|
CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) MAINTENANCE INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$44.78
|
|
|
Service Code
|
HCPCS J0706
|
| Hospital Charge Code |
77412
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$40.30 |
| Rate for Payer: Aetna American Axle |
$29.11
|
| Rate for Payer: Aetna American Axle |
$52.03
|
| Rate for Payer: Aetna American Axle |
$47.50
|
| Rate for Payer: Aetna American Axle |
$38.26
|
| Rate for Payer: Aetna American Axle |
$56.82
|
| Rate for Payer: Aetna Commercial |
$38.06
|
| Rate for Payer: Aetna Commercial |
$50.03
|
| Rate for Payer: Aetna Commercial |
$74.30
|
| Rate for Payer: Aetna Commercial |
$68.03
|
| Rate for Payer: Aetna Commercial |
$62.12
|
| Rate for Payer: Aetna Medicare |
$43.70
|
| Rate for Payer: Aetna Medicare |
$29.43
|
| Rate for Payer: Aetna Medicare |
$22.39
|
| Rate for Payer: Aetna Medicare |
$36.54
|
| Rate for Payer: Aetna Medicare |
$40.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.82
|
| Rate for Payer: BCBS Complete |
$32.02
|
| Rate for Payer: BCBS Complete |
$17.91
|
| Rate for Payer: BCBS Complete |
$23.54
|
| Rate for Payer: BCBS Complete |
$29.23
|
| Rate for Payer: BCBS Complete |
$34.96
|
| Rate for Payer: BCBS Trust/PPO |
$4.74
|
| Rate for Payer: BCBS Trust/PPO |
$4.74
|
| Rate for Payer: BCBS Trust/PPO |
$4.74
|
| Rate for Payer: BCBS Trust/PPO |
$4.74
|
| Rate for Payer: BCBS Trust/PPO |
$4.74
|
| Rate for Payer: BCN Commercial |
$4.74
|
| Rate for Payer: BCN Commercial |
$4.74
|
| Rate for Payer: BCN Commercial |
$4.74
|
| Rate for Payer: BCN Commercial |
$4.74
|
| Rate for Payer: BCN Commercial |
$4.74
|
| Rate for Payer: Cash Price |
$64.03
|
| Rate for Payer: Cash Price |
$69.93
|
| Rate for Payer: Cash Price |
$47.09
|
| Rate for Payer: Cash Price |
$35.82
|
| Rate for Payer: Cash Price |
$58.46
|
| Rate for Payer: Cash Price |
$35.82
|
| Rate for Payer: Cash Price |
$58.46
|
| Rate for Payer: Cash Price |
$64.03
|
| Rate for Payer: Cash Price |
$47.09
|
| Rate for Payer: Cash Price |
$69.93
|
| Rate for Payer: Cofinity Advantage |
$56.03
|
| Rate for Payer: Cofinity Advantage |
$41.20
|
| Rate for Payer: Cofinity Advantage |
$51.16
|
| Rate for Payer: Cofinity Advantage |
$61.19
|
| Rate for Payer: Cofinity Advantage |
$31.35
|
| Rate for Payer: Cofinity Commercial |
$68.83
|
| Rate for Payer: Cofinity Commercial |
$38.51
|
| Rate for Payer: Cofinity Commercial |
$50.62
|
| Rate for Payer: Cofinity Commercial |
$62.85
|
| Rate for Payer: Cofinity Commercial |
$75.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.46
|
| Rate for Payer: Healthscope Commercial |
$65.77
|
| Rate for Payer: Healthscope Commercial |
$78.67
|
| Rate for Payer: Healthscope Commercial |
$72.04
|
| Rate for Payer: Healthscope Commercial |
$40.30
|
| Rate for Payer: Healthscope Commercial |
$52.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.56
|
| Rate for Payer: PHP Commercial |
$50.03
|
| Rate for Payer: PHP Commercial |
$62.12
|
| Rate for Payer: PHP Commercial |
$74.30
|
| Rate for Payer: PHP Commercial |
$68.03
|
| Rate for Payer: PHP Commercial |
$38.06
|
| Rate for Payer: Priority Health SBD |
$46.04
|
| Rate for Payer: Priority Health SBD |
$28.21
|
| Rate for Payer: Priority Health SBD |
$50.43
|
| Rate for Payer: Priority Health SBD |
$55.07
|
| Rate for Payer: Priority Health SBD |
$37.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.35
|
| Rate for Payer: UHC Core |
$3.35
|
| Rate for Payer: UHC Core |
$3.35
|
| Rate for Payer: UHC Core |
$3.35
|
| Rate for Payer: UHC Core |
$3.35
|
| Rate for Payer: UHC Core |
$3.35
|
| Rate for Payer: UHC Exchange |
$3.35
|
| Rate for Payer: UHC Exchange |
$3.35
|
| Rate for Payer: UHC Exchange |
$3.35
|
| Rate for Payer: UHC Exchange |
$3.35
|
| Rate for Payer: UHC Exchange |
$3.35
|
| Rate for Payer: UMR Bronson Commercial |
$16.57
|
| Rate for Payer: UMR Bronson Commercial |
$29.61
|
| Rate for Payer: UMR Bronson Commercial |
$27.04
|
| Rate for Payer: UMR Bronson Commercial |
$32.34
|
| Rate for Payer: UMR Bronson Commercial |
$21.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.59
|
|
|
CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) MAINTENANCE INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$80.04
|
|
|
Service Code
|
HCPCS J0706
|
| Hospital Charge Code |
77412
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.22 |
| Max. Negotiated Rate |
$72.04 |
| Rate for Payer: Aetna American Axle |
$52.03
|
| Rate for Payer: Aetna American Axle |
$47.50
|
| Rate for Payer: Aetna American Axle |
$56.82
|
| Rate for Payer: Aetna American Axle |
$38.26
|
| Rate for Payer: Aetna American Axle |
$29.11
|
| Rate for Payer: Aetna Commercial |
$38.06
|
