|
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 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 |
$233.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$397.88
|
|
|
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 Commercial |
$171.70
|
| Rate for Payer: Cofinity Commercial |
$210.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$171.70
|
| 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: PHP Commercial |
$208.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.43
|
| 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
|
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 Commercial |
$191.12
|
| Rate for Payer: Cofinity Commercial |
$234.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$191.12
|
| 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: PHP Commercial |
$232.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.47
|
| Rate for Payer: Priority Health SBD |
$172.01
|
| 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
|
$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 Commercial |
$171.70
|
| Rate for Payer: Cofinity Commercial |
$210.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$171.70
|
| 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: PHP Commercial |
$208.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.43
|
| Rate for Payer: Priority Health SBD |
$154.53
|
| 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
|
$356.25
|
|
|
Service Code
|
NDC 60793011501
|
| Hospital Charge Code |
10443
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.81 |
| Max. Negotiated Rate |
$320.62 |
| Rate for Payer: Aetna American Axle |
$231.56
|
| Rate for Payer: Aetna Commercial |
$302.81
|
| Rate for Payer: Aetna Medicare |
$178.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.56
|
| Rate for Payer: BCBS Complete |
$142.50
|
| Rate for Payer: Cash Price |
$285.00
|
| Rate for Payer: Cofinity Commercial |
$249.38
|
| Rate for Payer: Cofinity Commercial |
$306.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$249.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.00
|
| Rate for Payer: Healthscope Commercial |
$320.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$249.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.81
|
| Rate for Payer: PHP Commercial |
$302.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.56
|
| Rate for Payer: Priority Health SBD |
$224.44
|
| Rate for Payer: UMR Bronson Commercial |
$131.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.19
|
|
|
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 Commercial |
$191.12
|
| Rate for Payer: Cofinity Commercial |
$234.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$191.12
|
| 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: PHP Commercial |
$232.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.47
|
| 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
|
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 Commercial |
$330.62
|
| Rate for Payer: Cofinity Commercial |
$406.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$330.62
|
| 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: PHP Commercial |
$401.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.01
|
| 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
|
$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 Commercial |
$247.38
|
| Rate for Payer: Cofinity Commercial |
$303.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$247.38
|
| 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: PHP Commercial |
$300.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.71
|
| Rate for Payer: Priority Health SBD |
$222.64
|
| 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
|
$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 Commercial |
$247.38
|
| Rate for Payer: Cofinity Commercial |
$303.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$247.38
|
| 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: PHP Commercial |
$300.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.71
|
| 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
|
|
|
LIOTHYRONINE 5 MCG TABLET
|
Facility
|
IP
|
$356.25
|
|
|
Service Code
|
NDC 60793011501
|
| Hospital Charge Code |
10443
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.75 |
| Max. Negotiated Rate |
$320.62 |
| Rate for Payer: Aetna American Axle |
$231.56
|
| Rate for Payer: Aetna Commercial |
$302.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.56
|
| Rate for Payer: Cash Price |
$285.00
|
| Rate for Payer: Cofinity Commercial |
$249.38
|
| Rate for Payer: Cofinity Commercial |
$306.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$249.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.00
|
| Rate for Payer: Healthscope Commercial |
$320.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$249.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.81
|
| Rate for Payer: PHP Commercial |
$302.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.56
|
| Rate for Payer: Priority Health SBD |
$224.44
|
| Rate for Payer: UMR Bronson Commercial |
$156.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.19
|
|
|
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 Commercial |
$330.62
|
| Rate for Payer: Cofinity Commercial |
$406.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$330.62
|
| 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: PHP Commercial |
$401.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.01
|
| Rate for Payer: Priority Health SBD |
$297.56
|
| Rate for Payer: UMR Bronson Commercial |
$174.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$354.24
|
|
|
LIPASE-PROTEASE-AMYLASE 12,000-38,000-60,000 UNIT CAPSULE,DELAYED 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 Commercial |
$1,000.52
|
| Rate for Payer: Cofinity Commercial |
$1,229.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,000.52
|
| 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: PHP Commercial |
$1,214.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$929.05
