|
ASCORBIC ACID (VITAMIN C) 250 MG TABLET
|
Facility
|
IP
|
$2.11
|
|
|
Service Code
|
NDC 50268086011
|
| Hospital Charge Code |
663
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Aetna American Axle |
$1.37
|
| Rate for Payer: Aetna Commercial |
$1.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.37
|
| Rate for Payer: Cash Price |
$1.69
|
| Rate for Payer: Cofinity Commercial |
$1.48
|
| Rate for Payer: Cofinity Commercial |
$1.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.69
|
| Rate for Payer: Healthscope Commercial |
$1.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.79
|
| Rate for Payer: PHP Commercial |
$1.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.37
|
| Rate for Payer: Priority Health SBD |
$1.33
|
| Rate for Payer: UMR Bronson Commercial |
$0.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.58
|
|
|
ASCORBIC ACID (VITAMIN C) 250 MG TABLET
|
Facility
|
OP
|
$105.05
|
|
|
Service Code
|
NDC 50268086015
|
| Hospital Charge Code |
663
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.87 |
| Max. Negotiated Rate |
$94.55 |
| Rate for Payer: Aetna American Axle |
$68.28
|
| Rate for Payer: Aetna Commercial |
$89.29
|
| Rate for Payer: Aetna Medicare |
$52.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.28
|
| Rate for Payer: BCBS Complete |
$42.02
|
| Rate for Payer: Cash Price |
$84.04
|
| Rate for Payer: Cofinity Commercial |
$73.53
|
| Rate for Payer: Cofinity Commercial |
$90.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.04
|
| Rate for Payer: Healthscope Commercial |
$94.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.29
|
| Rate for Payer: PHP Commercial |
$89.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.28
|
| Rate for Payer: Priority Health SBD |
$66.18
|
| Rate for Payer: UMR Bronson Commercial |
$38.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.79
|
|
|
ASCORBIC ACID (VITAMIN C) 250 MG TABLET
|
Facility
|
IP
|
$132.30
|
|
|
Service Code
|
NDC 96295012843
|
| Hospital Charge Code |
663
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.21 |
| Max. Negotiated Rate |
$119.07 |
| Rate for Payer: Aetna American Axle |
$86.00
|
| Rate for Payer: Aetna Commercial |
$112.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.00
|
| Rate for Payer: Cash Price |
$105.84
|
| Rate for Payer: Cofinity Commercial |
$113.78
|
| Rate for Payer: Cofinity Commercial |
$92.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.84
|
| Rate for Payer: Healthscope Commercial |
$119.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.45
|
| Rate for Payer: PHP Commercial |
$112.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.00
|
| Rate for Payer: Priority Health SBD |
$83.35
|
| Rate for Payer: UMR Bronson Commercial |
$58.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.22
|
|
|
ASCORBIC ACID (VITAMIN C) 250 MG TABLET
|
Facility
|
OP
|
$132.30
|
|
|
Service Code
|
NDC 96295012843
|
| Hospital Charge Code |
663
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.95 |
| Max. Negotiated Rate |
$119.07 |
| Rate for Payer: Aetna American Axle |
$86.00
|
| Rate for Payer: Aetna Commercial |
$112.45
|
| Rate for Payer: Aetna Medicare |
$66.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.00
|
| Rate for Payer: BCBS Complete |
$52.92
|
| Rate for Payer: Cash Price |
$105.84
|
| Rate for Payer: Cofinity Commercial |
$113.78
|
| Rate for Payer: Cofinity Commercial |
$92.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.84
|
| Rate for Payer: Healthscope Commercial |
$119.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.45
|
| Rate for Payer: PHP Commercial |
$112.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.00
|
| Rate for Payer: Priority Health SBD |
$83.35
|
| Rate for Payer: UMR Bronson Commercial |
$48.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.22
|
|
|
ASCORBIC ACID (VITAMIN C) 250 MG TABLET
|
Facility
|
IP
|
$138.60
|
|
|
Service Code
|
NDC 57896083101
|
| Hospital Charge Code |
663
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.98 |
| Max. Negotiated Rate |
$124.74 |
| Rate for Payer: Aetna American Axle |
$90.09
|
| Rate for Payer: Aetna Commercial |
$117.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.09
|
| Rate for Payer: Cash Price |
$110.88
|
| Rate for Payer: Cofinity Commercial |
$119.20
|
| Rate for Payer: Cofinity Commercial |
$97.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$97.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.88
|
| Rate for Payer: Healthscope Commercial |
$124.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.81
|
| Rate for Payer: PHP Commercial |
