|
ACUTE MYOCARDIAL INFARCTION
|
Facility
|
IP
|
$5,214.87
|
|
|
Service Code
|
APR-DRG 1902
|
| Min. Negotiated Rate |
$4,966.55 |
| Max. Negotiated Rate |
$5,214.87 |
| Rate for Payer: BCBS Complete |
$5,214.87
|
| Rate for Payer: Mclaren Medicaid |
$4,966.55
|
| Rate for Payer: Meridian Medicaid |
$5,214.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,966.55
|
| Rate for Payer: UHC Medicaid |
$4,966.55
|
| Rate for Payer: UHCCP Medicaid |
$4,966.55
|
|
|
ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC
|
Facility
|
IP
|
$21,617.66
|
|
|
Service Code
|
MSDRG 281
|
| Min. Negotiated Rate |
$7,865.16 |
| Max. Negotiated Rate |
$21,617.66 |
| Rate for Payer: Aetna Medicare |
$8,610.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,348.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,348.90
|
| Rate for Payer: BCBS MAPPO |
$8,279.12
|
| Rate for Payer: BCBS Trust/PPO |
$21,617.66
|
| Rate for Payer: BCN Commercial |
$21,617.66
|
| Rate for Payer: BCN Medicare Advantage |
$8,279.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,279.12
|
| Rate for Payer: Mclaren Medicare |
$8,279.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,693.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,520.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,107.03
|
| Rate for Payer: Nomi Health Commercial |
$11,856.39
|
| Rate for Payer: PACE Medicare |
$7,865.16
|
| Rate for Payer: PACE SWMI |
$8,279.12
|
| Rate for Payer: PHP Medicare Advantage |
$8,279.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14,817.86
|
| Rate for Payer: Priority Health Medicare |
$8,279.12
|
| Rate for Payer: Priority Health Tiered Network |
$11,854.29
|
| Rate for Payer: Railroad Medicare Medicare |
$8,279.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,981.33
|
| Rate for Payer: UHC Core |
$12,533.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,279.12
|
| Rate for Payer: UHC Exchange |
$10,236.02
|
| Rate for Payer: VA VA |
$8,279.12
|
|
|
ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC
|
Facility
|
IP
|
$31,082.77
|
|
|
Service Code
|
MSDRG 280
|
| Min. Negotiated Rate |
$13,307.17 |
| Max. Negotiated Rate |
$31,082.77 |
| Rate for Payer: Aetna Medicare |
$14,567.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,509.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,509.44
|
| Rate for Payer: BCBS MAPPO |
$14,007.55
|
| Rate for Payer: BCBS Trust/PPO |
$31,082.77
|
| Rate for Payer: BCN Commercial |
$31,082.77
|
| Rate for Payer: BCN Medicare Advantage |
$14,007.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,007.55
|
| Rate for Payer: Mclaren Medicare |
$14,007.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,707.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,108.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$15,408.31
|
| Rate for Payer: Nomi Health Commercial |
$20,692.89
|
| Rate for Payer: PACE Medicare |
$13,307.17
|
| Rate for Payer: PACE SWMI |
$14,007.55
|
| Rate for Payer: PHP Medicare Advantage |
$14,007.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$25,861.52
|
| Rate for Payer: Priority Health Medicare |
$14,007.55
|
| Rate for Payer: Priority Health Tiered Network |
$20,689.22
|
| Rate for Payer: Railroad Medicare Medicare |
$14,007.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,146.83
|
| Rate for Payer: UHC Core |
$21,875.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,007.55
|
| Rate for Payer: UHC Exchange |
$17,864.86
|
| Rate for Payer: VA VA |
$14,007.55
|
|
|
ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC
|
Facility
|
IP
|
$18,757.27
|
|
|
Service Code
|
MSDRG 282
|
| Min. Negotiated Rate |
$6,308.04 |
| Max. Negotiated Rate |
$18,757.27 |
| Rate for Payer: Aetna Medicare |
$6,905.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,300.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,300.05
|
| Rate for Payer: BCBS MAPPO |
$6,640.04
|
| Rate for Payer: BCBS Trust/PPO |
$18,757.27
|
| Rate for Payer: BCN Commercial |
$18,757.27
|
| Rate for Payer: BCN Medicare Advantage |
$6,640.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,640.04
|
| Rate for Payer: Mclaren Medicare |
