|
LINEZOLID 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$1,115.00
|
|
|
Service Code
|
NDC 59762130801
|
| Hospital Charge Code |
28225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$412.55 |
| Max. Negotiated Rate |
$1,003.50 |
| Rate for Payer: Aetna American Axle |
$724.75
|
| Rate for Payer: Aetna Commercial |
$947.75
|
| Rate for Payer: Aetna Medicare |
$557.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$724.75
|
| Rate for Payer: BCBS Complete |
$446.00
|
| Rate for Payer: Cash Price |
$892.00
|
| Rate for Payer: Cofinity Commercial |
$780.50
|
| Rate for Payer: Cofinity Commercial |
$958.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$780.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$892.00
|
| Rate for Payer: Healthscope Commercial |
$1,003.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$780.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$836.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$947.75
|
| Rate for Payer: PHP Commercial |
$947.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$724.75
|
| Rate for Payer: Priority Health SBD |
$702.45
|
| Rate for Payer: UMR Bronson Commercial |
$412.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$836.25
|
|
|
LINEZOLID 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$2,361.53
|
|
|
Service Code
|
NDC 00054031950
|
| Hospital Charge Code |
28225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$873.77 |
| Max. Negotiated Rate |
$2,125.38 |
| Rate for Payer: Aetna American Axle |
$1,534.99
|
| Rate for Payer: Aetna Commercial |
$2,007.30
|
| Rate for Payer: Aetna Medicare |
$1,180.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,534.99
|
| Rate for Payer: BCBS Complete |
$944.61
|
| Rate for Payer: Cash Price |
$1,889.22
|
| Rate for Payer: Cofinity Commercial |
$1,653.07
|
| Rate for Payer: Cofinity Commercial |
$2,030.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,653.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,889.22
|
| Rate for Payer: Healthscope Commercial |
$2,125.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,653.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,771.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,007.30
|
| Rate for Payer: PHP Commercial |
$2,007.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,534.99
|
| Rate for Payer: Priority Health SBD |
$1,487.76
|
| Rate for Payer: UMR Bronson Commercial |
$873.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,771.15
|
|
|
LINEZOLID 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$2,361.53
|
|
|
Service Code
|
NDC 00054031950
|
| Hospital Charge Code |
28225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,039.07 |
| Max. Negotiated Rate |
$2,125.38 |
| Rate for Payer: Aetna American Axle |
$1,534.99
|
| Rate for Payer: Aetna Commercial |
$2,007.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,534.99
|
| Rate for Payer: Cash Price |
$1,889.22
|
| Rate for Payer: Cofinity Commercial |
$1,653.07
|
| Rate for Payer: Cofinity Commercial |
$2,030.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,653.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,889.22
|
| Rate for Payer: Healthscope Commercial |
$2,125.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,653.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,771.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,007.30
|
| Rate for Payer: PHP Commercial |
$2,007.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,534.99
|
| Rate for Payer: Priority Health SBD |
$1,487.76
|
| Rate for Payer: UMR Bronson Commercial |
$1,039.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,771.15
|
|
|
LINEZOLID 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$1,691.09
|
|
|
Service Code
|
NDC 59762130804
|
| Hospital Charge Code |
28225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$625.70 |
| Max. Negotiated Rate |
$1,521.98 |
| Rate for Payer: Aetna American Axle |
$1,099.21
|
| Rate for Payer: Aetna Commercial |
$1,437.43
|
| Rate for Payer: Aetna Medicare |
$845.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,099.21
|
| Rate for Payer: BCBS Complete |
$676.44
|
| Rate for Payer: Cash Price |
$1,352.87
|
| Rate for Payer: Cofinity Commercial |
$1,183.76
|
| Rate for Payer: Cofinity Commercial |
