|
LIPASE-PROTEASE-AMYLASE(PORK)12,000-38,000-60,000 UNIT CAPSULE,DEL REL
|
Facility
|
IP
|
$1,514.78
|
|
|
Service Code
|
NDC 00032004770
|
| Hospital Charge Code |
98035
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$666.50 |
| Max. Negotiated Rate |
$1,363.30 |
| Rate for Payer: Aetna American Axle |
$984.61
|
| Rate for Payer: Aetna Commercial |
$1,287.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$984.61
|
| Rate for Payer: Cash Price |
$1,211.82
|
| Rate for Payer: Cofinity Advantage |
$1,060.35
|
| Rate for Payer: Cofinity Commercial |
$1,302.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,211.82
|
| Rate for Payer: Healthscope Commercial |
$1,363.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,060.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,136.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,287.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,136.09
|
| Rate for Payer: PHP Commercial |
$1,287.56
|
| Rate for Payer: Priority Health SBD |
$954.31
|
| Rate for Payer: UMR Bronson Commercial |
$666.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,136.09
|
|
|
LIPASE-PROTEASE-AMYLASE(PORK)12,000-38,000-60,000 UNIT CAPSULE,DEL REL
|
Facility
|
OP
|
$1,514.78
|
|
|
Service Code
|
NDC 00032004770
|
| Hospital Charge Code |
98035
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$560.47 |
| Max. Negotiated Rate |
$1,363.30 |
| Rate for Payer: Aetna American Axle |
$984.61
|
| Rate for Payer: Aetna Commercial |
$1,287.56
|
| Rate for Payer: Aetna Medicare |
$757.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$984.61
|
| Rate for Payer: BCBS Complete |
$605.91
|
| Rate for Payer: Cash Price |
$1,211.82
|
| Rate for Payer: Cofinity Advantage |
$1,060.35
|
| Rate for Payer: Cofinity Commercial |
$1,302.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,211.82
|
| Rate for Payer: Healthscope Commercial |
$1,363.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,060.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,136.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,211.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,287.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,136.09
|
| Rate for Payer: PHP Commercial |
$1,287.56
|
| Rate for Payer: Priority Health SBD |
$954.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$984.61
|
| Rate for Payer: UHC Core |
$789.20
|
| Rate for Payer: UHC Exchange |
$595.31
|
| Rate for Payer: UMR Bronson Commercial |
$560.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,136.09
|
|
|
LIPASE-PROTEASE-AMYLASE (PORK) 3,000-9,500-15,000 UNIT CAPSULE,DEL REL
|
Facility
|
OP
|
$549.36
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
153195
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$203.26 |
| Max. Negotiated Rate |
$494.42 |
| Rate for Payer: Aetna American Axle |
$357.08
|
| Rate for Payer: Aetna American Axle |
$377.83
|
| Rate for Payer: Aetna Commercial |
$466.96
|
| Rate for Payer: Aetna Commercial |
$494.09
|
| Rate for Payer: Aetna Medicare |
$274.68
|
| Rate for Payer: Aetna Medicare |
$290.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$357.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$377.83
|
| Rate for Payer: BCBS Complete |
$232.51
|
| Rate for Payer: BCBS Complete |
$219.74
|
| Rate for Payer: Cash Price |
$465.02
|
| Rate for Payer: Cash Price |
$439.49
|
| Rate for Payer: Cofinity Advantage |
$384.55
|
| Rate for Payer: Cofinity Advantage |
$406.90
|
| Rate for Payer: Cofinity Commercial |
$472.45
|
| Rate for Payer: Cofinity Commercial |
$499.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$465.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$439.49
|
| Rate for Payer: Healthscope Commercial |
$523.15
|
| Rate for Payer: Healthscope Commercial |
$494.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$384.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$406.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$412.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$435.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$439.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$466.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$494.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$412.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$435.96
|
| Rate for Payer: PHP Commercial |
$466.96
|
| Rate for Payer: PHP Commercial |
$494.09
|
| Rate for Payer: Priority Health SBD |
$346.10
|
