|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$386.88
|
|
|
Service Code
|
NDC 00245021201
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.23 |
| Max. Negotiated Rate |
$348.19 |
| Rate for Payer: Aetna American Axle |
$251.47
|
| Rate for Payer: Aetna Commercial |
$328.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.47
|
| Rate for Payer: Cash Price |
$309.50
|
| Rate for Payer: Cofinity Advantage |
$270.82
|
| Rate for Payer: Cofinity Commercial |
$332.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.50
|
| Rate for Payer: Healthscope Commercial |
$348.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$270.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$290.16
|
| Rate for Payer: PHP Commercial |
$328.85
|
| Rate for Payer: Priority Health SBD |
$243.73
|
| Rate for Payer: UMR Bronson Commercial |
$170.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.16
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
OP
|
$3.87
|
|
|
Service Code
|
NDC 00245021289
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Aetna American Axle |
$2.52
|
| Rate for Payer: Aetna Commercial |
$3.29
|
| Rate for Payer: Aetna Medicare |
$1.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.52
|
| Rate for Payer: BCBS Complete |
$1.55
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cofinity Advantage |
$2.71
|
| Rate for Payer: Cofinity Commercial |
$3.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.10
|
| Rate for Payer: Healthscope Commercial |
$3.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.90
|
| Rate for Payer: PHP Commercial |
$3.29
|
| Rate for Payer: Priority Health SBD |
$2.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.52
|
| Rate for Payer: UHC Core |
$2.02
|
| Rate for Payer: UHC Exchange |
$1.52
|
| Rate for Payer: UMR Bronson Commercial |
$1.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.90
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$318.25
|
|
|
Service Code
|
NDC 59651024701
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.03 |
| Max. Negotiated Rate |
$286.43 |
| Rate for Payer: Aetna American Axle |
$206.86
|
| Rate for Payer: Aetna Commercial |
$270.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.86
|
| Rate for Payer: Cash Price |
$254.60
|
| Rate for Payer: Cofinity Advantage |
$222.78
|
| Rate for Payer: Cofinity Commercial |
$273.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.60
|
| Rate for Payer: Healthscope Commercial |
$286.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$222.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.69
|
| Rate for Payer: PHP Commercial |
$270.51
|
| Rate for Payer: Priority Health SBD |
$200.50
|
| Rate for Payer: UMR Bronson Commercial |
$140.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.69
|
|
|
MIDOSTAURIN 25 MG CAPSULE
|
Facility
|
OP
|
$24,190.92
|
|
|
Service Code
|
NDC 00078069851
|
| Hospital Charge Code |
183299
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8,950.64 |
| Max. Negotiated Rate |
$21,771.83 |
| Rate for Payer: Aetna American Axle |
$15,724.10
|
| Rate for Payer: Aetna Commercial |
$20,562.28
|
| Rate for Payer: Aetna Medicare |
$12,095.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15,724.10
|
| Rate for Payer: BCBS Complete |
$9,676.37
|
| Rate for Payer: Cash Price |
$19,352.74
|
| Rate for Payer: Cofinity Advantage |
$16,933.64
|
| Rate for Payer: Cofinity Commercial |
$20,804.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,352.74
|
| Rate for Payer: Healthscope Commercial |
$21,771.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16,933.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18,143.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,352.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20,562.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18,143.19
