|
LINEZOLID 600 MG TABLET
|
Facility
|
IP
|
$12.05
|
|
|
Service Code
|
NDC 67877041933
|
| Hospital Charge Code |
28224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$10.85 |
| Rate for Payer: Aetna American Axle |
$7.83
|
| Rate for Payer: Aetna Commercial |
$10.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.83
|
| Rate for Payer: Cash Price |
$9.64
|
| Rate for Payer: Cofinity Advantage |
$8.44
|
| Rate for Payer: Cofinity Commercial |
$10.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.64
|
| Rate for Payer: Healthscope Commercial |
$10.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.04
|
| Rate for Payer: PHP Commercial |
$10.24
|
| Rate for Payer: Priority Health SBD |
$7.59
|
| Rate for Payer: UMR Bronson Commercial |
$5.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.04
|
|
|
LINEZOLID 600 MG TABLET
|
Facility
|
OP
|
$373.52
|
|
|
Service Code
|
NDC 60687030921
|
| Hospital Charge Code |
28224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.20 |
| Max. Negotiated Rate |
$336.17 |
| Rate for Payer: Aetna American Axle |
$242.79
|
| Rate for Payer: Aetna Commercial |
$317.49
|
| Rate for Payer: Aetna Medicare |
$186.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.79
|
| Rate for Payer: BCBS Complete |
$149.41
|
| Rate for Payer: Cash Price |
$298.82
|
| Rate for Payer: Cofinity Advantage |
$261.46
|
| Rate for Payer: Cofinity Commercial |
$321.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.82
|
| Rate for Payer: Healthscope Commercial |
$336.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$261.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$298.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.14
|
| Rate for Payer: PHP Commercial |
$317.49
|
| Rate for Payer: Priority Health SBD |
$235.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.79
|
| Rate for Payer: UHC Core |
$194.60
|
| Rate for Payer: UHC Exchange |
$146.79
|
| Rate for Payer: UMR Bronson Commercial |
$138.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.14
|
|
|
LINEZOLID 600 MG TABLET
|
Facility
|
OP
|
$12.05
|
|
|
Service Code
|
NDC 67877041933
|
| Hospital Charge Code |
28224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$10.85 |
| Rate for Payer: Aetna American Axle |
$7.83
|
| Rate for Payer: Aetna Commercial |
$10.24
|
| Rate for Payer: Aetna Medicare |
$6.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.83
|
| Rate for Payer: BCBS Complete |
$4.82
|
| Rate for Payer: Cash Price |
$9.64
|
| Rate for Payer: Cofinity Advantage |
$8.44
|
| Rate for Payer: Cofinity Commercial |
$10.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.64
|
| Rate for Payer: Healthscope Commercial |
$10.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.04
|
| Rate for Payer: PHP Commercial |
$10.24
|
| Rate for Payer: Priority Health SBD |
$7.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$6.28
|
| Rate for Payer: UHC Exchange |
$4.74
|
| Rate for Payer: UMR Bronson Commercial |
$4.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.04
|
|
|
LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$68.85
|
|
|
Service Code
|
HCPCS J2020
|
| Hospital Charge Code |
112020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.29 |
| Max. Negotiated Rate |
$61.97 |
| Rate for Payer: Aetna American Axle |
$44.75
|
| Rate for Payer: Aetna American Axle |
$42.97
|
| Rate for Payer: Aetna American Axle |
$62.20
|
| Rate for Payer: Aetna American Axle |
$90.48
|
| Rate for Payer: Aetna American Axle |
$71.54
|
| Rate for Payer: Aetna Commercial |
$93.55
|
| Rate for Payer: Aetna Commercial |
$56.19
|
| Rate for Payer: Aetna Commercial |
$58.52
|
| Rate for Payer: Aetna Commercial |
$81.34
|
| Rate for Payer: Aetna Commercial |
$118.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.20
|
| Rate for Payer: Cash Price |
$52.88
|
| Rate for Payer: Cash Price |
$111.36
|
| Rate for Payer: Cash Price |
$76.56
|
| Rate for Payer: Cash Price |
$55.08
|
| Rate for Payer: Cash Price |
$88.05
|
