|
NATEGLINIDE 60 MG TABLET
|
Facility
|
OP
|
$530.88
|
|
|
Service Code
|
NDC 49884098401
|
| Hospital Charge Code |
29437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.43 |
| Max. Negotiated Rate |
$477.79 |
| Rate for Payer: Aetna American Axle |
$345.07
|
| Rate for Payer: Aetna Commercial |
$451.25
|
| Rate for Payer: Aetna Medicare |
$265.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$345.07
|
| Rate for Payer: BCBS Complete |
$212.35
|
| Rate for Payer: Cash Price |
$424.70
|
| Rate for Payer: Cofinity Commercial |
$371.62
|
| Rate for Payer: Cofinity Commercial |
$456.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$371.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$424.70
|
| Rate for Payer: Healthscope Commercial |
$477.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$371.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$398.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$451.25
|
| Rate for Payer: PHP Commercial |
$451.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.07
|
| Rate for Payer: Priority Health SBD |
$334.45
|
| Rate for Payer: UMR Bronson Commercial |
$196.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$398.16
|
|
|
NECITUMUMAB 800 MG/50 ML (16 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19,440.58
|
|
|
Service Code
|
HCPCS J9295
|
| Hospital Charge Code |
176602
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$17,496.52 |
| Rate for Payer: Aetna American Axle |
$12,636.38
|
| Rate for Payer: Aetna Commercial |
$16,524.49
|
| Rate for Payer: Aetna Medicare |
$5.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,636.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.16
|
| Rate for Payer: BCBS Complete |
$3.22
|
| Rate for Payer: BCBS MAPPO |
$5.73
|
| Rate for Payer: BCBS Trust/PPO |
$15.43
|
| Rate for Payer: BCN Commercial |
$15.43
|
| Rate for Payer: BCN Medicare Advantage |
$5.73
|
| Rate for Payer: Cash Price |
$15,552.46
|
| Rate for Payer: Cash Price |
$15,552.46
|
| Rate for Payer: Cofinity Commercial |
$16,718.90
|
| Rate for Payer: Cofinity Commercial |
$13,608.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$13,608.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,552.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.73
|
| Rate for Payer: Healthscope Commercial |
$17,496.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13,608.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,580.44
|
| Rate for Payer: Mclaren Medicaid |
$3.07
|
| Rate for Payer: Mclaren Medicare |
$5.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.02
|
| Rate for Payer: Meridian Medicaid |
$3.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,524.49
|
| Rate for Payer: Nomi Health Commercial |
$17.19
|
| Rate for Payer: PACE Medicare |
$5.44
|
| Rate for Payer: PACE SWMI |
$5.73
|
| Rate for Payer: PHP Commercial |
$16,524.49
|
| Rate for Payer: PHP Medicare Advantage |
$5.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,636.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.50
|
| Rate for Payer: Priority Health Medicare |
$5.73
|
| Rate for Payer: Priority Health Narrow Network |
$13.20
|
| Rate for Payer: Priority Health SBD |
$12,247.57
|
| Rate for Payer: Railroad Medicare Medicare |
$5.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.73
|
| Rate for Payer: UHC Exchange |
$10.95
|
| Rate for Payer: UHC Medicare Advantage |
$5.73
|
| Rate for Payer: UHCCP Medicaid |
$3.07
|
| Rate for Payer: UMR Bronson Commercial |
$7,193.01
|
| Rate for Payer: VA VA |
$5.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,580.44
|
|
|
NECITUMUMAB 800 MG/50 ML (16 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19,440.58
|
|
|
Service Code
|
HCPCS J9295
|
| Hospital Charge Code |
176602
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8,553.86 |
| Max. Negotiated Rate |
$17,496.52 |
| Rate for Payer: Aetna American Axle |
$12,636.38
|
| Rate for Payer: Aetna Commercial |
$16,524.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,636.38
|
| Rate for Payer: Cash Price |
$15,552.46
|
| Rate for Payer: Cofinity Commercial |
$13,608.41
|
| Rate for Payer: Cofinity Commercial |
$16,718.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$13,608.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,552.46
|
| Rate for Payer: Healthscope Commercial |
$17,496.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13,608.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,580.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,524.49
|
| Rate for Payer: PHP Commercial |
$16,524.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,636.38
|
| Rate for Payer: Priority Health SBD |
$12,247.57
|
| Rate for Payer: UMR Bronson Commercial |
$8,553.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,580.44
|
|
|
NEEDLE INSERTION(S) WITHOUT INJECTION(S); 1 OR 2 MUSCLE(S)
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 20560
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12.86 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$24.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.99
|
| Rate for Payer: BCBS Complete |
$13.50
|
| Rate for Payer: BCBS MAPPO |
$23.99
|
| Rate for Payer: BCN Medicare Advantage |
$23.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.99
|
| Rate for Payer: Mclaren Medicaid |
$12.86
|
| Rate for Payer: Mclaren Medicare |
$23.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.19
|
| Rate for Payer: Meridian Medicaid |
$13.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.59
|
| Rate for Payer: Nomi Health Commercial |
$71.97
|
| Rate for Payer: PACE Medicare |
$22.79
|
| Rate for Payer: PACE SWMI |
$23.99
|
| Rate for Payer: PHP Medicare Advantage |
$23.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.43
|
| Rate for Payer: Priority Health Medicare |
$23.99
|
| Rate for Payer: Priority Health Narrow Network |
$60.34
|
| Rate for Payer: Railroad Medicare Medicare |
$23.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.55