$1,454.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,183.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,352.87
|
| Rate for Payer: Healthscope Commercial |
$1,521.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,183.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,268.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,437.43
|
| Rate for Payer: PHP Commercial |
$1,437.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,099.21
|
| Rate for Payer: Priority Health SBD |
$1,065.39
|
| Rate for Payer: UMR Bronson Commercial |
$625.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,268.32
|
|
|
LINEZOLID 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$1,691.09
|
|
|
Service Code
|
NDC 59762130804
|
| Hospital Charge Code |
28225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$744.08 |
| Max. Negotiated Rate |
$1,521.98 |
| Rate for Payer: Aetna American Axle |
$1,099.21
|
| Rate for Payer: Aetna Commercial |
$1,437.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,099.21
|
| Rate for Payer: Cash Price |
$1,352.87
|
| Rate for Payer: Cofinity Commercial |
$1,183.76
|
| Rate for Payer: Cofinity Commercial |
$1,454.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,183.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,352.87
|
| Rate for Payer: Healthscope Commercial |
$1,521.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,183.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,268.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,437.43
|
| Rate for Payer: PHP Commercial |
$1,437.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,099.21
|
| Rate for Payer: Priority Health SBD |
$1,065.39
|
| Rate for Payer: UMR Bronson Commercial |
$744.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,268.32
|
|
|
LINEZOLID 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$2,352.65
|
|
|
Service Code
|
NDC 00009513601
|
| Hospital Charge Code |
28225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,035.17 |
| Max. Negotiated Rate |
$2,117.39 |
| Rate for Payer: Aetna American Axle |
$1,529.22
|
| Rate for Payer: Aetna Commercial |
$1,999.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,529.22
|
| Rate for Payer: Cash Price |
$1,882.12
|
| Rate for Payer: Cofinity Commercial |
$1,646.86
|
| Rate for Payer: Cofinity Commercial |
$2,023.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,646.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,882.12
|
| Rate for Payer: Healthscope Commercial |
$2,117.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,646.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,764.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,999.75
|
| Rate for Payer: PHP Commercial |
$1,999.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,529.22
|
| Rate for Payer: Priority Health SBD |
$1,482.17
|
| Rate for Payer: UMR Bronson Commercial |
$1,035.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,764.49
|
|
|
LINEZOLID 600 MG/300 ML INTRAVENOUS (PEDS)
|
Facility
|
OP
|
$139.20
|
|
|
Service Code
|
HCPCS J2020
|
| Hospital Charge Code |
180001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.50 |
| Max. Negotiated Rate |
$125.28 |
| Rate for Payer: Aetna American Axle |
$90.48
|
| Rate for Payer: Aetna Commercial |
$118.32
|
| Rate for Payer: Aetna Medicare |
$69.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.48
|
| Rate for Payer: BCBS Complete |
$55.68
|
| Rate for Payer: Cash Price |
$111.36
|
| Rate for Payer: Cofinity Commercial |
$119.71
|
| Rate for Payer: Cofinity Commercial |
$97.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$97.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.36
|
| Rate for Payer: Healthscope Commercial |
$125.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.32
|
| Rate for Payer: PHP Commercial |
$118.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.48
|
| Rate for Payer: Priority Health SBD |
$87.70
|
| Rate for Payer: UMR Bronson Commercial |
$51.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.40
|
|
|
LINEZOLID 600 MG/300 ML INTRAVENOUS (PEDS)
|
Facility
|
IP
|
$139.20
|
|
|
Service Code
|
HCPCS J2020
|
| Hospital Charge Code |
180001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$125.28 |
| Rate for Payer: Aetna American Axle |
$90.48
|
| Rate for Payer: Aetna Commercial |