| Rate for Payer: Aetna Commercial |
$62.12
|
| Rate for Payer: Aetna Commercial |
$68.03
|
| Rate for Payer: Aetna Commercial |
$74.30
|
| Rate for Payer: Aetna Commercial |
$50.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.82
|
| Rate for Payer: Cash Price |
$58.46
|
| Rate for Payer: Cash Price |
$47.09
|
| Rate for Payer: Cash Price |
$69.93
|
| Rate for Payer: Cash Price |
$64.03
|
| Rate for Payer: Cash Price |
$35.82
|
| Rate for Payer: Cofinity Advantage |
$31.35
|
| Rate for Payer: Cofinity Advantage |
$61.19
|
| Rate for Payer: Cofinity Advantage |
$41.20
|
| Rate for Payer: Cofinity Advantage |
$56.03
|
| Rate for Payer: Cofinity Advantage |
$51.16
|
| Rate for Payer: Cofinity Commercial |
$75.17
|
| Rate for Payer: Cofinity Commercial |
$38.51
|
| Rate for Payer: Cofinity Commercial |
$50.62
|
| Rate for Payer: Cofinity Commercial |
$62.85
|
| Rate for Payer: Cofinity Commercial |
$68.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.93
|
| Rate for Payer: Healthscope Commercial |
$40.30
|
| Rate for Payer: Healthscope Commercial |
$52.97
|
| Rate for Payer: Healthscope Commercial |
$65.77
|
| Rate for Payer: Healthscope Commercial |
$72.04
|
| Rate for Payer: Healthscope Commercial |
$78.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.03
|
| Rate for Payer: PHP Commercial |
$62.12
|
| Rate for Payer: PHP Commercial |
$38.06
|
| Rate for Payer: PHP Commercial |
$68.03
|
| Rate for Payer: PHP Commercial |
$74.30
|
| Rate for Payer: PHP Commercial |
$50.03
|
| Rate for Payer: Priority Health SBD |
$50.43
|
| Rate for Payer: Priority Health SBD |
$55.07
|
| Rate for Payer: Priority Health SBD |
$37.08
|
| Rate for Payer: Priority Health SBD |
$28.21
|
| Rate for Payer: Priority Health SBD |
$46.04
|
| Rate for Payer: UMR Bronson Commercial |
$25.90
|
| Rate for Payer: UMR Bronson Commercial |
$38.46
|
| Rate for Payer: UMR Bronson Commercial |
$32.16
|
| Rate for Payer: UMR Bronson Commercial |
$19.70
|
| Rate for Payer: UMR Bronson Commercial |
$35.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.15
|
|
|
CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) MAINTENANCE ORAL SOLUTION
|
Facility
|
IP
|
$37.76
|
|
|
Service Code
|
HCPCS J0706
|
| Hospital Charge Code |
77411
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$33.98 |
| Rate for Payer: Aetna American Axle |
$24.54
|
| Rate for Payer: Aetna Commercial |
$32.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.54
|
| Rate for Payer: Cash Price |
$30.21
|
| Rate for Payer: Cofinity Advantage |
$26.43
|
| Rate for Payer: Cofinity Commercial |
$32.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.21
|
| Rate for Payer: Healthscope Commercial |
$33.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.32
|
| Rate for Payer: PHP Commercial |
$32.10
|
| Rate for Payer: Priority Health SBD |
$23.79
|
| Rate for Payer: UMR Bronson Commercial |
$16.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.32
|
|
|
CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) MAINTENANCE ORAL SOLUTION
|
Facility
|
OP
|
$37.76
|
|
|
Service Code
|
HCPCS J0706
|
| Hospital Charge Code |
77411
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$33.98 |
| Rate for Payer: Aetna American Axle |
$24.54
|
| Rate for Payer: Aetna Commercial |
$32.10
|
| Rate for Payer: Aetna Medicare |
$18.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.54
|
| Rate for Payer: BCBS Complete |
$15.10
|
| Rate for Payer: BCBS Trust/PPO |
$4.74
|
| Rate for Payer: BCN Commercial |
$4.74
|
| Rate for Payer: Cash Price |
$30.21
|
| Rate for Payer: Cash Price |
$30.21
|
| Rate for Payer: Cofinity Advantage |
$26.43
|
| Rate for Payer: Cofinity Commercial |
$32.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.21
|
| Rate for Payer: Healthscope Commercial |
$33.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.32
|
| Rate for Payer: PHP Commercial |
$32.10
|
| Rate for Payer: Priority Health SBD |
$23.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.35
|
| Rate for Payer: UHC Core |
$3.35
|
| Rate for Payer: UHC Exchange |
$3.35
|
| Rate for Payer: UMR Bronson Commercial |
$13.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.32
|
|
|
CAFFEINE-SODIUM BENZOATE 250 MG/ML(125 MG/ML CAFFEINE) INJECTION SOLN
|
Facility
|
OP
|
$139.81
|
|
|
Service Code
|
NDC 00517250210
|
| Hospital Charge Code |
1262
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$51.73 |
| Max. Negotiated Rate |
$125.83 |
| Rate for Payer: Aetna American Axle |
$90.88
|
| Rate for Payer: Aetna Commercial |
$118.84
|
| Rate for Payer: Aetna Medicare |
$69.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.88
|
| Rate for Payer: BCBS Complete |
$55.92
|
| Rate for Payer: Cash Price |
$111.85
|