|
| Rate for Payer: PHP Commercial |
$20,562.28
|
| Rate for Payer: Priority Health SBD |
$15,240.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,724.10
|
| Rate for Payer: UHC Core |
$12,603.47
|
| Rate for Payer: UHC Exchange |
$9,507.03
|
| Rate for Payer: UMR Bronson Commercial |
$8,950.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18,143.19
|
|
|
MIDOSTAURIN 25 MG CAPSULE
|
Facility
|
IP
|
$24,190.92
|
|
|
Service Code
|
NDC 00078069851
|
| Hospital Charge Code |
183299
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10,644.00 |
| Max. Negotiated Rate |
$21,771.83 |
| Rate for Payer: Aetna American Axle |
$15,724.10
|
| Rate for Payer: Aetna Commercial |
$20,562.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15,724.10
|
| Rate for Payer: Cash Price |
$19,352.74
|
| Rate for Payer: Cofinity Advantage |
$16,933.64
|
| Rate for Payer: Cofinity Commercial |
$20,804.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,352.74
|
| Rate for Payer: Healthscope Commercial |
$21,771.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16,933.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18,143.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20,562.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18,143.19
|
| Rate for Payer: PHP Commercial |
$20,562.28
|
| Rate for Payer: Priority Health SBD |
$15,240.28
|
| Rate for Payer: UMR Bronson Commercial |
$10,644.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18,143.19
|
|
|
MIDOSTAURIN 25 MG CAPSULE
|
Facility
|
OP
|
$48,381.83
|
|
|
Service Code
|
NDC 00078069899
|
| Hospital Charge Code |
183299
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17,901.28 |
| Max. Negotiated Rate |
$43,543.65 |
| Rate for Payer: Aetna American Axle |
$31,448.19
|
| Rate for Payer: Aetna Commercial |
$41,124.56
|
| Rate for Payer: Aetna Medicare |
$24,190.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31,448.19
|
| Rate for Payer: BCBS Complete |
$19,352.73
|
| Rate for Payer: Cash Price |
$38,705.46
|
| Rate for Payer: Cofinity Advantage |
$33,867.28
|
| Rate for Payer: Cofinity Commercial |
$41,608.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38,705.46
|
| Rate for Payer: Healthscope Commercial |
$43,543.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33,867.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36,286.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38,705.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41,124.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36,286.37
|
| Rate for Payer: PHP Commercial |
$41,124.56
|
| Rate for Payer: Priority Health SBD |
$30,480.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31,448.19
|
| Rate for Payer: UHC Core |
$25,206.93
|
| Rate for Payer: UHC Exchange |
$19,014.06
|
| Rate for Payer: UMR Bronson Commercial |
$17,901.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36,286.37
|
|
|
MIDOSTAURIN 25 MG CAPSULE
|
Facility
|
IP
|
$48,381.83
|
|
|
Service Code
|
NDC 00078069899
|
| Hospital Charge Code |
183299
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21,288.01 |
| Max. Negotiated Rate |
$43,543.65 |
| Rate for Payer: Aetna American Axle |
$31,448.19
|
| Rate for Payer: Aetna Commercial |
$41,124.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31,448.19
|
| Rate for Payer: Cash Price |
$38,705.46
|
| Rate for Payer: Cofinity Advantage |
$33,867.28
|
| Rate for Payer: Cofinity Commercial |
$41,608.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38,705.46
|
| Rate for Payer: Healthscope Commercial |
