|
MULTIVITAMIN WITH FOLIC ACID 400 MCG TABLET
|
Facility
|
IP
|
$196.56
|
|
|
Service Code
|
NDC 80681000300
|
| Hospital Charge Code |
159994
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.49 |
| Max. Negotiated Rate |
$176.90 |
| Rate for Payer: Aetna American Axle |
$127.76
|
| Rate for Payer: Aetna Commercial |
$167.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.76
|
| Rate for Payer: Cash Price |
$157.25
|
| Rate for Payer: Cofinity Commercial |
$137.59
|
| Rate for Payer: Cofinity Commercial |
$169.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.25
|
| Rate for Payer: Healthscope Commercial |
$176.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.08
|
| Rate for Payer: PHP Commercial |
$167.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.76
|
| Rate for Payer: Priority Health SBD |
$123.83
|
| Rate for Payer: UMR Bronson Commercial |
$86.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.42
|
|
|
MULTIVITAMIN WITH FOLIC ACID 400 MCG TABLET
|
Facility
|
OP
|
$196.56
|
|
|
Service Code
|
NDC 80681000300
|
| Hospital Charge Code |
159994
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.73 |
| Max. Negotiated Rate |
$176.90 |
| Rate for Payer: Aetna American Axle |
$127.76
|
| Rate for Payer: Aetna Commercial |
$167.08
|
| Rate for Payer: Aetna Medicare |
$98.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.76
|
| Rate for Payer: BCBS Complete |
$78.62
|
| Rate for Payer: Cash Price |
$157.25
|
| Rate for Payer: Cofinity Commercial |
$137.59
|
| Rate for Payer: Cofinity Commercial |
$169.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.25
|
| Rate for Payer: Healthscope Commercial |
$176.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.08
|
| Rate for Payer: PHP Commercial |
$167.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.76
|
| Rate for Payer: Priority Health SBD |
$123.83
|
| Rate for Payer: UMR Bronson Commercial |
$72.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.42
|
|
|
MULTIVITAMIN WITH FOLIC ACID 400 MCG TABLET
|
Facility
|
OP
|
$176.40
|
|
|
Service Code
|
NDC 00904053061
|
| Hospital Charge Code |
159994
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.27 |
| Max. Negotiated Rate |
$158.76 |
| Rate for Payer: Aetna American Axle |
$114.66
|
| Rate for Payer: Aetna Commercial |
$149.94
|
| Rate for Payer: Aetna Medicare |
$88.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.66
|
| Rate for Payer: BCBS Complete |
$70.56
|
| Rate for Payer: Cash Price |
$141.12
|
| Rate for Payer: Cofinity Commercial |
$123.48
|
| Rate for Payer: Cofinity Commercial |
$151.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.12
|
| Rate for Payer: Healthscope Commercial |
$158.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.94
|
| Rate for Payer: PHP Commercial |
$149.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.66
|
| Rate for Payer: Priority Health SBD |
$111.13
|
| Rate for Payer: UMR Bronson Commercial |
$65.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.30
|
|
|
MULTIVITAMIN WITH FOLIC ACID 400 MCG TABLET
|
Facility
|
IP
|
$176.40
|
|
|
Service Code
|
NDC 00904053061
|
| Hospital Charge Code |
159994
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.62 |
| Max. Negotiated Rate |
$158.76 |
| Rate for Payer: Aetna American Axle |
$114.66
|
| Rate for Payer: Aetna Commercial |
$149.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.66
|
| Rate for Payer: Cash Price |
$141.12
|
| Rate for Payer: Cofinity Commercial |
$123.48
|
| Rate for Payer: Cofinity Commercial |
$151.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.12
|
| Rate for Payer: Healthscope Commercial |
$158.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.94
|
| Rate for Payer: PHP Commercial |
$149.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.66
|
| Rate for Payer: Priority Health SBD |
$111.13
|
| Rate for Payer: UMR Bronson Commercial |
$77.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.30
|
|
|
MULTIVIT AND MINERALS-FERROUS GLUCONATE 9 MG IRON/15 ML ORAL LIQUID
|
Facility
|
OP
|
$387.04
|
|
|
Service Code
|
NDC 00573051330
|
| Hospital Charge Code |
119617
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.20 |
| Max. Negotiated Rate |
$348.34 |
| Rate for Payer: Aetna American Axle |
$251.58
|
| Rate for Payer: Aetna Commercial |
$328.98
|
| Rate for Payer: Aetna Medicare |
$193.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.58
|
| Rate for Payer: BCBS Complete |
$154.82
|
| Rate for Payer: Cash Price |
$309.63
|
| Rate for Payer: Cofinity Commercial |
$270.93
|
| Rate for Payer: Cofinity Commercial |
$332.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$270.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.63
|
| Rate for Payer: Healthscope Commercial |
$348.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$270.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.98
|
| Rate for Payer: PHP Commercial |
$328.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.58