$6,640.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,972.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,636.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,304.04
|
| Rate for Payer: Nomi Health Commercial |
$9,327.99
|
| Rate for Payer: PACE Medicare |
$6,308.04
|
| Rate for Payer: PACE SWMI |
$6,640.04
|
| Rate for Payer: PHP Medicare Advantage |
$6,640.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,657.92
|
| Rate for Payer: Priority Health Medicare |
$6,640.04
|
| Rate for Payer: Priority Health Tiered Network |
$9,326.33
|
| Rate for Payer: Railroad Medicare Medicare |
$6,640.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,786.53
|
| Rate for Payer: UHC Core |
$9,860.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,640.04
|
| Rate for Payer: UHC Exchange |
$8,053.16
|
| Rate for Payer: VA VA |
$6,640.04
|
|
|
ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC
|
Facility
|
IP
|
$17,985.90
|
|
|
Service Code
|
MSDRG 284
|
| Min. Negotiated Rate |
$6,062.55 |
| Max. Negotiated Rate |
$17,985.90 |
| Rate for Payer: Aetna Medicare |
$6,636.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,977.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,977.04
|
| Rate for Payer: BCBS MAPPO |
$6,381.63
|
| Rate for Payer: BCBS Trust/PPO |
$17,985.90
|
| Rate for Payer: BCN Commercial |
$17,985.90
|
| Rate for Payer: BCN Medicare Advantage |
$6,381.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,381.63
|
| Rate for Payer: Mclaren Medicare |
$6,381.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,700.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,338.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,019.79
|
| Rate for Payer: Nomi Health Commercial |
$8,929.38
|
| Rate for Payer: PACE Medicare |
$6,062.55
|
| Rate for Payer: PACE SWMI |
$6,381.63
|
| Rate for Payer: PHP Medicare Advantage |
$6,381.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,159.75
|
| Rate for Payer: Priority Health Medicare |
$6,381.63
|
| Rate for Payer: Priority Health Tiered Network |
$8,927.79
|
| Rate for Payer: Railroad Medicare Medicare |
$6,381.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,282.86
|
| Rate for Payer: UHC Core |
$9,439.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,381.63
|
| Rate for Payer: UHC Exchange |
$7,709.03
|
| Rate for Payer: VA VA |
$6,381.63
|
|
|
ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC
|
Facility
|
IP
|
$47,589.05
|
|
|
Service Code
|
MSDRG 283
|
| Min. Negotiated Rate |
$16,299.90 |
| Max. Negotiated Rate |
$47,589.05 |
| Rate for Payer: Aetna Medicare |
$17,844.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,447.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,447.24
|
| Rate for Payer: BCBS MAPPO |
$17,157.79
|
| Rate for Payer: BCBS Trust/PPO |
$47,589.05
|
| Rate for Payer: BCN Commercial |
$47,589.05
|
| Rate for Payer: BCN Medicare Advantage |
$17,157.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,157.79
|
| Rate for Payer: Mclaren Medicare |
$17,157.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,015.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,731.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$18,873.57
|
| Rate for Payer: Nomi Health Commercial |
$25,552.32
|
| Rate for Payer: PACE Medicare |
$16,299.90
|
| Rate for Payer: PACE SWMI |
$17,157.79
|
| Rate for Payer: PHP Medicare Advantage |
$17,157.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$31,934.73
|
| Rate for Payer: Priority Health Medicare |
$17,157.79
|
| Rate for Payer: Priority Health Tiered Network |
$25,547.78
|
| Rate for Payer: Railroad Medicare Medicare |
$17,157.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32,287.04
|
| Rate for Payer: UHC Core |
$27,012.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17,157.79
|
| Rate for Payer: UHC Exchange |
$22,060.17
|
| Rate for Payer: VA VA |
$17,157.79
|
|
|
ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC
|
Facility
|
IP
|
$11,880.79
|
|
|
Service Code
|
MSDRG 285
|
| Min. Negotiated Rate |
$5,321.32 |
| Max. Negotiated Rate |
$11,880.79 |
| Rate for Payer: Aetna Medicare |
$5,825.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,001.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,001.74