| Rate for Payer: Cofinity Advantage |
$77.04
|
| Rate for Payer: Cofinity Advantage |
$66.99
|
| Rate for Payer: Cofinity Advantage |
$97.44
|
| Rate for Payer: Cofinity Advantage |
$48.20
|
| Rate for Payer: Cofinity Advantage |
$46.27
|
| Rate for Payer: Cofinity Commercial |
$82.30
|
| Rate for Payer: Cofinity Commercial |
$94.65
|
| Rate for Payer: Cofinity Commercial |
$119.71
|
| Rate for Payer: Cofinity Commercial |
$56.85
|
| Rate for Payer: Cofinity Commercial |
$59.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.56
|
| Rate for Payer: Healthscope Commercial |
$99.05
|
| Rate for Payer: Healthscope Commercial |
$125.28
|
| Rate for Payer: Healthscope Commercial |
$59.49
|
| Rate for Payer: Healthscope Commercial |
$61.97
|
| Rate for Payer: Healthscope Commercial |
$86.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.64
|
| Rate for Payer: PHP Commercial |
$56.19
|
| Rate for Payer: PHP Commercial |
$93.55
|
| Rate for Payer: PHP Commercial |
$58.52
|
| Rate for Payer: PHP Commercial |
$81.34
|
| Rate for Payer: PHP Commercial |
$118.32
|
| Rate for Payer: Priority Health SBD |
$43.38
|
| Rate for Payer: Priority Health SBD |
$60.29
|
| Rate for Payer: Priority Health SBD |
$87.70
|
| Rate for Payer: Priority Health SBD |
$69.34
|
| Rate for Payer: Priority Health SBD |
$41.64
|
| Rate for Payer: UMR Bronson Commercial |
$61.25
|
| Rate for Payer: UMR Bronson Commercial |
$42.11
|
| Rate for Payer: UMR Bronson Commercial |
$29.08
|
| Rate for Payer: UMR Bronson Commercial |
$48.43
|
| Rate for Payer: UMR Bronson Commercial |
$30.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.40
|
|
|
LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$110.06
|
|
|
Service Code
|
HCPCS J2020
|
| Hospital Charge Code |
112020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$99.05 |
| Rate for Payer: Aetna American Axle |
$71.54
|
| Rate for Payer: Aetna American Axle |
$44.75
|
| Rate for Payer: Aetna American Axle |
$42.97
|
| Rate for Payer: Aetna American Axle |
$90.48
|
| Rate for Payer: Aetna American Axle |
$62.20
|
| Rate for Payer: Aetna Commercial |
$93.55
|
| Rate for Payer: Aetna Commercial |
$118.32
|
| Rate for Payer: Aetna Commercial |
$81.34
|
| Rate for Payer: Aetna Commercial |
$58.52
|
| Rate for Payer: Aetna Commercial |
$56.19
|
| Rate for Payer: Aetna Medicare |
$47.85
|
| Rate for Payer: Aetna Medicare |
$69.60
|
| Rate for Payer: Aetna Medicare |
$55.03
|
| Rate for Payer: Aetna Medicare |
$33.05
|
| Rate for Payer: Aetna Medicare |
$34.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.20
|
| Rate for Payer: BCBS Complete |
$27.54
|
| Rate for Payer: BCBS Complete |
$44.02
|
| Rate for Payer: BCBS Complete |
$55.68
|
| Rate for Payer: BCBS Complete |
$26.44
|
| Rate for Payer: BCBS Complete |
$38.28
|
| Rate for Payer: BCBS Trust/PPO |
$8.88
|
| Rate for Payer: BCBS Trust/PPO |
$8.88
|
| Rate for Payer: BCBS Trust/PPO |
$8.88
|
| Rate for Payer: BCBS Trust/PPO |
$8.88
|
| Rate for Payer: BCBS Trust/PPO |
$8.88
|
| Rate for Payer: BCN Commercial |
$8.88
|
| Rate for Payer: BCN Commercial |
$8.88
|
| Rate for Payer: BCN Commercial |
$8.88
|
| Rate for Payer: BCN Commercial |
$8.88
|
| Rate for Payer: BCN Commercial |
$8.88
|
| Rate for Payer: Cash Price |
$55.08
|
| Rate for Payer: Cash Price |
$76.56
|
| Rate for Payer: Cash Price |
$111.36
|
| Rate for Payer: Cash Price |
$88.05
|
| Rate for Payer: Cash Price |
$52.88
|
| Rate for Payer: Cash Price |
$88.05
|
| Rate for Payer: Cash Price |
$52.88
|
| Rate for Payer: Cash Price |
$55.08
|
| Rate for Payer: Cash Price |
$111.36
|
| Rate for Payer: Cash Price |
$76.56
|
| Rate for Payer: Cofinity Advantage |
$48.20
|
| Rate for Payer: Cofinity Advantage |
$97.44
|
| Rate for Payer: Cofinity Advantage |
$46.27
|
| Rate for Payer: Cofinity Advantage |
$66.99
|
| Rate for Payer: Cofinity Advantage |
$77.04
|
| Rate for Payer: Cofinity Commercial |
$59.21
|
| Rate for Payer: Cofinity Commercial |
$94.65
|
| Rate for Payer: Cofinity Commercial |