| Rate for Payer: Priority Health SBD |
$366.21
|
| Rate for Payer: UMR Bronson Commercial |
$203.26
|
| Rate for Payer: UMR Bronson Commercial |
$215.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$412.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$435.96
|
|
|
LIPASE-PROTEASE-AMYLASE (PORK) 3,000-9,500-15,000 UNIT CAPSULE,DEL REL
|
Facility
|
IP
|
$549.36
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
153195
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$241.72 |
| Max. Negotiated Rate |
$494.42 |
| Rate for Payer: Aetna American Axle |
$357.08
|
| Rate for Payer: Aetna American Axle |
$377.83
|
| Rate for Payer: Aetna Commercial |
$466.96
|
| Rate for Payer: Aetna Commercial |
$494.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$357.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$377.83
|
| Rate for Payer: Cash Price |
$439.49
|
| Rate for Payer: Cash Price |
$465.02
|
| Rate for Payer: Cofinity Advantage |
$406.90
|
| Rate for Payer: Cofinity Advantage |
$384.55
|
| Rate for Payer: Cofinity Commercial |
$499.90
|
| Rate for Payer: Cofinity Commercial |
$472.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$439.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$465.02
|
| Rate for Payer: Healthscope Commercial |
$494.42
|
| Rate for Payer: Healthscope Commercial |
$523.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$406.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$384.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$412.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$435.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$466.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$494.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$412.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$435.96
|
| Rate for Payer: PHP Commercial |
$466.96
|
| Rate for Payer: PHP Commercial |
$494.09
|
| Rate for Payer: Priority Health SBD |
$366.21
|
| Rate for Payer: Priority Health SBD |
$346.10
|
| Rate for Payer: UMR Bronson Commercial |
$241.72
|
| Rate for Payer: UMR Bronson Commercial |
$255.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$412.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$435.96
|
|
|
LIPASE-PROTEASE-AMYLASE (PORK)36,000-114,000-180K UNIT CAPSULE,DEL REL
|
Facility
|
OP
|
$4,558.77
|
|
|
Service Code
|
NDC 00032301613
|
| Hospital Charge Code |
166135
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,686.74 |
| Max. Negotiated Rate |
$4,102.89 |
| Rate for Payer: Aetna American Axle |
$2,963.20
|
| Rate for Payer: Aetna Commercial |
$3,874.95
|
| Rate for Payer: Aetna Medicare |
$2,279.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,963.20
|
| Rate for Payer: BCBS Complete |
$1,823.51
|
| Rate for Payer: Cash Price |
$3,647.02
|
| Rate for Payer: Cofinity Advantage |
$3,191.14
|
| Rate for Payer: Cofinity Commercial |
$3,920.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,647.02
|
| Rate for Payer: Healthscope Commercial |
$4,102.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,191.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,419.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,647.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,874.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,419.08
|
| Rate for Payer: PHP Commercial |
$3,874.95
|
| Rate for Payer: Priority Health SBD |
$2,872.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,963.20
|
| Rate for Payer: UHC Core |
$2,375.12
|
| Rate for Payer: UHC Exchange |
$1,791.60
|
| Rate for Payer: UMR Bronson Commercial |
$1,686.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,419.08
|
|
|
LIPASE-PROTEASE-AMYLASE (PORK)36,000-114,000-180K UNIT CAPSULE,DEL REL
|
Facility
|
IP
|
$4,558.77
|
|
|
Service Code
|
NDC 00032301613
|
| Hospital Charge Code |
166135
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,005.86 |
| Max. Negotiated Rate |
$4,102.89 |
| Rate for Payer: Aetna American Axle |
$2,963.20
|
| Rate for Payer: Aetna Commercial |
$3,874.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,963.20
|
| Rate for Payer: Cash Price |
$3,647.02
|
| Rate for Payer: Cofinity Advantage |
$3,191.14
|
| Rate for Payer: Cofinity Commercial |
$3,920.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,647.02
|
| Rate for Payer: Healthscope Commercial |
$4,102.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,191.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,419.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,874.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,419.08