| Rate for Payer: Cofinity Advantage |
$97.87
|
| Rate for Payer: Cofinity Commercial |
$120.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.85
|
| Rate for Payer: Healthscope Commercial |
$125.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$111.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.86
|
| Rate for Payer: PHP Commercial |
$118.84
|
| Rate for Payer: Priority Health SBD |
$88.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.88
|
| Rate for Payer: UHC Core |
$72.84
|
| Rate for Payer: UHC Exchange |
$54.95
|
| Rate for Payer: UMR Bronson Commercial |
$51.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.86
|
|
|
CAFFEINE-SODIUM BENZOATE 250 MG/ML(125 MG/ML CAFFEINE) INJECTION SOLN
|
Facility
|
OP
|
$139.81
|
|
|
Service Code
|
NDC 00517250201
|
| Hospital Charge Code |
1262
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$51.73 |
| Max. Negotiated Rate |
$125.83 |
| Rate for Payer: Aetna American Axle |
$90.88
|
| Rate for Payer: Aetna Commercial |
$118.84
|
| Rate for Payer: Aetna Medicare |
$69.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.88
|
| Rate for Payer: BCBS Complete |
$55.92
|
| Rate for Payer: Cash Price |
$111.85
|
| Rate for Payer: Cofinity Advantage |
$97.87
|
| Rate for Payer: Cofinity Commercial |
$120.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.85
|
| Rate for Payer: Healthscope Commercial |
$125.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$111.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.86
|
| Rate for Payer: PHP Commercial |
$118.84
|
| Rate for Payer: Priority Health SBD |
$88.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.88
|
| Rate for Payer: UHC Core |
$72.84
|
| Rate for Payer: UHC Exchange |
$54.95
|
| Rate for Payer: UMR Bronson Commercial |
$51.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.86
|
|
|
CAFFEINE-SODIUM BENZOATE 250 MG/ML(125 MG/ML CAFFEINE) INJECTION SOLN
|
Facility
|
IP
|
$139.81
|
|
|
Service Code
|
NDC 00517250201
|
| Hospital Charge Code |
1262
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$61.52 |
| Max. Negotiated Rate |
$125.83 |
| Rate for Payer: Aetna American Axle |
$90.88
|
| Rate for Payer: Aetna Commercial |
$118.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.88
|
| Rate for Payer: Cash Price |
$111.85
|
| Rate for Payer: Cofinity Advantage |
$97.87
|
| Rate for Payer: Cofinity Commercial |
$120.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.85
|
| Rate for Payer: Healthscope Commercial |
$125.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.86
|
| Rate for Payer: PHP Commercial |
$118.84
|
| Rate for Payer: Priority Health SBD |
$88.08
|
| Rate for Payer: UMR Bronson Commercial |
$61.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.86
|
|
|
CAFFEINE-SODIUM BENZOATE 250 MG/ML(125 MG/ML CAFFEINE) INJECTION SOLN
|
Facility
|
IP
|
$139.81
|
|
|
Service Code
|
NDC 00517250210
|
| Hospital Charge Code |
1262
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$61.52 |
| Max. Negotiated Rate |
$125.83 |
| Rate for Payer: Aetna American Axle |
$90.88
|
| Rate for Payer: Aetna Commercial |
$118.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.88
|
| Rate for Payer: Cash Price |
$111.85
|
| Rate for Payer: Cofinity Advantage |
$97.87
|
| Rate for Payer: Cofinity Commercial |
$120.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.85
|
| Rate for Payer: Healthscope Commercial |
$125.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.86
|
| Rate for Payer: PHP Commercial |
$118.84
|
| Rate for Payer: Priority Health SBD |
$88.08
|
| Rate for Payer: UMR Bronson Commercial |
$61.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.86
|
|
|
CALAMINE 8 %-ZINC OXIDE 8 % LOTION
|
Facility
|
IP
|
$17.53
|
|
|
Service Code
|
NDC 00395041396
|
| Hospital Charge Code |
78879
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.71 |
| Max. Negotiated Rate |
$15.78 |
| Rate for Payer: Aetna American Axle |
$11.39
|
| Rate for Payer: Aetna Commercial |
$14.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.39
|
| Rate for Payer: Cash Price |
$14.02
|
| Rate for Payer: Cofinity Advantage |
$12.27
|
| Rate for Payer: Cofinity Commercial |
$15.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.02
|
| Rate for Payer: Healthscope Commercial |
$15.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.15
|
| Rate for Payer: PHP Commercial |
$14.90
|
| Rate for Payer: Priority Health SBD |
$11.04
|
| Rate for Payer: UMR Bronson Commercial |
$7.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.15
|
|
|
CALAMINE 8 %-ZINC OXIDE 8 % LOTION
|
Facility
|
OP
|
$8.50
|
|
|
Service Code
|
NDC 00904253321
|
| Hospital Charge Code |
78879
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna American Axle |