$119.71
|
| Rate for Payer: Cofinity Commercial |
$56.85
|
| Rate for Payer: Cofinity Commercial |
$82.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.88
|
| Rate for Payer: Healthscope Commercial |
$59.49
|
| Rate for Payer: Healthscope Commercial |
$86.13
|
| Rate for Payer: Healthscope Commercial |
$61.97
|
| Rate for Payer: Healthscope Commercial |
$99.05
|
| Rate for Payer: Healthscope Commercial |
$125.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$111.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.78
|
| Rate for Payer: PHP Commercial |
$118.32
|
| Rate for Payer: PHP Commercial |
$56.19
|
| Rate for Payer: PHP Commercial |
$81.34
|
| Rate for Payer: PHP Commercial |
$58.52
|
| Rate for Payer: PHP Commercial |
$93.55
|
| Rate for Payer: Priority Health SBD |
$41.64
|
| Rate for Payer: Priority Health SBD |
$69.34
|
| Rate for Payer: Priority Health SBD |
$43.38
|
| Rate for Payer: Priority Health SBD |
$60.29
|
| Rate for Payer: Priority Health SBD |
$87.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.52
|
| Rate for Payer: UHC Core |
$4.52
|
| Rate for Payer: UHC Core |
$4.52
|
| Rate for Payer: UHC Core |
$4.52
|
| Rate for Payer: UHC Core |
$4.52
|
| Rate for Payer: UHC Core |
$4.52
|
| Rate for Payer: UHC Exchange |
$4.52
|
| Rate for Payer: UHC Exchange |
$4.52
|
| Rate for Payer: UHC Exchange |
$4.52
|
| Rate for Payer: UHC Exchange |
$4.52
|
| Rate for Payer: UHC Exchange |
$4.52
|
| Rate for Payer: UMR Bronson Commercial |
$40.72
|
| Rate for Payer: UMR Bronson Commercial |
$25.47
|
| Rate for Payer: UMR Bronson Commercial |
$24.46
|
| Rate for Payer: UMR Bronson Commercial |
$35.41
|
| Rate for Payer: UMR Bronson Commercial |
$51.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.55
|
|
|
LIOTHYRONINE 25 MCG TABLET
|
Facility
|
OP
|
$620.64
|
|
|
Service Code
|
NDC 51862032101
|
| Hospital Charge Code |
4504
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$229.64 |
| Max. Negotiated Rate |
$558.58 |
| Rate for Payer: Aetna American Axle |
$403.42
|
| Rate for Payer: Aetna Commercial |
$527.54
|
| Rate for Payer: Aetna Medicare |
$310.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$403.42
|
| Rate for Payer: BCBS Complete |
$248.26
|
| Rate for Payer: Cash Price |
$496.51
|
| Rate for Payer: Cofinity Advantage |
$434.45
|
| Rate for Payer: Cofinity Commercial |
$533.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$496.51
|
| Rate for Payer: Healthscope Commercial |
$558.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$434.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$465.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$496.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$527.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$465.48
|
| Rate for Payer: PHP Commercial |
$527.54
|
| Rate for Payer: Priority Health SBD |
$391.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$403.42
|
| Rate for Payer: UHC Core |
$323.35
|
| Rate for Payer: UHC Exchange |
$243.91
|
| Rate for Payer: UMR Bronson Commercial |
$229.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$465.48
|
|
|
LIOTHYRONINE 25 MCG TABLET
|
Facility
|
IP
|
$268.32
|
|
|
Service Code
|
NDC 70377011512
|
| Hospital Charge Code |
4504
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.06 |
| Max. Negotiated Rate |
$241.49 |
| Rate for Payer: Aetna American Axle |
$174.41
|
| Rate for Payer: Aetna Commercial |
$228.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.41
|
| Rate for Payer: Cash Price |
$214.66
|
| Rate for Payer: Cofinity Advantage |
$187.82
|
| Rate for Payer: Cofinity Commercial |
$230.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.66
|
| Rate for Payer: Healthscope Commercial |
$241.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$201.24
|
| Rate for Payer: PHP Commercial |
$228.07
|
| Rate for Payer: Priority Health SBD |
$169.04
|
| Rate for Payer: UMR Bronson Commercial |
$118.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.24
|
|
|
