bronson Commercial |
$37.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.45
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET
|
Facility
|
IP
|
$37.60
|
|
|
Service Code
|
NDC 8068116900
|
| Hospital Charge Code |
82639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.54 |
| Max. Negotiated Rate |
$33.84 |
| Rate for Payer: Aetna American Axle |
$24.44
|
| Rate for Payer: Aetna Commercial |
$31.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.44
|
| Rate for Payer: Cash Price |
$30.08
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Cofinity Commercial |
$32.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.08
|
| Rate for Payer: Healthscope Commercial |
$33.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.96
|
| Rate for Payer: PHP Commercial |
$31.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.32
|
| Rate for Payer: Priority Health SBD |
$23.69
|
| Rate for Payer: UMR Bronson Commercial |
$16.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.20
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET
|
Facility
|
IP
|
$103.40
|
|
|
Service Code
|
NDC 0761-0098-40
|
| Hospital Charge Code |
82639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$93.06 |
| Rate for Payer: Aetna American Axle |
$67.21
|
| Rate for Payer: Aetna Commercial |
$87.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.21
|
| Rate for Payer: Cash Price |
$82.72
|
| Rate for Payer: Cofinity Commercial |
$72.38
|
| Rate for Payer: Cofinity Commercial |
$88.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.72
|
| Rate for Payer: Healthscope Commercial |
$93.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.89
|
| Rate for Payer: PHP Commercial |
$87.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.38
|
| Rate for Payer: Priority Health SBD |
$65.14
|
| Rate for Payer: UMR Bronson Commercial |
$45.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.55
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET
|
Facility
|
IP
|
$30.55
|
|
|
Service Code
|
NDC 904582460
|
| Hospital Charge Code |
82639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$27.50 |
| Rate for Payer: Aetna American Axle |
$19.86
|
| Rate for Payer: Aetna Commercial |
$25.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.86
|
| Rate for Payer: Cash Price |
$24.44
|
| Rate for Payer: Cofinity Commercial |
$21.38
|
| Rate for Payer: Cofinity Commercial |
$26.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.44
|
| Rate for Payer: Healthscope Commercial |
$27.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.97
|
| Rate for Payer: PHP Commercial |
$25.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.38
|
| Rate for Payer: Priority Health SBD |
$19.25
|
| Rate for Payer: UMR Bronson Commercial |
$13.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.91
|
|
|
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC
|
Facility
|
IP
|
$39,088.16
|
|
|
Service Code
|
MS-DRG 415
|
| Min. Negotiated Rate |
$14,951.02 |
| Max. Negotiated Rate |
$39,088.16 |
| Rate for Payer: Aetna Medicare |
$16,367.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,672.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,672.40
|
| Rate for Payer: BCBS MAPPO |
$15,737.92
|
| Rate for Payer: BCBS Trust/PPO |
$39,088.16
|
| Rate for Payer: BCN Medicare Advantage |
$15,737.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,737.92
|
| Rate for Payer: Mclaren Medicare |
$15,737.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,524.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,098.61
|
| Rate for Payer: PACE Medicare |
$14,951.02
|
| Rate for Payer: PACE SWMI |
$15,737.92
|
| Rate for Payer: PHP Medicare Advantage |
$15,737.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28,352.57
|
| Rate for Payer: Priority Health Medicare |
$15,737.92
|
| Rate for Payer: Priority Health Narrow Network |
$22,682.06
|
| Rate for Payer: Railroad Medicare Medicare |
$15,737.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30,138.85
|
| Rate for Payer: UHC Core |
$24,713.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,737.92
|
| Rate for Payer: UHC Exchange |
$19,647.36
|
| Rate for Payer: UHC Medicare Advantage |
$16,210.06
|
| Rate for Payer: VA VA |
$15,737.92
|
|
|
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC
|
Facility
|
IP
|
$67,850.81
|
|
|
Service Code
|
MS-DRG 414
|
| Min. Negotiated Rate |
$26,293.78 |
| Max. Negotiated Rate |
$67,850.81 |
| Rate for Payer: Aetna Medicare |
$28,784.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34,597.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34,597.08
|
| Rate for Payer: BCBS MAPPO |
$27,677.66
