|
ALLOPURINOL 300 MG TABLET
|
Facility
IP
|
$2.77
|
|
|
Service Code
|
NDC 51079-206-01
|
| Hospital Charge Code |
311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$2.49 |
| Rate for Payer: Aetna American Axle |
$1.80
|
| Rate for Payer: Aetna Commercial |
$2.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.80
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cofinity Commercial |
$1.94
|
| Rate for Payer: Cofinity Commercial |
$2.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.22
|
| Rate for Payer: Healthscope Commercial |
$2.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.35
|
| Rate for Payer: PHP Commercial |
$2.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.94
|
| Rate for Payer: Priority Health SBD |
$1.75
|
| Rate for Payer: UMR Bronson Commercial |
$1.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.08
|
|
|
ALLOPURINOL 300 MG TABLET
|
Facility
IP
|
$240.96
|
|
|
Service Code
|
NDC 62584-713-01
|
| Hospital Charge Code |
311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.02 |
| Max. Negotiated Rate |
$216.86 |
| Rate for Payer: Aetna American Axle |
$156.62
|
| Rate for Payer: Aetna Commercial |
$204.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.62
|
| Rate for Payer: Cash Price |
$192.77
|
| Rate for Payer: Cofinity Commercial |
$168.67
|
| Rate for Payer: Cofinity Commercial |
$207.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.77
|
| Rate for Payer: Healthscope Commercial |
$216.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$168.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$204.82
|
| Rate for Payer: PHP Commercial |
$204.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.67
|
| Rate for Payer: Priority Health SBD |
$151.80
|
| Rate for Payer: UMR Bronson Commercial |
$106.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.72
|
|
|
ALLOPURINOL 300 MG TABLET
|
Facility
IP
|
$449.35
|
|
|
Service Code
|
NDC 63739-796-10
|
| Hospital Charge Code |
311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$197.71 |
| Max. Negotiated Rate |
$404.42 |
| Rate for Payer: Aetna American Axle |
$292.08
|
| Rate for Payer: Aetna Commercial |
$381.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.08
|
| Rate for Payer: Cash Price |
$359.48
|
| Rate for Payer: Cofinity Commercial |
$314.54
|
| Rate for Payer: Cofinity Commercial |
$386.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.48
|
| Rate for Payer: Healthscope Commercial |
$404.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$314.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$381.95
|
| Rate for Payer: PHP Commercial |
$381.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$314.54
|
| Rate for Payer: Priority Health SBD |
$283.09
|
| Rate for Payer: UMR Bronson Commercial |
$197.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.01
|
|
|
ALLOPURINOL 300 MG TABLET
|
Facility
IP
|
$2.41
|
|
|
Service Code
|
NDC 62584-713-11
|
| Hospital Charge Code |
311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$2.17 |
| Rate for Payer: Aetna American Axle |
$1.57
|
| Rate for Payer: Aetna Commercial |
$2.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.57
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Cofinity Commercial |
$1.69
|
| Rate for Payer: Cofinity Commercial |
$2.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.93
|
| Rate for Payer: Healthscope Commercial |
$2.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.05
|
| Rate for Payer: PHP Commercial |
$2.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.69
|
| Rate for Payer: Priority Health SBD |
$1.52
|
| Rate for Payer: UMR Bronson Commercial |
$1.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.81
|
|
|
ALLOPURINOL 500 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$5,356.80
|
|
|
Service Code
|
HCPCS J0206
|
| Hospital Charge Code |
25408
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,356.99 |
| Max. Negotiated Rate |
$4,821.12 |
| Rate for Payer: Aetna American Axle |
$3,481.92
|
| Rate for Payer: Aetna American Axle |
$3,732.79
|
| Rate for Payer: Aetna American Axle |
$3,929.25
|
| Rate for Payer: Aetna Commercial |
$5,138.25
|
| Rate for Payer: Aetna Commercial |
$4,881.34
|
| Rate for Payer: Aetna Commercial |
$4,553.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,481.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,929.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,732.79
|
| Rate for Payer: Cash Price |
$4,285.44
|
| Rate for Payer: Cash Price |
$4,594.20
|
| Rate for Payer: Cash Price |
$4,836.00
|
| Rate for Payer: Cofinity Commercial |
$4,606.85
|
| Rate for Payer: Cofinity Commercial |
$3,749.76
|
| Rate for Payer: Cofinity Commercial |
$4,019.92
|
| Rate for Payer: Cofinity Commercial |
$4,938.76
|
| Rate for Payer: Cofinity Commercial |
$4,231.50
|
| Rate for Payer: Cofinity Commercial |
$5,198.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,285.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,836.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,594.20
|
| Rate for Payer: Healthscope Commercial |
$4,821.12
|