$43,543.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33,867.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36,286.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41,124.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36,286.37
|
| Rate for Payer: PHP Commercial |
$41,124.56
|
| Rate for Payer: Priority Health SBD |
$30,480.55
|
| Rate for Payer: UMR Bronson Commercial |
$21,288.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36,286.37
|
|
|
MIGRAINE AND OTHER HEADACHES
|
Facility
|
IP
|
$7,079.88
|
|
|
Service Code
|
APR-DRG 0543
|
| Min. Negotiated Rate |
$6,742.74 |
| Max. Negotiated Rate |
$7,079.88 |
| Rate for Payer: BCBS Complete |
$7,079.88
|
| Rate for Payer: Mclaren Medicaid |
$6,742.74
|
| Rate for Payer: Meridian Medicaid |
$7,079.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,742.74
|
| Rate for Payer: UHC Medicaid |
$6,742.74
|
| Rate for Payer: UHCCP Medicaid |
$6,742.74
|
|
|
MIGRAINE AND OTHER HEADACHES
|
Facility
|
IP
|
$5,501.80
|
|
|
Service Code
|
APR-DRG 0542
|
| Min. Negotiated Rate |
$5,239.81 |
| Max. Negotiated Rate |
$5,501.80 |
| Rate for Payer: BCBS Complete |
$5,501.80
|
| Rate for Payer: Mclaren Medicaid |
$5,239.81
|
| Rate for Payer: Meridian Medicaid |
$5,501.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,239.81
|
| Rate for Payer: UHC Medicaid |
$5,239.81
|
| Rate for Payer: UHCCP Medicaid |
$5,239.81
|
|
|
MIGRAINE AND OTHER HEADACHES
|
Facility
|
IP
|
$10,812.32
|
|
|
Service Code
|
APR-DRG 0544
|
| Min. Negotiated Rate |
$10,297.44 |
| Max. Negotiated Rate |
$10,812.32 |
| Rate for Payer: BCBS Complete |
$10,812.32
|
| Rate for Payer: Mclaren Medicaid |
$10,297.44
|
| Rate for Payer: Meridian Medicaid |
$10,812.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,297.44
|
| Rate for Payer: UHC Medicaid |
$10,297.44
|
| Rate for Payer: UHCCP Medicaid |
$10,297.44
|
|
|
MIGRAINE AND OTHER HEADACHES
|
Facility
|
IP
|
$4,466.09
|
|
|
Service Code
|
APR-DRG 0541
|
| Min. Negotiated Rate |
$4,253.42 |
| Max. Negotiated Rate |
$4,466.09 |
| Rate for Payer: BCBS Complete |
$4,466.09
|
| Rate for Payer: Mclaren Medicaid |
$4,253.42
|
| Rate for Payer: Meridian Medicaid |
$4,466.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,253.42
|
| Rate for Payer: UHC Medicaid |
$4,253.42
|
| Rate for Payer: UHCCP Medicaid |
$4,253.42
|
|
|
MILNACIPRAN 50 MG TABLET
|
Facility
|
OP
|
$1,761.13
|
|
|
Service Code
|
NDC 00456155060
|
| Hospital Charge Code |
97089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$651.62 |
| Max. Negotiated Rate |
$1,585.02 |
| Rate for Payer: Aetna American Axle |
$1,144.73
|
| Rate for Payer: Aetna Commercial |
$1,496.96
|
| Rate for Payer: Aetna Medicare |
$880.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,144.73
|
| Rate for Payer: BCBS Complete |
$704.45
|
| Rate for Payer: Cash Price |
$1,408.90
|
| Rate for Payer: Cofinity Advantage |
$1,232.79
|
| Rate for Payer: Cofinity Commercial |
$1,514.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,408.90
|
| Rate for Payer: Healthscope Commercial |
$1,585.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,232.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,320.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,408.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,496.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,320.85
|
| Rate for Payer: PHP Commercial |
$1,496.96
|
| Rate for Payer: Priority Health SBD |
$1,109.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,144.73
|
| Rate for Payer: UHC Core |
$917.55
|
| Rate for Payer: UHC Exchange |
$692.12
|
| Rate for Payer: UMR Bronson Commercial |
$651.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,320.85
|
|
|
MILNACIPRAN 50 MG TABLET
|
Facility
|
IP
|
$1,761.13
|
|
|
Service Code
|
NDC 00456155060
|
| Hospital Charge Code |