|
| Rate for Payer: BCBS MAPPO |
$5,601.39
|
| Rate for Payer: BCBS Trust/PPO |
$11,880.79
|
| Rate for Payer: BCN Commercial |
$11,880.79
|
| Rate for Payer: BCN Medicare Advantage |
$5,601.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,601.39
|
| Rate for Payer: Mclaren Medicare |
$5,601.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,881.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,441.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,161.53
|
| Rate for Payer: Nomi Health Commercial |
$7,725.81
|
| Rate for Payer: PACE Medicare |
$5,321.32
|
| Rate for Payer: PACE SWMI |
$5,601.39
|
| Rate for Payer: PHP Medicare Advantage |
$5,601.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9,655.55
|
| Rate for Payer: Priority Health Medicare |
$5,601.39
|
| Rate for Payer: Priority Health Tiered Network |
$7,724.44
|
| Rate for Payer: Railroad Medicare Medicare |
$5,601.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,762.07
|
| Rate for Payer: UHC Core |
$8,167.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,601.39
|
| Rate for Payer: UHC Exchange |
$6,669.95
|
| Rate for Payer: VA VA |
$5,601.39
|
|
|
ACYCLOVIR 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$1,589.28
|
|
|
Service Code
|
NDC 00472008216
|
| Hospital Charge Code |
8970
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$699.28 |
| Max. Negotiated Rate |
$1,430.35 |
| Rate for Payer: Aetna American Axle |
$1,033.03
|
| Rate for Payer: Aetna Commercial |
$1,350.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,033.03
|
| Rate for Payer: Cash Price |
$1,271.42
|
| Rate for Payer: Cofinity Advantage |
$1,112.50
|
| Rate for Payer: Cofinity Commercial |
$1,366.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,271.42
|
| Rate for Payer: Healthscope Commercial |
$1,430.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,112.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,191.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,350.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,191.96
|
| Rate for Payer: PHP Commercial |
$1,350.89
|
| Rate for Payer: Priority Health SBD |
$1,001.25
|
| Rate for Payer: UMR Bronson Commercial |
$699.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,191.96
|
|
|
ACYCLOVIR 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$1,589.28
|
|
|
Service Code
|
NDC 00472008216
|
| Hospital Charge Code |
8970
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$588.03 |
| Max. Negotiated Rate |
$1,430.35 |
| Rate for Payer: Aetna American Axle |
$1,033.03
|
| Rate for Payer: Aetna Commercial |
$1,350.89
|
| Rate for Payer: Aetna Medicare |
$794.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,033.03
|
| Rate for Payer: BCBS Complete |
$635.71
|
| Rate for Payer: Cash Price |
$1,271.42
|
| Rate for Payer: Cofinity Advantage |
$1,112.50
|
| Rate for Payer: Cofinity Commercial |
$1,366.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,271.42
|
| Rate for Payer: Healthscope Commercial |
$1,430.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,112.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,191.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,271.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,350.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,191.96
|
| Rate for Payer: PHP Commercial |
$1,350.89
|
| Rate for Payer: Priority Health SBD |
$1,001.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,033.03
|
| Rate for Payer: UHC Core |
$828.01
|
| Rate for Payer: UHC Exchange |
$624.59
|
| Rate for Payer: UMR Bronson Commercial |
$588.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,191.96
|
|
|
ACYCLOVIR 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$1,367.21
|
|
|
Service Code
|
NDC 50383081016
|
| Hospital Charge Code |
8970
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$505.87 |
| Max. Negotiated Rate |
$1,230.49 |
| Rate for Payer: Aetna American Axle |
$888.69
|
| Rate for Payer: Aetna Commercial |
$1,162.13
|
| Rate for Payer: Aetna Medicare |
$683.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$888.69
|
| Rate for Payer: BCBS Complete |