|
| Rate for Payer: PHP Commercial |
$3,874.95
|
| Rate for Payer: Priority Health SBD |
$2,872.03
|
| Rate for Payer: UMR Bronson Commercial |
$2,005.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,419.08
|
|
|
LIPASE-PROTEASE-AMYLASE (PORK)6,000-19,000-30,000 UNIT CAPSULE,DEL REL
|
Facility
|
OP
|
$2,209.20
|
|
|
Service Code
|
NDC 00032120607
|
| Hospital Charge Code |
98034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$817.40 |
| Max. Negotiated Rate |
$1,988.28 |
| Rate for Payer: Aetna American Axle |
$1,435.98
|
| Rate for Payer: Aetna Commercial |
$1,877.82
|
| Rate for Payer: Aetna Medicare |
$1,104.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,435.98
|
| Rate for Payer: BCBS Complete |
$883.68
|
| Rate for Payer: Cash Price |
$1,767.36
|
| Rate for Payer: Cofinity Advantage |
$1,546.44
|
| Rate for Payer: Cofinity Commercial |
$1,899.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,767.36
|
| Rate for Payer: Healthscope Commercial |
$1,988.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,546.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,656.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,767.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,877.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,656.90
|
| Rate for Payer: PHP Commercial |
$1,877.82
|
| Rate for Payer: Priority Health SBD |
$1,391.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,435.98
|
| Rate for Payer: UHC Core |
$1,150.99
|
| Rate for Payer: UHC Exchange |
$868.22
|
| Rate for Payer: UMR Bronson Commercial |
$817.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,656.90
|
|
|
LIPASE-PROTEASE-AMYLASE (PORK)6,000-19,000-30,000 UNIT CAPSULE,DEL REL
|
Facility
|
IP
|
$2,209.20
|
|
|
Service Code
|
NDC 00032120607
|
| Hospital Charge Code |
98034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$972.05 |
| Max. Negotiated Rate |
$1,988.28 |
| Rate for Payer: Aetna American Axle |
$1,435.98
|
| Rate for Payer: Aetna Commercial |
$1,877.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,435.98
|
| Rate for Payer: Cash Price |
$1,767.36
|
| Rate for Payer: Cofinity Advantage |
$1,546.44
|
| Rate for Payer: Cofinity Commercial |
$1,899.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,767.36
|
| Rate for Payer: Healthscope Commercial |
$1,988.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,546.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,656.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,877.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,656.90
|
| Rate for Payer: PHP Commercial |
$1,877.82
|
| Rate for Payer: Priority Health SBD |
$1,391.80
|
| Rate for Payer: UMR Bronson Commercial |
$972.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,656.90
|
|
|
LIPASE-PROTEASE-AMYLASE (PORK)6,000-19,000-30,000 UNIT CAPSULE,DEL REL
|
Facility
|
IP
|
$933.12
|
|
|
Service Code
|
NDC 00032120601
|
| Hospital Charge Code |
98034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$410.57 |
| Max. Negotiated Rate |
$839.81 |
| Rate for Payer: Aetna American Axle |
$606.53
|
| Rate for Payer: Aetna Commercial |
$793.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$606.53
|
| Rate for Payer: Cash Price |
$746.50
|
| Rate for Payer: Cofinity Advantage |
$653.18
|
| Rate for Payer: Cofinity Commercial |
$802.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$746.50
|
| Rate for Payer: Healthscope Commercial |
$839.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$653.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$699.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$793.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$699.84
|
| Rate for Payer: PHP Commercial |
$793.15
|
| Rate for Payer: Priority Health SBD |
$587.87
|
| Rate for Payer: UMR Bronson Commercial |
$410.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$699.84
|
|
|
LIPASE-PROTEASE-AMYLASE (PORK)6,000-19,000-30,000 UNIT CAPSULE,DEL REL
|
Facility
|
IP
|
$757.76
|
|
|
Service Code
|
NDC 00032004670
|
| Hospital Charge Code |
98034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$333.41 |
| Max. Negotiated Rate |
$681.98 |
| Rate for Payer: Aetna American Axle |
$492.54
|
| Rate for Payer: Aetna Commercial |
$644.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$492.54
|
| Rate for Payer: Cash Price |
$606.21
|
| Rate for Payer: Cofinity Advantage |