|
| Rate for Payer: Priority Health SBD |
$243.84
|
| Rate for Payer: UMR Bronson Commercial |
$143.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.28
|
|
|
MULTIVIT AND MINERALS-FERROUS GLUCONATE 9 MG IRON/15 ML ORAL LIQUID
|
Facility
|
IP
|
$21.95
|
|
|
Service Code
|
NDC 09900000800
|
| Hospital Charge Code |
119617
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.66 |
| Max. Negotiated Rate |
$19.76 |
| Rate for Payer: Aetna American Axle |
$14.27
|
| Rate for Payer: Aetna Commercial |
$18.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.27
|
| Rate for Payer: Cash Price |
$17.56
|
| Rate for Payer: Cofinity Commercial |
$15.36
|
| Rate for Payer: Cofinity Commercial |
$18.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.56
|
| Rate for Payer: Healthscope Commercial |
$19.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.66
|
| Rate for Payer: PHP Commercial |
$18.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.27
|
| Rate for Payer: Priority Health SBD |
$13.83
|
| Rate for Payer: UMR Bronson Commercial |
$9.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.46
|
|
|
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 |
$19.76 |
| Rate for Payer: Aetna American Axle |
$14.27
|
| Rate for Payer: Aetna Commercial |
$18.66
|
| Rate for Payer: Aetna Medicare |
$10.98
|
| 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 Commercial |
$15.36
|
| Rate for Payer: Cofinity Commercial |
$18.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.56
|
| Rate for Payer: Healthscope Commercial |
$19.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.66
|
| Rate for Payer: PHP Commercial |
$18.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.27
|
| Rate for Payer: Priority Health SBD |
$13.83
|
| Rate for Payer: UMR Bronson Commercial |
$8.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.46
|
|
|
MULTIVIT AND MINERALS-FERROUS GLUCONATE 9 MG IRON/15 ML ORAL LIQUID
|
Facility
|
IP
|
$387.04
|
|
|
Service Code
|
NDC 00573051330
|
| Hospital Charge Code |
119617
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.30 |
| Max. Negotiated Rate |
$348.34 |
| Rate for Payer: Aetna American Axle |
$251.58
|
| Rate for Payer: Aetna Commercial |
$328.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.58
|
| Rate for Payer: Cash Price |
$309.63
|
| Rate for Payer: Cofinity Commercial |
$270.93
|
| Rate for Payer: Cofinity Commercial |
$332.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$270.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.63
|
| Rate for Payer: Healthscope Commercial |
$348.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$270.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.98
|
| Rate for Payer: PHP Commercial |
$328.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.58
|
| Rate for Payer: Priority Health SBD |
$243.84
|
| Rate for Payer: UMR Bronson Commercial |
$170.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.28
|
|
|
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 Commercial |
$238.00
|
| Rate for Payer: Cofinity Commercial |
$292.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$238.00
|
| 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: PHP Commercial |
$289.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.00
|
| 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 Commercial |
$238.00
|
| Rate for Payer: Cofinity Commercial |
$292.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$238.00
|
| 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: PHP Commercial |
$289.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.00
|
| Rate for Payer: Priority Health SBD |
$214.20
|
| 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
|
$46.89
|
|
|
Service Code
|
NDC 81033050150
|
| Hospital Charge Code |
162541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.35 |
| Max. Negotiated Rate |
$42.20 |
| Rate for Payer: Aetna American Axle |
$30.48
|
| Rate for Payer: Aetna Commercial |
$39.86
|
| Rate for Payer: Aetna Medicare |
$23.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.48
|
| Rate for Payer: BCBS Complete |
$18.76
|
| Rate for Payer: Cash Price |
$37.51
|
| Rate for Payer: Cofinity Commercial |
$32.82
|
| Rate for Payer: Cofinity Commercial |
$40.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.51
|
| Rate for Payer: Healthscope Commercial |
$42.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.86
|
| Rate for Payer: PHP Commercial |
$39.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.48
|
| Rate for Payer: Priority Health SBD |
$29.54
|
| Rate for Payer: UMR Bronson Commercial |
$17.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.17
|
|
|
MULTIVIT-MINS-FERROUS GLUCONATE 9 MG IRON/15 ML (15 ML) ORAL LIQUID
|
Facility
|
OP
|
$46.89
|
|
|
Service Code
|
NDC 81033050115
|
| Hospital Charge Code |
162541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.35 |
| Max. Negotiated Rate |
$42.20 |
| Rate for Payer: Aetna American Axle |