$117.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.09
|
| Rate for Payer: Priority Health SBD |
$87.32
|
| Rate for Payer: UMR Bronson Commercial |
$60.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.95
|
|
|
ASCORBIC ACID (VITAMIN C) 250 MG TABLET
|
Facility
|
IP
|
$94.50
|
|
|
Service Code
|
NDC 20555000100
|
| Hospital Charge Code |
663
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.58 |
| Max. Negotiated Rate |
$85.05 |
| Rate for Payer: Aetna American Axle |
$61.42
|
| Rate for Payer: Aetna Commercial |
$80.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.42
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cofinity Commercial |
$66.15
|
| Rate for Payer: Cofinity Commercial |
$81.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.60
|
| Rate for Payer: Healthscope Commercial |
$85.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.33
|
| Rate for Payer: PHP Commercial |
$80.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.42
|
| Rate for Payer: Priority Health SBD |
$59.53
|
| Rate for Payer: UMR Bronson Commercial |
$41.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.88
|
|
|
ASCORBIC ACID (VITAMIN C) 250 MG TABLET
|
Facility
|
OP
|
$94.50
|
|
|
Service Code
|
NDC 20555000100
|
| Hospital Charge Code |
663
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.97 |
| Max. Negotiated Rate |
$85.05 |
| Rate for Payer: Aetna American Axle |
$61.42
|
| Rate for Payer: Aetna Commercial |
$80.33
|
| Rate for Payer: Aetna Medicare |
$47.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.42
|
| Rate for Payer: BCBS Complete |
$37.80
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cofinity Commercial |
$66.15
|
| Rate for Payer: Cofinity Commercial |
$81.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.60
|
| Rate for Payer: Healthscope Commercial |
$85.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.33
|
| Rate for Payer: PHP Commercial |
$80.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.42
|
| Rate for Payer: Priority Health SBD |
$59.53
|
| Rate for Payer: UMR Bronson Commercial |
$34.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.88
|
|
|
ASCORBIC ACID (VITAMIN C) 250 MG TABLET
|
Facility
|
IP
|
$105.05
|
|
|
Service Code
|
NDC 50268086015
|
| Hospital Charge Code |
663
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.22 |
| Max. Negotiated Rate |
$94.55 |
| Rate for Payer: Aetna American Axle |
$68.28
|
| Rate for Payer: Aetna Commercial |
$89.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.28
|
| Rate for Payer: Cash Price |
$84.04
|
| Rate for Payer: Cofinity Commercial |
$73.53
|
| Rate for Payer: Cofinity Commercial |
$90.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.04
|
| Rate for Payer: Healthscope Commercial |
$94.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.29
|
| Rate for Payer: PHP Commercial |
$89.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.28
|
| Rate for Payer: Priority Health SBD |
$66.18
|
| Rate for Payer: UMR Bronson Commercial |
$46.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.79
|
|
|
ASCORBIC ACID (VITAMIN C) 250 MG TABLET
|
Facility
|
OP
|
$138.60
|
|
|
Service Code
|
NDC 57896083101
|
| Hospital Charge Code |
663
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.28 |
| Max. Negotiated Rate |
$124.74 |
| Rate for Payer: Aetna American Axle |
$90.09
|
| Rate for Payer: Aetna Commercial |
$117.81
|
| Rate for Payer: Aetna Medicare |
$69.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.09
|
| Rate for Payer: BCBS Complete |
$55.44
|
| Rate for Payer: Cash Price |
$110.88
|
| Rate for Payer: Cofinity Commercial |
$119.20
|
| Rate for Payer: Cofinity Commercial |
$97.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$97.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.88
|
| Rate for Payer: Healthscope Commercial |
$124.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.81
|
| Rate for Payer: PHP Commercial |
$117.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.09
|
| Rate for Payer: Priority Health SBD |
$87.32
|
| Rate for Payer: UMR Bronson Commercial |
$51.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.95
|
|
|
ASCORBIC ACID (VITAMIN C) 250 MG TABLET
|
Facility
|
OP
|
$2.11
|
|
|
Service Code
|
NDC 50268086011
|
| Hospital Charge Code |
663
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Aetna American Axle |
$1.37
|
| Rate for Payer: Aetna Commercial |
$1.79
|
| Rate for Payer: Aetna Medicare |
$1.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.37
|
| Rate for Payer: BCBS Complete |
$0.84
|
| Rate for Payer: Cash Price |
$1.69
|