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.99
|
| Rate for Payer: UHC Exchange |
$14.14
|
| Rate for Payer: UHC Medicare Advantage |
$23.99
|
| Rate for Payer: UHCCP Medicaid |
$12.86
|
| Rate for Payer: VA VA |
$23.99
|
|
|
NEGATIVE PRESSURE WOUND THERAPY, (EG, VACUUM ASSISTED DRAINAGE COLLECTION), UTILIZING DISPOSABLE, NON-DURABLE MEDICAL EQUIPMENT INCLUDING PROVISION OF EXUDATE MANAGEMENT COLLECTION SYSTEM, TOPICAL APPLICATION(S), WOUND ASSESSMENT, AND INSTRUCTIONS FOR ONGOING CARE, PER SESSION; TOTAL WOUND(S) SURFACE AREA GREATER THAN 50 SQUARE CENTIMETERS
|
Facility
|
OP
|
$1,230.33
|
|
|
Service Code
|
CPT 97608
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$24.19 |
| Max. Negotiated Rate |
$1,230.33 |
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Aetna Medicare |
$407.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$436.07
|
| Rate for Payer: BCN Commercial |
$436.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.45
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Nomi Health Commercial |
$822.04
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,230.33
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$984.26
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Exchange |
$24.19
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$209.82
|
| Rate for Payer: VA VA |
$391.45
|
|
|
NEGATIVE PRESSURE WOUND THERAPY, (EG, VACUUM ASSISTED DRAINAGE COLLECTION), UTILIZING DISPOSABLE, NON-DURABLE MEDICAL EQUIPMENT INCLUDING PROVISION OF EXUDATE MANAGEMENT COLLECTION SYSTEM, TOPICAL APPLICATION(S), WOUND ASSESSMENT, AND INSTRUCTIONS FOR ONGOING CARE, PER SESSION; TOTAL WOUND(S) SURFACE AREA LESS THAN OR EQUAL TO 50 SQUARE CENTIMETERS
|
Facility
|
OP
|
$1,230.33
|
|
|
Service Code
|
CPT 97607
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$1,230.33 |
| Rate for Payer: Aetna Medicare |
$407.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$421.55
|
| Rate for Payer: BCN Commercial |
$421.55
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.45
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Nomi Health Commercial |
$822.04
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,230.33
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$984.26
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Exchange |
$20.50
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$209.82
|
| Rate for Payer: VA VA |
$391.45
|
|
|
NEGATIVE PRESSURE WOUND THERAPY (EG, VACUUM ASSISTED DRAINAGE COLLECTION), UTILIZING DURABLE MEDICAL EQUIPMENT (DME), INCLUDING TOPICAL APPLICATION(S), WOUND ASSESSMENT, AND INSTRUCTION(S) FOR ONGOING CARE, PER SESSION; TOTAL WOUND(S) SURFACE AREA GREATER THAN 50 SQUARE CENTIMETERS
|
Facility
|
OP
|
$1,230.33
|
|
|
Service Code
|
CPT 97606
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$25.40 |
| Max. Negotiated Rate |
$1,230.33 |
| Rate for Payer: Aetna Medicare |
$407.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$215.66
|
| Rate for Payer: BCN Commercial |
$215.66
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.45
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Nomi Health Commercial |
$1,174.35
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,230.33
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$984.26
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Exchange |
$25.40
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$209.82
|
| Rate for Payer: VA VA |
$391.45
|
|
|
NEGATIVE PRESSURE WOUND THERAPY (EG, VACUUM ASSISTED DRAINAGE COLLECTION), UTILIZING DURABLE MEDICAL EQUIPMENT (DME), INCLUDING TOPICAL APPLICATION(S), WOUND ASSESSMENT, AND INSTRUCTION(S) FOR ONGOING CARE, PER SESSION; TOTAL WOUND(S) SURFACE AREA LESS THAN OR EQUAL TO 50 SQUARE CENTIMETERS
|
Facility
|
OP
|
$611.90
|
|
|
Service Code
|
CPT 97605
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$23.17 |
| Max. Negotiated Rate |
$611.90 |
| Rate for Payer: Aetna Medicare |
$202.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.35
|
| Rate for Payer: BCBS Complete |
$109.57
|
| Rate for Payer: BCBS MAPPO |
$194.68
|
| Rate for Payer: BCBS Trust/PPO |
$85.40
|
| Rate for Payer: BCN Commercial |
$85.40
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.68
|
| Rate for Payer: Mclaren Medicaid |
$104.35
|
| Rate for Payer: Mclaren Medicare |
$194.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.41
|
| Rate for Payer: Meridian Medicaid |
$109.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.88
|
| Rate for Payer: Nomi Health Commercial |
$584.04
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$611.90
|
| Rate for Payer: Priority Health Medicare |
$194.68
|
| Rate for Payer: Priority Health Narrow Network |
$489.52
|
| Rate for Payer: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Exchange |
$23.17
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$104.35
|
| Rate for Payer: VA VA |
$194.68
|
|
|
NEGATIVE PRESSURE WOUND THERAPY (EG, VACUUM ASSISTED DRAINAGE COLLECTION), UTILIZING DURABLE MEDICAL EQUIPMENT (DME), INCLUDING TOPICAL APPLICATION(S), WOUND ASSESSMENT, AND INSTRUCTION(S) FOR ONGOING CARE, PER SESSION; TOTAL WOUND(S) SURFACE AREA LESS THAN OR EQUAL TO 50 SQUARE CENTIMETERS
|
Facility
|
OP
|
$611.90
|
|
|
Service Code
|
CPT 97605
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$23.17 |
| Max. Negotiated Rate |
$611.90 |
| Rate for Payer: Aetna Medicare |
$202.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.35
|
| Rate for Payer: BCBS Complete |
$109.57
|
| Rate for Payer: BCBS MAPPO |
$194.68
|
| Rate for Payer: BCBS Trust/PPO |
$85.40
|
| Rate for Payer: BCN Commercial |
$85.40
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.68
|
| Rate for Payer: Mclaren Medicaid |
$104.35
|
| Rate for Payer: Mclaren Medicare |
$194.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.41
|
| Rate for Payer: Meridian Medicaid |
$109.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.88
|
| Rate for Payer: Nomi Health Commercial |
$584.04