$546.88
|
| Rate for Payer: Cash Price |
$1,093.77
|
| Rate for Payer: Cofinity Advantage |
$957.05
|
| Rate for Payer: Cofinity Commercial |
$1,175.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,093.77
|
| Rate for Payer: Healthscope Commercial |
$1,230.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$957.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,025.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,093.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,162.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,025.41
|
| Rate for Payer: PHP Commercial |
$1,162.13
|
| Rate for Payer: Priority Health SBD |
$861.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$888.69
|
| Rate for Payer: UHC Core |
$712.32
|
| Rate for Payer: UHC Exchange |
$537.31
|
| Rate for Payer: UMR Bronson Commercial |
$505.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,025.41
|
|
|
ACYCLOVIR 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$1,367.21
|
|
|
Service Code
|
NDC 50383081016
|
| Hospital Charge Code |
8970
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$601.57 |
| Max. Negotiated Rate |
$1,230.49 |
| Rate for Payer: Aetna American Axle |
$888.69
|
| Rate for Payer: Aetna Commercial |
$1,162.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$888.69
|
| Rate for Payer: Cash Price |
$1,093.77
|
| Rate for Payer: Cofinity Advantage |
$957.05
|
| Rate for Payer: Cofinity Commercial |
$1,175.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,093.77
|
| Rate for Payer: Healthscope Commercial |
$1,230.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$957.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,025.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,162.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,025.41
|
| Rate for Payer: PHP Commercial |
$1,162.13
|
| Rate for Payer: Priority Health SBD |
$861.34
|
| Rate for Payer: UMR Bronson Commercial |
$601.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,025.41
|
|
|
ACYCLOVIR 200 MG CAPSULE
|
Facility
|
OP
|
$239.70
|
|
|
Service Code
|
NDC 75834012401
|
| Hospital Charge Code |
8969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.69 |
| Max. Negotiated Rate |
$215.73 |
| Rate for Payer: Aetna American Axle |
$155.81
|
| Rate for Payer: Aetna Commercial |
$203.75
|
| Rate for Payer: Aetna Medicare |
$119.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.81
|
| Rate for Payer: BCBS Complete |
$95.88
|
| Rate for Payer: Cash Price |
$191.76
|
| Rate for Payer: Cofinity Advantage |
$167.79
|
| Rate for Payer: Cofinity Commercial |
$206.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.76
|
| Rate for Payer: Healthscope Commercial |
$215.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$167.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$191.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.78
|
| Rate for Payer: PHP Commercial |
$203.75
|
| Rate for Payer: Priority Health SBD |
$151.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.81
|
| Rate for Payer: UHC Core |
$124.88
|
| Rate for Payer: UHC Exchange |
$94.20
|
| Rate for Payer: UMR Bronson Commercial |
$88.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.78
|
|
|
ACYCLOVIR 200 MG CAPSULE
|
Facility
|
IP
|
$394.80
|
|
|
Service Code
|
NDC 60505004206
|
| Hospital Charge Code |
8969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.71 |
| Max. Negotiated Rate |
$355.32 |
| Rate for Payer: Aetna American Axle |
$256.62
|
| Rate for Payer: Aetna Commercial |
$335.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.62
|
| Rate for Payer: Cash Price |
$315.84
|
| Rate for Payer: Cofinity Advantage |
$276.36
|
| Rate for Payer: Cofinity Commercial |
$339.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.84
|
| Rate for Payer: Healthscope Commercial |
$355.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$276.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$296.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$296.10
|
| Rate for Payer: PHP Commercial |
$335.58
|
| Rate for Payer: Priority Health SBD |
$248.72
|
| Rate for Payer: UMR Bronson Commercial |
$173.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$296.10