97089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$774.90 |
| Max. Negotiated Rate |
$1,585.02 |
| Rate for Payer: Aetna American Axle |
$1,144.73
|
| Rate for Payer: Aetna Commercial |
$1,496.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,144.73
|
| Rate for Payer: Cash Price |
$1,408.90
|
| Rate for Payer: Cofinity Advantage |
$1,232.79
|
| Rate for Payer: Cofinity Commercial |
$1,514.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,408.90
|
| Rate for Payer: Healthscope Commercial |
$1,585.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,232.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,320.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,496.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,320.85
|
| Rate for Payer: PHP Commercial |
$1,496.96
|
| Rate for Payer: Priority Health SBD |
$1,109.51
|
| Rate for Payer: UMR Bronson Commercial |
$774.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,320.85
|
|
|
MILRINONE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$112.50
|
|
|
Service Code
|
HCPCS J2260
|
| Hospital Charge Code |
27327
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$101.25 |
| Rate for Payer: Aetna American Axle |
$73.12
|
| Rate for Payer: Aetna American Axle |
$90.67
|
| Rate for Payer: Aetna Commercial |
$95.62
|
| Rate for Payer: Aetna Commercial |
$118.58
|
| Rate for Payer: Aetna Medicare |
$56.25
|
| Rate for Payer: Aetna Medicare |
$69.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.67
|
| Rate for Payer: BCBS Complete |
$55.80
|
| Rate for Payer: BCBS Complete |
$45.00
|
| Rate for Payer: BCBS Trust/PPO |
$4.36
|
| Rate for Payer: BCBS Trust/PPO |
$4.36
|
| Rate for Payer: BCN Commercial |
$4.36
|
| Rate for Payer: BCN Commercial |
$4.36
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cofinity Advantage |
$78.75
|
| Rate for Payer: Cofinity Advantage |
$97.65
|
| Rate for Payer: Cofinity Commercial |
$96.75
|
| Rate for Payer: Cofinity Commercial |
$119.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.60
|
| Rate for Payer: Healthscope Commercial |
$101.25
|
| Rate for Payer: Healthscope Commercial |
$125.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$111.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.38
|
| Rate for Payer: PHP Commercial |
$95.62
|
| Rate for Payer: PHP Commercial |
$118.58
|
| Rate for Payer: Priority Health SBD |
$70.88
|
| Rate for Payer: Priority Health SBD |
$87.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.23
|
| Rate for Payer: UHC Core |
$2.23
|
| Rate for Payer: UHC Core |
$2.23
|
| Rate for Payer: UHC Exchange |
$2.23
|
| Rate for Payer: UHC Exchange |
$2.23
|
| Rate for Payer: UMR Bronson Commercial |
$41.62
|
| Rate for Payer: UMR Bronson Commercial |
$51.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.62
|
|
|
MILRINONE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$112.50
|
|
|
Service Code
|
HCPCS J2260
|
| Hospital Charge Code |
27327
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.50 |
| Max. Negotiated Rate |
$101.25 |
| Rate for Payer: Aetna American Axle |
$73.12
|
| Rate for Payer: Aetna American Axle |
$90.67
|
| Rate for Payer: Aetna Commercial |
$95.62
|
| Rate for Payer: Aetna Commercial |
$118.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.67
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cofinity Advantage |
$97.65
|
| Rate for Payer: Cofinity Advantage |
$78.75
|
| Rate for Payer: Cofinity Commercial |
$119.97
|
| Rate for Payer: Cofinity Commercial |
$96.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.60
|
| Rate for Payer: Healthscope Commercial |
$101.25
|
| Rate for Payer: Healthscope Commercial |
$125.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.62