$118.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.48
|
| Rate for Payer: Cash Price |
$111.36
|
| Rate for Payer: Cofinity Commercial |
$119.71
|
| Rate for Payer: Cofinity Commercial |
$97.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$97.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.36
|
| Rate for Payer: Healthscope Commercial |
$125.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.32
|
| Rate for Payer: PHP Commercial |
$118.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.48
|
| Rate for Payer: Priority Health SBD |
$87.70
|
| Rate for Payer: UMR Bronson Commercial |
$61.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.40
|
|
|
LINEZOLID 600 MG TABLET
|
Facility
|
OP
|
$360.53
|
|
|
Service Code
|
NDC 60687030921
|
| Hospital Charge Code |
28224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.40 |
| Max. Negotiated Rate |
$324.48 |
| Rate for Payer: Aetna American Axle |
$234.34
|
| Rate for Payer: Aetna Commercial |
$306.45
|
| Rate for Payer: Aetna Medicare |
$180.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.34
|
| Rate for Payer: BCBS Complete |
$144.21
|
| Rate for Payer: Cash Price |
$288.42
|
| Rate for Payer: Cofinity Commercial |
$252.37
|
| Rate for Payer: Cofinity Commercial |
$310.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$252.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.42
|
| Rate for Payer: Healthscope Commercial |
$324.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$252.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.45
|
| Rate for Payer: PHP Commercial |
$306.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.34
|
| Rate for Payer: Priority Health SBD |
$227.13
|
| Rate for Payer: UMR Bronson Commercial |
$133.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.40
|
|
|
LINEZOLID 600 MG TABLET
|
Facility
|
OP
|
$354.09
|
|
|
Service Code
|
NDC 72606000103
|
| Hospital Charge Code |
28224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.01 |
| Max. Negotiated Rate |
$318.68 |
| Rate for Payer: Aetna American Axle |
$230.16
|
| Rate for Payer: Aetna Commercial |
$300.98
|
| Rate for Payer: Aetna Medicare |
$177.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.16
|
| Rate for Payer: BCBS Complete |
$141.64
|
| Rate for Payer: Cash Price |
$283.27
|
| Rate for Payer: Cofinity Commercial |
$247.86
|
| Rate for Payer: Cofinity Commercial |
$304.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$247.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.27
|
| Rate for Payer: Healthscope Commercial |
$318.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$247.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.98
|
| Rate for Payer: PHP Commercial |
$300.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.16
|
| Rate for Payer: Priority Health SBD |
$223.08
|
| Rate for Payer: UMR Bronson Commercial |
$131.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.57
|
|
|
LINEZOLID 600 MG TABLET
|
Facility
|
IP
|
$360.53
|
|
|
Service Code
|
NDC 60687030921
|
| Hospital Charge Code |
28224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.63 |
| Max. Negotiated Rate |
$324.48 |
| Rate for Payer: Aetna American Axle |
$234.34
|
| Rate for Payer: Aetna Commercial |
$306.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.34
|
| Rate for Payer: Cash Price |
$288.42
|
| Rate for Payer: Cofinity Commercial |
$252.37
|
| Rate for Payer: Cofinity Commercial |
$310.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$252.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.42
|
| Rate for Payer: Healthscope Commercial |
$324.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$252.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.45
|
| Rate for Payer: PHP Commercial |
$306.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.34
|
| Rate for Payer: Priority Health SBD |
$227.13
|
| Rate for Payer: UMR Bronson Commercial |
$158.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.40
|
|
|
LINEZOLID 600 MG TABLET
|
Facility
|
OP
|
$12.02
|
|
|
Service Code
|
NDC 60687030911
|
| Hospital Charge Code |
28224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.45 |
| Max. Negotiated Rate |
$10.82 |
| Rate for Payer: Aetna American Axle |
$7.81
|
| Rate for Payer: Aetna Commercial |
$10.22
|
| Rate for Payer: Aetna Medicare |
