|
MULTIVIT AND MINERALS-FERROUS GLUCONATE 9 MG IRON/15 ML ORAL LIQUID
|
Facility
|
OP
|
$21.95
|
|
|
Service Code
|
NDC 09900000800
|
| Hospital Charge Code |
119617
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.12 |
| Max. Negotiated Rate |
$19.75 |
| Rate for Payer: Aetna American Axle |
$14.27
|
| Rate for Payer: Aetna Commercial |
$18.66
|
| Rate for Payer: Aetna Medicare |
$10.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.27
|
| Rate for Payer: BCBS Complete |
$8.78
|
| Rate for Payer: Cash Price |
$17.56
|
| Rate for Payer: Cofinity Advantage |
$15.37
|
| Rate for Payer: Cofinity Commercial |
$18.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.56
|
| Rate for Payer: Healthscope Commercial |
$19.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.46
|
| Rate for Payer: PHP Commercial |
$18.66
|
| Rate for Payer: Priority Health SBD |
$13.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.27
|
| Rate for Payer: UHC Core |
$11.44
|
| Rate for Payer: UHC Exchange |
$8.63
|
| Rate for Payer: UMR Bronson Commercial |
$8.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.46
|
|
|
MULTIVIT-MINERALS-IRON 8 MG-FOLIC AC 400 MCG-VIT K 10 MCG CHEW TABLET
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
NDC 00005452835
|
| Hospital Charge Code |
188719
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.60 |
| Max. Negotiated Rate |
$306.00 |
| Rate for Payer: Aetna American Axle |
$221.00
|
| Rate for Payer: Aetna Commercial |
$289.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.00
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cofinity Advantage |
$238.00
|
| Rate for Payer: Cofinity Commercial |
$292.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.00
|
| Rate for Payer: Healthscope Commercial |
$306.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$238.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$255.00
|
| Rate for Payer: PHP Commercial |
$289.00
|
| Rate for Payer: Priority Health SBD |
$214.20
|
| Rate for Payer: UMR Bronson Commercial |
$149.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.00
|
|
|
MULTIVIT-MINERALS-IRON 8 MG-FOLIC AC 400 MCG-VIT K 10 MCG CHEW TABLET
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
NDC 00005452835
|
| Hospital Charge Code |
188719
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.80 |
| Max. Negotiated Rate |
$306.00 |
| Rate for Payer: Aetna American Axle |
$221.00
|
| Rate for Payer: Aetna Commercial |
$289.00
|
| Rate for Payer: Aetna Medicare |
$170.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.00
|
| Rate for Payer: BCBS Complete |
$136.00
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cofinity Advantage |
$238.00
|
| Rate for Payer: Cofinity Commercial |
$292.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.00
|
| Rate for Payer: Healthscope Commercial |
$306.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$238.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$255.00
|
| Rate for Payer: PHP Commercial |
$289.00
|
| Rate for Payer: Priority Health SBD |
$214.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.00
|
| Rate for Payer: UHC Core |
$177.14
|
| Rate for Payer: UHC Exchange |
$133.62
|
| Rate for Payer: UMR Bronson Commercial |
$125.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.00
|
|
|
MULTIVIT-MINS-FERROUS GLUCONATE 9 MG IRON/15 ML (15 ML) ORAL LIQUID
|
Facility
|
OP
|
$58.17
|
|
|
Service Code
|
NDC 68094012059
|
| Hospital Charge Code |
162541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.52 |
| Max. Negotiated Rate |
$52.35 |
| Rate for Payer: Aetna American Axle |
$37.81
|
| Rate for Payer: Aetna Commercial |
$49.44
|
| Rate for Payer: Aetna Medicare |
$29.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.81
|
| Rate for Payer: BCBS Complete |
$23.27
|
| Rate for Payer: Cash Price |
$46.54
|
| Rate for Payer: Cofinity Advantage |
$40.72
|
| Rate for Payer: Cofinity Commercial |
$50.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.54