| Rate for Payer: Healthscope Commercial |
$5,440.50
|
| Rate for Payer: Healthscope Commercial |
$5,168.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,019.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,749.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,231.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,533.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,307.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,017.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,553.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,881.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,138.25
|
| Rate for Payer: PHP Commercial |
$4,553.28
|
| Rate for Payer: PHP Commercial |
$4,881.34
|
| Rate for Payer: PHP Commercial |
$5,138.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,231.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,749.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,019.92
|
| Rate for Payer: Priority Health SBD |
$3,808.35
|
| Rate for Payer: Priority Health SBD |
$3,374.78
|
| Rate for Payer: Priority Health SBD |
$3,617.93
|
| Rate for Payer: UMR Bronson Commercial |
$2,659.80
|
| Rate for Payer: UMR Bronson Commercial |
$2,526.81
|
| Rate for Payer: UMR Bronson Commercial |
$2,356.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,017.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,307.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,533.75
|
|
|
ALOE VERA-COLLAGEN TOPICAL FOAM
|
Facility
IP
|
$28.09
|
|
|
Service Code
|
NDC 6845510841
|
| Hospital Charge Code |
108259
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.36 |
| Max. Negotiated Rate |
$25.28 |
| Rate for Payer: Aetna American Axle |
$18.26
|
| Rate for Payer: Aetna Commercial |
$23.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.26
|
| Rate for Payer: Cash Price |
$22.47
|
| Rate for Payer: Cofinity Commercial |
$19.66
|
| Rate for Payer: Cofinity Commercial |
$24.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.47
|
| Rate for Payer: Healthscope Commercial |
$25.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.88
|
| Rate for Payer: PHP Commercial |
$23.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.66
|
| Rate for Payer: Priority Health SBD |
$17.70
|
| Rate for Payer: UMR Bronson Commercial |
$12.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.07
|
|
|
ALOSETRON 1 MG TABLET
|
Facility
IP
|
$1,066.71
|
|
|
Service Code
|
NDC 65162-249-03
|
| Hospital Charge Code |
27127
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$469.35 |
| Max. Negotiated Rate |
$960.04 |
| Rate for Payer: Aetna American Axle |
$693.36
|
| Rate for Payer: Aetna Commercial |
$906.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$693.36
|
| Rate for Payer: Cash Price |
$853.37
|
| Rate for Payer: Cofinity Commercial |
$746.70
|
| Rate for Payer: Cofinity Commercial |
$917.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$853.37
|
| Rate for Payer: Healthscope Commercial |
$960.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$746.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$800.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$906.70
|
| Rate for Payer: PHP Commercial |
$906.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$746.70
|
| Rate for Payer: Priority Health SBD |
$672.03
|
| Rate for Payer: UMR Bronson Commercial |
$469.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$800.03
|
|
|
ALPHA-1-PROTEINASE INHIBITOR (HUMAN) 1,000 MG (+/-)/20 ML IV SOLUTION
|
Facility
OP
|
$1.48
|
|
|
Service Code
|
HCPCS J0256
|
| Hospital Charge Code |
185673
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$15.76 |
| Rate for Payer: Aetna American Axle |
$0.96
|
| Rate for Payer: Aetna Commercial |
$1.26
|
| Rate for Payer: Aetna Medicare |
$5.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.10
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: BCBS MAPPO |
$4.88
|
| Rate for Payer: BCBS Trust/PPO |
$15.76
|
| Rate for Payer: BCN Medicare Advantage |
$4.88
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Cofinity Commercial |
$1.04
|
| Rate for Payer: Cofinity Commercial |
$1.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.88
|
| Rate for Payer: Healthscope Commercial |
$1.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.11
|
| Rate for Payer: Mclaren Medicaid |
$2.67
|
| Rate for Payer: Mclaren Medicare |
$4.88
|
| Rate for Payer: Meridian Medicaid |
$2.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.26
|
| Rate for Payer: PACE Medicare |
$4.64
|
| Rate for Payer: PACE SWMI |
$4.88
|
| Rate for Payer: PHP Commercial |
$1.26
|
| Rate for Payer: PHP Medicare Advantage |
$4.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.11
|
| Rate for Payer: Priority Health Medicare |
$4.88
|
| Rate for Payer: Priority Health Narrow Network |
$11.29
|
| Rate for Payer: Priority Health SBD |
$0.93
|
| Rate for Payer: Railroad Medicare Medicare |
$4.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.88
|
| Rate for Payer: UHC Medicare Advantage |
$5.03
|
| Rate for Payer: UMR Bronson Commercial |
$0.55
|
| Rate for Payer: VA VA |