$30.48
|
| Rate for Payer: Aetna Commercial |
$39.86
|
| Rate for Payer: Aetna Medicare |
$23.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.48
|
| Rate for Payer: BCBS Complete |
$18.76
|
| Rate for Payer: Cash Price |
$37.51
|
| Rate for Payer: Cofinity Commercial |
$32.82
|
| Rate for Payer: Cofinity Commercial |
$40.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.51
|
| Rate for Payer: Healthscope Commercial |
$42.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.86
|
| Rate for Payer: PHP Commercial |
$39.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.48
|
| Rate for Payer: Priority Health SBD |
$29.54
|
| Rate for Payer: UMR Bronson Commercial |
$17.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.17
|
|
|
MULTIVIT-MINS-FERROUS GLUCONATE 9 MG IRON/15 ML (15 ML) ORAL LIQUID
|
Facility
|
IP
|
$46.89
|
|
|
Service Code
|
NDC 81033050115
|
| Hospital Charge Code |
162541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.63 |
| Max. Negotiated Rate |
$42.20 |
| Rate for Payer: Aetna American Axle |
$30.48
|
| Rate for Payer: Aetna Commercial |
$39.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.48
|
| Rate for Payer: Cash Price |
$37.51
|
| Rate for Payer: Cofinity Commercial |
$32.82
|
| Rate for Payer: Cofinity Commercial |
$40.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.51
|
| Rate for Payer: Healthscope Commercial |
$42.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.86
|
| Rate for Payer: PHP Commercial |
$39.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.48
|
| Rate for Payer: Priority Health SBD |
$29.54
|
| Rate for Payer: UMR Bronson Commercial |
$20.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.17
|
|
|
MULTIVIT-MINS-FERROUS GLUCONATE 9 MG IRON/15 ML (15 ML) ORAL LIQUID
|
Facility
|
IP
|
$46.89
|
|
|
Service Code
|
NDC 81033050150
|
| Hospital Charge Code |
162541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.63 |
| Max. Negotiated Rate |
$42.20 |
| Rate for Payer: Aetna American Axle |
$30.48
|
| Rate for Payer: Aetna Commercial |
$39.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.48
|
| Rate for Payer: Cash Price |
$37.51
|
| Rate for Payer: Cofinity Commercial |
$32.82
|
| Rate for Payer: Cofinity Commercial |
$40.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.51
|
| Rate for Payer: Healthscope Commercial |
$42.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.86
|
| Rate for Payer: PHP Commercial |
$39.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.48
|
| Rate for Payer: Priority Health SBD |
$29.54
|
| Rate for Payer: UMR Bronson Commercial |
$20.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.17
|
|
|
MULTIVIT-MINS NO.56-FA 200 MCG-VIT K 1,000 MCG-COQ10 10 MG CHEW TABLET
|
Facility
|
IP
|
$181.44
|
|
|
Service Code
|
NDC 68176000015
|
| Hospital Charge Code |
181160
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.83 |
| Max. Negotiated Rate |
$163.30 |
| Rate for Payer: Aetna American Axle |
$117.94
|
| Rate for Payer: Aetna Commercial |
$154.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.94
|
| Rate for Payer: Cash Price |
$145.15
|
| Rate for Payer: Cofinity Commercial |
$127.01
|
| Rate for Payer: Cofinity Commercial |
$156.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$127.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.15
|
| Rate for Payer: Healthscope Commercial |
$163.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.22
|
| Rate for Payer: PHP Commercial |
$154.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.94
|
| Rate for Payer: Priority Health SBD |
$114.31
|
| Rate for Payer: UMR Bronson Commercial |
$79.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.08
|
|
|
MULTIVIT-MINS NO.56-FA 200 MCG-VIT K 1,000 MCG-COQ10 10 MG CHEW TABLET
|
Facility
|
OP
|
$181.44
|
|
|
Service Code
|
NDC 68176000015
|
| Hospital Charge Code |
181160
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.13 |
| Max. Negotiated Rate |
$163.30 |
| Rate for Payer: Aetna American Axle |
$117.94
|
| Rate for Payer: Aetna Commercial |
$154.22
|
| Rate for Payer: Aetna Medicare |
$90.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.94
|
| Rate for Payer: BCBS Complete |
$72.58
|
| Rate for Payer: Cash Price |
$145.15
|
| Rate for Payer: Cofinity Commercial |
$127.01
|
| Rate for Payer: Cofinity Commercial |
$156.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$127.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.15
|
| Rate for Payer: Healthscope Commercial |
$163.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.22
|
| Rate for Payer: PHP Commercial |
$154.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.94
|
| Rate for Payer: Priority Health SBD |
$114.31
|
| Rate for Payer: UMR Bronson Commercial |
$67.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.08
|
|
|
MUPIROCIN 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$29.96
|
|
|
Service Code
|
NDC 45802011222
|
| 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 Commercial |