|
| Rate for Payer: BCBS Trust/PPO |
$67,850.81
|
| Rate for Payer: BCN Medicare Advantage |
$27,677.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27,677.66
|
| Rate for Payer: Mclaren Medicare |
$27,677.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$29,061.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31,829.31
|
| Rate for Payer: PACE Medicare |
$26,293.78
|
| Rate for Payer: PACE SWMI |
$27,677.66
|
| Rate for Payer: PHP Medicare Advantage |
$27,677.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50,586.34
|
| Rate for Payer: Priority Health Medicare |
$27,677.66
|
| Rate for Payer: Priority Health Narrow Network |
$40,469.07
|
| Rate for Payer: Railroad Medicare Medicare |
$27,677.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53,773.40
|
| Rate for Payer: UHC Core |
$44,093.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$27,677.66
|
| Rate for Payer: UHC Exchange |
$35,054.59
|
| Rate for Payer: UHC Medicare Advantage |
$28,507.99
|
| Rate for Payer: VA VA |
$27,677.66
|
|
|
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC
|
Facility
|
IP
|
$30,293.01
|
|
|
Service Code
|
MS-DRG 416
|
| Min. Negotiated Rate |
$10,290.66 |
| Max. Negotiated Rate |
$30,293.01 |
| Rate for Payer: Aetna Medicare |
$11,265.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,540.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,540.34
|
| Rate for Payer: BCBS MAPPO |
$10,832.27
|
| Rate for Payer: BCBS Trust/PPO |
$30,293.01
|
| Rate for Payer: BCN Medicare Advantage |
$10,832.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,832.27
|
| Rate for Payer: Mclaren Medicare |
$10,832.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,373.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,457.11
|
| Rate for Payer: PACE Medicare |
$10,290.66
|
| Rate for Payer: PACE SWMI |
$10,832.27
|
| Rate for Payer: PHP Medicare Advantage |
$10,832.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,217.41
|
| Rate for Payer: Priority Health Medicare |
$10,832.27
|
| Rate for Payer: Priority Health Narrow Network |
$15,373.93
|
| Rate for Payer: Railroad Medicare Medicare |
$10,832.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20,428.16
|
| Rate for Payer: UHC Core |
$16,750.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,832.27
|
| Rate for Payer: UHC Exchange |
$13,317.00
|
| Rate for Payer: UHC Medicare Advantage |
$11,157.24
|
| Rate for Payer: VA VA |
$10,832.27
|
|
|
CHOLECYSTECTOMY WITH C.D.E. WITH CC
|
Facility
|
IP
|
$33,657.78
|
|
|
Service Code
|
MS-DRG 412
|
| Min. Negotiated Rate |
$15,612.10 |
| Max. Negotiated Rate |
$33,657.78 |
| Rate for Payer: Aetna Medicare |
$17,091.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,542.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,542.24
|
| Rate for Payer: BCBS MAPPO |
$16,433.79
|
| Rate for Payer: BCBS Trust/PPO |
$33,657.78
|
| Rate for Payer: BCN Medicare Advantage |
$16,433.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,433.79
|
| Rate for Payer: Mclaren Medicare |
$16,433.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,255.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,898.86
|
| Rate for Payer: PACE Medicare |
$15,612.10
|
| Rate for Payer: PACE SWMI |
$16,433.79
|
| Rate for Payer: PHP Medicare Advantage |
$16,433.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29,352.76
|
| Rate for Payer: Priority Health Medicare |
$16,433.79
|
| Rate for Payer: Priority Health Narrow Network |
$23,482.21
|
| Rate for Payer: Railroad Medicare Medicare |
$16,433.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31,202.06
|
| Rate for Payer: UHC Core |
$25,585.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$16,433.79
|
| Rate for Payer: UHC Exchange |
$20,340.45
|
| Rate for Payer: UHC Medicare Advantage |
$16,926.80
|
| Rate for Payer: VA VA |
$16,433.79
|
|
|
CHOLECYSTECTOMY WITH C.D.E. WITH MCC
|
Facility
|
IP
|
$50,521.85
|
|
|
Service Code
|
MS-DRG 411
|
| Min. Negotiated Rate |
$22,744.69 |
| Max. Negotiated Rate |
$50,521.85 |
| Rate for Payer: Aetna Medicare |
$24,899.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29,927.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29,927.22
|
| Rate for Payer: BCBS MAPPO |
$23,941.78
|
| Rate for Payer: BCBS Trust/PPO |
$50,521.85
|
| Rate for Payer: BCN Medicare Advantage |
$23,941.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23,941.78
|
| Rate for Payer: Mclaren Medicare |
$23,941.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25,138.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27,533.05
|
| Rate for Payer: PACE Medicare |
$22,744.69
|
| Rate for Payer: PACE SWMI |