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$611.90
|
| Rate for Payer: Priority Health Medicare |
$194.68
|
| Rate for Payer: Priority Health Narrow Network |
$489.52
|
| Rate for Payer: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Exchange |
$23.17
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$104.35
|
| Rate for Payer: VA VA |
$194.68
|
|
|
NELARABINE 250 MG/50 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,913.20
|
|
|
Service Code
|
HCPCS J9261
|
| Hospital Charge Code |
70267
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.07 |
| Max. Negotiated Rate |
$6,221.88 |
| Rate for Payer: Aetna American Axle |
$4,493.58
|
| Rate for Payer: Aetna American Axle |
$4,458.09
|
| Rate for Payer: Aetna American Axle |
$3,910.89
|
| Rate for Payer: Aetna American Axle |
$4,531.80
|
| Rate for Payer: Aetna American Axle |
$3,407.87
|
| Rate for Payer: Aetna American Axle |
$4,453.54
|
| Rate for Payer: Aetna American Axle |
$9,260.88
|
| Rate for Payer: Aetna Commercial |
$5,823.86
|
| Rate for Payer: Aetna Commercial |
$12,110.38
|
| Rate for Payer: Aetna Commercial |
$5,829.81
|
| Rate for Payer: Aetna Commercial |
$4,456.45
|
| Rate for Payer: Aetna Commercial |
$5,876.22
|
| Rate for Payer: Aetna Commercial |
$5,926.20
|
| Rate for Payer: Aetna Commercial |
$5,114.24
|
| Rate for Payer: Aetna Medicare |
$77.75
|
| Rate for Payer: Aetna Medicare |
$77.75
|
| Rate for Payer: Aetna Medicare |
$77.75
|
| Rate for Payer: Aetna Medicare |
$77.75
|
| Rate for Payer: Aetna Medicare |
$77.75
|
| Rate for Payer: Aetna Medicare |
$77.75
|
| Rate for Payer: Aetna Medicare |
$77.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,260.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,458.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,493.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,407.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,531.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,910.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,453.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.45
|
| Rate for Payer: BCBS Complete |
$42.07
|
| Rate for Payer: BCBS Complete |
$42.07
|
| Rate for Payer: BCBS Complete |
$42.07
|
| Rate for Payer: BCBS Complete |
$42.07
|
| Rate for Payer: BCBS Complete |
$42.07
|
| Rate for Payer: BCBS Complete |
$42.07
|
| Rate for Payer: BCBS Complete |
$42.07
|
| Rate for Payer: BCBS MAPPO |
$74.76
|
| Rate for Payer: BCBS MAPPO |
$74.76
|
| Rate for Payer: BCBS MAPPO |
$74.76
|
| Rate for Payer: BCBS MAPPO |
$74.76
|
| Rate for Payer: BCBS MAPPO |
$74.76
|
| Rate for Payer: BCBS MAPPO |
$74.76
|
| Rate for Payer: BCBS MAPPO |
$74.76
|
| Rate for Payer: BCBS Trust/PPO |
$201.29
|
| Rate for Payer: BCBS Trust/PPO |
$201.29
|
| Rate for Payer: BCBS Trust/PPO |
$201.29
|
| Rate for Payer: BCBS Trust/PPO |
$201.29
|
| Rate for Payer: BCBS Trust/PPO |
$201.29
|
| Rate for Payer: BCBS Trust/PPO |
$201.29
|
| Rate for Payer: BCBS Trust/PPO |
$201.29
|
| Rate for Payer: BCN Commercial |
$201.29
|
| Rate for Payer: BCN Commercial |
$201.29
|
| Rate for Payer: BCN Commercial |
$201.29
|
| Rate for Payer: BCN Commercial |
$201.29
|
| Rate for Payer: BCN Commercial |
$201.29
|
| Rate for Payer: BCN Commercial |
$201.29
|
| Rate for Payer: BCN Commercial |
$201.29
|
| Rate for Payer: BCN Medicare Advantage |
$74.76
|
| Rate for Payer: BCN Medicare Advantage |
$74.76
|
| Rate for Payer: BCN Medicare Advantage |
$74.76
|
| Rate for Payer: BCN Medicare Advantage |
$74.76
|
| Rate for Payer: BCN Medicare Advantage |
$74.76
|
| Rate for Payer: BCN Medicare Advantage |
$74.76
|
| Rate for Payer: BCN Medicare Advantage |
$74.76
|
| Rate for Payer: Cash Price |
$5,530.56
|
| Rate for Payer: Cash Price |
$5,481.28
|
| Rate for Payer: Cash Price |
$5,481.28
|
| Rate for Payer: Cash Price |
$5,486.88
|
| Rate for Payer: Cash Price |
$4,813.40
|
| Rate for Payer: Cash Price |
$4,813.40
|
| Rate for Payer: Cash Price |
$5,577.60
|
| Rate for Payer: Cash Price |
$5,577.60
|
| Rate for Payer: Cash Price |
$11,398.00
|
| Rate for Payer: Cash Price |
$5,486.88
|
| Rate for Payer: Cash Price |
$5,530.56
|
| Rate for Payer: Cash Price |
$4,194.30
|
| Rate for Payer: Cash Price |
$4,194.30
|
| Rate for Payer: Cash Price |
$11,398.00
|
| Rate for Payer: Cofinity Commercial |
$4,796.12
|
| Rate for Payer: Cofinity Commercial |
$9,973.25
|
| Rate for Payer: Cofinity Commercial |
$12,252.85
|
| Rate for Payer: Cofinity Commercial |
$5,995.92
|
| Rate for Payer: Cofinity Commercial |
$4,880.40
|
| Rate for Payer: Cofinity Commercial |
$5,945.35
|
| Rate for Payer: Cofinity Commercial |
$4,839.24
|
| Rate for Payer: Cofinity Commercial |
$3,670.02
|
| Rate for Payer: Cofinity Commercial |
$4,508.88
|
| Rate for Payer: Cofinity Commercial |
$5,898.40
|
| Rate for Payer: Cofinity Commercial |
$4,801.02
|
| Rate for Payer: Cofinity Commercial |
$4,211.72
|
| Rate for Payer: Cofinity Commercial |
$5,174.40
|
| Rate for Payer: Cofinity Commercial |
$5,892.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,796.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,670.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,801.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,211.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$9,973.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,880.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,839.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,481.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,194.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,530.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,486.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,577.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,813.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,398.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.76
|
| Rate for Payer: Healthscope Commercial |
$5,415.08
|
| Rate for Payer: Healthscope Commercial |
$6,221.88
|
| Rate for Payer: Healthscope Commercial |