LIOTHYRONINE 25 MCG TABLET
|
Facility
|
IP
|
$620.64
|
|
|
Service Code
|
NDC 51862032101
|
| Hospital Charge Code |
4504
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$273.08 |
| Max. Negotiated Rate |
$558.58 |
| Rate for Payer: Aetna American Axle |
$403.42
|
| Rate for Payer: Aetna Commercial |
$527.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$403.42
|
| Rate for Payer: Cash Price |
$496.51
|
| Rate for Payer: Cofinity Advantage |
$434.45
|
| Rate for Payer: Cofinity Commercial |
$533.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$496.51
|
| Rate for Payer: Healthscope Commercial |
$558.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$434.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$465.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$527.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$465.48
|
| Rate for Payer: PHP Commercial |
$527.54
|
| Rate for Payer: Priority Health SBD |
$391.00
|
| Rate for Payer: UMR Bronson Commercial |
$273.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$465.48
|
|
|
LIOTHYRONINE 25 MCG TABLET
|
Facility
|
OP
|
$268.32
|
|
|
Service Code
|
NDC 70377011512
|
| Hospital Charge Code |
4504
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.28 |
| Max. Negotiated Rate |
$241.49 |
| Rate for Payer: Aetna American Axle |
$174.41
|
| Rate for Payer: Aetna Commercial |
$228.07
|
| Rate for Payer: Aetna Medicare |
$134.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.41
|
| Rate for Payer: BCBS Complete |
$107.33
|
| Rate for Payer: Cash Price |
$214.66
|
| Rate for Payer: Cofinity Advantage |
$187.82
|
| Rate for Payer: Cofinity Commercial |
$230.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.66
|
| Rate for Payer: Healthscope Commercial |
$241.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$214.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$201.24
|
| Rate for Payer: PHP Commercial |
$228.07
|
| Rate for Payer: Priority Health SBD |
$169.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.41
|
| Rate for Payer: UHC Core |
$139.79
|
| Rate for Payer: UHC Exchange |
$105.45
|
| Rate for Payer: UMR Bronson Commercial |
$99.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.24
|
|
|
LIOTHYRONINE 50 MCG TABLET
|
Facility
|
IP
|
$530.50
|
|
|
Service Code
|
NDC 42794002012
|
| Hospital Charge Code |
4505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$233.42 |
| Max. Negotiated Rate |
$477.45 |
| Rate for Payer: Aetna American Axle |
$344.82
|
| Rate for Payer: Aetna Commercial |
$450.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$344.82
|
| Rate for Payer: Cash Price |
$424.40
|
| Rate for Payer: Cofinity Advantage |
$371.35
|
| Rate for Payer: Cofinity Commercial |
$456.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$424.40
|
| Rate for Payer: Healthscope Commercial |
$477.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$371.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$397.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$450.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$397.88
|
| Rate for Payer: PHP Commercial |
$450.93
|
| Rate for Payer: Priority Health SBD |
$334.21
|
| Rate for Payer: UMR Bronson Commercial |
$233.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$397.88
|
|
|
LIOTHYRONINE 50 MCG TABLET
|
Facility
|
OP
|
$530.50
|
|
|
Service Code
|
NDC 42794002012
|
| Hospital Charge Code |
4505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.28 |
| Max. Negotiated Rate |
$477.45 |
| Rate for Payer: Aetna American Axle |
$344.82
|
| Rate for Payer: Aetna Commercial |
$450.93
|
| Rate for Payer: Aetna Medicare |
$265.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$344.82
|
| Rate for Payer: BCBS Complete |
$212.20
|
| Rate for Payer: Cash Price |
$424.40
|
| Rate for Payer: Cofinity Advantage |
$371.35
|
| Rate for Payer: Cofinity Commercial |
$456.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$424.40
|
| Rate for Payer: Healthscope Commercial |