|
| Rate for Payer: PHP Commercial |
$95.62
|
| Rate for Payer: PHP Commercial |
$118.58
|
| Rate for Payer: Priority Health SBD |
$87.89
|
| Rate for Payer: Priority Health SBD |
$70.88
|
| Rate for Payer: UMR Bronson Commercial |
$49.50
|
| Rate for Payer: UMR Bronson Commercial |
$61.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.62
|
|
|
MILRINONE 20 MG/100 ML(200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS PIGGYBK
|
Facility
|
IP
|
$68.59
|
|
|
Service Code
|
HCPCS J2260
|
| Hospital Charge Code |
14961
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.18 |
| Max. Negotiated Rate |
$61.73 |
| Rate for Payer: Aetna American Axle |
$44.58
|
| Rate for Payer: Aetna American Axle |
$42.97
|
| Rate for Payer: Aetna American Axle |
$60.87
|
| Rate for Payer: Aetna American Axle |
$34.22
|
| Rate for Payer: Aetna American Axle |
$96.08
|
| Rate for Payer: Aetna Commercial |
$125.64
|
| Rate for Payer: Aetna Commercial |
$56.19
|
| Rate for Payer: Aetna Commercial |
$58.30
|
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: Aetna Commercial |
$44.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.87
|
| Rate for Payer: Cash Price |
$52.88
|
| Rate for Payer: Cash Price |
$42.11
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cash Price |
$54.87
|
| Rate for Payer: Cash Price |
$118.25
|
| Rate for Payer: Cofinity Advantage |
$103.47
|
| Rate for Payer: Cofinity Advantage |
$65.55
|
| Rate for Payer: Cofinity Advantage |
$36.85
|
| Rate for Payer: Cofinity Advantage |
$48.01
|
| Rate for Payer: Cofinity Advantage |
$46.27
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
| Rate for Payer: Cofinity Commercial |
$127.12
|
| Rate for Payer: Cofinity Commercial |
$45.27
|
| Rate for Payer: Cofinity Commercial |
$56.85
|
| Rate for Payer: Cofinity Commercial |
$58.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$133.03
|
| Rate for Payer: Healthscope Commercial |
$47.38
|
| Rate for Payer: Healthscope Commercial |
$59.49
|
| Rate for Payer: Healthscope Commercial |
$61.73
|
| Rate for Payer: Healthscope Commercial |
$84.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.44
|
| Rate for Payer: PHP Commercial |
$56.19
|
| Rate for Payer: PHP Commercial |
$125.64
|
| Rate for Payer: PHP Commercial |
$58.30
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: PHP Commercial |
$44.74
|
| Rate for Payer: Priority Health SBD |
$43.21
|
| Rate for Payer: Priority Health SBD |
$58.99
|
| Rate for Payer: Priority Health SBD |
$33.16
|
| Rate for Payer: Priority Health SBD |
$93.12
|
| Rate for Payer: Priority Health SBD |
$41.64
|
| Rate for Payer: UMR Bronson Commercial |
$23.16
|
| Rate for Payer: UMR Bronson Commercial |
$41.20
|
| Rate for Payer: UMR Bronson Commercial |
$29.08
|
| Rate for Payer: UMR Bronson Commercial |
$65.04
|
| Rate for Payer: UMR Bronson Commercial |
$30.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.48
|
|
|
MILRINONE 20 MG/100 ML(200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS PIGGYBK
|
Facility
|
OP
|
$147.81
|
|
|
Service Code
|
HCPCS J2260
|
| Hospital Charge Code |
14961
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$133.03 |
| Rate for Payer: Aetna American Axle |
$96.08
|
| Rate for Payer: Aetna American Axle |
$44.58
|
| Rate for Payer: Aetna American Axle |
$42.97
|
| Rate for Payer: Aetna American Axle |
$34.22
|
| Rate for Payer: Aetna American Axle |
$60.87
|
| Rate for Payer: Aetna Commercial |
$125.64
|
| Rate for Payer: Aetna Commercial |
$44.74
|
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: Aetna Commercial |
$58.30
|
| Rate for Payer: Aetna Commercial |
$56.19
|
| Rate for Payer: Aetna Medicare |
$46.82
|
| Rate for Payer: Aetna Medicare |
$26.32
|
