|
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
|
$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
|
$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
|
$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 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
|
$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: Cofinity Commercial |
$252.37
|
| Rate for Payer: Cofinity Commercial |
$310.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$252.37
|
| 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: 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
|
$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
|
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
|
$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 IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$79.87
|
|
|
Service Code
|
HCPCS J2020
|
| Hospital Charge Code |
112020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.28 |
| Max. Negotiated Rate |
$71.88 |
| Rate for Payer: Aetna American Axle |
$51.92
|
| Rate for Payer: Aetna American Axle |
$90.48
|
| Rate for Payer: Aetna American Axle |
$65.32
|
| Rate for Payer: Aetna American Axle |
$176.44
|
| Rate for Payer: Aetna American Axle |
$42.96
|
| Rate for Payer: Aetna American Axle |
$44.75
|
| Rate for Payer: Aetna Commercial |
$230.72
|
| Rate for Payer: Aetna Commercial |
$58.52
|
| Rate for Payer: Aetna Commercial |
$118.32
|
| Rate for Payer: Aetna Commercial |
$85.42
|
| Rate for Payer: Aetna Commercial |
$67.89
|
| Rate for Payer: Aetna Commercial |
$56.18
|
| 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 Medicare |
$34.42
|
| Rate for Payer: Aetna Medicare |
$135.72
|
| Rate for Payer: Aetna Medicare |
$50.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.75
|
| Rate for Payer: BCBS Complete |
$27.54
|
| Rate for Payer: BCBS Complete |
$26.44
|
| Rate for Payer: BCBS Complete |
$40.20
|
| Rate for Payer: BCBS Complete |
$108.58
|
| Rate for Payer: BCBS Complete |
$55.68
|
| Rate for Payer: BCBS Complete |
$31.95
|
| Rate for Payer: BCBS Trust/PPO |
$8.28
|
| Rate for Payer: BCBS Trust/PPO |
$8.28
|
| Rate for Payer: BCBS Trust/PPO |
$8.28
|
| Rate for Payer: BCBS Trust/PPO |
$8.28
|
| Rate for Payer: BCBS Trust/PPO |
$8.28
|
| Rate for Payer: BCBS Trust/PPO |
$8.28
|
| Rate for Payer: BCN Commercial |
$8.28
|
| Rate for Payer: BCN Commercial |
$8.28
|
| Rate for Payer: BCN Commercial |
$8.28
|
| Rate for Payer: BCN Commercial |
$8.28
|
| Rate for Payer: BCN Commercial |
$8.28
|
| Rate for Payer: BCN Commercial |
$8.28
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$217.15
|
| Rate for Payer: Cash Price |
$55.08
|
| Rate for Payer: Cash Price |
$111.36
|
| Rate for Payer: Cash Price |
$80.39
|
| Rate for Payer: Cash Price |
$111.36
|
| Rate for Payer: Cash Price |
$217.15
|
| Rate for Payer: Cash Price |
$55.08
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$52.88
|
| Rate for Payer: Cash Price |
$52.88
|
| Rate for Payer: Cash Price |
$80.39
|
| Rate for Payer: Cofinity Commercial |
$190.01
|
| Rate for Payer: Cofinity Commercial |
$55.91
|
| Rate for Payer: Cofinity Commercial |
$119.71
|
| Rate for Payer: Cofinity Commercial |
$86.42
|
| Rate for Payer: Cofinity Commercial |
$70.34
|
| Rate for Payer: Cofinity Commercial |
$97.44
|
| Rate for Payer: Cofinity Commercial |
$59.21
|
| Rate for Payer: Cofinity Commercial |
$48.20
|
| Rate for Payer: Cofinity Commercial |
$56.85
|
| Rate for Payer: Cofinity Commercial |
$46.27
|
| Rate for Payer: Cofinity Commercial |
$233.44
|
| Rate for Payer: Cofinity Commercial |
$68.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$97.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.15
|
| 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 |
$111.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.90
|
| Rate for Payer: Healthscope Commercial |
$61.96
|
| Rate for Payer: Healthscope Commercial |
$71.88
|
| Rate for Payer: Healthscope Commercial |
$59.49
|
| Rate for Payer: Healthscope Commercial |
$244.30
|
| Rate for Payer: Healthscope Commercial |
$125.28
|
| Rate for Payer: Healthscope Commercial |
$90.44
|
| 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 |
$190.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.27
|
| 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 |
$59.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.72
|
| 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 |
$67.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.18
|
| Rate for Payer: PHP Commercial |
$230.72
|
| Rate for Payer: PHP Commercial |
$56.18
|
| Rate for Payer: PHP Commercial |
$118.32
|
| Rate for Payer: PHP Commercial |
$85.42
|
| Rate for Payer: PHP Commercial |
$58.52
|
| Rate for Payer: PHP Commercial |
$67.89
|
| 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 Cigna Priority Health |
$44.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.48
|
| Rate for Payer: Priority Health SBD |
$43.38
|
| Rate for Payer: Priority Health SBD |
$87.70
|
| 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 |
$25.47
|
| Rate for Payer: UMR Bronson Commercial |
$29.55
|
| Rate for Payer: UMR Bronson Commercial |
$100.43
|
| Rate for Payer: UMR Bronson Commercial |
$37.18
|
| Rate for Payer: UMR Bronson Commercial |
$51.50
|
| Rate for Payer: UMR Bronson Commercial |
$24.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.40
|
| 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 |
$49.58
|
|
|
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 |
$42.96
|
| 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 |
$56.18
|
| 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) |
$42.96
|
| 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 |
$61.96
|
| 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 |
$56.18
|
| 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 |
$56.18
|
| 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 |
$42.96
|
| 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
|
|
|
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 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 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 |
$450.92
|
| 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 |
$450.92
|
| Rate for Payer: PHP Commercial |
$450.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$344.82
|
| Rate for Payer: Priority Health SBD |
$334.22
|
| Rate for Payer: UMR Bronson Commercial |
$196.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$397.88
|
|
|
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 |
$450.92
|
| 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 |
$450.92
|
| Rate for Payer: PHP Commercial |
$450.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$344.82
|
| Rate for Payer: Priority Health SBD |
$334.22
|
| 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
|
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
|
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
|
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
|
$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
|
|
|
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 |
$136.52
|
| 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
|
$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
|
$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
|
|