$477.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$371.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$397.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$424.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$450.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$397.88
|
| Rate for Payer: PHP Commercial |
$450.93
|
| Rate for Payer: Priority Health SBD |
$334.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$344.82
|
| Rate for Payer: UHC Core |
$276.39
|
| Rate for Payer: UHC Exchange |
$208.49
|
| Rate for Payer: UMR Bronson Commercial |
$196.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$397.88
|
|
|
LIOTHYRONINE 5 MCG TABLET
|
Facility
|
OP
|
$353.40
|
|
|
Service Code
|
NDC 42794001802
|
| Hospital Charge Code |
10443
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.76 |
| Max. Negotiated Rate |
$318.06 |
| Rate for Payer: Aetna American Axle |
$229.71
|
| Rate for Payer: Aetna Commercial |
$300.39
|
| Rate for Payer: Aetna Medicare |
$176.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.71
|
| Rate for Payer: BCBS Complete |
$141.36
|
| Rate for Payer: Cash Price |
$282.72
|
| Rate for Payer: Cofinity Advantage |
$247.38
|
| Rate for Payer: Cofinity Commercial |
$303.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.72
|
| Rate for Payer: Healthscope Commercial |
$318.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$247.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$265.05
|
| Rate for Payer: PHP Commercial |
$300.39
|
| Rate for Payer: Priority Health SBD |
$222.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$229.71
|
| Rate for Payer: UHC Core |
$184.12
|
| Rate for Payer: UHC Exchange |
$138.89
|
| Rate for Payer: UMR Bronson Commercial |
$130.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.05
|
|
|
LIOTHYRONINE 5 MCG TABLET
|
Facility
|
IP
|
$273.03
|
|
|
Service Code
|
NDC 42794001812
|
| Hospital Charge Code |
10443
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.13 |
| Max. Negotiated Rate |
$245.73 |
| Rate for Payer: Aetna American Axle |
$177.47
|
| Rate for Payer: Aetna Commercial |
$232.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.47
|
| Rate for Payer: Cash Price |
$218.42
|
| Rate for Payer: Cofinity Advantage |
$191.12
|
| Rate for Payer: Cofinity Commercial |
$234.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.42
|
| Rate for Payer: Healthscope Commercial |
$245.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$191.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.77
|
| Rate for Payer: PHP Commercial |
$232.08
|
| Rate for Payer: Priority Health SBD |
$172.01
|
| Rate for Payer: UMR Bronson Commercial |
$120.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.77
|
|
|
LIOTHYRONINE 5 MCG TABLET
|
Facility
|
OP
|
$374.30
|
|
|
Service Code
|
NDC 60793011501
|
| Hospital Charge Code |
10443
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.49 |
| Max. Negotiated Rate |
$336.87 |
| Rate for Payer: Aetna American Axle |
$243.29
|
| Rate for Payer: Aetna Commercial |
$318.15
|
| Rate for Payer: Aetna Medicare |
$187.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.29
|
| Rate for Payer: BCBS Complete |
$149.72
|
| Rate for Payer: Cash Price |
$299.44
|
| Rate for Payer: Cofinity Advantage |
$262.01
|
| Rate for Payer: Cofinity Commercial |
$321.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.44
|
| Rate for Payer: Healthscope Commercial |
$336.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$262.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$299.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.73
|
| Rate for Payer: PHP Commercial |
$318.15
|
| Rate for Payer: Priority Health SBD |
$235.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$243.29
|
| Rate for Payer: UHC Core |
$195.01
|
| Rate for Payer: UHC Exchange |
$147.10
|
| Rate for Payer: UMR Bronson Commercial |
$138.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.73
|
|
|
LIOTHYRONINE 5 MCG TABLET
|
Facility
|