|
|
|
ACYCLOVIR 200 MG CAPSULE
|
Facility
|
OP
|
$371.30
|
|
|
Service Code
|
NDC 69076014601
|
| Hospital Charge Code |
8969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.38 |
| Max. Negotiated Rate |
$334.17 |
| Rate for Payer: Aetna American Axle |
$241.34
|
| Rate for Payer: Aetna Commercial |
$315.61
|
| Rate for Payer: Aetna Medicare |
$185.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.34
|
| Rate for Payer: BCBS Complete |
$148.52
|
| Rate for Payer: Cash Price |
$297.04
|
| Rate for Payer: Cofinity Advantage |
$259.91
|
| Rate for Payer: Cofinity Commercial |
$319.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.04
|
| Rate for Payer: Healthscope Commercial |
$334.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$259.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$297.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$278.48
|
| Rate for Payer: PHP Commercial |
$315.61
|
| Rate for Payer: Priority Health SBD |
$233.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.34
|
| Rate for Payer: UHC Core |
$193.45
|
| Rate for Payer: UHC Exchange |
$145.92
|
| Rate for Payer: UMR Bronson Commercial |
$137.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.48
|
|
|
ACYCLOVIR 200 MG CAPSULE
|
Facility
|
OP
|
$261.25
|
|
|
Service Code
|
NDC 68084010701
|
| Hospital Charge Code |
8969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.66 |
| Max. Negotiated Rate |
$235.12 |
| Rate for Payer: Aetna American Axle |
$169.81
|
| Rate for Payer: Aetna Commercial |
$222.06
|
| Rate for Payer: Aetna Medicare |
$130.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.81
|
| Rate for Payer: BCBS Complete |
$104.50
|
| Rate for Payer: Cash Price |
$209.00
|
| Rate for Payer: Cofinity Advantage |
$182.88
|
| Rate for Payer: Cofinity Commercial |
$224.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.00
|
| Rate for Payer: Healthscope Commercial |
$235.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$209.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.94
|
| Rate for Payer: PHP Commercial |
$222.06
|
| Rate for Payer: Priority Health SBD |
$164.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.81
|
| Rate for Payer: UHC Core |
$136.11
|
| Rate for Payer: UHC Exchange |
$102.67
|
| Rate for Payer: UMR Bronson Commercial |
$96.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.94
|
|
|
ACYCLOVIR 200 MG CAPSULE
|
Facility
|
OP
|
$2.62
|
|
|
Service Code
|
NDC 68084010711
|
| Hospital Charge Code |
8969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$2.36 |
| Rate for Payer: Aetna American Axle |
$1.70
|
| Rate for Payer: Aetna Commercial |
$2.23
|
| Rate for Payer: Aetna Medicare |
$1.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.70
|
| Rate for Payer: BCBS Complete |
$1.05
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cofinity Advantage |
$1.83
|
| Rate for Payer: Cofinity Commercial |
$2.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.10
|
| Rate for Payer: Healthscope Commercial |
$2.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.97
|
| Rate for Payer: PHP Commercial |
$2.23
|
| Rate for Payer: Priority Health SBD |
$1.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.70
|
| Rate for Payer: UHC Core |
$1.37
|
| Rate for Payer: UHC Exchange |
$1.03
|
| Rate for Payer: UMR Bronson Commercial |
$0.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.97
|
|
|
ACYCLOVIR 200 MG CAPSULE
|
Facility
|
OP
|
$394.80
|
|
|
Service Code
|
NDC 60505004206
|
| Hospital Charge Code |
8969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.08 |
| Max. Negotiated Rate |
$355.32 |
| Rate for Payer: Aetna American Axle |
$256.62
|
| Rate for Payer: Aetna Commercial |
$335.58
|
| Rate for Payer: Aetna Medicare |
$197.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.62
|
| Rate for Payer: BCBS Complete |
$157.92
|
| Rate for Payer: Cash Price |
$315.84
|
| Rate for Payer: Cofinity Advantage |
$276.36
|
| Rate for Payer: Cofinity Commercial |
$339.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.84
|
| Rate for Payer: Healthscope Commercial |