$4,718.59
|
| Rate for Payer: Healthscope Commercial |
$6,274.80
|
| Rate for Payer: Healthscope Commercial |
$12,822.75
|
| Rate for Payer: Healthscope Commercial |
$6,166.44
|
| Rate for Payer: Healthscope Commercial |
$6,172.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,670.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,839.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,973.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,796.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,880.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,211.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,801.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,229.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,184.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,512.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,138.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,932.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,685.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,143.95
|
| Rate for Payer: Mclaren Medicaid |
$40.07
|
| Rate for Payer: Mclaren Medicaid |
$40.07
|
| Rate for Payer: Mclaren Medicaid |
$40.07
|
| Rate for Payer: Mclaren Medicaid |
$40.07
|
| Rate for Payer: Mclaren Medicaid |
$40.07
|
| Rate for Payer: Mclaren Medicaid |
$40.07
|
| Rate for Payer: Mclaren Medicaid |
$40.07
|
| Rate for Payer: Mclaren Medicare |
$74.76
|
| Rate for Payer: Mclaren Medicare |
$74.76
|
| Rate for Payer: Mclaren Medicare |
$74.76
|
| Rate for Payer: Mclaren Medicare |
$74.76
|
| Rate for Payer: Mclaren Medicare |
$74.76
|
| Rate for Payer: Mclaren Medicare |
$74.76
|
| Rate for Payer: Mclaren Medicare |
$74.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.50
|
| Rate for Payer: Meridian Medicaid |
$42.07
|
| Rate for Payer: Meridian Medicaid |
$42.07
|
| Rate for Payer: Meridian Medicaid |
$42.07
|
| Rate for Payer: Meridian Medicaid |
$42.07
|
| Rate for Payer: Meridian Medicaid |
$42.07
|
| Rate for Payer: Meridian Medicaid |
$42.07
|
| Rate for Payer: Meridian Medicaid |
$42.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,823.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,829.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,114.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,926.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,456.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,110.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,876.22
|
| Rate for Payer: Nomi Health Commercial |
$224.28
|
| Rate for Payer: Nomi Health Commercial |
$224.28
|
| Rate for Payer: Nomi Health Commercial |
$224.28
|
| Rate for Payer: Nomi Health Commercial |
$224.28
|
| Rate for Payer: Nomi Health Commercial |
$224.28
|
| Rate for Payer: Nomi Health Commercial |
$224.28
|
| Rate for Payer: Nomi Health Commercial |
$224.28
|
| Rate for Payer: PACE Medicare |
$71.02
|
| Rate for Payer: PACE Medicare |
$71.02
|
| Rate for Payer: PACE Medicare |
$71.02
|
| Rate for Payer: PACE Medicare |
$71.02
|
| Rate for Payer: PACE Medicare |
$71.02
|
| Rate for Payer: PACE Medicare |
$71.02
|
| Rate for Payer: PACE Medicare |
$71.02
|
| Rate for Payer: PACE SWMI |
$74.76
|
| Rate for Payer: PACE SWMI |
$74.76
|
| Rate for Payer: PACE SWMI |
$74.76
|
| Rate for Payer: PACE SWMI |
$74.76
|
| Rate for Payer: PACE SWMI |
$74.76
|
| Rate for Payer: PACE SWMI |
$74.76
|
| Rate for Payer: PACE SWMI |
$74.76
|
| Rate for Payer: PHP Commercial |
$5,829.81
|
| Rate for Payer: PHP Commercial |
$5,926.20
|
| Rate for Payer: PHP Commercial |
$5,876.22
|
| Rate for Payer: PHP Commercial |
$5,114.24
|
| Rate for Payer: PHP Commercial |
$12,110.38
|
| Rate for Payer: PHP Commercial |
$5,823.86
|
| Rate for Payer: PHP Commercial |
$4,456.45
|
| Rate for Payer: PHP Medicare Advantage |
$74.76
|
| Rate for Payer: PHP Medicare Advantage |
$74.76
|
| Rate for Payer: PHP Medicare Advantage |
$74.76
|
| Rate for Payer: PHP Medicare Advantage |
$74.76
|
| Rate for Payer: PHP Medicare Advantage |
$74.76
|
| Rate for Payer: PHP Medicare Advantage |
$74.76
|
| Rate for Payer: PHP Medicare Advantage |
$74.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,453.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,531.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,260.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,458.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,493.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,407.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,910.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$208.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$208.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$208.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$208.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$208.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$208.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$208.74
|
| Rate for Payer: Priority Health Medicare |
$74.76
|
| Rate for Payer: Priority Health Medicare |
$74.76
|
| Rate for Payer: Priority Health Medicare |
$74.76
|
| Rate for Payer: Priority Health Medicare |
$74.76
|
| Rate for Payer: Priority Health Medicare |
$74.76
|
| Rate for Payer: Priority Health Medicare |
$74.76
|
| Rate for Payer: Priority Health Medicare |
$74.76
|
| Rate for Payer: Priority Health Narrow Network |
$166.99
|
| Rate for Payer: Priority Health Narrow Network |
$166.99
|
| Rate for Payer: Priority Health Narrow Network |
$166.99
|
| Rate for Payer: Priority Health Narrow Network |
$166.99
|
| Rate for Payer: Priority Health Narrow Network |
$166.99
|
| Rate for Payer: Priority Health Narrow Network |
$166.99
|
| Rate for Payer: Priority Health Narrow Network |
$166.99
|
| Rate for Payer: Priority Health SBD |
$4,355.32
|
| Rate for Payer: Priority Health SBD |
$8,975.92
|
| Rate for Payer: Priority Health SBD |
$4,316.51
|
| Rate for Payer: Priority Health SBD |
$3,790.55
|
| Rate for Payer: Priority Health SBD |
$4,320.92
|