|
| Rate for Payer: Healthscope Commercial |
$52.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.63
|
| Rate for Payer: PHP Commercial |
$49.44
|
| Rate for Payer: Priority Health SBD |
$36.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.81
|
| Rate for Payer: UHC Core |
$30.31
|
| Rate for Payer: UHC Exchange |
$22.86
|
| Rate for Payer: UMR Bronson Commercial |
$21.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.63
|
|
|
MULTIVIT-MINS-FERROUS GLUCONATE 9 MG IRON/15 ML (15 ML) ORAL LIQUID
|
Facility
|
IP
|
$58.17
|
|
|
Service Code
|
NDC 68094012061
|
| Hospital Charge Code |
162541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.59 |
| Max. Negotiated Rate |
$52.35 |
| Rate for Payer: Aetna American Axle |
$37.81
|
| Rate for Payer: Aetna Commercial |
$49.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.81
|
| Rate for Payer: Cash Price |
$46.54
|
| Rate for Payer: Cofinity Advantage |
$40.72
|
| Rate for Payer: Cofinity Commercial |
$50.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.54
|
| Rate for Payer: Healthscope Commercial |
$52.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.63
|
| Rate for Payer: PHP Commercial |
$49.44
|
| Rate for Payer: Priority Health SBD |
$36.65
|
| Rate for Payer: UMR Bronson Commercial |
$25.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.63
|
|
|
MULTIVIT-MINS-FERROUS GLUCONATE 9 MG IRON/15 ML (15 ML) ORAL LIQUID
|
Facility
|
OP
|
$58.17
|
|
|
Service Code
|
NDC 68094012061
|
| Hospital Charge Code |
162541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.52 |
| Max. Negotiated Rate |
$52.35 |
| Rate for Payer: Aetna American Axle |
$37.81
|
| Rate for Payer: Aetna Commercial |
$49.44
|
| Rate for Payer: Aetna Medicare |
$29.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.81
|
| Rate for Payer: BCBS Complete |
$23.27
|
| Rate for Payer: Cash Price |
$46.54
|
| Rate for Payer: Cofinity Advantage |
$40.72
|
| Rate for Payer: Cofinity Commercial |
$50.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.54
|
| Rate for Payer: Healthscope Commercial |
$52.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.63
|
| Rate for Payer: PHP Commercial |
$49.44
|
| Rate for Payer: Priority Health SBD |
$36.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.81
|
| Rate for Payer: UHC Core |
$30.31
|
| Rate for Payer: UHC Exchange |
$22.86
|
| Rate for Payer: UMR Bronson Commercial |
$21.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.63
|
|
|
MULTIVIT-MINS-FERROUS GLUCONATE 9 MG IRON/15 ML (15 ML) ORAL LIQUID
|
Facility
|
IP
|
$58.17
|
|
|
Service Code
|
NDC 68094012059
|
| Hospital Charge Code |
162541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.59 |
| Max. Negotiated Rate |
$52.35 |
| Rate for Payer: Aetna American Axle |
$37.81
|
| Rate for Payer: Aetna Commercial |
$49.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.81
|
| Rate for Payer: Cash Price |
$46.54
|
| Rate for Payer: Cofinity Advantage |
$40.72
|
| Rate for Payer: Cofinity Commercial |
$50.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.54
|
| Rate for Payer: Healthscope Commercial |
$52.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.63
|
| Rate for Payer: PHP Commercial |
$49.44
|
| Rate for Payer: Priority Health SBD |
$36.65
|
| Rate for Payer: UMR Bronson Commercial |
$25.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.63
|
|
|
MULTIVIT-MINS NO.56-FA 200 MCG-VIT K 1,000 MCG-COQ10 10 MG CHEW TABLET
|
Facility
|
IP
|
$184.61
|
|
|
Service Code
|
NDC 68176000015
|
| Hospital Charge Code |
181160
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.23 |
| Max. Negotiated Rate |
$166.15 |
| Rate for Payer: Aetna American Axle |
$120.00
|
| Rate for Payer: Aetna Commercial |
$156.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.00
|
| Rate for Payer: Cash Price |
$147.69
|
| Rate for Payer: Cofinity Advantage |
$129.23
|
| Rate for Payer: Cofinity Commercial |