$6.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.81
|
| Rate for Payer: BCBS Complete |
$4.81
|
| Rate for Payer: Cash Price |
$9.62
|
| Rate for Payer: Cofinity Commercial |
$10.34
|
| Rate for Payer: Cofinity Commercial |
$8.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.62
|
| Rate for Payer: Healthscope Commercial |
$10.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.22
|
| Rate for Payer: PHP Commercial |
$10.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.81
|
| Rate for Payer: Priority Health SBD |
$7.57
|
| Rate for Payer: UMR Bronson Commercial |
$4.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.02
|
|
|
LINEZOLID 600 MG TABLET
|
Facility
|
OP
|
$120.44
|
|
|
Service Code
|
NDC 67877041933
|
| Hospital Charge Code |
28224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.56 |
| Max. Negotiated Rate |
$108.40 |
| Rate for Payer: Aetna American Axle |
$78.29
|
| Rate for Payer: Aetna Commercial |
$102.37
|
| Rate for Payer: Aetna Medicare |
$60.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.29
|
| Rate for Payer: BCBS Complete |
$48.18
|
| Rate for Payer: Cash Price |
$96.35
|
| Rate for Payer: Cofinity Commercial |
$103.58
|
| Rate for Payer: Cofinity Commercial |
$84.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$84.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.35
|
| Rate for Payer: Healthscope Commercial |
$108.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.37
|
| Rate for Payer: PHP Commercial |
$102.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.29
|
| Rate for Payer: Priority Health SBD |
$75.88
|
| Rate for Payer: UMR Bronson Commercial |
$44.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.33
|
|
|
LINEZOLID 600 MG TABLET
|
Facility
|
IP
|
$354.09
|
|
|
Service Code
|
NDC 72606000103
|
| Hospital Charge Code |
28224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.80 |
| Max. Negotiated Rate |
$318.68 |
| Rate for Payer: Aetna American Axle |
$230.16
|
| Rate for Payer: Aetna Commercial |
$300.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.16
|
| Rate for Payer: Cash Price |
$283.27
|
| Rate for Payer: Cofinity Commercial |
$247.86
|
| Rate for Payer: Cofinity Commercial |
$304.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$247.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.27
|
| Rate for Payer: Healthscope Commercial |
$318.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$247.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.98
|
| Rate for Payer: PHP Commercial |
$300.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.16
|
| Rate for Payer: Priority Health SBD |
$223.08
|
| Rate for Payer: UMR Bronson Commercial |
$155.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.57
|
|
|
LINEZOLID 600 MG TABLET
|
Facility
|
IP
|
$275.40
|
|
|
Service Code
|
NDC 00904655304
|
| Hospital Charge Code |
28224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.18 |
| Max. Negotiated Rate |
$247.86 |
| Rate for Payer: Aetna American Axle |
$179.01
|
| Rate for Payer: Aetna Commercial |
$234.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.01
|
| Rate for Payer: Cash Price |
$220.32
|
| Rate for Payer: Cofinity Commercial |
$192.78
|
| Rate for Payer: Cofinity Commercial |
$236.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$192.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.32
|
| Rate for Payer: Healthscope Commercial |
$247.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.09
|
| Rate for Payer: PHP Commercial |
$234.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.01
|
| Rate for Payer: Priority Health SBD |
$173.50
|
| Rate for Payer: UMR Bronson Commercial |
$121.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.55
|
|
|
LINEZOLID 600 MG TABLET
|
Facility
|
IP
|
$120.44
|
|
|
Service Code
|
NDC 67877041933
|
| Hospital Charge Code |
28224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.99 |
| Max. Negotiated Rate |
$108.40 |
| Rate for Payer: Aetna American Axle |
$78.29
|
| Rate for Payer: Aetna Commercial |
$102.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.29
|
| Rate for Payer: Cash Price |
$96.35
|
| Rate for Payer: Cofinity Commercial |
$103.58
|
| Rate for Payer: Cofinity Commercial |