$23,941.78
|
| Rate for Payer: PHP Medicare Advantage |
$23,941.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41,334.94
|
| Rate for Payer: Priority Health Medicare |
$23,941.78
|
| Rate for Payer: Priority Health Narrow Network |
$33,067.95
|
| Rate for Payer: Railroad Medicare Medicare |
$23,941.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43,939.15
|
| Rate for Payer: UHC Core |
$36,029.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$23,941.78
|
| Rate for Payer: UHC Exchange |
$28,643.69
|
| Rate for Payer: UHC Medicare Advantage |
$24,660.03
|
| Rate for Payer: VA VA |
$23,941.78
|
|
|
CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC
|
Facility
|
IP
|
$30,471.43
|
|
|
Service Code
|
MS-DRG 413
|
| Min. Negotiated Rate |
$11,538.11 |
| Max. Negotiated Rate |
$30,471.43 |
| Rate for Payer: Aetna Medicare |
$12,631.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,181.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,181.72
|
| Rate for Payer: BCBS MAPPO |
$12,145.38
|
| Rate for Payer: BCBS Trust/PPO |
$30,471.43
|
| Rate for Payer: BCN Medicare Advantage |
$12,145.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,145.38
|
| Rate for Payer: Mclaren Medicare |
$12,145.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,752.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,967.19
|
| Rate for Payer: PACE Medicare |
$11,538.11
|
| Rate for Payer: PACE SWMI |
$12,145.38
|
| Rate for Payer: PHP Medicare Advantage |
$12,145.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,662.64
|
| Rate for Payer: Priority Health Medicare |
$12,145.38
|
| Rate for Payer: Priority Health Narrow Network |
$17,330.11
|
| Rate for Payer: Railroad Medicare Medicare |
$12,145.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23,027.44
|
| Rate for Payer: UHC Core |
$18,882.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,145.38
|
| Rate for Payer: UHC Exchange |
$15,011.46
|
| Rate for Payer: UHC Medicare Advantage |
$12,509.74
|
| Rate for Payer: VA VA |
$12,145.38
|
|
|
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER
|
Facility
|
IP
|
$709.59
|
|
|
Service Code
|
NDC 0185-0939-97
|
| Hospital Charge Code |
117399
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$312.22 |
| Max. Negotiated Rate |
$638.63 |
| Rate for Payer: Aetna American Axle |
$461.23
|
| Rate for Payer: Aetna Commercial |
$603.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$461.23
|
| Rate for Payer: Cash Price |
$567.67
|
| Rate for Payer: Cofinity Commercial |
$496.71
|
| Rate for Payer: Cofinity Commercial |
$610.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$567.67
|
| Rate for Payer: Healthscope Commercial |
$638.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$496.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$532.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$603.15
|
| Rate for Payer: PHP Commercial |
$603.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$496.71
|
| Rate for Payer: Priority Health SBD |
$447.04
|
| Rate for Payer: UMR Bronson Commercial |
$312.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$532.19
|
|
|
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET
|
Facility
|
IP
|
$165.32
|
|
|
Service Code
|
NDC 68382-529-60
|
| Hospital Charge Code |
113348
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.74 |
| Max. Negotiated Rate |
$148.79 |
| Rate for Payer: Aetna American Axle |
$107.46
|
| Rate for Payer: Aetna Commercial |
$140.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.46
|
| Rate for Payer: Cash Price |
$132.26
|
| Rate for Payer: Cofinity Commercial |
$115.72
|
| Rate for Payer: Cofinity Commercial |
$142.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.26
|
| Rate for Payer: Healthscope Commercial |
$148.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$140.52
|
| Rate for Payer: PHP Commercial |
$140.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.72
|
| Rate for Payer: Priority Health SBD |
$104.15
|
| Rate for Payer: UMR Bronson Commercial |
$72.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.99
|
|
|
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET
|
Facility
|
IP
|
$9.16
|
|
|
Service Code
|
NDC 49884-466-63
|
| Hospital Charge Code |
113348
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.03 |
| Max. Negotiated Rate |
$8.24 |
| Rate for Payer: Aetna American Axle |
$5.95
|
| Rate for Payer: Aetna Commercial |
$7.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.95
|
| Rate for Payer: Cash Price |
$7.33
|
| Rate for Payer: Cofinity Commercial |
$6.41
|
| Rate for Payer: Cofinity Commercial |
$7.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.33