|
| Rate for Payer: Priority Health SBD |
$900.47
|
| Rate for Payer: UMR Bronson Commercial |
$528.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,071.98
|
|
|
LIPASE-PROTEASE-AMYLASE 12,000-38,000-60,000 UNIT CAPSULE,DELAYED REL
|
Facility
|
IP
|
$1,476.30
|
|
|
Service Code
|
NDC 00032004770
|
| Hospital Charge Code |
98035
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$649.57 |
| Max. Negotiated Rate |
$1,328.67 |
| Rate for Payer: Aetna American Axle |
$959.60
|
| Rate for Payer: Aetna Commercial |
$1,254.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$959.60
|
| Rate for Payer: Cash Price |
$1,181.04
|
| Rate for Payer: Cofinity Commercial |
$1,033.41
|
| Rate for Payer: Cofinity Commercial |
$1,269.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,033.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,181.04
|
| Rate for Payer: Healthscope Commercial |
$1,328.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,033.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,107.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,254.86
|
| Rate for Payer: PHP Commercial |
$1,254.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$959.60
|
| Rate for Payer: Priority Health SBD |
$930.07
|
| Rate for Payer: UMR Bronson Commercial |
$649.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,107.22
|
|
|
LIPASE-PROTEASE-AMYLASE 12,000-38,000-60,000 UNIT CAPSULE,DELAYED REL
|
Facility
|
OP
|
$1,476.30
|
|
|
Service Code
|
NDC 00032004770
|
| Hospital Charge Code |
98035
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$546.23 |
| Max. Negotiated Rate |
$1,328.67 |
| Rate for Payer: Aetna American Axle |
$959.60
|
| Rate for Payer: Aetna Commercial |
$1,254.86
|
| Rate for Payer: Aetna Medicare |
$738.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$959.60
|
| Rate for Payer: BCBS Complete |
$590.52
|
| Rate for Payer: Cash Price |
$1,181.04
|
| Rate for Payer: Cofinity Commercial |
$1,033.41
|
| Rate for Payer: Cofinity Commercial |
$1,269.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,033.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,181.04
|
| Rate for Payer: Healthscope Commercial |
$1,328.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,033.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,107.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,254.86
|
| Rate for Payer: PHP Commercial |
$1,254.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$959.60
|
| Rate for Payer: Priority Health SBD |
$930.07
|
| Rate for Payer: UMR Bronson Commercial |
$546.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,107.22
|
|
|
LIPASE-PROTEASE-AMYLASE 12,000-38,000-60,000 UNIT CAPSULE,DELAYED 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 Commercial |
$1,000.52
|
| Rate for Payer: Cofinity Commercial |
$1,229.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,000.52
|
| 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: PHP Commercial |
$1,214.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$929.05
|
| 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
|
|
|
LIPASE-PROTEASE-AMYLASE 24,000-76,000-120,000 UNIT CAPSULE,DELAYED 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 Commercial |
$4,645.16
|
| Rate for Payer: Cofinity Commercial |
$5,706.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,645.16
|
| 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: PHP Commercial |
$5,640.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,313.37
|
| Rate for Payer: Priority Health SBD |
$4,180.65
|
| Rate for Payer: UMR Bronson Commercial |
$2,455.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,976.96
|
|
|
LIPASE-PROTEASE-AMYLASE 24,000-76,000-120,000 UNIT CAPSULE,DELAYED 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 Commercial |
$1,982.90
|
| Rate for Payer: Cofinity Commercial |
$2,436.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,982.90
|
| 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: PHP Commercial |
$2,407.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,841.27
|
| Rate for Payer: Priority Health SBD |
$1,784.61
|
| Rate for Payer: UMR Bronson Commercial |
$1,048.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,124.54
|
|
|
LIPASE-PROTEASE-AMYLASE 24,000-76,000-120,000 UNIT CAPSULE,DELAYED 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 Commercial |
$4,645.16
|
| Rate for Payer: Cofinity Commercial |
$5,706.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,645.16
|
| 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: PHP Commercial |
$5,640.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,313.37
|
| 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-AMYLASE 24,000-76,000-120,000 UNIT CAPSULE,DELAYED 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 Commercial |
$1,982.90
|
| Rate for Payer: Cofinity Commercial |
$2,436.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,982.90
|
| 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: PHP Commercial |
$2,407.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,841.27
|
| 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-AMYLASE 24,000-76,000-120,000 UNIT CAPSULE,DELAYED REL
|
Facility
|
IP
|
$2,926.33
|
|
|
Service Code
|
NDC 00032263601
|
| Hospital Charge Code |
98036
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,287.59 |
| Max. Negotiated Rate |
$2,633.70 |
| Rate for Payer: Aetna American Axle |
$1,902.11
|
| Rate for Payer: Aetna Commercial |
$2,487.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,902.11
|
| Rate for Payer: Cash Price |
$2,341.06
|
| Rate for Payer: Cofinity Commercial |
$2,048.43
|
| Rate for Payer: Cofinity Commercial |
$2,516.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,048.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,341.06
|
| Rate for Payer: Healthscope Commercial |
$2,633.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,048.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,194.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,487.38