IP
|
$245.28
|
|
|
Service Code
|
NDC 62756058988
|
| Hospital Charge Code |
10443
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.92 |
| Max. Negotiated Rate |
$220.75 |
| Rate for Payer: Aetna American Axle |
$159.43
|
| Rate for Payer: Aetna Commercial |
$208.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.43
|
| Rate for Payer: Cash Price |
$196.22
|
| Rate for Payer: Cofinity Advantage |
$171.70
|
| Rate for Payer: Cofinity Commercial |
$210.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.22
|
| Rate for Payer: Healthscope Commercial |
$220.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.96
|
| Rate for Payer: PHP Commercial |
$208.49
|
| Rate for Payer: Priority Health SBD |
$154.53
|
| Rate for Payer: UMR Bronson Commercial |
$107.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.96
|
|
|
LIOTHYRONINE 5 MCG TABLET
|
Facility
|
IP
|
$472.32
|
|
|
Service Code
|
NDC 51862032001
|
| Hospital Charge Code |
10443
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$207.82 |
| Max. Negotiated Rate |
$425.09 |
| Rate for Payer: Aetna American Axle |
$307.01
|
| Rate for Payer: Aetna Commercial |
$401.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.01
|
| Rate for Payer: Cash Price |
$377.86
|
| Rate for Payer: Cofinity Advantage |
$330.62
|
| Rate for Payer: Cofinity Commercial |
$406.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$377.86
|
| Rate for Payer: Healthscope Commercial |
$425.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$330.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$354.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$401.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$354.24
|
| Rate for Payer: PHP Commercial |
$401.47
|
| Rate for Payer: Priority Health SBD |
$297.56
|
| Rate for Payer: UMR Bronson Commercial |
$207.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$354.24
|
|
|
LIOTHYRONINE 5 MCG TABLET
|
Facility
|
OP
|
$245.28
|
|
|
Service Code
|
NDC 62756058988
|
| Hospital Charge Code |
10443
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.75 |
| Max. Negotiated Rate |
$220.75 |
| Rate for Payer: Aetna American Axle |
$159.43
|
| Rate for Payer: Aetna Commercial |
$208.49
|
| Rate for Payer: Aetna Medicare |
$122.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.43
|
| Rate for Payer: BCBS Complete |
$98.11
|
| Rate for Payer: Cash Price |
$196.22
|
| Rate for Payer: Cofinity Advantage |
$171.70
|
| Rate for Payer: Cofinity Commercial |
$210.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.22
|
| Rate for Payer: Healthscope Commercial |
$220.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$196.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.96
|
| Rate for Payer: PHP Commercial |
$208.49
|
| Rate for Payer: Priority Health SBD |
$154.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.43
|
| Rate for Payer: UHC Core |
$127.79
|
| Rate for Payer: UHC Exchange |
$96.40
|
| Rate for Payer: UMR Bronson Commercial |
$90.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.96
|
|
|
LIOTHYRONINE 5 MCG TABLET
|
Facility
|
OP
|
$273.03
|
|
|
Service Code
|
NDC 42794001812
|
| Hospital Charge Code |
10443
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.02 |
| Max. Negotiated Rate |
$245.73 |
| Rate for Payer: Aetna American Axle |
$177.47
|
| Rate for Payer: Aetna Commercial |
$232.08
|
| Rate for Payer: Aetna Medicare |
$136.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.47
|
| Rate for Payer: BCBS Complete |
$109.21
|
| Rate for Payer: Cash Price |
$218.42
|
| Rate for Payer: Cofinity Advantage |
$191.12
|
| Rate for Payer: Cofinity Commercial |
$234.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.42
|
| Rate for Payer: Healthscope Commercial |
$245.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$191.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.77
|
| Rate for Payer: PHP Commercial |
$232.08
|
| Rate for Payer: Priority Health SBD |
$172.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.47