$158.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.69
|
| Rate for Payer: Healthscope Commercial |
$166.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$138.46
|
| Rate for Payer: PHP Commercial |
$156.92
|
| Rate for Payer: Priority Health SBD |
$116.30
|
| Rate for Payer: UMR Bronson Commercial |
$81.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.46
|
|
|
MULTIVIT-MINS NO.56-FA 200 MCG-VIT K 1,000 MCG-COQ10 10 MG CHEW TABLET
|
Facility
|
OP
|
$184.61
|
|
|
Service Code
|
NDC 68176000015
|
| Hospital Charge Code |
181160
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.31 |
| Max. Negotiated Rate |
$166.15 |
| Rate for Payer: Aetna American Axle |
$120.00
|
| Rate for Payer: Aetna Commercial |
$156.92
|
| Rate for Payer: Aetna Medicare |
$92.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.00
|
| Rate for Payer: BCBS Complete |
$73.84
|
| Rate for Payer: Cash Price |
$147.69
|
| Rate for Payer: Cofinity Advantage |
$129.23
|
| Rate for Payer: Cofinity Commercial |
$158.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.69
|
| Rate for Payer: Healthscope Commercial |
$166.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$147.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$138.46
|
| Rate for Payer: PHP Commercial |
$156.92
|
| Rate for Payer: Priority Health SBD |
$116.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.00
|
| Rate for Payer: UHC Core |
$96.18
|
| Rate for Payer: UHC Exchange |
$72.55
|
| Rate for Payer: UMR Bronson Commercial |
$68.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.46
|
|
|
MUPIROCIN 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$29.26
|
|
|
Service Code
|
NDC 45802011222
|
| Hospital Charge Code |
10674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$26.33 |
| Rate for Payer: Aetna American Axle |
$19.02
|
| Rate for Payer: Aetna Commercial |
$24.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.02
|
| Rate for Payer: Cash Price |
$23.41
|
| Rate for Payer: Cofinity Advantage |
$20.48
|
| Rate for Payer: Cofinity Commercial |
$25.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.41
|
| Rate for Payer: Healthscope Commercial |
$26.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.95
|
| Rate for Payer: PHP Commercial |
$24.87
|
| Rate for Payer: Priority Health SBD |
$18.43
|
| Rate for Payer: UMR Bronson Commercial |
$12.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.95
|
|
|
MUPIROCIN 2 % TOPICAL OINTMENT
|
Facility
|
OP
|
$20.79
|
|
|
Service Code
|
NDC 51672131200
|
| Hospital Charge Code |
10674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.69 |
| Max. Negotiated Rate |
$18.71 |
| Rate for Payer: Aetna American Axle |
$13.51
|
| Rate for Payer: Aetna Commercial |
$17.67
|
| Rate for Payer: Aetna Medicare |
$10.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.51
|
| Rate for Payer: BCBS Complete |
$8.32
|
| Rate for Payer: Cash Price |
$16.63
|
| Rate for Payer: Cofinity Advantage |
$14.55
|
| Rate for Payer: Cofinity Commercial |
$17.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.63
|
| Rate for Payer: Healthscope Commercial |
$18.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.59
|
| Rate for Payer: PHP Commercial |
$17.67
|
| Rate for Payer: Priority Health SBD |
$13.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.51
|
| Rate for Payer: UHC Core |
$10.83
|
| Rate for Payer: UHC Exchange |
$8.17
|
| Rate for Payer: UMR Bronson Commercial |
$7.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.59
|
|
|
MUPIROCIN 2 % TOPICAL OINTMENT
|
Facility
|
OP
|
$29.96
|
|
|
Service Code
|
NDC 68462018022
|
| Hospital Charge Code |
10674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.09 |
| Max. Negotiated Rate |
$26.96 |
| Rate for Payer: Aetna American Axle |
$19.47
|
| Rate for Payer: Aetna Commercial |
$25.47
|
| Rate for Payer: Aetna Medicare |
$14.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.47
|
| Rate for Payer: BCBS Complete |
$11.98
|
| Rate for Payer: Cash Price |