|
| Rate for Payer: Healthscope Commercial |
$8.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.79
|
| Rate for Payer: PHP Commercial |
$7.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.41
|
| Rate for Payer: Priority Health SBD |
$5.77
|
| Rate for Payer: UMR Bronson Commercial |
$4.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.87
|
|
|
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET
|
Facility
|
IP
|
$561.03
|
|
|
Service Code
|
NDC 0245-0036-60
|
| Hospital Charge Code |
113348
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$246.85 |
| Max. Negotiated Rate |
$504.93 |
| Rate for Payer: Aetna American Axle |
$364.67
|
| Rate for Payer: Aetna Commercial |
$476.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$364.67
|
| Rate for Payer: Cash Price |
$448.82
|
| Rate for Payer: Cofinity Commercial |
$392.72
|
| Rate for Payer: Cofinity Commercial |
$482.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$448.82
|
| Rate for Payer: Healthscope Commercial |
$504.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$392.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$420.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$476.88
|
| Rate for Payer: PHP Commercial |
$476.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$392.72
|
| Rate for Payer: Priority Health SBD |
$353.45
|
| Rate for Payer: UMR Bronson Commercial |
$246.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$420.77
|
|
|
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET
|
Facility
|
IP
|
$9.16
|
|
|
Service Code
|
NDC 49884-466-65
|
| Hospital Charge Code |
113348
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.03 |
| Max. Negotiated Rate |
$8.24 |
| Rate for Payer: Aetna American Axle |
$5.95
|
| Rate for Payer: Aetna Commercial |
$7.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.95
|
| Rate for Payer: Cash Price |
$7.33
|
| Rate for Payer: Cofinity Commercial |
$6.41
|
| Rate for Payer: Cofinity Commercial |
$7.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.33
|
| Rate for Payer: Healthscope Commercial |
$8.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.79
|
| Rate for Payer: PHP Commercial |
$7.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.41
|
| Rate for Payer: Priority Health SBD |
$5.77
|
| Rate for Payer: UMR Bronson Commercial |
$4.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.87
|
|
|
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET
|
Facility
|
IP
|
$9.36
|
|
|
Service Code
|
NDC 0245-0036-89
|
| Hospital Charge Code |
113348
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Aetna American Axle |
$6.08
|
| Rate for Payer: Aetna Commercial |
$7.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.08
|
| Rate for Payer: Cash Price |
$7.49
|
| Rate for Payer: Cofinity Commercial |
$6.55
|
| Rate for Payer: Cofinity Commercial |
$8.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.49
|
| Rate for Payer: Healthscope Commercial |
$8.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.96
|
| Rate for Payer: PHP Commercial |
$7.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.55
|
| Rate for Payer: Priority Health SBD |
$5.90
|
| Rate for Payer: UMR Bronson Commercial |
$4.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.02
|
|
|
CHONDROITIN-SOD HYALURON 3 %-4 %(0.5 ML)1 %(0.55 ML)INTRAOCULAR SYRING
|
Facility
|
IP
|
$345.54
|
|
|
Service Code
|
NDC 8065183150
|
| Hospital Charge Code |
28917
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$152.04 |
| Max. Negotiated Rate |
$310.99 |
| Rate for Payer: Aetna American Axle |
$224.60
|
| Rate for Payer: Aetna Commercial |
$293.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.60
|
| Rate for Payer: Cash Price |
$276.43
|
| Rate for Payer: Cofinity Commercial |
$241.88
|
| Rate for Payer: Cofinity Commercial |
$297.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.43
|
| Rate for Payer: Healthscope Commercial |
$310.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$241.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$293.71
|
| Rate for Payer: PHP Commercial |
$293.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.88
|
| Rate for Payer: Priority Health SBD |
$217.69
|
| Rate for Payer: UMR Bronson Commercial |
$152.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.16
|
|
|
CHONDROITIN-SOD HYALURON 4 %-3 % (40 MG-30 MG/ML) INTRAOCULAR SYRINGE
|
Facility
|
IP
|
$233.06
|
|
|
Service Code
|
HCPCS J7327
|
| Hospital Charge Code |
28923
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$102.55 |
| Max. Negotiated Rate |
$209.75 |
| Rate for Payer: Aetna American Axle |
$151.49
|