$4.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.11
|
|
|
ALPHA-1-PROTEINASE INHIBITOR (HUMAN) 1,000 MG (+/-)/20 ML IV SOLUTION
|
Facility
IP
|
$1.48
|
|
|
Service Code
|
HCPCS J0256
|
| Hospital Charge Code |
185673
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$1.33 |
| Rate for Payer: Aetna American Axle |
$0.96
|
| Rate for Payer: Aetna Commercial |
$1.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.96
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Cofinity Commercial |
$1.04
|
| Rate for Payer: Cofinity Commercial |
$1.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.18
|
| Rate for Payer: Healthscope Commercial |
$1.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.26
|
| Rate for Payer: PHP Commercial |
$1.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.04
|
| Rate for Payer: Priority Health SBD |
$0.93
|
| Rate for Payer: UMR Bronson Commercial |
$0.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.11
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
IP
|
$47.25
|
|
|
Service Code
|
NDC 0781-1061-01
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.79 |
| Max. Negotiated Rate |
$42.52 |
| Rate for Payer: Aetna American Axle |
$30.71
|
| Rate for Payer: Aetna Commercial |
$40.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.71
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cofinity Commercial |
$33.08
|
| Rate for Payer: Cofinity Commercial |
$40.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.80
|
| Rate for Payer: Healthscope Commercial |
$42.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.16
|
| Rate for Payer: PHP Commercial |
$40.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.08
|
| Rate for Payer: Priority Health SBD |
$29.77
|
| Rate for Payer: UMR Bronson Commercial |
$20.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.44
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
IP
|
$57.75
|
|
|
Service Code
|
NDC 59762-3719-1
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.41 |
| Max. Negotiated Rate |
$51.98 |
| Rate for Payer: Aetna American Axle |
$37.54
|
| Rate for Payer: Aetna Commercial |
$49.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.54
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cofinity Commercial |
$40.42
|
| Rate for Payer: Cofinity Commercial |
$49.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.20
|
| Rate for Payer: Healthscope Commercial |
$51.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.09
|
| Rate for Payer: PHP Commercial |
$49.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.42
|
| Rate for Payer: Priority Health SBD |
$36.38
|
| Rate for Payer: UMR Bronson Commercial |
$25.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.31
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
IP
|
$105.00
|
|
|
Service Code
|
NDC 51079-788-20
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna American Axle |
$68.25
|
| Rate for Payer: Aetna Commercial |
$89.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.25
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$73.50
|
| Rate for Payer: Cofinity Commercial |
$90.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.00
|
| Rate for Payer: Healthscope Commercial |
$94.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.25
|
| Rate for Payer: PHP Commercial |
$89.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.50
|
| Rate for Payer: Priority Health SBD |
$66.15
|
| Rate for Payer: UMR Bronson Commercial |
$46.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.75
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
IP
|
$64.75
|
|
|
Service Code
|
NDC 65862-676-01
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.49 |
| Max. Negotiated Rate |
$58.28 |
| Rate for Payer: Aetna American Axle |
$42.09
|
| Rate for Payer: Aetna Commercial |
$55.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.09
|
| Rate for Payer: Cash Price |
$51.80
|
| Rate for Payer: Cofinity Commercial |
$45.32
|
| Rate for Payer: Cofinity Commercial |
$55.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.80
|
| Rate for Payer: Healthscope Commercial |
$58.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.04
|
| Rate for Payer: PHP Commercial |
$55.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.32
|
| Rate for Payer: Priority Health SBD |
$40.79
|
| Rate for Payer: UMR Bronson Commercial |
$28.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.56
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
IP
|
$80.50
|
|
|
Service Code
|
NDC 0228-2027-10
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.42 |
| Max. Negotiated Rate |
$72.45 |
| Rate for Payer: Aetna American Axle |
$52.32
|
| Rate for Payer: Aetna Commercial |
$68.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.32
|
| Rate for Payer: Cash Price |
$64.40
|
| Rate for Payer: Cofinity Commercial |
$56.35
|
| Rate for Payer: Cofinity Commercial |
$69.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.40
|
| Rate for Payer: Healthscope Commercial |
$72.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.42
|
| Rate for Payer: PHP Commercial |