$20.97
|
| Rate for Payer: Cofinity Commercial |
$25.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.97
|
| 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: PHP Commercial |
$25.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.47
|
| 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
|
$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 |
$10.40
|
| 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 Commercial |
$14.55
|
| Rate for Payer: Cofinity Commercial |
$17.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.55
|
| 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: PHP Commercial |
$17.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.51
|
| Rate for Payer: Priority Health SBD |
$13.10
|
| 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 45802011222
|
| 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 Commercial |
$20.97
|
| Rate for Payer: Cofinity Commercial |
$25.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.97
|
| 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: PHP Commercial |
$25.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.47
|
| Rate for Payer: Priority Health SBD |
$18.87
|
| 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 Commercial |
$73.47
|
| Rate for Payer: Cofinity Commercial |
$90.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.47
|
| 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: PHP Commercial |
$89.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.22
|
| 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
|
$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 Commercial |
$20.97
|
| Rate for Payer: Cofinity Commercial |
$25.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.97
|
| 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: PHP Commercial |
$25.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.47
|
| 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
|
$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 Commercial |
$20.97
|
| Rate for Payer: Cofinity Commercial |
$25.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.97
|
| 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: PHP Commercial |
$25.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.47
|
| Rate for Payer: Priority Health SBD |
$18.87
|
| 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
|
$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 Commercial |
$14.55
|
| Rate for Payer: Cofinity Commercial |
$17.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.55
|
| 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: PHP Commercial |
$17.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.51
|
| 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
|
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 Commercial |
$73.47
|
| Rate for Payer: Cofinity Commercial |
$90.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.47
|
| 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: PHP Commercial |
$89.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.22
|
| Rate for Payer: Priority Health SBD |
$66.12
|
| Rate for Payer: UMR Bronson Commercial |
$38.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.72
|
|
|
MUSCLE, MYOCUTANEOUS, OR FASCIOCUTANEOUS FLAP; TRUNK
|
Facility
|
OP
|
$11,273.70
|
|
|
Service Code
|
CPT 15734
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,452.40 |
| Max. Negotiated Rate |
$11,273.70 |
| Rate for Payer: Aetna Medicare |
$3,730.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,483.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,483.69
|
| Rate for Payer: BCBS Complete |
$2,018.74
|
| Rate for Payer: BCBS MAPPO |
$3,586.95
|
| Rate for Payer: BCBS Trust/PPO |
$2,459.44
|
| Rate for Payer: BCN Commercial |
$2,459.44
|
| Rate for Payer: BCN Medicare Advantage |
$3,586.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,586.95
|
| Rate for Payer: Mclaren Medicaid |
$1,922.61
|
| Rate for Payer: Mclaren Medicare |
$3,586.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,766.30
|
| Rate for Payer: Meridian Medicaid |
$2,018.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,124.99
|
| Rate for Payer: Nomi Health Commercial |
$7,532.60
|
| Rate for Payer: PACE Medicare |
$3,407.60
|
| Rate for Payer: PACE SWMI |
$3,586.95
|
| Rate for Payer: PHP Medicare Advantage |
$3,586.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,922.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,273.70
|
| Rate for Payer: Priority Health Medicare |
$3,586.95
|
| Rate for Payer: Priority Health Narrow Network |
$9,018.96
|
| Rate for Payer: Railroad Medicare Medicare |
$3,586.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,597.64
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,586.95
|
| Rate for Payer: UHC Exchange |
$1,452.40
|
| Rate for Payer: UHC Medicare Advantage |
$3,586.95
|
| Rate for Payer: UHCCP Medicaid |
$1,922.61
|
| Rate for Payer: VA VA |
$3,586.95
|
|