$5.53
|
| Rate for Payer: Aetna Commercial |
$7.22
|
| Rate for Payer: Aetna Medicare |
$4.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.53
|
| Rate for Payer: BCBS Complete |
$3.40
|
| Rate for Payer: Cash Price |
$6.80
|
| Rate for Payer: Cofinity Advantage |
$5.95
|
| Rate for Payer: Cofinity Commercial |
$7.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.80
|
| Rate for Payer: Healthscope Commercial |
$7.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.38
|
| Rate for Payer: PHP Commercial |
$7.22
|
| Rate for Payer: Priority Health SBD |
$5.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.53
|
| Rate for Payer: UHC Core |
$4.43
|
| Rate for Payer: UHC Exchange |
$3.34
|
| Rate for Payer: UMR Bronson Commercial |
$3.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.38
|
|
|
CALAMINE 8 %-ZINC OXIDE 8 % LOTION
|
Facility
|
OP
|
$17.53
|
|
|
Service Code
|
NDC 00395041396
|
| Hospital Charge Code |
78879
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.49 |
| Max. Negotiated Rate |
$15.78 |
| Rate for Payer: Aetna American Axle |
$11.39
|
| Rate for Payer: Aetna Commercial |
$14.90
|
| Rate for Payer: Aetna Medicare |
$8.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.39
|
| Rate for Payer: BCBS Complete |
$7.01
|
| Rate for Payer: Cash Price |
$14.02
|
| Rate for Payer: Cofinity Advantage |
$12.27
|
| Rate for Payer: Cofinity Commercial |
$15.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.02
|
| Rate for Payer: Healthscope Commercial |
$15.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.15
|
| Rate for Payer: PHP Commercial |
$14.90
|
| Rate for Payer: Priority Health SBD |
$11.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.39
|
| Rate for Payer: UHC Core |
$9.13
|
| Rate for Payer: UHC Exchange |
$6.89
|
| Rate for Payer: UMR Bronson Commercial |
$6.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.15
|
|
|
CALAMINE 8 %-ZINC OXIDE 8 % LOTION
|
Facility
|
IP
|
$8.50
|
|
|
Service Code
|
NDC 00904253321
|
| Hospital Charge Code |
78879
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna American Axle |
$5.53
|
| Rate for Payer: Aetna Commercial |
$7.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.53
|
| Rate for Payer: Cash Price |
$6.80
|
| Rate for Payer: Cofinity Advantage |
$5.95
|
| Rate for Payer: Cofinity Commercial |
$7.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.80
|
| Rate for Payer: Healthscope Commercial |
$7.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.38
|
| Rate for Payer: PHP Commercial |
$7.22
|
| Rate for Payer: Priority Health SBD |
$5.36
|
| Rate for Payer: UMR Bronson Commercial |
$3.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.38
|
|
|
CALASPARGASE PEGOL-MKNL 750 UNIT/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$133,631.52
|
|
|
Service Code
|
HCPCS J9118
|
| Hospital Charge Code |
191705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.93 |
| Max. Negotiated Rate |
$120,268.37 |
| Rate for Payer: Aetna American Axle |
$86,860.49
|
| Rate for Payer: Aetna Commercial |
$113,586.79
|
| Rate for Payer: Aetna Medicare |
$85.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86,860.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$102.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$102.60
|
| Rate for Payer: BCBS Complete |
$45.08
|
| Rate for Payer: BCBS MAPPO |
$82.08
|
| Rate for Payer: BCBS Trust/PPO |
$266.13
|
| Rate for Payer: BCN Commercial |
$266.13
|
| Rate for Payer: BCN Medicare Advantage |
$82.08
|
| Rate for Payer: Cash Price |
$106,905.22
|
| Rate for Payer: Cash Price |
$106,905.22
|
| Rate for Payer: Cofinity Advantage |
$93,542.06
|
| Rate for Payer: Cofinity Commercial |
$114,923.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106,905.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.08
|
| Rate for Payer: Healthscope Commercial |
$120,268.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93,542.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100,223.64
|
| Rate for Payer: Mclaren Medicaid |
$82.08
|
| Rate for Payer: Mclaren Medicare |
$82.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.18
|
| Rate for Payer: Meridian Medicaid |
$86.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$90.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113,586.79
|
| Rate for Payer: Nomi Health Commercial |
$246.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100,223.64
|
| Rate for Payer: PACE Medicare |
$77.98
|
| Rate for Payer: PACE SWMI |
$82.08
|
| Rate for Payer: PHP Commercial |
$113,586.79
|
| Rate for Payer: PHP Medicare Advantage |
$82.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$258.85
|
| Rate for Payer: Priority Health Medicare |