| Rate for Payer: Aetna Medicare |
$73.91
|
| Rate for Payer: Aetna Medicare |
$33.05
|
| Rate for Payer: Aetna Medicare |
$34.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.87
|
| Rate for Payer: BCBS Complete |
$27.44
|
| Rate for Payer: BCBS Complete |
$59.12
|
| Rate for Payer: BCBS Complete |
$21.06
|
| Rate for Payer: BCBS Complete |
$26.44
|
| Rate for Payer: BCBS Complete |
$37.46
|
| Rate for Payer: BCBS Trust/PPO |
$4.36
|
| Rate for Payer: BCBS Trust/PPO |
$4.36
|
| Rate for Payer: BCBS Trust/PPO |
$4.36
|
| Rate for Payer: BCBS Trust/PPO |
$4.36
|
| Rate for Payer: BCBS Trust/PPO |
$4.36
|
| Rate for Payer: BCN Commercial |
$4.36
|
| Rate for Payer: BCN Commercial |
$4.36
|
| Rate for Payer: BCN Commercial |
$4.36
|
| Rate for Payer: BCN Commercial |
$4.36
|
| Rate for Payer: BCN Commercial |
$4.36
|
| Rate for Payer: Cash Price |
$54.87
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cash Price |
$42.11
|
| Rate for Payer: Cash Price |
$118.25
|
| Rate for Payer: Cash Price |
$52.88
|
| Rate for Payer: Cash Price |
$118.25
|
| Rate for Payer: Cash Price |
$52.88
|
| Rate for Payer: Cash Price |
$54.87
|
| Rate for Payer: Cash Price |
$42.11
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Advantage |
$48.01
|
| Rate for Payer: Cofinity Advantage |
$36.85
|
| Rate for Payer: Cofinity Advantage |
$46.27
|
| Rate for Payer: Cofinity Advantage |
$65.55
|
| Rate for Payer: Cofinity Advantage |
$103.47
|
| Rate for Payer: Cofinity Commercial |
$58.99
|
| Rate for Payer: Cofinity Commercial |
$127.12
|
| Rate for Payer: Cofinity Commercial |
$45.27
|
| Rate for Payer: Cofinity Commercial |
$56.85
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.88
|
| Rate for Payer: Healthscope Commercial |
$59.49
|
| Rate for Payer: Healthscope Commercial |
$84.28
|
| Rate for Payer: Healthscope Commercial |
$61.73
|
| Rate for Payer: Healthscope Commercial |
$133.03
|
| Rate for Payer: Healthscope Commercial |
$47.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$118.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.23
|
| Rate for Payer: PHP Commercial |
$44.74
|
| Rate for Payer: PHP Commercial |
$56.19
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: PHP Commercial |
$58.30
|
| Rate for Payer: PHP Commercial |
$125.64
|
| Rate for Payer: Priority Health SBD |
$41.64
|
| Rate for Payer: Priority Health SBD |
$93.12
|
| Rate for Payer: Priority Health SBD |
$43.21
|
| Rate for Payer: Priority Health SBD |
$58.99
|
| Rate for Payer: Priority Health SBD |
$33.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.23
|
| Rate for Payer: UHC Core |
$2.23
|
| Rate for Payer: UHC Core |
$2.23
|
| Rate for Payer: UHC Core |
$2.23
|
| Rate for Payer: UHC Core |
$2.23
|
| Rate for Payer: UHC Core |
$2.23
|
| Rate for Payer: UHC Exchange |
$2.23
|
| Rate for Payer: UHC Exchange |
$2.23
|
| Rate for Payer: UHC Exchange |
$2.23
|
| Rate for Payer: UHC Exchange |
$2.23
|
| Rate for Payer: UHC Exchange |
$2.23
|
| Rate for Payer: UMR Bronson Commercial |
$54.69
|
| Rate for Payer: UMR Bronson Commercial |
$25.38
|
| Rate for Payer: UMR Bronson Commercial |
$24.46
|
| Rate for Payer: UMR Bronson Commercial |
$34.65
|
| Rate for Payer: UMR Bronson Commercial |
$19.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.86
|
|
|
MILRINONE 40 MG/200 ML(200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS PIGGYBK
|
Facility
|
IP
|
$100.98
|
|
|
Service Code
|
HCPCS J2260
|
| Hospital Charge Code |
118311
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.43 |
| Max. Negotiated Rate |
$90.88 |
| Rate for Payer: Aetna American Axle |
$65.64
|
| Rate for Payer: Aetna Commercial |
$85.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.64
|
| Rate for Payer: Cash Price |