| Rate for Payer: Aetna Commercial |
$198.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.49
|
| Rate for Payer: Cash Price |
$186.45
|
| Rate for Payer: Cofinity Commercial |
$163.14
|
| Rate for Payer: Cofinity Commercial |
$200.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.45
|
| Rate for Payer: Healthscope Commercial |
$209.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$163.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$198.10
|
| Rate for Payer: PHP Commercial |
$198.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.14
|
| Rate for Payer: Priority Health SBD |
$146.83
|
| Rate for Payer: UMR Bronson Commercial |
$102.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.80
|
|
|
CHONDROITIN SULF-SODIUM HYALURONATE 40 MG-17 MG/ML INTRAOCULAR SYRINGE
|
Facility
|
IP
|
$321.34
|
|
|
Service Code
|
NDC 8065183710
|
| Hospital Charge Code |
70498
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$141.39 |
| Max. Negotiated Rate |
$289.21 |
| Rate for Payer: Aetna American Axle |
$208.87
|
| Rate for Payer: Aetna Commercial |
$273.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.87
|
| Rate for Payer: Cash Price |
$257.07
|
| Rate for Payer: Cofinity Commercial |
$224.94
|
| Rate for Payer: Cofinity Commercial |
$276.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.07
|
| Rate for Payer: Healthscope Commercial |
$289.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$224.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$273.14
|
| Rate for Payer: PHP Commercial |
$273.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.94
|
| Rate for Payer: Priority Health SBD |
$202.44
|
| Rate for Payer: UMR Bronson Commercial |
$141.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.00
|
|
|
CHROMIUM CHLORIDE 4 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$248.10
|
|
|
Service Code
|
NDC 0409-4093-10
|
| Hospital Charge Code |
1685
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$109.16 |
| Max. Negotiated Rate |
$223.29 |
| Rate for Payer: Aetna American Axle |
$161.26
|
| Rate for Payer: Aetna Commercial |
$210.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.26
|
| Rate for Payer: Cash Price |
$198.48
|
| Rate for Payer: Cofinity Commercial |
$173.67
|
| Rate for Payer: Cofinity Commercial |
$213.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.48
|
| Rate for Payer: Healthscope Commercial |
$223.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$210.88
|
| Rate for Payer: PHP Commercial |
$210.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.67
|
| Rate for Payer: Priority Health SBD |
$156.30
|
| Rate for Payer: UMR Bronson Commercial |
$109.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.08
|
|
|
CHROMIUM CHLORIDE 4 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$246.50
|
|
|
Service Code
|
NDC 0409-4093-01
|
| Hospital Charge Code |
1685
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$108.46 |
| Max. Negotiated Rate |
$221.85 |
| Rate for Payer: Aetna American Axle |
$160.22
|
| Rate for Payer: Aetna Commercial |
$209.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.22
|
| Rate for Payer: Cash Price |
$197.20
|
| Rate for Payer: Cofinity Commercial |
$172.55
|
| Rate for Payer: Cofinity Commercial |
$211.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.20
|
| Rate for Payer: Healthscope Commercial |
$221.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$209.52
|
| Rate for Payer: PHP Commercial |
$209.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.55
|
| Rate for Payer: Priority Health SBD |
$155.30
|
| Rate for Payer: UMR Bronson Commercial |
$108.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.88
|
|
|
CHROMIUM CHLORIDE 4 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$248.10
|
|
|
Service Code
|
NDC 0409-4093-09
|
| Hospital Charge Code |
1685
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$109.16 |
| Max. Negotiated Rate |
$223.29 |
| Rate for Payer: Aetna American Axle |
$161.26
|
| Rate for Payer: Aetna Commercial |
$210.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.26
|
| Rate for Payer: Cash Price |
$198.48
|
| Rate for Payer: Cofinity Commercial |
$173.67
|
| Rate for Payer: Cofinity Commercial |
$213.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.48
|
| Rate for Payer: Healthscope Commercial |
$223.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$210.88
|
| Rate for Payer: PHP Commercial |
$210.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.67
|
| Rate for Payer: Priority Health SBD |
$156.30
|
| Rate for Payer: UMR Bronson Commercial |
$109.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.08
|
|