$82.08
|
| Rate for Payer: Priority Health SBD |
$84,187.86
|
| Rate for Payer: Priority Health Tiered Network |
$207.08
|
| Rate for Payer: Railroad Medicare Medicare |
$82.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.43
|
| Rate for Payer: UHC Core |
$135.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$82.08
|
| Rate for Payer: UHC Exchange |
$135.43
|
| Rate for Payer: UHC Medicaid |
$42.93
|
| Rate for Payer: UHCCP Medicaid |
$42.93
|
| Rate for Payer: UMR Bronson Commercial |
$49,443.66
|
| Rate for Payer: VA VA |
$82.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100,223.64
|
|
|
CALASPARGASE PEGOL-MKNL 750 UNIT/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$133,631.52
|
|
|
Service Code
|
HCPCS J9118
|
| Hospital Charge Code |
191705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58,797.87 |
| Max. Negotiated Rate |
$120,268.37 |
| Rate for Payer: Aetna American Axle |
$86,860.49
|
| Rate for Payer: Aetna Commercial |
$113,586.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86,860.49
|
| Rate for Payer: Cash Price |
$106,905.22
|
| Rate for Payer: Cofinity Advantage |
$93,542.06
|
| Rate for Payer: Cofinity Commercial |
$114,923.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106,905.22
|
| Rate for Payer: Healthscope Commercial |
$120,268.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93,542.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100,223.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113,586.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100,223.64
|
| Rate for Payer: PHP Commercial |
$113,586.79
|
| Rate for Payer: Priority Health SBD |
$84,187.86
|
| Rate for Payer: UMR Bronson Commercial |
$58,797.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100,223.64
|
|
|
CALCIPOTRIENE 0.005 % TOPICAL CREAM
|
Facility
|
IP
|
$261.87
|
|
|
Service Code
|
NDC 66993087761
|
| Hospital Charge Code |
16034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.22 |
| Max. Negotiated Rate |
$235.68 |
| Rate for Payer: Aetna American Axle |
$170.22
|
| Rate for Payer: Aetna Commercial |
$222.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.22
|
| Rate for Payer: Cash Price |
$209.50
|
| Rate for Payer: Cofinity Advantage |
$183.31
|
| Rate for Payer: Cofinity Commercial |
$225.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.50
|
| Rate for Payer: Healthscope Commercial |
$235.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.40
|
| Rate for Payer: PHP Commercial |
$222.59
|
| Rate for Payer: Priority Health SBD |
$164.98
|
| Rate for Payer: UMR Bronson Commercial |
$115.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.40
|
|
|
CALCIPOTRIENE 0.005 % TOPICAL CREAM
|
Facility
|
IP
|
$717.99
|
|
|
Service Code
|
NDC 68462050165
|
| Hospital Charge Code |
16034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$315.92 |
| Max. Negotiated Rate |
$646.19 |
| Rate for Payer: Aetna American Axle |
$466.69
|
| Rate for Payer: Aetna Commercial |
$610.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$466.69
|
| Rate for Payer: Cash Price |
$574.39
|
| Rate for Payer: Cofinity Advantage |
$502.59
|
| Rate for Payer: Cofinity Commercial |
$617.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$574.39
|
| Rate for Payer: Healthscope Commercial |
$646.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$502.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$538.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$610.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$538.49
|
| Rate for Payer: PHP Commercial |
$610.29
|
| Rate for Payer: Priority Health SBD |
$452.33
|
| Rate for Payer: UMR Bronson Commercial |
$315.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$538.49
|
|
|
CALCIPOTRIENE 0.005 % TOPICAL CREAM
|
Facility
|
IP
|
$1,150.59
|
|
|
Service Code
|
NDC 00781711735
|
| Hospital Charge Code |
16034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$506.26 |
| Max. Negotiated Rate |
$1,035.53 |
| Rate for Payer: Aetna American Axle |
$747.88
|
| Rate for Payer: Aetna Commercial |
$978.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$747.88
|
| Rate for Payer: Cash Price |
$920.47
|
| Rate for Payer: Cofinity Advantage |
$805.41
|
| Rate for Payer: Cofinity Commercial |
$989.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$920.47
|
| Rate for Payer: Healthscope Commercial |
$1,035.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$805.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$862.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$978.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$862.94
|
| Rate for Payer: PHP Commercial |
$978.00
|
| Rate for Payer: Priority Health SBD |
$724.87
|