$80.78
|
| Rate for Payer: Cofinity Advantage |
$70.69
|
| Rate for Payer: Cofinity Commercial |
$86.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.78
|
| Rate for Payer: Healthscope Commercial |
$90.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.73
|
| Rate for Payer: PHP Commercial |
$85.83
|
| Rate for Payer: Priority Health SBD |
$63.62
|
| Rate for Payer: UMR Bronson Commercial |
$44.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.73
|
|
|
MILRINONE 40 MG/200 ML(200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS PIGGYBK
|
Facility
|
OP
|
$100.98
|
|
|
Service Code
|
HCPCS J2260
|
| Hospital Charge Code |
118311
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$90.88 |
| Rate for Payer: Aetna American Axle |
$65.64
|
| Rate for Payer: Aetna Commercial |
$85.83
|
| Rate for Payer: Aetna Medicare |
$50.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.64
|
| Rate for Payer: BCBS Complete |
$40.39
|
| Rate for Payer: BCBS Trust/PPO |
$4.36
|
| Rate for Payer: BCN Commercial |
$4.36
|
| Rate for Payer: Cash Price |
$80.78
|
| Rate for Payer: Cash Price |
$80.78
|
| Rate for Payer: Cofinity Advantage |
$70.69
|
| Rate for Payer: Cofinity Commercial |
$86.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.78
|
| Rate for Payer: Healthscope Commercial |
$90.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.73
|
| Rate for Payer: PHP Commercial |
$85.83
|
| Rate for Payer: Priority Health SBD |
$63.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.23
|
| Rate for Payer: UHC Core |
$2.23
|
| Rate for Payer: UHC Exchange |
$2.23
|
| Rate for Payer: UMR Bronson Commercial |
$37.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.73
|
|
|
MINERAL OIL
|
Facility
|
OP
|
$78.37
|
|
|
Service Code
|
NDC 63323025410
|
| Hospital Charge Code |
109056
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.00 |
| Max. Negotiated Rate |
$70.53 |
| Rate for Payer: Aetna American Axle |
$50.94
|
| Rate for Payer: Aetna Commercial |
$66.61
|
| Rate for Payer: Aetna Medicare |
$39.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.94
|
| Rate for Payer: BCBS Complete |
$31.35
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cofinity Advantage |
$54.86
|
| Rate for Payer: Cofinity Commercial |
$67.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.70
|
| Rate for Payer: Healthscope Commercial |
$70.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.78
|
| Rate for Payer: PHP Commercial |
$66.61
|
| Rate for Payer: Priority Health SBD |
$49.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.94
|
| Rate for Payer: UHC Core |
$40.83
|
| Rate for Payer: UHC Exchange |
$30.80
|
| Rate for Payer: UMR Bronson Commercial |
$29.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.78
|
|
|
MINERAL OIL
|
Facility
|
IP
|
$78.37
|
|
|
Service Code
|
NDC 63323025410
|
| Hospital Charge Code |
109056
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.48 |
| Max. Negotiated Rate |
$70.53 |
| Rate for Payer: Aetna American Axle |
$50.94
|
| Rate for Payer: Aetna Commercial |
$66.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.94
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cofinity Advantage |
$54.86
|
| Rate for Payer: Cofinity Commercial |
$67.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.70
|
| Rate for Payer: Healthscope Commercial |
$70.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.78
|
| Rate for Payer: PHP Commercial |
$66.61
|
| Rate for Payer: Priority Health SBD |
$49.37
|
| Rate for Payer: UMR Bronson Commercial |
$34.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.78
|
|
|
MINERAL OIL ENEMA
|
Facility
|
IP
|
$46.89
|
|
|
Service Code
|
NDC 96295012753
|
| Hospital Charge Code |
5087