$530.43
|
| Rate for Payer: Cofinity Commercial |
$651.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$606.21
|
| Rate for Payer: Healthscope Commercial |
$681.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$530.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$568.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$644.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$568.32
|
| Rate for Payer: PHP Commercial |
$644.10
|
| Rate for Payer: Priority Health SBD |
$477.39
|
| Rate for Payer: UMR Bronson Commercial |
$333.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$568.32
|
|
|
LIPASE-PROTEASE-AMYLASE (PORK)6,000-19,000-30,000 UNIT CAPSULE,DEL REL
|
Facility
|
OP
|
$757.76
|
|
|
Service Code
|
NDC 00032004670
|
| Hospital Charge Code |
98034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$280.37 |
| Max. Negotiated Rate |
$681.98 |
| Rate for Payer: Aetna American Axle |
$492.54
|
| Rate for Payer: Aetna Commercial |
$644.10
|
| Rate for Payer: Aetna Medicare |
$378.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$492.54
|
| Rate for Payer: BCBS Complete |
$303.10
|
| Rate for Payer: Cash Price |
$606.21
|
| Rate for Payer: Cofinity Advantage |
$530.43
|
| Rate for Payer: Cofinity Commercial |
$651.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$606.21
|
| Rate for Payer: Healthscope Commercial |
$681.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$530.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$568.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$606.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$644.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$568.32
|
| Rate for Payer: PHP Commercial |
$644.10
|
| Rate for Payer: Priority Health SBD |
$477.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$492.54
|
| Rate for Payer: UHC Core |
$394.79
|
| Rate for Payer: UHC Exchange |
$297.80
|
| Rate for Payer: UMR Bronson Commercial |
$280.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$568.32
|
|
|
LIPASE-PROTEASE-AMYLASE (PORK)6,000-19,000-30,000 UNIT CAPSULE,DEL REL
|
Facility
|
OP
|
$933.12
|
|
|
Service Code
|
NDC 00032120601
|
| Hospital Charge Code |
98034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$345.25 |
| Max. Negotiated Rate |
$839.81 |
| Rate for Payer: Aetna American Axle |
$606.53
|
| Rate for Payer: Aetna Commercial |
$793.15
|
| Rate for Payer: Aetna Medicare |
$466.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$606.53
|
| Rate for Payer: BCBS Complete |
$373.25
|
| Rate for Payer: Cash Price |
$746.50
|
| Rate for Payer: Cofinity Advantage |
$653.18
|
| Rate for Payer: Cofinity Commercial |
$802.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$746.50
|
| Rate for Payer: Healthscope Commercial |
$839.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$653.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$699.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$746.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$793.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$699.84
|
| Rate for Payer: PHP Commercial |
$793.15
|
| Rate for Payer: Priority Health SBD |
$587.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$606.53
|
| Rate for Payer: UHC Core |
$486.16
|
| Rate for Payer: UHC Exchange |
$366.72
|
| Rate for Payer: UMR Bronson Commercial |
$345.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$699.84
|
|
|
LIPASE-PROTEASE-AMYLAS(PORK)24,000-76,000-120,000 UNIT CAPSULE,DEL REL
|
Facility
|
OP
|
$6,635.95
|
|
|
Service Code
|
NDC 00032122407
|
| Hospital Charge Code |
98036
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,455.30 |
| Max. Negotiated Rate |
$5,972.35 |
| Rate for Payer: Aetna American Axle |
$4,313.37
|
| Rate for Payer: Aetna Commercial |
$5,640.56
|
| Rate for Payer: Aetna Medicare |
$3,317.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,313.37
|
| Rate for Payer: BCBS Complete |
$2,654.38
|
| Rate for Payer: Cash Price |
$5,308.76
|
| Rate for Payer: Cofinity Advantage |
$4,645.16
|
| Rate for Payer: Cofinity Commercial |
$5,706.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,308.76
|
| Rate for Payer: Healthscope Commercial |
$5,972.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,645.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,976.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,308.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,640.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,976.96