|
| Rate for Payer: PHP Commercial |
$2,487.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,902.11
|
| Rate for Payer: Priority Health SBD |
$1,843.59
|
| Rate for Payer: UMR Bronson Commercial |
$1,287.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,194.75
|
|
|
LIPASE-PROTEASE-AMYLASE 24,000-76,000-120,000 UNIT CAPSULE,DELAYED REL
|
Facility
|
OP
|
$2,926.33
|
|
|
Service Code
|
NDC 00032263601
|
| Hospital Charge Code |
98036
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,082.74 |
| Max. Negotiated Rate |
$2,633.70 |
| Rate for Payer: Aetna American Axle |
$1,902.11
|
| Rate for Payer: Aetna Commercial |
$2,487.38
|
| Rate for Payer: Aetna Medicare |
$1,463.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,902.11
|
| Rate for Payer: BCBS Complete |
$1,170.53
|
| Rate for Payer: Cash Price |
$2,341.06
|
| Rate for Payer: Cofinity Commercial |
$2,048.43
|
| Rate for Payer: Cofinity Commercial |
$2,516.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,048.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,341.06
|
| Rate for Payer: Healthscope Commercial |
$2,633.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,048.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,194.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,487.38
|
| Rate for Payer: PHP Commercial |
$2,487.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,902.11
|
| Rate for Payer: Priority Health SBD |
$1,843.59
|
| Rate for Payer: UMR Bronson Commercial |
$1,082.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,194.75
|
|
|
LIPASE-PROTEASE-AMYLASE 3,000-9,500-15,000 UNIT CAPSULE, DELAYED 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 Commercial |
$466.96
|
| Rate for Payer: Aetna Medicare |
$274.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$357.08
|
| Rate for Payer: BCBS Complete |
$219.74
|
| Rate for Payer: Cash Price |
$439.49
|
| Rate for Payer: Cofinity Commercial |
$384.55
|
| Rate for Payer: Cofinity Commercial |
$472.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$384.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$439.49
|
| Rate for Payer: Healthscope Commercial |
$494.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$384.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$412.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$466.96
|
| Rate for Payer: PHP Commercial |
$466.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.08
|
| Rate for Payer: Priority Health SBD |
$346.10
|
| Rate for Payer: UMR Bronson Commercial |
$203.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$412.02
|
|
|
LIPASE-PROTEASE-AMYLASE 3,000-9,500-15,000 UNIT CAPSULE, DELAYED 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 Commercial |
$466.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$357.08
|
| Rate for Payer: Cash Price |
$439.49
|
| Rate for Payer: Cofinity Commercial |
$384.55
|
| Rate for Payer: Cofinity Commercial |
$472.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$384.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$439.49
|
| Rate for Payer: Healthscope Commercial |
$494.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$384.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$412.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$466.96
|
| Rate for Payer: PHP Commercial |
$466.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.08
|
| Rate for Payer: Priority Health SBD |
$346.10
|
| Rate for Payer: UMR Bronson Commercial |
$241.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$412.02
|
|
|
LIPASE-PROTEASE-AMYLASE 36,000-114,000-180,000 UNIT CAPSULE,DELAY REL
|
Facility
|
IP
|
$4,443.33
|
|
|
Service Code
|
NDC 00032301613
|
| Hospital Charge Code |
166135
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,955.07 |
| Max. Negotiated Rate |
$3,999.00 |
| Rate for Payer: Aetna American Axle |
$2,888.16
|
| Rate for Payer: Aetna Commercial |
$3,776.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,888.16
|
| Rate for Payer: Cash Price |
$3,554.66
|
| Rate for Payer: Cofinity Commercial |
$3,110.33
|
| Rate for Payer: Cofinity Commercial |
$3,821.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,110.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,554.66
|
| Rate for Payer: Healthscope Commercial |
$3,999.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,110.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,332.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,776.83
|
| Rate for Payer: PHP Commercial |
$3,776.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,888.16
|
| Rate for Payer: Priority Health SBD |
$2,799.30
|
| Rate for Payer: UMR Bronson Commercial |
$1,955.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,332.50
|
|
|
LIPASE-PROTEASE-AMYLASE 36,000-114,000-180,000 UNIT CAPSULE,DELAY REL
|
Facility
|
OP
|
$4,443.33
|
|
|
Service Code
|
NDC 00032301613
|
| Hospital Charge Code |
166135
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,644.03 |
| Max. Negotiated Rate |
$3,999.00 |
| Rate for Payer: Aetna American Axle |
$2,888.16
|
| Rate for Payer: Aetna Commercial |
$3,776.83
|
| Rate for Payer: Aetna Medicare |
$2,221.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,888.16
|
| Rate for Payer: BCBS Complete |
$1,777.33
|
| Rate for Payer: Cash Price |
$3,554.66
|
| Rate for Payer: Cofinity Commercial |
$3,110.33
|
| Rate for Payer: Cofinity Commercial |
$3,821.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,110.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,554.66
|
| Rate for Payer: Healthscope Commercial |
$3,999.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,110.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,332.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,776.83
|
| Rate for Payer: PHP Commercial |
$3,776.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,888.16
|
| Rate for Payer: Priority Health SBD |
$2,799.30
|
| Rate for Payer: UMR Bronson Commercial |
$1,644.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,332.50
|
|