| Rate for Payer: UMR Bronson Commercial |
$506.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$862.94
|
|
|
CALCIPOTRIENE 0.005 % TOPICAL CREAM
|
Facility
|
OP
|
$1,150.59
|
|
|
Service Code
|
NDC 00781711735
|
| Hospital Charge Code |
16034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$425.72 |
| Max. Negotiated Rate |
$1,035.53 |
| Rate for Payer: Aetna American Axle |
$747.88
|
| Rate for Payer: Aetna Commercial |
$978.00
|
| Rate for Payer: Aetna Medicare |
$575.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$747.88
|
| Rate for Payer: BCBS Complete |
$460.24
|
| Rate for Payer: Cash Price |
$920.47
|
| Rate for Payer: Cofinity Advantage |
$805.41
|
| Rate for Payer: Cofinity Commercial |
$989.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$920.47
|
| Rate for Payer: Healthscope Commercial |
$1,035.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$805.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$862.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$920.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$978.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$862.94
|
| Rate for Payer: PHP Commercial |
$978.00
|
| Rate for Payer: Priority Health SBD |
$724.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$747.88
|
| Rate for Payer: UHC Core |
$599.46
|
| Rate for Payer: UHC Exchange |
$452.18
|
| Rate for Payer: UMR Bronson Commercial |
$425.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$862.94
|
|
|
CALCIPOTRIENE 0.005 % TOPICAL CREAM
|
Facility
|
OP
|
$717.99
|
|
|
Service Code
|
NDC 68462050165
|
| Hospital Charge Code |
16034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$265.66 |
| Max. Negotiated Rate |
$646.19 |
| Rate for Payer: Aetna American Axle |
$466.69
|
| Rate for Payer: Aetna Commercial |
$610.29
|
| Rate for Payer: Aetna Medicare |
$359.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$466.69
|
| Rate for Payer: BCBS Complete |
$287.20
|
| Rate for Payer: Cash Price |
$574.39
|
| Rate for Payer: Cofinity Advantage |
$502.59
|
| Rate for Payer: Cofinity Commercial |
$617.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$574.39
|
| Rate for Payer: Healthscope Commercial |
$646.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$502.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$538.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$574.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$610.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$538.49
|
| Rate for Payer: PHP Commercial |
$610.29
|
| Rate for Payer: Priority Health SBD |
$452.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$466.69
|
| Rate for Payer: UHC Core |
$374.07
|
| Rate for Payer: UHC Exchange |
$282.17
|
| Rate for Payer: UMR Bronson Commercial |
$265.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$538.49
|
|
|
CALCIPOTRIENE 0.005 % TOPICAL CREAM
|
Facility
|
OP
|
$261.87
|
|
|
Service Code
|
NDC 66993087761
|
| Hospital Charge Code |
16034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.89 |
| Max. Negotiated Rate |
$235.68 |
| Rate for Payer: Aetna American Axle |
$170.22
|
| Rate for Payer: Aetna Commercial |
$222.59
|
| Rate for Payer: Aetna Medicare |
$130.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.22
|
| Rate for Payer: BCBS Complete |
$104.75
|
| Rate for Payer: Cash Price |
$209.50
|
| Rate for Payer: Cofinity Advantage |
$183.31
|
| Rate for Payer: Cofinity Commercial |
$225.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.50
|
| Rate for Payer: Healthscope Commercial |
$235.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$209.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.40
|
| Rate for Payer: PHP Commercial |
$222.59
|
| Rate for Payer: Priority Health SBD |
$164.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.22
|
| Rate for Payer: UHC Core |
$136.43
|
| Rate for Payer: UHC Exchange |
$102.91
|
| Rate for Payer: UMR Bronson Commercial |
$96.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.40
|
|
|
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY
|
Facility
|
IP
|
$243.71
|
|
|
Service Code
|
NDC 60505082306
|
| Hospital Charge Code |
15738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.23 |
| Max. Negotiated Rate |
$219.34 |
| Rate for Payer: Aetna American Axle |
$158.41
|
| Rate for Payer: Aetna Commercial |
$207.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.41
|
| Rate for Payer: Cash Price |
$194.97
|
| Rate for Payer: Cofinity Advantage |
$170.60
|
| Rate for Payer: Cofinity Commercial |
$209.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.97
|
| Rate for Payer: Healthscope Commercial |
$219.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$170.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$182.78