|
| Rate for Payer: UHC Core |
$142.25
|
| Rate for Payer: UHC Exchange |
$107.30
|
| Rate for Payer: UMR Bronson Commercial |
$101.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.77
|
|
|
LIOTHYRONINE 5 MCG TABLET
|
Facility
|
OP
|
$270.75
|
|
|
Service Code
|
NDC 70377011412
|
| Hospital Charge Code |
10443
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.18 |
| Max. Negotiated Rate |
$243.68 |
| Rate for Payer: Aetna American Axle |
$175.99
|
| Rate for Payer: Aetna Commercial |
$230.14
|
| Rate for Payer: Aetna Medicare |
$135.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.99
|
| Rate for Payer: BCBS Complete |
$108.30
|
| Rate for Payer: Cash Price |
$216.60
|
| Rate for Payer: Cofinity Advantage |
$189.53
|
| Rate for Payer: Cofinity Commercial |
$232.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.60
|
| Rate for Payer: Healthscope Commercial |
$243.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$216.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.06
|
| Rate for Payer: PHP Commercial |
$230.14
|
| Rate for Payer: Priority Health SBD |
$170.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.99
|
| Rate for Payer: UHC Core |
$141.06
|
| Rate for Payer: UHC Exchange |
$106.40
|
| Rate for Payer: UMR Bronson Commercial |
$100.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.06
|
|
|
LIOTHYRONINE 5 MCG TABLET
|
Facility
|
OP
|
$472.32
|
|
|
Service Code
|
NDC 51862032001
|
| Hospital Charge Code |
10443
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.76 |
| Max. Negotiated Rate |
$425.09 |
| Rate for Payer: Aetna American Axle |
$307.01
|
| Rate for Payer: Aetna Commercial |
$401.47
|
| Rate for Payer: Aetna Medicare |
$236.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.01
|
| Rate for Payer: BCBS Complete |
$188.93
|
| Rate for Payer: Cash Price |
$377.86
|
| Rate for Payer: Cofinity Advantage |
$330.62
|
| Rate for Payer: Cofinity Commercial |
$406.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$377.86
|
| Rate for Payer: Healthscope Commercial |
$425.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$330.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$354.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$377.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$401.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$354.24
|
| Rate for Payer: PHP Commercial |
$401.47
|
| Rate for Payer: Priority Health SBD |
$297.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$307.01
|
| Rate for Payer: UHC Core |
$246.08
|
| Rate for Payer: UHC Exchange |
$185.62
|
| Rate for Payer: UMR Bronson Commercial |
$174.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$354.24
|
|
|
LIOTHYRONINE 5 MCG TABLET
|
Facility
|
IP
|
$374.30
|
|
|
Service Code
|
NDC 60793011501
|
| Hospital Charge Code |
10443
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.69 |
| Max. Negotiated Rate |
$336.87 |
| Rate for Payer: Aetna American Axle |
$243.29
|
| Rate for Payer: Aetna Commercial |
$318.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.29
|
| Rate for Payer: Cash Price |
$299.44
|
| Rate for Payer: Cofinity Advantage |
$262.01
|
| Rate for Payer: Cofinity Commercial |
$321.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.44
|
| Rate for Payer: Healthscope Commercial |
$336.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$262.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.73
|
| Rate for Payer: PHP Commercial |
$318.15
|
| Rate for Payer: Priority Health SBD |
$235.81
|
| Rate for Payer: UMR Bronson Commercial |
$164.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.73
|
|
|
LIOTHYRONINE 5 MCG TABLET
|
Facility
|
IP
|
$270.75
|
|
|
Service Code
|
NDC 70377011412
|
| Hospital Charge Code |
10443
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.13 |
| Max. Negotiated Rate |
$243.68 |
| Rate for Payer: Aetna American Axle |
$175.99
|
| Rate for Payer: Aetna Commercial |
$230.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.99