|
| Rate for Payer: PHP Commercial |
$5,640.56
|
| Rate for Payer: Priority Health SBD |
$4,180.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,313.37
|
| Rate for Payer: UHC Core |
$3,457.33
|
| Rate for Payer: UHC Exchange |
$2,607.93
|
| Rate for Payer: UMR Bronson Commercial |
$2,455.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,976.96
|
|
|
LIPASE-PROTEASE-AMYLAS(PORK)24,000-76,000-120,000 UNIT CAPSULE,DEL REL
|
Facility
|
IP
|
$3,002.55
|
|
|
Service Code
|
NDC 00032263601
|
| Hospital Charge Code |
98036
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,321.12 |
| Max. Negotiated Rate |
$2,702.30 |
| Rate for Payer: Aetna American Axle |
$1,951.66
|
| Rate for Payer: Aetna Commercial |
$2,552.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,951.66
|
| Rate for Payer: Cash Price |
$2,402.04
|
| Rate for Payer: Cofinity Advantage |
$2,101.78
|
| Rate for Payer: Cofinity Commercial |
$2,582.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,402.04
|
| Rate for Payer: Healthscope Commercial |
$2,702.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,101.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,251.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,552.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,251.91
|
| Rate for Payer: PHP Commercial |
$2,552.17
|
| Rate for Payer: Priority Health SBD |
$1,891.61
|
| Rate for Payer: UMR Bronson Commercial |
$1,321.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,251.91
|
|
|
LIPASE-PROTEASE-AMYLAS(PORK)24,000-76,000-120,000 UNIT CAPSULE,DEL REL
|
Facility
|
OP
|
$3,002.55
|
|
|
Service Code
|
NDC 00032263601
|
| Hospital Charge Code |
98036
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,110.94 |
| Max. Negotiated Rate |
$2,702.30 |
| Rate for Payer: Aetna American Axle |
$1,951.66
|
| Rate for Payer: Aetna Commercial |
$2,552.17
|
| Rate for Payer: Aetna Medicare |
$1,501.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,951.66
|
| Rate for Payer: BCBS Complete |
$1,201.02
|
| Rate for Payer: Cash Price |
$2,402.04
|
| Rate for Payer: Cofinity Advantage |
$2,101.78
|
| Rate for Payer: Cofinity Commercial |
$2,582.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,402.04
|
| Rate for Payer: Healthscope Commercial |
$2,702.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,101.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,251.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,402.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,552.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,251.91
|
| Rate for Payer: PHP Commercial |
$2,552.17
|
| Rate for Payer: Priority Health SBD |
$1,891.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,951.66
|
| Rate for Payer: UHC Core |
$1,564.33
|
| Rate for Payer: UHC Exchange |
$1,180.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,110.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,251.91
|
|
|
LIPASE-PROTEASE-AMYLAS(PORK)24,000-76,000-120,000 UNIT CAPSULE,DEL REL
|
Facility
|
IP
|
$6,635.95
|
|
|
Service Code
|
NDC 00032122407
|
| Hospital Charge Code |
98036
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,919.82 |
| Max. Negotiated Rate |
$5,972.35 |
| Rate for Payer: Aetna American Axle |
$4,313.37
|
| Rate for Payer: Aetna Commercial |
$5,640.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,313.37
|
| Rate for Payer: Cash Price |
$5,308.76
|
| Rate for Payer: Cofinity Advantage |
$4,645.16
|
| Rate for Payer: Cofinity Commercial |
$5,706.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,308.76
|
| Rate for Payer: Healthscope Commercial |
$5,972.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,645.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,976.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,640.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,976.96
|
| Rate for Payer: PHP Commercial |
$5,640.56
|
| Rate for Payer: Priority Health SBD |
$4,180.65
|
| Rate for Payer: UMR Bronson Commercial |
$2,919.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,976.96
|
|
|
LIPASE-PROTEASE-AMYLAS(PORK)24,000-76,000-120,000 UNIT CAPSULE,DEL REL
|
Facility
|
IP
|
$2,832.72
|
|
|
Service Code
|
NDC 00032122401
|
| Hospital Charge Code |
98036
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,246.40 |
| Max. Negotiated Rate |
$2,549.45 |
| Rate for Payer: Aetna American Axle |
$1,841.27
|
| Rate for Payer: Aetna Commercial |