|
| Rate for Payer: PHP Commercial |
$207.15
|
| Rate for Payer: Priority Health SBD |
$153.54
|
| Rate for Payer: UMR Bronson Commercial |
$107.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.78
|
|
|
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY
|
Facility
|
OP
|
$243.71
|
|
|
Service Code
|
NDC 60505082306
|
| Hospital Charge Code |
15738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.17 |
| Max. Negotiated Rate |
$219.34 |
| Rate for Payer: Aetna American Axle |
$158.41
|
| Rate for Payer: Aetna Commercial |
$207.15
|
| Rate for Payer: Aetna Medicare |
$121.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.41
|
| Rate for Payer: BCBS Complete |
$97.48
|
| Rate for Payer: Cash Price |
$194.97
|
| Rate for Payer: Cofinity Advantage |
$170.60
|
| Rate for Payer: Cofinity Commercial |
$209.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.97
|
| Rate for Payer: Healthscope Commercial |
$219.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$170.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$194.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$182.78
|
| Rate for Payer: PHP Commercial |
$207.15
|
| Rate for Payer: Priority Health SBD |
$153.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.41
|
| Rate for Payer: UHC Core |
$126.97
|
| Rate for Payer: UHC Exchange |
$95.78
|
| Rate for Payer: UMR Bronson Commercial |
$90.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.78
|
|
|
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY
|
Facility
|
OP
|
$159.92
|
|
|
Service Code
|
NDC 49884016111
|
| Hospital Charge Code |
15738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.17 |
| Max. Negotiated Rate |
$143.93 |
| Rate for Payer: Aetna American Axle |
$103.95
|
| Rate for Payer: Aetna Commercial |
$135.93
|
| Rate for Payer: Aetna Medicare |
$79.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.95
|
| Rate for Payer: BCBS Complete |
$63.97
|
| Rate for Payer: Cash Price |
$127.94
|
| Rate for Payer: Cofinity Advantage |
$111.94
|
| Rate for Payer: Cofinity Commercial |
$137.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.94
|
| Rate for Payer: Healthscope Commercial |
$143.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$127.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.94
|
| Rate for Payer: PHP Commercial |
$135.93
|
| Rate for Payer: Priority Health SBD |
$100.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.95
|
| Rate for Payer: UHC Core |
$83.32
|
| Rate for Payer: UHC Exchange |
$62.85
|
| Rate for Payer: UMR Bronson Commercial |
$59.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.94
|
|
|
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY
|
Facility
|
IP
|
$159.92
|
|
|
Service Code
|
NDC 49884016111
|
| Hospital Charge Code |
15738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.36 |
| Max. Negotiated Rate |
$143.93 |
| Rate for Payer: Aetna American Axle |
$103.95
|
| Rate for Payer: Aetna Commercial |
$135.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.95
|
| Rate for Payer: Cash Price |
$127.94
|
| Rate for Payer: Cofinity Advantage |
$111.94
|
| Rate for Payer: Cofinity Commercial |
$137.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.94
|
| Rate for Payer: Healthscope Commercial |
$143.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.94
|
| Rate for Payer: PHP Commercial |
$135.93
|
| Rate for Payer: Priority Health SBD |
$100.75
|
| Rate for Payer: UMR Bronson Commercial |
$70.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.94
|
|
|
CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$1,428.48
|
|
|
Service Code
|
HCPCS J0630
|
| Hospital Charge Code |
9347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$528.54 |
| Max. Negotiated Rate |
$2,364.78 |
| Rate for Payer: Aetna American Axle |
$928.51
|
| Rate for Payer: Aetna American Axle |
$983.78
|
| Rate for Payer: Aetna American Axle |
$1,402.42
|
| Rate for Payer: Aetna American Axle |
$986.54
|
| Rate for Payer: Aetna Commercial |
$1,833.93
|
| Rate for Payer: Aetna Commercial |
$1,286.48
|
| Rate for Payer: Aetna Commercial |
$1,214.21
|
| Rate for Payer: Aetna Commercial |
$1,290.10
|
| Rate for Payer: Aetna Medicare |
$1,078.79
|
| Rate for Payer: Aetna Medicare |
$758.88
|
| Rate for Payer: Aetna Medicare |
$756.75
|
| Rate for Payer: Aetna Medicare |
$714.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$983.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,402.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$986.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$928.51
|
| Rate for Payer: BCBS Complete |
$605.40
|
| Rate for Payer: BCBS Complete |
$571.39
|
| Rate for Payer: BCBS Complete |