$68.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.35
|
| Rate for Payer: Priority Health SBD |
$50.72
|
| Rate for Payer: UMR Bronson Commercial |
$35.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.38
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
IP
|
$1.05
|
|
|
Service Code
|
NDC 51079-788-01
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna American Axle |
$0.68
|
| Rate for Payer: Aetna Commercial |
$0.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.68
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: Cofinity Commercial |
$0.74
|
| Rate for Payer: Cofinity Commercial |
$0.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.84
|
| Rate for Payer: Healthscope Commercial |
$0.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.89
|
| Rate for Payer: PHP Commercial |
$0.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.74
|
| Rate for Payer: Priority Health SBD |
$0.66
|
| Rate for Payer: UMR Bronson Commercial |
$0.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.79
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
IP
|
$1,881.75
|
|
|
Service Code
|
NDC 0009-0029-01
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$827.97 |
| Max. Negotiated Rate |
$1,693.58 |
| Rate for Payer: Aetna American Axle |
$1,223.14
|
| Rate for Payer: Aetna Commercial |
$1,599.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,223.14
|
| Rate for Payer: Cash Price |
$1,505.40
|
| Rate for Payer: Cofinity Commercial |
$1,317.22
|
| Rate for Payer: Cofinity Commercial |
$1,618.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,505.40
|
| Rate for Payer: Healthscope Commercial |
$1,693.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,317.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,411.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,599.49
|
| Rate for Payer: PHP Commercial |
$1,599.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,317.22
|
| Rate for Payer: Priority Health SBD |
$1,185.50
|
| Rate for Payer: UMR Bronson Commercial |
$827.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,411.31
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
IP
|
$70.00
|
|
|
Service Code
|
NDC 47335-604-88
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna American Axle |
$45.50
|
| Rate for Payer: Aetna Commercial |
$59.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.50
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$49.00
|
| Rate for Payer: Cofinity Commercial |
$60.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.00
|
| Rate for Payer: Healthscope Commercial |
$63.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.50
|
| Rate for Payer: PHP Commercial |
$59.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.00
|
| Rate for Payer: Priority Health SBD |
$44.10
|
| Rate for Payer: UMR Bronson Commercial |
$30.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.50
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
IP
|
$0.93
|
|
|
Service Code
|
NDC 51079-789-01
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Aetna American Axle |
$0.60
|
| Rate for Payer: Aetna Commercial |
$0.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.60
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Cofinity Commercial |
$0.65
|
| Rate for Payer: Cofinity Commercial |
$0.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.74
|
| Rate for Payer: Healthscope Commercial |
$0.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.79
|
| Rate for Payer: PHP Commercial |
$0.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.65
|
| Rate for Payer: Priority Health SBD |
$0.59
|
| Rate for Payer: UMR Bronson Commercial |
$0.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.70
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
IP
|
$56.00
|
|
|
Service Code
|
NDC 0781-1077-01
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.64 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna American Axle |
$36.40
|
| Rate for Payer: Aetna Commercial |
$47.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.40
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$39.20
|
| Rate for Payer: Cofinity Commercial |
$48.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.80
|
| Rate for Payer: Healthscope Commercial |
$50.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.60
|
| Rate for Payer: PHP Commercial |
$47.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.20
|
| Rate for Payer: Priority Health SBD |
$35.28
|
| Rate for Payer: UMR Bronson Commercial |
$24.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.00
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
IP
|
$57.75
|
|
|
Service Code
|
NDC 65862-677-01
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.41 |
| Max. Negotiated Rate |
$51.98 |
| Rate for Payer: Aetna American Axle |
$37.54
|
| Rate for Payer: Aetna Commercial |
$49.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.54
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cofinity Commercial |
$40.42
|
| Rate for Payer: Cofinity Commercial |
$49.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.20
|