$84.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$84.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.35
|
| Rate for Payer: Healthscope Commercial |
$108.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.37
|
| Rate for Payer: PHP Commercial |
$102.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.29
|
| Rate for Payer: Priority Health SBD |
$75.88
|
| Rate for Payer: UMR Bronson Commercial |
$52.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.33
|
|
|
LINEZOLID 600 MG TABLET
|
Facility
|
IP
|
$361.31
|
|
|
Service Code
|
NDC 67877041984
|
| Hospital Charge Code |
28224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.98 |
| Max. Negotiated Rate |
$325.18 |
| Rate for Payer: Aetna American Axle |
$234.85
|
| Rate for Payer: Aetna Commercial |
$307.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.85
|
| Rate for Payer: Cash Price |
$289.05
|
| Rate for Payer: Cofinity Commercial |
$252.92
|
| Rate for Payer: Cofinity Commercial |
$310.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$252.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.05
|
| Rate for Payer: Healthscope Commercial |
$325.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$252.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.11
|
| Rate for Payer: PHP Commercial |
$307.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.85
|
| Rate for Payer: Priority Health SBD |
$227.63
|
| Rate for Payer: UMR Bronson Commercial |
$158.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.98
|
|
|
LINEZOLID 600 MG TABLET
|
Facility
|
OP
|
$361.31
|
|
|
Service Code
|
NDC 67877041984
|
| Hospital Charge Code |
28224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.68 |
| Max. Negotiated Rate |
$325.18 |
| Rate for Payer: Aetna American Axle |
$234.85
|
| Rate for Payer: Aetna Commercial |
$307.11
|
| Rate for Payer: Aetna Medicare |
$180.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.85
|
| Rate for Payer: BCBS Complete |
$144.52
|
| Rate for Payer: Cash Price |
$289.05
|
| Rate for Payer: Cofinity Commercial |
$252.92
|
| Rate for Payer: Cofinity Commercial |
$310.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$252.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.05
|
| Rate for Payer: Healthscope Commercial |
$325.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$252.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.11
|
| Rate for Payer: PHP Commercial |
$307.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.85
|
| Rate for Payer: Priority Health SBD |
$227.63
|
| Rate for Payer: UMR Bronson Commercial |
$133.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.98
|
|
|
LINEZOLID 600 MG TABLET
|
Facility
|
IP
|
$12.02
|
|
|
Service Code
|
NDC 60687030911
|
| Hospital Charge Code |
28224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.29 |
| Max. Negotiated Rate |
$10.82 |
| Rate for Payer: Aetna American Axle |
$7.81
|
| Rate for Payer: Aetna Commercial |
$10.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.81
|
| Rate for Payer: Cash Price |
$9.62
|
| Rate for Payer: Cofinity Commercial |
$10.34
|
| Rate for Payer: Cofinity Commercial |
$8.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.62
|
| Rate for Payer: Healthscope Commercial |
$10.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.22
|
| Rate for Payer: PHP Commercial |
$10.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.81
|
| Rate for Payer: Priority Health SBD |
$7.57
|
| Rate for Payer: UMR Bronson Commercial |
$5.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.02
|
|
|
LINEZOLID 600 MG TABLET
|
Facility
|
OP
|
$275.40
|
|
|
Service Code
|
NDC 00904655304
|
| Hospital Charge Code |
28224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.90 |
| Max. Negotiated Rate |
$247.86 |
| Rate for Payer: Aetna American Axle |
$179.01
|
| Rate for Payer: Aetna Commercial |
$234.09
|
| Rate for Payer: Aetna Medicare |
$137.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.01
|
| Rate for Payer: BCBS Complete |
$110.16
|
| Rate for Payer: Cash Price |
$220.32
|
| Rate for Payer: Cofinity Commercial |
$192.78
|
| Rate for Payer: Cofinity Commercial |
$236.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$192.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.32
|
| Rate for Payer: Healthscope Commercial |
$247.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.09