$2,407.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,841.27
|
| Rate for Payer: Cash Price |
$2,266.18
|
| Rate for Payer: Cofinity Advantage |
$1,982.90
|
| Rate for Payer: Cofinity Commercial |
$2,436.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,266.18
|
| Rate for Payer: Healthscope Commercial |
$2,549.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,982.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,124.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,407.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,124.54
|
| Rate for Payer: PHP Commercial |
$2,407.81
|
| Rate for Payer: Priority Health SBD |
$1,784.61
|
| Rate for Payer: UMR Bronson Commercial |
$1,246.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,124.54
|
|
|
LIPASE-PROTEASE-AMYLAS(PORK)24,000-76,000-120,000 UNIT CAPSULE,DEL REL
|
Facility
|
OP
|
$2,832.72
|
|
|
Service Code
|
NDC 00032122401
|
| Hospital Charge Code |
98036
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,048.11 |
| Max. Negotiated Rate |
$2,549.45 |
| Rate for Payer: Aetna American Axle |
$1,841.27
|
| Rate for Payer: Aetna Commercial |
$2,407.81
|
| Rate for Payer: Aetna Medicare |
$1,416.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,841.27
|
| Rate for Payer: BCBS Complete |
$1,133.09
|
| Rate for Payer: Cash Price |
$2,266.18
|
| Rate for Payer: Cofinity Advantage |
$1,982.90
|
| Rate for Payer: Cofinity Commercial |
$2,436.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,266.18
|
| Rate for Payer: Healthscope Commercial |
$2,549.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,982.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,124.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,266.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,407.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,124.54
|
| Rate for Payer: PHP Commercial |
$2,407.81
|
| Rate for Payer: Priority Health SBD |
$1,784.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,841.27
|
| Rate for Payer: UHC Core |
$1,475.85
|
| Rate for Payer: UHC Exchange |
$1,113.26
|
| Rate for Payer: UMR Bronson Commercial |
$1,048.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,124.54
|
|
|
LIPID (FAT EMULSION 20%) NEONATAL SYRINGE CUSTOM
|
Facility
|
IP
|
$63.80
|
|
|
Service Code
|
NDC 09900000103
|
| Hospital Charge Code |
164988
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.07 |
| Max. Negotiated Rate |
$57.42 |
| Rate for Payer: Aetna American Axle |
$41.47
|
| Rate for Payer: Aetna Commercial |
$54.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.47
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cofinity Advantage |
$44.66
|
| Rate for Payer: Cofinity Commercial |
$54.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.04
|
| Rate for Payer: Healthscope Commercial |
$57.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.85
|
| Rate for Payer: PHP Commercial |
$54.23
|
| Rate for Payer: Priority Health SBD |
$40.19
|
| Rate for Payer: UMR Bronson Commercial |
$28.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.85
|
|
|
LIPID (FAT EMULSION 20%) NEONATAL SYRINGE CUSTOM
|
Facility
|
OP
|
$135.60
|
|
|
Service Code
|
NDC 09900000107
|
| Hospital Charge Code |
164988
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$50.17 |
| Max. Negotiated Rate |
$122.04 |
| Rate for Payer: Aetna American Axle |
$88.14
|
| Rate for Payer: Aetna Commercial |
$115.26
|
| Rate for Payer: Aetna Medicare |
$67.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.14
|
| Rate for Payer: BCBS Complete |
$54.24
|
| Rate for Payer: Cash Price |
$108.48
|
| Rate for Payer: Cofinity Advantage |
$94.92
|
| Rate for Payer: Cofinity Commercial |
$116.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.48
|
| Rate for Payer: Healthscope Commercial |
$122.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.70
|
| Rate for Payer: PHP Commercial |
$115.26
|
| Rate for Payer: Priority Health SBD |
$85.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.14
|
| Rate for Payer: UHC Core |
$70.65
|
| Rate for Payer: UHC Exchange |
$53.29
|
| Rate for Payer: UMR Bronson Commercial |
$50.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.70
|
|
|
LIPID (FAT EMULSION 20%) NEONATAL SYRINGE CUSTOM
|
Facility
|
IP
|
$135.60
|
|
|
Service Code
|
NDC 09900000107
|
| Hospital Charge Code |
164988
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$59.66 |
| Max. Negotiated Rate |
$122.04 |
| Rate for Payer: Aetna American Axle |