$23.97
|
| Rate for Payer: Cofinity Advantage |
$20.97
|
| Rate for Payer: Cofinity Commercial |
$25.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.97
|
| Rate for Payer: Healthscope Commercial |
$26.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.47
|
| Rate for Payer: PHP Commercial |
$25.47
|
| Rate for Payer: Priority Health SBD |
$18.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.47
|
| Rate for Payer: UHC Core |
$15.61
|
| Rate for Payer: UHC Exchange |
$11.77
|
| Rate for Payer: UMR Bronson Commercial |
$11.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.47
|
|
|
MUPIROCIN 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$104.96
|
|
|
Service Code
|
NDC 00168035222
|
| Hospital Charge Code |
10674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.18 |
| Max. Negotiated Rate |
$94.46 |
| Rate for Payer: Aetna American Axle |
$68.22
|
| Rate for Payer: Aetna Commercial |
$89.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.22
|
| Rate for Payer: Cash Price |
$83.97
|
| Rate for Payer: Cofinity Advantage |
$73.47
|
| Rate for Payer: Cofinity Commercial |
$90.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.97
|
| Rate for Payer: Healthscope Commercial |
$94.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.72
|
| Rate for Payer: PHP Commercial |
$89.22
|
| Rate for Payer: Priority Health SBD |
$66.12
|
| Rate for Payer: UMR Bronson Commercial |
$46.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.72
|
|
|
MUPIROCIN 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$20.79
|
|
|
Service Code
|
NDC 51672131200
|
| Hospital Charge Code |
10674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.15 |
| Max. Negotiated Rate |
$18.71 |
| Rate for Payer: Aetna American Axle |
$13.51
|
| Rate for Payer: Aetna Commercial |
$17.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.51
|
| Rate for Payer: Cash Price |
$16.63
|
| Rate for Payer: Cofinity Advantage |
$14.55
|
| Rate for Payer: Cofinity Commercial |
$17.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.63
|
| Rate for Payer: Healthscope Commercial |
$18.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.59
|
| Rate for Payer: PHP Commercial |
$17.67
|
| Rate for Payer: Priority Health SBD |
$13.10
|
| Rate for Payer: UMR Bronson Commercial |
$9.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.59
|
|
|
MUPIROCIN 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$29.96
|
|
|
Service Code
|
NDC 68462018022
|
| Hospital Charge Code |
10674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.18 |
| Max. Negotiated Rate |
$26.96 |
| Rate for Payer: Aetna American Axle |
$19.47
|
| Rate for Payer: Aetna Commercial |
$25.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.47
|
| Rate for Payer: Cash Price |
$23.97
|
| Rate for Payer: Cofinity Advantage |
$20.97
|
| Rate for Payer: Cofinity Commercial |
$25.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.97
|
| Rate for Payer: Healthscope Commercial |
$26.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.47
|
| Rate for Payer: PHP Commercial |
$25.47
|
| Rate for Payer: Priority Health SBD |
$18.87
|
| Rate for Payer: UMR Bronson Commercial |
$13.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.47
|
|
|
MUPIROCIN 2 % TOPICAL OINTMENT
|
Facility
|
OP
|
$104.96
|
|
|
Service Code
|
NDC 00168035222
|
| Hospital Charge Code |
10674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.84 |
| Max. Negotiated Rate |
$94.46 |
| Rate for Payer: Aetna American Axle |
$68.22
|
| Rate for Payer: Aetna Commercial |
$89.22
|
| Rate for Payer: Aetna Medicare |
$52.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.22
|
| Rate for Payer: BCBS Complete |
$41.98
|
| Rate for Payer: Cash Price |
$83.97
|
| Rate for Payer: Cofinity Advantage |
$73.47
|
| Rate for Payer: Cofinity Commercial |
$90.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.97
|
| Rate for Payer: Healthscope Commercial |
