|
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
|
$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
|
|
|
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
|
$1,429.31
|
|
|
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 |
$714.66
|
| 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
|
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
|
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
|
$2,832.72
|
|
|
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 |
$5,972.36 |
| 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 |
$5,972.36
|
| 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
|
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 |
$5,972.36 |
| Rate for Payer: Aetna American Axle |
$4,313.37
|
| Rate for Payer: Aetna Commercial |
$5,640.56
|
| Rate for Payer: Aetna Medicare |
$3,317.98
|
| 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 |
$5,972.36
|
| 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
|
$2,926.33
|
|
|
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
|
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 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 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
|
|
|
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 6,000-19,000-30,000 UNIT CAPSULE,DELAYED REL
|
Facility
|
OP
|
$933.12
|
|
|
Service Code
|
NDC 00032120601
|
| Hospital Charge Code |
98034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$345.25 |
| Max. Negotiated Rate |
$839.81 |
| Rate for Payer: Aetna American Axle |
$606.53
|
| Rate for Payer: Aetna Commercial |
$793.15
|
| Rate for Payer: Aetna Medicare |
$466.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$606.53
|
| Rate for Payer: BCBS Complete |
$373.25
|
| Rate for Payer: Cash Price |
$746.50
|
| Rate for Payer: Cofinity Commercial |
$653.18
|
| Rate for Payer: Cofinity Commercial |
$802.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$653.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$746.50
|
| Rate for Payer: Healthscope Commercial |
$839.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$653.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$699.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$793.15
|
| Rate for Payer: PHP Commercial |
$793.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$606.53
|
| Rate for Payer: Priority Health SBD |
$587.87
|
| Rate for Payer: UMR Bronson Commercial |
$345.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$699.84
|
|
|
LIPASE-PROTEASE-AMYLASE 6,000-19,000-30,000 UNIT CAPSULE,DELAYED REL
|
Facility
|
IP
|
$2,209.20
|
|
|
Service Code
|
NDC 00032120607
|
| Hospital Charge Code |
98034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$972.05 |
| Max. Negotiated Rate |
$1,988.28 |
| Rate for Payer: Aetna American Axle |
$1,435.98
|
| Rate for Payer: Aetna Commercial |
$1,877.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,435.98
|
| Rate for Payer: Cash Price |
$1,767.36
|
| Rate for Payer: Cofinity Commercial |
$1,546.44
|
| Rate for Payer: Cofinity Commercial |
$1,899.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,546.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,767.36
|
| Rate for Payer: Healthscope Commercial |
$1,988.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,546.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,656.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,877.82
|
| Rate for Payer: PHP Commercial |
$1,877.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,435.98
|
| Rate for Payer: Priority Health SBD |
$1,391.80
|
| Rate for Payer: UMR Bronson Commercial |
$972.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,656.90
|
|
|
LIPASE-PROTEASE-AMYLASE 6,000-19,000-30,000 UNIT CAPSULE,DELAYED REL
|
Facility
|
IP
|
$958.08
|
|
|
Service Code
|
NDC 00032004670
|
| Hospital Charge Code |
98034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$421.56 |
| Max. Negotiated Rate |
$862.27 |
| Rate for Payer: Aetna American Axle |
$622.75
|
| Rate for Payer: Aetna Commercial |
$814.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$622.75
|
| Rate for Payer: Cash Price |
$766.46
|
| Rate for Payer: Cofinity Commercial |
$670.66
|
| Rate for Payer: Cofinity Commercial |
$823.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$670.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$766.46
|
| Rate for Payer: Healthscope Commercial |
$862.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$670.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$718.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$814.37
|
| Rate for Payer: PHP Commercial |
$814.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$622.75
|
| Rate for Payer: Priority Health SBD |
$603.59
|
| Rate for Payer: UMR Bronson Commercial |
$421.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$718.56
|
|
|
LIPASE-PROTEASE-AMYLASE 6,000-19,000-30,000 UNIT CAPSULE,DELAYED REL
|
Facility
|
OP
|
$2,209.20
|
|
|
Service Code
|
NDC 00032120607
|
| Hospital Charge Code |
98034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$817.40 |
| Max. Negotiated Rate |
$1,988.28 |
| Rate for Payer: Aetna American Axle |
$1,435.98
|
| Rate for Payer: Aetna Commercial |