$607.10
|
| Rate for Payer: BCBS Complete |
$863.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,492.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,492.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,492.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,492.96
|
| Rate for Payer: BCN Commercial |
$1,492.96
|
| Rate for Payer: BCN Commercial |
$1,492.96
|
| Rate for Payer: BCN Commercial |
$1,492.96
|
| Rate for Payer: BCN Commercial |
$1,492.96
|
| Rate for Payer: Cash Price |
$1,726.06
|
| Rate for Payer: Cash Price |
$1,214.21
|
| Rate for Payer: Cash Price |
$1,142.78
|
| Rate for Payer: Cash Price |
$1,142.78
|
| Rate for Payer: Cash Price |
$1,210.81
|
| Rate for Payer: Cash Price |
$1,210.81
|
| Rate for Payer: Cash Price |
$1,214.21
|
| Rate for Payer: Cash Price |
$1,726.06
|
| Rate for Payer: Cofinity Advantage |
$1,510.30
|
| Rate for Payer: Cofinity Advantage |
$999.94
|
| Rate for Payer: Cofinity Advantage |
$1,059.46
|
| Rate for Payer: Cofinity Advantage |
$1,062.43
|
| Rate for Payer: Cofinity Commercial |
$1,305.27
|
| Rate for Payer: Cofinity Commercial |
$1,855.51
|
| Rate for Payer: Cofinity Commercial |
$1,301.62
|
| Rate for Payer: Cofinity Commercial |
$1,228.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,210.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,142.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,726.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,214.21
|
| Rate for Payer: Healthscope Commercial |
$1,285.63
|
| Rate for Payer: Healthscope Commercial |
$1,362.16
|
| Rate for Payer: Healthscope Commercial |
$1,941.81
|
| Rate for Payer: Healthscope Commercial |
$1,365.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,062.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,059.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$999.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,510.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,071.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,618.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,135.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,138.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,210.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,142.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,214.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,726.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,290.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,833.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,286.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,214.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,071.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,135.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,618.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,138.32
|
| Rate for Payer: PHP Commercial |
$1,833.93
|
| Rate for Payer: PHP Commercial |
$1,290.10
|
| Rate for Payer: PHP Commercial |
$1,214.21
|
| Rate for Payer: PHP Commercial |
$1,286.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$848.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$848.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$848.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$848.00
|
| Rate for Payer: Priority Health SBD |
$953.51
|
| Rate for Payer: Priority Health SBD |
$1,359.27
|
| Rate for Payer: Priority Health SBD |
$956.19
|
| Rate for Payer: Priority Health SBD |
$899.94
|
| Rate for Payer: Priority Health Tiered Network |
$678.40
|
| Rate for Payer: Priority Health Tiered Network |
$678.40
|
| Rate for Payer: Priority Health Tiered Network |
$678.40
|
| Rate for Payer: Priority Health Tiered Network |
$678.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,364.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,364.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,364.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,364.78
|
| Rate for Payer: UHC Core |
$2,364.78
|
| Rate for Payer: UHC Core |
$2,364.78
|
| Rate for Payer: UHC Core |
$2,364.78
|
| Rate for Payer: UHC Core |
$2,364.78
|
| Rate for Payer: UHC Exchange |
$2,364.78
|
| Rate for Payer: UHC Exchange |
$2,364.78
|
| Rate for Payer: UHC Exchange |
$2,364.78
|
| Rate for Payer: UHC Exchange |
$2,364.78
|
| Rate for Payer: UMR Bronson Commercial |
$798.30
|
| Rate for Payer: UMR Bronson Commercial |
$561.57
|
| Rate for Payer: UMR Bronson Commercial |
$528.54
|
| Rate for Payer: UMR Bronson Commercial |
$560.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,135.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,071.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,618.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,138.32
|
|