$94.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.72
|
| Rate for Payer: PHP Commercial |
$89.22
|
| Rate for Payer: Priority Health SBD |
$66.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.22
|
| Rate for Payer: UHC Core |
$54.68
|
| Rate for Payer: UHC Exchange |
$41.25
|
| Rate for Payer: UMR Bronson Commercial |
$38.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.72
|
|
|
MUPIROCIN 2 % TOPICAL OINTMENT
|
Facility
|
OP
|
$29.26
|
|
|
Service Code
|
NDC 45802011222
|
| Hospital Charge Code |
10674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.83 |
| Max. Negotiated Rate |
$26.33 |
| Rate for Payer: Aetna American Axle |
$19.02
|
| Rate for Payer: Aetna Commercial |
$24.87
|
| Rate for Payer: Aetna Medicare |
$14.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.02
|
| Rate for Payer: BCBS Complete |
$11.70
|
| Rate for Payer: Cash Price |
$23.41
|
| Rate for Payer: Cofinity Advantage |
$20.48
|
| Rate for Payer: Cofinity Commercial |
$25.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.41
|
| Rate for Payer: Healthscope Commercial |
$26.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.95
|
| Rate for Payer: PHP Commercial |
$24.87
|
| Rate for Payer: Priority Health SBD |
$18.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.02
|
| Rate for Payer: UHC Core |
$15.24
|
| Rate for Payer: UHC Exchange |
$11.50
|
| Rate for Payer: UMR Bronson Commercial |
$10.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.95
|
|
|
MUSCLE, MYOCUTANEOUS, OR FASCIOCUTANEOUS FLAP; TRUNK
|
Facility
|
OP
|
$11,418.88
|
|
|
Service Code
|
CPT 15734
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,846.70 |
| Max. Negotiated Rate |
$11,418.88 |
| Rate for Payer: Aetna Medicare |
$3,672.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,413.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,413.73
|
| Rate for Payer: BCBS Complete |
$1,939.21
|
| Rate for Payer: BCBS MAPPO |
$3,530.98
|
| Rate for Payer: BCBS Trust/PPO |
$2,971.24
|
| Rate for Payer: BCN Commercial |
$2,971.24
|
| Rate for Payer: BCN Medicare Advantage |
$3,530.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,530.98
|
| Rate for Payer: Mclaren Medicaid |
$3,530.98
|
| Rate for Payer: Mclaren Medicare |
$3,530.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,707.53
|
| Rate for Payer: Meridian Medicaid |
$3,707.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,060.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,884.08
|
| Rate for Payer: Nomi Health Commercial |
$10,592.94
|
| Rate for Payer: PACE Medicare |
$3,354.43
|
| Rate for Payer: PACE SWMI |
$3,530.98
|
| Rate for Payer: PHP Medicare Advantage |
$3,530.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,846.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,418.88
|
| Rate for Payer: Priority Health Medicare |
$3,530.98
|
| Rate for Payer: Priority Health Tiered Network |
$9,135.10
|
| Rate for Payer: Railroad Medicare Medicare |
$3,530.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,530.98
|
| Rate for Payer: UHC Medicaid |
$1,846.70
|
| Rate for Payer: UHCCP Medicaid |
$1,846.70
|
| Rate for Payer: VA VA |
$3,530.98
|
|
|
MUSCLE OR TENDON TRANSFER, ANY TYPE, UPPER ARM OR ELBOW, SINGLE (EXCLUDING 24320-24331)
|
Facility
|
OP
|
$23,381.57
|
|
|
Service Code
|
CPT 24301
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,781.35 |
| Max. Negotiated Rate |
$23,381.57 |
| Rate for Payer: Aetna Medicare |
$7,519.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,037.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,037.65
|
| Rate for Payer: BCBS Complete |
$3,970.78
|
| Rate for Payer: BCBS MAPPO |
$7,230.12
|
| Rate for Payer: BCBS Trust/PPO |
$4,985.59
|
| Rate for Payer: BCN Commercial |
$4,985.59
|
| Rate for Payer: BCN Medicare Advantage |
$7,230.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,230.12
|
| Rate for Payer: Mclaren Medicaid |
$7,230.12
|
| Rate for Payer: Mclaren Medicare |