|
| Rate for Payer: PHP Commercial |
$234.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.01
|
| Rate for Payer: Priority Health SBD |
$173.50
|
| Rate for Payer: UMR Bronson Commercial |
$101.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.55
|
|
|
LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$100.49
|
|
|
Service Code
|
HCPCS J2020
|
| Hospital Charge Code |
112020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.22 |
| Max. Negotiated Rate |
$90.44 |
| Rate for Payer: Aetna American Axle |
$65.32
|
| 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 |
$176.44
|
| Rate for Payer: Aetna American Axle |
$51.92
|
| Rate for Payer: Aetna Commercial |
$85.42
|
| Rate for Payer: Aetna Commercial |
$118.32
|
| Rate for Payer: Aetna Commercial |
$56.19
|
| Rate for Payer: Aetna Commercial |
$67.89
|
| Rate for Payer: Aetna Commercial |
$58.52
|
| Rate for Payer: Aetna Commercial |
$230.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.75
|
| Rate for Payer: Cash Price |
$55.08
|
| Rate for Payer: Cash Price |
$52.88
|
| Rate for Payer: Cash Price |
$80.39
|
| Rate for Payer: Cash Price |
$217.15
|
| Rate for Payer: Cash Price |
$111.36
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cofinity Commercial |
$59.21
|
| Rate for Payer: Cofinity Commercial |
$70.34
|
| Rate for Payer: Cofinity Commercial |
$56.85
|
| Rate for Payer: Cofinity Commercial |
$46.27
|
| Rate for Payer: Cofinity Commercial |
$190.01
|
| Rate for Payer: Cofinity Commercial |
$119.71
|
| Rate for Payer: Cofinity Commercial |
$97.44
|
| Rate for Payer: Cofinity Commercial |
$233.44
|
| Rate for Payer: Cofinity Commercial |
$86.42
|
| Rate for Payer: Cofinity Commercial |
$68.69
|
| Rate for Payer: Cofinity Commercial |
$55.91
|
| Rate for Payer: Cofinity Commercial |
$48.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$97.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.15
|
| 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 |
$63.90
|
| Rate for Payer: Healthscope Commercial |
$59.49
|
| Rate for Payer: Healthscope Commercial |
$71.88
|
| Rate for Payer: Healthscope Commercial |
$61.97
|
| Rate for Payer: Healthscope Commercial |
$125.28
|
| Rate for Payer: Healthscope Commercial |
$244.30
|
| Rate for Payer: Healthscope Commercial |
$90.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.72
|
| Rate for Payer: PHP Commercial |
$85.42
|
| Rate for Payer: PHP Commercial |
$118.32
|
| Rate for Payer: PHP Commercial |
$56.19
|
| Rate for Payer: PHP Commercial |
$58.52
|
| Rate for Payer: PHP Commercial |
$230.72
|
| Rate for Payer: PHP Commercial |
$67.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.92
|
| Rate for Payer: Priority Health SBD |
$43.38
|
| Rate for Payer: Priority Health SBD |
$41.64
|
| Rate for Payer: Priority Health SBD |
$63.31
|
| Rate for Payer: Priority Health SBD |
$87.70
|
| Rate for Payer: Priority Health SBD |
$171.01
|
| Rate for Payer: Priority Health SBD |
$50.32
|
| Rate for Payer: UMR Bronson Commercial |
$35.14
|
| Rate for Payer: UMR Bronson Commercial |
$61.25
|
| Rate for Payer: UMR Bronson Commercial |
$119.43
|
| Rate for Payer: UMR Bronson Commercial |
$30.29
|
| Rate for Payer: UMR Bronson Commercial |
$29.08
|
| Rate for Payer: UMR Bronson Commercial |
$44.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.37
|
|
|
LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$66.10
|
|
|
Service Code
|
HCPCS J2020
|
| Hospital Charge Code |
112020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.46 |
| Max. Negotiated Rate |
$59.49 |
| Rate for Payer: Aetna American Axle |
$42.97
|
| Rate for Payer: Aetna American Axle |
$90.48
|
| Rate for Payer: Aetna American Axle |
$65.32
|
| Rate for Payer: Aetna American Axle |
$44.75
|
| Rate for Payer: Aetna American Axle |
$176.44
|
| Rate for Payer: Aetna American Axle |
$51.92
|
| Rate for Payer: Aetna Commercial |
$67.89
|
| Rate for Payer: Aetna Commercial |
$56.19
|
| Rate for Payer: Aetna Commercial |
$118.32
|
| Rate for Payer: Aetna Commercial |
$85.42
|
| Rate for Payer: Aetna Commercial |
$58.52
|
| Rate for Payer: Aetna Commercial |
$230.72
|
| Rate for Payer: Aetna Medicare |
$135.72
|
| Rate for Payer: Aetna Medicare |
$50.24
|
| Rate for Payer: Aetna Medicare |
$34.42
|
| Rate for Payer: Aetna Medicare |