$88.14
|
| Rate for Payer: Aetna Commercial |
$115.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.14
|
| Rate for Payer: Cash Price |
$108.48
|
| Rate for Payer: Cofinity Advantage |
$94.92
|
| Rate for Payer: Cofinity Commercial |
$116.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.48
|
| Rate for Payer: Healthscope Commercial |
$122.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.70
|
| Rate for Payer: PHP Commercial |
$115.26
|
| Rate for Payer: Priority Health SBD |
$85.43
|
| Rate for Payer: UMR Bronson Commercial |
$59.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.70
|
|
|
LIPID (FAT EMULSION 20%) NEONATAL SYRINGE CUSTOM
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 09900000102
|
| Hospital Charge Code |
164988
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.76 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna American Axle |
$45.45
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Advantage |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UMR Bronson Commercial |
$30.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
LIPID (FAT EMULSION 20%) NEONATAL SYRINGE CUSTOM
|
Facility
|
OP
|
$110.16
|
|
|
Service Code
|
NDC 09900000105
|
| Hospital Charge Code |
164988
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.76 |
| Max. Negotiated Rate |
$99.14 |
| Rate for Payer: Aetna American Axle |
$71.60
|
| Rate for Payer: Aetna Commercial |
$93.64
|
| Rate for Payer: Aetna Medicare |
$55.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.60
|
| Rate for Payer: BCBS Complete |
$44.06
|
| Rate for Payer: Cash Price |
$88.13
|
| Rate for Payer: Cofinity Advantage |
$77.11
|
| Rate for Payer: Cofinity Commercial |
$94.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.13
|
| Rate for Payer: Healthscope Commercial |
$99.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.62
|
| Rate for Payer: PHP Commercial |
$93.64
|
| Rate for Payer: Priority Health SBD |
$69.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.60
|
| Rate for Payer: UHC Core |
$57.39
|
| Rate for Payer: UHC Exchange |
$43.29
|
| Rate for Payer: UMR Bronson Commercial |
$40.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.62
|
|
|
LIPID (FAT EMULSION 20%) NEONATAL SYRINGE CUSTOM
|
Facility
|
IP
|
$110.16
|
|
|
Service Code
|
NDC 09900000105
|
| Hospital Charge Code |
164988
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.47 |
| Max. Negotiated Rate |
$99.14 |
| Rate for Payer: Aetna American Axle |
$71.60
|
| Rate for Payer: Aetna Commercial |
$93.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.60
|
| Rate for Payer: Cash Price |
$88.13
|
| Rate for Payer: Cofinity Advantage |
$77.11
|
| Rate for Payer: Cofinity Commercial |
$94.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.13
|
| Rate for Payer: Healthscope Commercial |
$99.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.62
|
| Rate for Payer: PHP Commercial |
$93.64
|
| Rate for Payer: Priority Health SBD |
$69.40
|
| Rate for Payer: UMR Bronson Commercial |
$48.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.62
|
|
|
LIPID (FAT EMULSION 20%) NEONATAL SYRINGE CUSTOM
|
Facility
|
OP
|
$464.00
|
|
|
Service Code
|
NDC 338051909
|
| Hospital Charge Code |
164988
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$171.68 |
| Max. Negotiated Rate |
$417.60 |
| Rate for Payer: Aetna American Axle |
$301.60
|
| Rate for Payer: Aetna Commercial |
$394.40
|
| Rate for Payer: Aetna Medicare |
$232.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.60
|
| Rate for Payer: BCBS Complete |
$185.60
|
| Rate for Payer: Cash Price |
$371.20
|
| Rate for Payer: Cofinity Advantage |
$324.80
|
| Rate for Payer: Cofinity Commercial |
$399.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$371.20
|
| Rate for Payer: Healthscope Commercial |
$417.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$324.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$348.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$371.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$394.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$348.00
|
| Rate for Payer: PHP Commercial |
$394.40
|
| Rate for Payer: Priority Health SBD |
$292.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$301.60
|
| Rate for Payer: UHC Core |
$241.74
|
| Rate for Payer: UHC Exchange |
$182.35
|
| Rate for Payer: UMR Bronson Commercial |
$171.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$348.00
|
|