$355.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$276.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$296.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$315.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$296.10
|
| Rate for Payer: PHP Commercial |
$335.58
|
| Rate for Payer: Priority Health SBD |
$248.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$256.62
|
| Rate for Payer: UHC Core |
$205.69
|
| Rate for Payer: UHC Exchange |
$155.16
|
| Rate for Payer: UMR Bronson Commercial |
$146.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$296.10
|
|
|
ACYCLOVIR 200 MG CAPSULE
|
Facility
|
IP
|
$371.30
|
|
|
Service Code
|
NDC 69076014601
|
| Hospital Charge Code |
8969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.37 |
| Max. Negotiated Rate |
$334.17 |
| Rate for Payer: Aetna American Axle |
$241.34
|
| Rate for Payer: Aetna Commercial |
$315.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.34
|
| Rate for Payer: Cash Price |
$297.04
|
| Rate for Payer: Cofinity Advantage |
$259.91
|
| Rate for Payer: Cofinity Commercial |
$319.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.04
|
| Rate for Payer: Healthscope Commercial |
$334.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$259.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$278.48
|
| Rate for Payer: PHP Commercial |
$315.61
|
| Rate for Payer: Priority Health SBD |
$233.92
|
| Rate for Payer: UMR Bronson Commercial |
$163.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.48
|
|
|
ACYCLOVIR 200 MG CAPSULE
|
Facility
|
IP
|
$261.25
|
|
|
Service Code
|
NDC 68084010701
|
| Hospital Charge Code |
8969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.95 |
| Max. Negotiated Rate |
$235.12 |
| Rate for Payer: Aetna American Axle |
$169.81
|
| Rate for Payer: Aetna Commercial |
$222.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.81
|
| Rate for Payer: Cash Price |
$209.00
|
| Rate for Payer: Cofinity Advantage |
$182.88
|
| Rate for Payer: Cofinity Commercial |
$224.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.00
|
| Rate for Payer: Healthscope Commercial |
$235.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.94
|
| Rate for Payer: PHP Commercial |
$222.06
|
| Rate for Payer: Priority Health SBD |
$164.59
|
| Rate for Payer: UMR Bronson Commercial |
$114.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.94
|
|
|
ACYCLOVIR 200 MG CAPSULE
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
NDC 72578000201
|
| Hospital Charge Code |
8969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.34 |
| Max. Negotiated Rate |
$253.80 |
| Rate for Payer: Aetna American Axle |
$183.30
|
| Rate for Payer: Aetna Commercial |
$239.70
|
| Rate for Payer: Aetna Medicare |
$141.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.30
|
| Rate for Payer: BCBS Complete |
$112.80
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cofinity Advantage |
$197.40
|
| Rate for Payer: Cofinity Commercial |
$242.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.60
|
| Rate for Payer: Healthscope Commercial |
$253.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$197.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$225.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.50
|
| Rate for Payer: PHP Commercial |
$239.70
|
| Rate for Payer: Priority Health SBD |
$177.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.30
|
| Rate for Payer: UHC Core |
$146.92
|
| Rate for Payer: UHC Exchange |
$110.83
|
| Rate for Payer: UMR Bronson Commercial |
$104.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.50
|
|
|
ACYCLOVIR 200 MG CAPSULE
|
Facility
|
OP
|
$392.45
|
|
|
Service Code
|
NDC 23155022901
|
| Hospital Charge Code |
8969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.21 |
| Max. Negotiated Rate |
$353.20 |
| Rate for Payer: Aetna American Axle |
$255.09
|
| Rate for Payer: Aetna Commercial |
$333.58
|
| Rate for Payer: Aetna Medicare |
$196.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.09
|
| Rate for Payer: BCBS Complete |
$156.98
|
| Rate for Payer: Cash Price |
$313.96
|
| Rate for Payer: Cofinity Advantage |
$274.71
|
| Rate for Payer: Cofinity Commercial |
$337.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.96