|
| Rate for Payer: Cash Price |
$216.60
|
| Rate for Payer: Cofinity Advantage |
$189.53
|
| Rate for Payer: Cofinity Commercial |
$232.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.60
|
| Rate for Payer: Healthscope Commercial |
$243.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.06
|
| Rate for Payer: PHP Commercial |
$230.14
|
| Rate for Payer: Priority Health SBD |
$170.57
|
| Rate for Payer: UMR Bronson Commercial |
$119.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.06
|
|
|
LIOTHYRONINE 5 MCG TABLET
|
Facility
|
IP
|
$353.40
|
|
|
Service Code
|
NDC 42794001802
|
| Hospital Charge Code |
10443
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.50 |
| Max. Negotiated Rate |
$318.06 |
| Rate for Payer: Aetna American Axle |
$229.71
|
| Rate for Payer: Aetna Commercial |
$300.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.71
|
| Rate for Payer: Cash Price |
$282.72
|
| Rate for Payer: Cofinity Advantage |
$247.38
|
| Rate for Payer: Cofinity Commercial |
$303.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.72
|
| Rate for Payer: Healthscope Commercial |
$318.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$247.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$265.05
|
| Rate for Payer: PHP Commercial |
$300.39
|
| Rate for Payer: Priority Health SBD |
$222.64
|
| Rate for Payer: UMR Bronson Commercial |
$155.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.05
|
|
|
LIPASE-PROTEASE-AMYLASE(PORK)12,000-38,000-60,000 UNIT CAPSULE,DEL REL
|
Facility
|
OP
|
$1,429.31
|
|
|
Service Code
|
NDC 00032121201
|
| Hospital Charge Code |
98035
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$528.84 |
| Max. Negotiated Rate |
$1,286.38 |
| Rate for Payer: Aetna American Axle |
$929.05
|
| Rate for Payer: Aetna Commercial |
$1,214.91
|
| Rate for Payer: Aetna Medicare |
$714.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$929.05
|
| Rate for Payer: BCBS Complete |
$571.72
|
| Rate for Payer: Cash Price |
$1,143.45
|
| Rate for Payer: Cofinity Advantage |
$1,000.52
|
| Rate for Payer: Cofinity Commercial |
$1,229.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,143.45
|
| Rate for Payer: Healthscope Commercial |
$1,286.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,000.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,071.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,143.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,214.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,071.98
|
| Rate for Payer: PHP Commercial |
$1,214.91
|
| Rate for Payer: Priority Health SBD |
$900.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$929.05
|
| Rate for Payer: UHC Core |
$744.67
|
| Rate for Payer: UHC Exchange |
$561.72
|
| Rate for Payer: UMR Bronson Commercial |
$528.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,071.98
|
|
|
LIPASE-PROTEASE-AMYLASE(PORK)12,000-38,000-60,000 UNIT CAPSULE,DEL REL
|
Facility
|
IP
|
$1,429.31
|
|
|
Service Code
|
NDC 00032121201
|
| Hospital Charge Code |
98035
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$628.90 |
| Max. Negotiated Rate |
$1,286.38 |
| Rate for Payer: Aetna American Axle |
$929.05
|
| Rate for Payer: Aetna Commercial |
$1,214.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$929.05
|
| Rate for Payer: Cash Price |
$1,143.45
|
| Rate for Payer: Cofinity Advantage |
$1,000.52
|
| Rate for Payer: Cofinity Commercial |
$1,229.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,143.45
|
| Rate for Payer: Healthscope Commercial |
$1,286.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,000.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,071.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,214.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,071.98
|
| Rate for Payer: PHP Commercial |
$1,214.91
|
| Rate for Payer: Priority Health SBD |
$900.47
|
| Rate for Payer: UMR Bronson Commercial |
$628.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,071.98
|
|