$1,877.82
|
| Rate for Payer: Aetna Medicare |
$1,104.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,435.98
|
| Rate for Payer: BCBS Complete |
$883.68
|
| Rate for Payer: Cash Price |
$1,767.36
|
| Rate for Payer: Cofinity Commercial |
$1,546.44
|
| Rate for Payer: Cofinity Commercial |
$1,899.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,546.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,767.36
|
| Rate for Payer: Healthscope Commercial |
$1,988.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,546.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,656.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,877.82
|
| Rate for Payer: PHP Commercial |
$1,877.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,435.98
|
| Rate for Payer: Priority Health SBD |
$1,391.80
|
| Rate for Payer: UMR Bronson Commercial |
$817.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,656.90
|
|
|
LIPASE-PROTEASE-AMYLASE 6,000-19,000-30,000 UNIT CAPSULE,DELAYED REL
|
Facility
|
OP
|
$958.08
|
|
|
Service Code
|
NDC 00032004670
|
| Hospital Charge Code |
98034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$354.49 |
| Max. Negotiated Rate |
$862.27 |
| Rate for Payer: Aetna American Axle |
$622.75
|
| Rate for Payer: Aetna Commercial |
$814.37
|
| Rate for Payer: Aetna Medicare |
$479.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$622.75
|
| Rate for Payer: BCBS Complete |
$383.23
|
| Rate for Payer: Cash Price |
$766.46
|
| Rate for Payer: Cofinity Commercial |
$670.66
|
| Rate for Payer: Cofinity Commercial |
$823.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$670.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$766.46
|
| Rate for Payer: Healthscope Commercial |
$862.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$670.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$718.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$814.37
|
| Rate for Payer: PHP Commercial |
$814.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$622.75
|
| Rate for Payer: Priority Health SBD |
$603.59
|
| Rate for Payer: UMR Bronson Commercial |
$354.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$718.56
|
|
|
LIPASE-PROTEASE-AMYLASE 6,000-19,000-30,000 UNIT CAPSULE,DELAYED REL
|
Facility
|
IP
|
$933.12
|
|
|
Service Code
|
NDC 00032120601
|
| Hospital Charge Code |
98034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$410.57 |
| Max. Negotiated Rate |
$839.81 |
| Rate for Payer: Aetna American Axle |
$606.53
|
| Rate for Payer: Aetna Commercial |
$793.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$606.53
|
| Rate for Payer: Cash Price |
$746.50
|
| Rate for Payer: Cofinity Commercial |
$653.18
|
| Rate for Payer: Cofinity Commercial |
$802.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$653.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$746.50
|
| Rate for Payer: Healthscope Commercial |
$839.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$653.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$699.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$793.15
|
| Rate for Payer: PHP Commercial |
$793.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$606.53
|
| Rate for Payer: Priority Health SBD |
$587.87
|
| Rate for Payer: UMR Bronson Commercial |
$410.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$699.84
|
|
|
LIPID (FAT EMULSION 20%) NEONATAL SYRINGE CUSTOM
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
NDC 09900000102
|
| Hospital Charge Code |
164988
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.87 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna American Axle |
$45.45
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna Medicare |
$34.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UMR Bronson Commercial |
$25.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
LIPID (FAT EMULSION 20%) NEONATAL SYRINGE CUSTOM
|
Facility
|
IP
|
$108.48
|
|
|
Service Code
|
NDC 09900000106
|
| Hospital Charge Code |
164988
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.73 |
| Max. Negotiated Rate |
$97.63 |
| Rate for Payer: Aetna American Axle |
$70.51
|
| Rate for Payer: Aetna Commercial |
$92.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.51
|
| Rate for Payer: Cash Price |
$86.78
|
| Rate for Payer: Cofinity Commercial |
$75.94
|
| Rate for Payer: Cofinity Commercial |
$93.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.78
|
| Rate for Payer: Healthscope Commercial |
$97.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.21
|
| Rate for Payer: PHP Commercial |
$92.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.51
|
| Rate for Payer: Priority Health SBD |
$68.34
|
| Rate for Payer: UMR Bronson Commercial |
$47.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.36
|
|
|
LIPID (FAT EMULSION 20%) NEONATAL SYRINGE CUSTOM
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 09900000102
|
| Hospital Charge Code |
164988
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.76 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna American Axle |
$45.45
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UMR Bronson Commercial |
$30.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