|
| Rate for Payer: Healthscope Commercial |
$353.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$274.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$313.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$294.34
|
| Rate for Payer: PHP Commercial |
$333.58
|
| Rate for Payer: Priority Health SBD |
$247.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.09
|
| Rate for Payer: UHC Core |
$204.47
|
| Rate for Payer: UHC Exchange |
$154.23
|
| Rate for Payer: UMR Bronson Commercial |
$145.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.34
|
|
|
ACYCLOVIR 200 MG CAPSULE
|
Facility
|
IP
|
$239.70
|
|
|
Service Code
|
NDC 75834012401
|
| Hospital Charge Code |
8969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.47 |
| Max. Negotiated Rate |
$215.73 |
| Rate for Payer: Aetna American Axle |
$155.81
|
| Rate for Payer: Aetna Commercial |
$203.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.81
|
| Rate for Payer: Cash Price |
$191.76
|
| Rate for Payer: Cofinity Advantage |
$167.79
|
| Rate for Payer: Cofinity Commercial |
$206.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.76
|
| Rate for Payer: Healthscope Commercial |
$215.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$167.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.78
|
| Rate for Payer: PHP Commercial |
$203.75
|
| Rate for Payer: Priority Health SBD |
$151.01
|
| Rate for Payer: UMR Bronson Commercial |
$105.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.78
|
|
|
ACYCLOVIR 200 MG CAPSULE
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
NDC 72578000201
|
| Hospital Charge Code |
8969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.08 |
| Max. Negotiated Rate |
$253.80 |
| Rate for Payer: Aetna American Axle |
$183.30
|
| Rate for Payer: Aetna Commercial |
$239.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.30
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cofinity Advantage |
$197.40
|
| Rate for Payer: Cofinity Commercial |
$242.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.60
|
| Rate for Payer: Healthscope Commercial |
$253.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$197.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.50
|
| Rate for Payer: PHP Commercial |
$239.70
|
| Rate for Payer: Priority Health SBD |
$177.66
|
| Rate for Payer: UMR Bronson Commercial |
$124.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.50
|
|
|
ACYCLOVIR 200 MG CAPSULE
|
Facility
|
IP
|
$2.62
|
|
|
Service Code
|
NDC 68084010711
|
| Hospital Charge Code |
8969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$2.36 |
| Rate for Payer: Aetna American Axle |
$1.70
|
| Rate for Payer: Aetna Commercial |
$2.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.70
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cofinity Advantage |
$1.83
|
| Rate for Payer: Cofinity Commercial |
$2.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.10
|
| Rate for Payer: Healthscope Commercial |
$2.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.97
|
| Rate for Payer: PHP Commercial |
$2.23
|
| Rate for Payer: Priority Health SBD |
$1.65
|
| Rate for Payer: UMR Bronson Commercial |
$1.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.97
|
|
|
ACYCLOVIR 200 MG CAPSULE
|
Facility
|
IP
|
$392.45
|
|
|
Service Code
|
NDC 23155022901
|
| Hospital Charge Code |
8969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.68 |
| Max. Negotiated Rate |
$353.20 |
| Rate for Payer: Aetna American Axle |
$255.09
|
| Rate for Payer: Aetna Commercial |
$333.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.09
|
| Rate for Payer: Cash Price |
$313.96
|
| Rate for Payer: Cofinity Advantage |
$274.71
|
| Rate for Payer: Cofinity Commercial |
$337.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.96
|
| Rate for Payer: Healthscope Commercial |
$353.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$274.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$294.34
|
| Rate for Payer: PHP Commercial |
$333.58
|
| Rate for Payer: Priority Health SBD |
$247.24
|
| Rate for Payer: UMR Bronson Commercial |
$172.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.34
|
|