| Rate for Payer: Priority Health SBD |
$3,303.01
|
| Rate for Payer: Priority Health SBD |
$4,392.36
|
| Rate for Payer: Railroad Medicare Medicare |
$74.76
|
| Rate for Payer: Railroad Medicare Medicare |
$74.76
|
| Rate for Payer: Railroad Medicare Medicare |
$74.76
|
| Rate for Payer: Railroad Medicare Medicare |
$74.76
|
| Rate for Payer: Railroad Medicare Medicare |
$74.76
|
| Rate for Payer: Railroad Medicare Medicare |
$74.76
|
| Rate for Payer: Railroad Medicare Medicare |
$74.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.76
|
| Rate for Payer: UHC Exchange |
$142.87
|
| Rate for Payer: UHC Exchange |
$142.87
|
| Rate for Payer: UHC Exchange |
$142.87
|
| Rate for Payer: UHC Exchange |
$142.87
|
| Rate for Payer: UHC Exchange |
$142.87
|
| Rate for Payer: UHC Exchange |
$142.87
|
| Rate for Payer: UHC Exchange |
$142.87
|
| Rate for Payer: UHC Medicare Advantage |
$74.76
|
| Rate for Payer: UHC Medicare Advantage |
$74.76
|
| Rate for Payer: UHC Medicare Advantage |
$74.76
|
| Rate for Payer: UHC Medicare Advantage |
$74.76
|
| Rate for Payer: UHC Medicare Advantage |
$74.76
|
| Rate for Payer: UHC Medicare Advantage |
$74.76
|
| Rate for Payer: UHC Medicare Advantage |
$74.76
|
| Rate for Payer: UHCCP Medicaid |
$40.07
|
| Rate for Payer: UHCCP Medicaid |
$40.07
|
| Rate for Payer: UHCCP Medicaid |
$40.07
|
| Rate for Payer: UHCCP Medicaid |
$40.07
|
| Rate for Payer: UHCCP Medicaid |
$40.07
|
| Rate for Payer: UHCCP Medicaid |
$40.07
|
| Rate for Payer: UHCCP Medicaid |
$40.07
|
| Rate for Payer: UMR Bronson Commercial |
$2,557.88
|
| Rate for Payer: UMR Bronson Commercial |
$2,537.68
|
| Rate for Payer: UMR Bronson Commercial |
$2,579.64
|
| Rate for Payer: UMR Bronson Commercial |
$5,271.58
|
| Rate for Payer: UMR Bronson Commercial |
$2,535.09
|
| Rate for Payer: UMR Bronson Commercial |
$2,226.20
|
| Rate for Payer: UMR Bronson Commercial |
$1,939.87
|
| Rate for Payer: VA VA |
$74.76
|
| Rate for Payer: VA VA |
$74.76
|
| Rate for Payer: VA VA |
$74.76
|
| Rate for Payer: VA VA |
$74.76
|
| Rate for Payer: VA VA |
$74.76
|
| Rate for Payer: VA VA |
$74.76
|
| Rate for Payer: VA VA |
$74.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,138.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,512.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,229.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,184.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,685.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,143.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,932.16
|
|
|
NELARABINE 250 MG/50 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$14,247.50
|
|
|
Service Code
|
HCPCS J9261
|
| Hospital Charge Code |
70267
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,268.90 |
| Max. Negotiated Rate |
$12,822.75 |
| Rate for Payer: Aetna American Axle |
$9,260.88
|
| Rate for Payer: Aetna American Axle |
$4,493.58
|
| Rate for Payer: Aetna American Axle |
$4,458.09
|
| Rate for Payer: Aetna American Axle |
$3,910.89
|
| Rate for Payer: Aetna American Axle |
$3,407.87
|
| Rate for Payer: Aetna American Axle |
$4,453.54
|
| Rate for Payer: Aetna American Axle |
$4,531.80
|
| Rate for Payer: Aetna Commercial |
$5,876.22
|
| Rate for Payer: Aetna Commercial |
$4,456.45
|
| Rate for Payer: Aetna Commercial |
$5,823.86
|
| Rate for Payer: Aetna Commercial |
$5,829.81
|
| Rate for Payer: Aetna Commercial |
$5,926.20
|
| Rate for Payer: Aetna Commercial |
$5,114.24
|
| Rate for Payer: Aetna Commercial |
$12,110.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,458.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,260.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,407.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,453.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,910.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,531.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,493.58
|
| Rate for Payer: Cash Price |
$5,481.28
|
| Rate for Payer: Cash Price |
$5,530.56
|
| Rate for Payer: Cash Price |
$4,194.30
|
| Rate for Payer: Cash Price |
$11,398.00
|
| Rate for Payer: Cash Price |
$4,813.40
|
| Rate for Payer: Cash Price |
$5,486.88
|
| Rate for Payer: Cash Price |
$5,577.60
|
| Rate for Payer: Cofinity Commercial |
$5,945.35
|
| Rate for Payer: Cofinity Commercial |
$12,252.85
|
| Rate for Payer: Cofinity Commercial |
$5,892.38
|
| Rate for Payer: Cofinity Commercial |
$4,796.12
|
| Rate for Payer: Cofinity Commercial |
$4,211.72
|
| Rate for Payer: Cofinity Commercial |
$3,670.02
|
| Rate for Payer: Cofinity Commercial |
$4,508.88
|
| Rate for Payer: Cofinity Commercial |
$5,174.40
|
| Rate for Payer: Cofinity Commercial |
$9,973.25
|
| Rate for Payer: Cofinity Commercial |
$4,801.02
|
| Rate for Payer: Cofinity Commercial |
$5,898.40
|
| Rate for Payer: Cofinity Commercial |
$4,839.24
|
| Rate for Payer: Cofinity Commercial |
$4,880.40
|
| Rate for Payer: Cofinity Commercial |
$5,995.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,880.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,211.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,796.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$9,973.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,839.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,801.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,670.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,530.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,486.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,577.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,194.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,813.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,481.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,398.00
|
| Rate for Payer: Healthscope Commercial |
$6,274.80
|
| Rate for Payer: Healthscope Commercial |
$6,172.74
|
| Rate for Payer: Healthscope Commercial |
$5,415.08
|
| Rate for Payer: Healthscope Commercial |
$6,166.44