| Rate for Payer: Healthscope Commercial |
$51.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.09
|
| Rate for Payer: PHP Commercial |
$49.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.42
|
| Rate for Payer: Priority Health SBD |
$36.38
|
| Rate for Payer: UMR Bronson Commercial |
$25.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.31
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
IP
|
$92.75
|
|
|
Service Code
|
NDC 51079-789-20
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.81 |
| Max. Negotiated Rate |
$83.48 |
| Rate for Payer: Aetna American Axle |
$60.29
|
| Rate for Payer: Aetna Commercial |
$78.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.29
|
| Rate for Payer: Cash Price |
$74.20
|
| Rate for Payer: Cofinity Commercial |
$64.92
|
| Rate for Payer: Cofinity Commercial |
$79.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.20
|
| Rate for Payer: Healthscope Commercial |
$83.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.84
|
| Rate for Payer: PHP Commercial |
$78.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.92
|
| Rate for Payer: Priority Health SBD |
$58.43
|
| Rate for Payer: UMR Bronson Commercial |
$40.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.56
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
IP
|
$245.00
|
|
|
Service Code
|
NDC 65862-677-05
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.80 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Aetna American Axle |
$159.25
|
| Rate for Payer: Aetna Commercial |
$208.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.25
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cofinity Commercial |
$171.50
|
| Rate for Payer: Cofinity Commercial |
$210.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.00
|
| Rate for Payer: Healthscope Commercial |
$220.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.25
|
| Rate for Payer: PHP Commercial |
$208.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.50
|
| Rate for Payer: Priority Health SBD |
$154.35
|
| Rate for Payer: UMR Bronson Commercial |
$107.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.75
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
IP
|
$78.75
|
|
|
Service Code
|
NDC 0228-2029-10
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.65 |
| Max. Negotiated Rate |
$70.88 |
| Rate for Payer: Aetna American Axle |
$51.19
|
| Rate for Payer: Aetna Commercial |
$66.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.19
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cofinity Commercial |
$55.12
|
| Rate for Payer: Cofinity Commercial |
$67.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.00
|
| Rate for Payer: Healthscope Commercial |
$70.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.94
|
| Rate for Payer: PHP Commercial |
$66.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.12
|
| Rate for Payer: Priority Health SBD |
$49.61
|
| Rate for Payer: UMR Bronson Commercial |
$34.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.06
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
IP
|
$411.25
|
|
|
Service Code
|
NDC 0228-2029-50
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$180.95 |
| Max. Negotiated Rate |
$370.12 |
| Rate for Payer: Aetna American Axle |
$267.31
|
| Rate for Payer: Aetna Commercial |
$349.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.31
|
| Rate for Payer: Cash Price |
$329.00
|
| Rate for Payer: Cofinity Commercial |
$287.88
|
| Rate for Payer: Cofinity Commercial |
$353.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.00
|
| Rate for Payer: Healthscope Commercial |
$370.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$287.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$308.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$349.56
|
| Rate for Payer: PHP Commercial |
$349.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.88
|
| Rate for Payer: Priority Health SBD |
$259.09
|
| Rate for Payer: UMR Bronson Commercial |
$180.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$308.44
|
|
|
ALPROSTADIL 500 MCG/ML INJECTION SOLUTION
|
Facility
IP
|
$407.47
|
|
|
Service Code
|
HCPCS J0270
|
| Hospital Charge Code |
9001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$179.29 |
| Max. Negotiated Rate |
$366.72 |
| Rate for Payer: Aetna American Axle |
$264.86
|
| Rate for Payer: Aetna Commercial |
$346.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$264.86
|
| Rate for Payer: Cash Price |
$325.98
|
| Rate for Payer: Cofinity Commercial |
$285.23
|
| Rate for Payer: Cofinity Commercial |
$350.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.98
|
| Rate for Payer: Healthscope Commercial |
$366.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$285.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$305.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$346.35
|
| Rate for Payer: PHP Commercial |
$346.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.23
|
| Rate for Payer: Priority Health SBD |
$256.71
|
| Rate for Payer: UMR Bronson Commercial |
$179.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$305.60
|
|