$39.94
|
| Rate for Payer: Aetna Medicare |
$33.05
|
| Rate for Payer: Aetna Medicare |
$69.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.92
|
| Rate for Payer: BCBS Complete |
$31.95
|
| Rate for Payer: BCBS Complete |
$26.44
|
| Rate for Payer: BCBS Complete |
$55.68
|
| Rate for Payer: BCBS Complete |
$108.58
|
| Rate for Payer: BCBS Complete |
$27.54
|
| Rate for Payer: BCBS Complete |
$40.20
|
| Rate for Payer: Cash Price |
$111.36
|
| Rate for Payer: Cash Price |
$217.15
|
| Rate for Payer: Cash Price |
$52.88
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$55.08
|
| Rate for Payer: Cash Price |
$80.39
|
| Rate for Payer: Cofinity Commercial |
$68.69
|
| Rate for Payer: Cofinity Commercial |
$56.85
|
| Rate for Payer: Cofinity Commercial |
$70.34
|
| Rate for Payer: Cofinity Commercial |
$233.44
|
| Rate for Payer: Cofinity Commercial |
$190.01
|
| Rate for Payer: Cofinity Commercial |
$46.27
|
| Rate for Payer: Cofinity Commercial |
$86.42
|
| Rate for Payer: Cofinity Commercial |
$119.71
|
| Rate for Payer: Cofinity Commercial |
$97.44
|
| Rate for Payer: Cofinity Commercial |
$55.91
|
| Rate for Payer: Cofinity Commercial |
$59.21
|
| Rate for Payer: Cofinity Commercial |
$48.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$97.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.91
|
| 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 |
$80.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.90
|
| Rate for Payer: Healthscope Commercial |
$125.28
|
| Rate for Payer: Healthscope Commercial |
$244.30
|
| Rate for Payer: Healthscope Commercial |
$90.44
|
| Rate for Payer: Healthscope Commercial |
$59.49
|
| Rate for Payer: Healthscope Commercial |
$71.88
|
| Rate for Payer: Healthscope Commercial |
$61.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.42
|
| 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 |
$67.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.72
|
| Rate for Payer: PHP Commercial |
$85.42
|
| Rate for Payer: PHP Commercial |
$56.19
|
| Rate for Payer: PHP Commercial |
$230.72
|
| Rate for Payer: PHP Commercial |
$118.32
|
| Rate for Payer: PHP Commercial |
$58.52
|
| Rate for Payer: PHP Commercial |
$67.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.44
|
| Rate for Payer: Priority Health SBD |
$87.70
|
| Rate for Payer: Priority Health SBD |
$43.38
|
| Rate for Payer: Priority Health SBD |
$171.01
|
| Rate for Payer: Priority Health SBD |
$41.64
|
| Rate for Payer: Priority Health SBD |
$63.31
|
| Rate for Payer: Priority Health SBD |
$50.32
|
| Rate for Payer: UMR Bronson Commercial |
$29.55
|
| Rate for Payer: UMR Bronson Commercial |
$37.18
|
| Rate for Payer: UMR Bronson Commercial |
$51.50
|
| Rate for Payer: UMR Bronson Commercial |
$100.43
|
| Rate for Payer: UMR Bronson Commercial |
$24.46
|
| Rate for Payer: UMR Bronson Commercial |
$25.47
|
| 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 |
$59.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.40
|
|
|
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 Commercial |
$434.45
|
| Rate for Payer: Cofinity Commercial |
$533.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$434.45
|
| 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: PHP Commercial |
$527.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$403.42
|
| Rate for Payer: Priority Health SBD |
$391.00
|
| 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
|
$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 Commercial |
$434.45
|
| Rate for Payer: Cofinity Commercial |
$533.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$434.45
|
| 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: PHP Commercial |
$527.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$403.42
|
| 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 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 Commercial |
$371.35
|
| Rate for Payer: Cofinity Commercial |
$456.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$371.35
|
| 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: PHP Commercial |
$450.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$344.82
|
| Rate for Payer: Priority Health SBD |
$334.21
|
| Rate for Payer: UMR Bronson Commercial |
$196.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$397.88
|
|