|
| Rate for Payer: Healthscope Commercial |
$4,718.59
|
| Rate for Payer: Healthscope Commercial |
$12,822.75
|
| Rate for Payer: Healthscope Commercial |
$6,221.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,973.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,211.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,796.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,670.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,880.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,801.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,839.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,685.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,143.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,932.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,512.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,138.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,184.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,229.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,823.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,114.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,456.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,110.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,926.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,829.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,876.22
|
| Rate for Payer: PHP Commercial |
$5,829.81
|
| Rate for Payer: PHP Commercial |
$5,114.24
|
| Rate for Payer: PHP Commercial |
$5,823.86
|
| Rate for Payer: PHP Commercial |
$12,110.38
|
| Rate for Payer: PHP Commercial |
$4,456.45
|
| Rate for Payer: PHP Commercial |
$5,926.20
|
| Rate for Payer: PHP Commercial |
$5,876.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,493.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,407.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,910.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,453.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,531.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,260.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,458.09
|
| Rate for Payer: Priority Health SBD |
$3,790.55
|
| Rate for Payer: Priority Health SBD |
$3,303.01
|
| Rate for Payer: Priority Health SBD |
$8,975.92
|
| Rate for Payer: Priority Health SBD |
$4,392.36
|
| Rate for Payer: Priority Health SBD |
$4,355.32
|
| Rate for Payer: Priority Health SBD |
$4,320.92
|
| Rate for Payer: Priority Health SBD |
$4,316.51
|
| Rate for Payer: UMR Bronson Commercial |
$3,014.70
|
| Rate for Payer: UMR Bronson Commercial |
$3,067.68
|
| Rate for Payer: UMR Bronson Commercial |
$3,017.78
|
| Rate for Payer: UMR Bronson Commercial |
$3,041.81
|
| Rate for Payer: UMR Bronson Commercial |
$6,268.90
|
| Rate for Payer: UMR Bronson Commercial |
$2,647.37
|
| Rate for Payer: UMR Bronson Commercial |
$2,306.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,932.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,138.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,184.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,512.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,143.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,229.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,685.62
|
|
|
NELFINAVIR 250 MG TABLET
|
Facility
|
IP
|
$4,380.06
|
|
|
Service Code
|
NDC 63010001030
|
| Hospital Charge Code |
20032
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,927.23 |
| Max. Negotiated Rate |
$3,942.05 |
| Rate for Payer: Aetna American Axle |
$2,847.04
|
| Rate for Payer: Aetna Commercial |
$3,723.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,847.04
|
| Rate for Payer: Cash Price |
$3,504.05
|
| Rate for Payer: Cofinity Commercial |
$3,066.04
|
| Rate for Payer: Cofinity Commercial |
$3,766.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,066.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,504.05
|
| Rate for Payer: Healthscope Commercial |
$3,942.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,066.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,285.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,723.05
|
| Rate for Payer: PHP Commercial |
$3,723.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,847.04
|
| Rate for Payer: Priority Health SBD |
$2,759.44
|
| Rate for Payer: UMR Bronson Commercial |
$1,927.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,285.04
|
|
|
NELFINAVIR 250 MG TABLET
|
Facility
|
OP
|
$4,380.06
|
|
|
Service Code
|
NDC 63010001030
|
| Hospital Charge Code |
20032
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,620.62 |
| Max. Negotiated Rate |
$3,942.05 |
| Rate for Payer: Aetna American Axle |
$2,847.04
|
| Rate for Payer: Aetna Commercial |
$3,723.05
|
| Rate for Payer: Aetna Medicare |
$2,190.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,847.04
|
| Rate for Payer: BCBS Complete |
$1,752.02
|
| Rate for Payer: Cash Price |
$3,504.05
|
| Rate for Payer: Cofinity Commercial |
$3,066.04
|
| Rate for Payer: Cofinity Commercial |
$3,766.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,066.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,504.05
|
| Rate for Payer: Healthscope Commercial |
$3,942.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,066.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,285.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,723.05
|
| Rate for Payer: PHP Commercial |
$3,723.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,847.04
|
| Rate for Payer: Priority Health SBD |
$2,759.44
|
| Rate for Payer: UMR Bronson Commercial |
$1,620.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,285.04
|
|
|
NEOMY-BACIT-POLYMYX-PRAMOXINE 3.5 MG-500 UNIT-10,000 UNIT/G TOP OINT
|
Facility
|
IP
|
$39.54
|
|
|
Service Code
|
NDC 00713062231
|
| Hospital Charge Code |
21070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.40 |
| Max. Negotiated Rate |
$35.59 |
| Rate for Payer: Aetna American Axle |
$25.70
|