$7,230.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,591.63
|
| Rate for Payer: Meridian Medicaid |
$7,591.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,314.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,953.13
|
| Rate for Payer: Nomi Health Commercial |
$21,690.36
|
| Rate for Payer: PACE Medicare |
$6,868.61
|
| Rate for Payer: PACE SWMI |
$7,230.12
|
| Rate for Payer: PHP Medicare Advantage |
$7,230.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,781.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,381.57
|
| Rate for Payer: Priority Health Medicare |
$7,230.12
|
| Rate for Payer: Priority Health Tiered Network |
$18,705.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,230.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,230.12
|
| Rate for Payer: UHC Medicaid |
$3,781.35
|
| Rate for Payer: UHCCP Medicaid |
$3,781.35
|
| Rate for Payer: VA VA |
$7,230.12
|
|
|
MUSCULOSKELETAL AND OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$36,638.51
|
|
|
Service Code
|
APR-DRG 9124
|
| Min. Negotiated Rate |
$34,893.82 |
| Max. Negotiated Rate |
$36,638.51 |
| Rate for Payer: BCBS Complete |
$36,638.51
|
| Rate for Payer: Mclaren Medicaid |
$34,893.82
|
| Rate for Payer: Meridian Medicaid |
$36,638.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$34,893.82
|
| Rate for Payer: UHC Medicaid |
$34,893.82
|
| Rate for Payer: UHCCP Medicaid |
$34,893.82
|
|
|
MUSCULOSKELETAL AND OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$17,470.28
|
|
|
Service Code
|
APR-DRG 9122
|
| Min. Negotiated Rate |
$16,638.37 |
| Max. Negotiated Rate |
$17,470.28 |
| Rate for Payer: BCBS Complete |
$17,470.28
|
| Rate for Payer: Mclaren Medicaid |
$16,638.37
|
| Rate for Payer: Meridian Medicaid |
$17,470.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$16,638.37
|
| Rate for Payer: UHC Medicaid |
$16,638.37
|
| Rate for Payer: UHCCP Medicaid |
$16,638.37
|
|
|
MUSCULOSKELETAL AND OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$23,484.19
|
|
|
Service Code
|
APR-DRG 9123
|
| Min. Negotiated Rate |
$22,365.89 |
| Max. Negotiated Rate |
$23,484.19 |
| Rate for Payer: BCBS Complete |
$23,484.19
|
| Rate for Payer: Mclaren Medicaid |
$22,365.89
|
| Rate for Payer: Meridian Medicaid |
$23,484.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$22,365.89
|
| Rate for Payer: UHC Medicaid |
$22,365.89
|
| Rate for Payer: UHCCP Medicaid |
$22,365.89
|
|
|
MUSCULOSKELETAL AND OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$13,141.61
|
|
|
Service Code
|
APR-DRG 9121
|
| Min. Negotiated Rate |
$12,515.82 |
| Max. Negotiated Rate |
$13,141.61 |
| Rate for Payer: BCBS Complete |
$13,141.61
|
| Rate for Payer: Mclaren Medicaid |
$12,515.82
|
| Rate for Payer: Meridian Medicaid |
$13,141.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,515.82
|
| Rate for Payer: UHC Medicaid |
$12,515.82
|
| Rate for Payer: UHCCP Medicaid |
$12,515.82
|
|
|
MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FRACTURE DUE TO MUSCULOSKELETAL MALIG
|
Facility
|
IP
|
$11,346.82
|
|
|
Service Code
|
APR-DRG 3433
|
| Min. Negotiated Rate |
$10,806.49 |
| Max. Negotiated Rate |
$11,346.82 |
| Rate for Payer: BCBS Complete |
$11,346.82
|
| Rate for Payer: Mclaren Medicaid |
$10,806.49
|
| Rate for Payer: Meridian Medicaid |
$11,346.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,806.49
|
| Rate for Payer: UHC Medicaid |
$10,806.49
|
| Rate for Payer: UHCCP Medicaid |
$10,806.49
|
|
|
MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FRACTURE DUE TO MUSCULOSKELETAL MALIG
|
Facility
|
IP
|
$6,255.43
|
|
|
Service Code
|
APR-DRG 3431
|
| Min. Negotiated Rate |
$5,957.55 |
| Max. Negotiated Rate |
$6,255.43 |
| Rate for Payer: BCBS Complete |
$6,255.43
|
| Rate for Payer: Mclaren Medicaid |
$5,957.55
|
| Rate for Payer: Meridian Medicaid |
$6,255.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,957.55
|
| Rate for Payer: UHC Medicaid |
$5,957.55
|
| Rate for Payer: UHCCP Medicaid |
$5,957.55
|
|