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.63 |
| Max. Negotiated Rate |
$42.20 |
| Rate for Payer: Aetna American Axle |
$30.48
|
| Rate for Payer: Aetna Commercial |
$39.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.48
|
| Rate for Payer: Cash Price |
$37.51
|
| Rate for Payer: Cofinity Advantage |
$32.82
|
| Rate for Payer: Cofinity Commercial |
$40.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.51
|
| Rate for Payer: Healthscope Commercial |
$42.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.17
|
| Rate for Payer: PHP Commercial |
$39.86
|
| Rate for Payer: Priority Health SBD |
$29.54
|
| Rate for Payer: UMR Bronson Commercial |
$20.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.17
|
|
|
MINERAL OIL ENEMA
|
Facility
|
OP
|
$59.39
|
|
|
Service Code
|
NDC 00132030140
|
| Hospital Charge Code |
5087
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.97 |
| Max. Negotiated Rate |
$53.45 |
| Rate for Payer: Aetna American Axle |
$38.60
|
| Rate for Payer: Aetna Commercial |
$50.48
|
| Rate for Payer: Aetna Medicare |
$29.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.60
|
| Rate for Payer: BCBS Complete |
$23.76
|
| Rate for Payer: Cash Price |
$47.51
|
| Rate for Payer: Cofinity Advantage |
$41.57
|
| Rate for Payer: Cofinity Commercial |
$51.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.51
|
| Rate for Payer: Healthscope Commercial |
$53.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.54
|
| Rate for Payer: PHP Commercial |
$50.48
|
| Rate for Payer: Priority Health SBD |
$37.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.60
|
| Rate for Payer: UHC Core |
$30.94
|
| Rate for Payer: UHC Exchange |
$23.34
|
| Rate for Payer: UMR Bronson Commercial |
$21.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.54
|
|
|
MINERAL OIL ENEMA
|
Facility
|
OP
|
$46.89
|
|
|
Service Code
|
NDC 96295012753
|
| Hospital Charge Code |
5087
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.35 |
| Max. Negotiated Rate |
$42.20 |
| Rate for Payer: Aetna American Axle |
$30.48
|
| Rate for Payer: Aetna Commercial |
$39.86
|
| Rate for Payer: Aetna Medicare |
$23.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.48
|
| Rate for Payer: BCBS Complete |
$18.76
|
| Rate for Payer: Cash Price |
$37.51
|
| Rate for Payer: Cofinity Advantage |
$32.82
|
| Rate for Payer: Cofinity Commercial |
$40.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.51
|
| Rate for Payer: Healthscope Commercial |
$42.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.17
|
| Rate for Payer: PHP Commercial |
$39.86
|
| Rate for Payer: Priority Health SBD |
$29.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.48
|
| Rate for Payer: UHC Core |
$24.43
|
| Rate for Payer: UHC Exchange |
$18.43
|
| Rate for Payer: UMR Bronson Commercial |
$17.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.17
|
|
|
MINERAL OIL ENEMA
|
Facility
|
IP
|
$59.39
|
|
|
Service Code
|
NDC 00132030140
|
| Hospital Charge Code |
5087
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.13 |
| Max. Negotiated Rate |
$53.45 |
| Rate for Payer: Aetna American Axle |
$38.60
|
| Rate for Payer: Aetna Commercial |
$50.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.60
|
| Rate for Payer: Cash Price |
$47.51
|
| Rate for Payer: Cofinity Advantage |
$41.57
|
| Rate for Payer: Cofinity Commercial |
$51.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.51
|
| Rate for Payer: Healthscope Commercial |
$53.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.54
|
| Rate for Payer: PHP Commercial |
$50.48
|
| Rate for Payer: Priority Health SBD |
$37.42
|
| Rate for Payer: UMR Bronson Commercial |
$26.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.54
|
|