| Rate for Payer: Aetna Commercial |
$33.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.70
|
| Rate for Payer: Cash Price |
$31.63
|
| Rate for Payer: Cofinity Commercial |
$27.68
|
| Rate for Payer: Cofinity Commercial |
$34.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.63
|
| Rate for Payer: Healthscope Commercial |
$35.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.61
|
| Rate for Payer: PHP Commercial |
$33.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: Priority Health SBD |
$24.91
|
| Rate for Payer: UMR Bronson Commercial |
$17.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.66
|
|
|
NEOMY-BACIT-POLYMYX-PRAMOXINE 3.5 MG-500 UNIT-10,000 UNIT/G TOP OINT
|
Facility
|
OP
|
$39.54
|
|
|
Service Code
|
NDC 00713062231
|
| Hospital Charge Code |
21070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.63 |
| Max. Negotiated Rate |
$35.59 |
| Rate for Payer: Aetna American Axle |
$25.70
|
| Rate for Payer: Aetna Commercial |
$33.61
|
| Rate for Payer: Aetna Medicare |
$19.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.70
|
| Rate for Payer: BCBS Complete |
$15.82
|
| Rate for Payer: Cash Price |
$31.63
|
| Rate for Payer: Cofinity Commercial |
$27.68
|
| Rate for Payer: Cofinity Commercial |
$34.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.63
|
| Rate for Payer: Healthscope Commercial |
$35.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.61
|
| Rate for Payer: PHP Commercial |
$33.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: Priority Health SBD |
$24.91
|
| Rate for Payer: UMR Bronson Commercial |
$14.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.66
|
|
|
NEOMYCIN 1.75 MG-POLYMYXIN 10,000 UNIT-GRAMICIDIN 0.025MG/ML EYE DROPS
|
Facility
|
IP
|
$166.15
|
|
|
Service Code
|
NDC 24208079062
|
| Hospital Charge Code |
5474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.11 |
| Max. Negotiated Rate |
$149.54 |
| Rate for Payer: Aetna American Axle |
$108.00
|
| Rate for Payer: Aetna Commercial |
$141.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.00
|
| Rate for Payer: Cash Price |
$132.92
|
| Rate for Payer: Cofinity Commercial |
$116.30
|
| Rate for Payer: Cofinity Commercial |
$142.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$116.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.92
|
| Rate for Payer: Healthscope Commercial |
$149.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.23
|
| Rate for Payer: PHP Commercial |
$141.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.00
|
| Rate for Payer: Priority Health SBD |
$104.67
|
| Rate for Payer: UMR Bronson Commercial |
$73.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.61
|
|
|
NEOMYCIN 1.75 MG-POLYMYXIN 10,000 UNIT-GRAMICIDIN 0.025MG/ML EYE DROPS
|
Facility
|
OP
|
$166.15
|
|
|
Service Code
|
NDC 24208079062
|
| Hospital Charge Code |
5474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.48 |
| Max. Negotiated Rate |
$149.54 |
| Rate for Payer: Aetna American Axle |
$108.00
|
| Rate for Payer: Aetna Commercial |
$141.23
|
| Rate for Payer: Aetna Medicare |
$83.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.00
|
| Rate for Payer: BCBS Complete |
$66.46
|
| Rate for Payer: Cash Price |
$132.92
|
| Rate for Payer: Cofinity Commercial |
$116.30
|
| Rate for Payer: Cofinity Commercial |
$142.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$116.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.92
|
| Rate for Payer: Healthscope Commercial |
$149.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.23
|
| Rate for Payer: PHP Commercial |
$141.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.00
|
| Rate for Payer: Priority Health SBD |
$104.67
|
| Rate for Payer: UMR Bronson Commercial |
$61.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.61
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT
|
Facility
|
OP
|
$41.34
|
|
|
Service Code
|
NDC 00574416035
|
| Hospital Charge Code |
19495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$37.21 |
| Rate for Payer: Aetna American Axle |
$26.87
|
| Rate for Payer: Aetna Commercial |
$35.14
|
| Rate for Payer: Aetna Medicare |
$20.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.87
|
| Rate for Payer: BCBS Complete |
$16.54
|
| Rate for Payer: Cash Price |
$33.07
|
| Rate for Payer: Cofinity Commercial |
$28.94
|
| Rate for Payer: Cofinity Commercial |
$35.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.07
|
| Rate for Payer: Healthscope Commercial |
$37.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.14
|
| Rate for Payer: PHP Commercial |
$35.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.87
|
| Rate for Payer: Priority Health SBD |
$26.04
|
| Rate for Payer: UMR Bronson Commercial |
$15.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.00
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT
|
Facility
|
IP
|
$41.34
|
|
|
Service Code
|
NDC 00574416035
|
| Hospital Charge Code |
19495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.19 |
| Max. Negotiated Rate |
$37.21 |
| Rate for Payer: Aetna American Axle |
$26.87
|
| Rate for Payer: Aetna Commercial |
$35.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.87
|
| Rate for Payer: Cash Price |
$33.07
|
| Rate for Payer: Cofinity Commercial |
$28.94
|
| Rate for Payer: Cofinity Commercial |
$35.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.07
|
| Rate for Payer: Healthscope Commercial |
$37.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.14
|
| Rate for Payer: PHP Commercial |
$35.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.87
|
| Rate for Payer: Priority Health SBD |
$26.04
|
| Rate for Payer: UMR Bronson Commercial |
$18.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.00
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT
|
Facility
|
IP
|
$58.60
|
|
|
Service Code
|
NDC 61314063136
|
| Hospital Charge Code |
19495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.78 |
| Max. Negotiated Rate |
$52.74 |
| Rate for Payer: PHP Commercial |
$49.81
|
| Rate for Payer: Aetna American Axle |
$38.09
|
| Rate for Payer: Aetna Commercial |
$49.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.09
|
| Rate for Payer: Cash Price |
$46.88
|
| Rate for Payer: Cofinity Commercial |
$41.02
|
| Rate for Payer: Cofinity Commercial |
$50.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.88
|
| Rate for Payer: Healthscope Commercial |
$52.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.09
|
| Rate for Payer: Priority Health SBD |
$36.92
|
| Rate for Payer: UMR Bronson Commercial |
$25.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.95
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT
|
Facility
|
OP
|
$733.42
|
|
|
Service Code
|
NDC 00078077101
|
| Hospital Charge Code |
19495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$271.37 |
| Max. Negotiated Rate |
$660.08 |
| Rate for Payer: Aetna American Axle |
$476.72
|
| Rate for Payer: Aetna Commercial |
$623.41
|
| Rate for Payer: Aetna Medicare |
$366.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$476.72
|
| Rate for Payer: BCBS Complete |
$293.37
|
| Rate for Payer: Cash Price |
$586.74
|
| Rate for Payer: Cofinity Commercial |
$513.39
|
| Rate for Payer: Cofinity Commercial |
$630.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$513.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$586.74
|
| Rate for Payer: Healthscope Commercial |
$660.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$513.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$550.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$623.41
|
| Rate for Payer: PHP Commercial |
$623.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$476.72
|
| Rate for Payer: Priority Health SBD |
$462.05
|
| Rate for Payer: UMR Bronson Commercial |
$271.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$550.06
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT
|
Facility
|
IP
|
$733.42
|
|
|
Service Code
|
NDC 00078077101
|
| Hospital Charge Code |
19495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$322.70 |
| Max. Negotiated Rate |
$660.08 |
| Rate for Payer: Aetna American Axle |
$476.72
|
| Rate for Payer: Aetna Commercial |
$623.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$476.72
|
| Rate for Payer: Cash Price |
$586.74
|
| Rate for Payer: Cofinity Commercial |
$513.39
|
| Rate for Payer: Cofinity Commercial |
$630.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$513.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$586.74
|
| Rate for Payer: Healthscope Commercial |
$660.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$513.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$550.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$623.41
|
| Rate for Payer: PHP Commercial |
$623.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$476.72
|
| Rate for Payer: Priority Health SBD |
$462.05
|
| Rate for Payer: UMR Bronson Commercial |
$322.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$550.06
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT
|
Facility
|
OP
|
$46.73
|
|
|
Service Code
|
NDC 24208079535
|
| Hospital Charge Code |
19495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.29 |
| Max. Negotiated Rate |
$42.06 |
| Rate for Payer: Aetna American Axle |
$30.37
|
| Rate for Payer: Aetna Commercial |
$39.72
|
| Rate for Payer: Aetna Medicare |
$23.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.37
|
| Rate for Payer: BCBS Complete |
$18.69
|
| Rate for Payer: Cash Price |
$37.38
|
| Rate for Payer: Cofinity Commercial |
$32.71
|
| Rate for Payer: Cofinity Commercial |
$40.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.38
|
| Rate for Payer: Healthscope Commercial |
$42.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.72
|
| Rate for Payer: PHP Commercial |
$39.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.37
|
| Rate for Payer: Priority Health SBD |
$29.44
|
| Rate for Payer: UMR Bronson Commercial |
$17.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.05
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT
|
Facility
|
OP
|
$58.60
|
|
|
Service Code
|
NDC 61314063136
|
| Hospital Charge Code |
19495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.68 |
| Max. Negotiated Rate |
$52.74 |
| Rate for Payer: Aetna American Axle |
$38.09
|
| Rate for Payer: Aetna Commercial |
$49.81
|
| Rate for Payer: Aetna Medicare |
$29.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.09
|
| Rate for Payer: BCBS Complete |
$23.44
|
| Rate for Payer: Cash Price |
$46.88
|
| Rate for Payer: Cofinity Commercial |
$41.02
|
| Rate for Payer: Cofinity Commercial |
$50.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.88
|
| Rate for Payer: Healthscope Commercial |
$52.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.81
|
| Rate for Payer: PHP Commercial |
$49.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.09
|
| Rate for Payer: Priority Health SBD |
$36.92
|
| Rate for Payer: UMR Bronson Commercial |
$21.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.95
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT
|
Facility
|
IP
|
$46.73
|
|
|
Service Code
|
NDC 24208079535
|
| Hospital Charge Code |
19495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.56 |
| Max. Negotiated Rate |
$42.06 |
| Rate for Payer: Aetna American Axle |
$30.37
|
| Rate for Payer: Aetna Commercial |
$39.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.37
|
| Rate for Payer: Cash Price |
$37.38
|
| Rate for Payer: Cofinity Commercial |
$32.71
|
| Rate for Payer: Cofinity Commercial |
$40.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.38
|
| Rate for Payer: Healthscope Commercial |
$42.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.72
|
| Rate for Payer: PHP Commercial |
$39.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.37
|
| Rate for Payer: Priority Health SBD |
$29.44
|
| Rate for Payer: UMR Bronson Commercial |
$20.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.05
|
|