| Rate for Payer: Cofinity Commercial |
$1.48
|
| Rate for Payer: Cofinity Commercial |
$1.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.69
|
| Rate for Payer: Healthscope Commercial |
$1.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.79
|
| Rate for Payer: PHP Commercial |
$1.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.37
|
| Rate for Payer: Priority Health SBD |
$1.33
|
| Rate for Payer: UMR Bronson Commercial |
$0.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.58
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$292.17
|
|
|
Service Code
|
NDC 71414011501
|
| Hospital Charge Code |
654
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$108.10 |
| Max. Negotiated Rate |
$262.95 |
| Rate for Payer: Aetna American Axle |
$189.91
|
| Rate for Payer: Aetna Commercial |
$248.34
|
| Rate for Payer: Aetna Medicare |
$146.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.91
|
| Rate for Payer: BCBS Complete |
$116.87
|
| Rate for Payer: Cash Price |
$233.74
|
| Rate for Payer: Cofinity Commercial |
$204.52
|
| Rate for Payer: Cofinity Commercial |
$251.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$204.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.74
|
| Rate for Payer: Healthscope Commercial |
$262.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$204.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$219.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.34
|
| Rate for Payer: PHP Commercial |
$248.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.91
|
| Rate for Payer: Priority Health SBD |
$184.07
|
| Rate for Payer: UMR Bronson Commercial |
$108.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$219.13
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$292.17
|
|
|
Service Code
|
NDC 71414011501
|
| Hospital Charge Code |
654
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$128.55 |
| Max. Negotiated Rate |
$262.95 |
| Rate for Payer: Aetna American Axle |
$189.91
|
| Rate for Payer: Aetna Commercial |
$248.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.91
|
| Rate for Payer: Cash Price |
$233.74
|
| Rate for Payer: Cofinity Commercial |
$204.52
|
| Rate for Payer: Cofinity Commercial |
$251.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$204.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.74
|
| Rate for Payer: Healthscope Commercial |
$262.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$204.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$219.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.34
|
| Rate for Payer: PHP Commercial |
$248.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.91
|
| Rate for Payer: Priority Health SBD |
$184.07
|
| Rate for Payer: UMR Bronson Commercial |
$128.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$219.13
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$291.28
|
|
|
Service Code
|
NDC 67457011850
|
| Hospital Charge Code |
654
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$128.16 |
| Max. Negotiated Rate |
$262.15 |
| Rate for Payer: Aetna American Axle |
$189.33
|
| Rate for Payer: Aetna Commercial |
$247.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.33
|
| Rate for Payer: Cash Price |
$233.02
|
| Rate for Payer: Cofinity Commercial |
$203.90
|
| Rate for Payer: Cofinity Commercial |
$250.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$203.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.02
|
| Rate for Payer: Healthscope Commercial |
$262.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.59
|
| Rate for Payer: PHP Commercial |
$247.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.33
|
| Rate for Payer: Priority Health SBD |
$183.51
|
| Rate for Payer: UMR Bronson Commercial |
$128.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.46
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$291.28
|
|
|
Service Code
|
NDC 67457011850
|
| Hospital Charge Code |
654
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$107.77 |
| Max. Negotiated Rate |
$262.15 |
| Rate for Payer: Aetna American Axle |
$189.33
|
| Rate for Payer: Aetna Commercial |
$247.59
|
| Rate for Payer: Aetna Medicare |
$145.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.33
|
| Rate for Payer: BCBS Complete |
$116.51
|
| Rate for Payer: Cash Price |
$233.02
|
| Rate for Payer: Cofinity Commercial |
$203.90
|
| Rate for Payer: Cofinity Commercial |
$250.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$203.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.02
|
| Rate for Payer: Healthscope Commercial |
$262.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.59
|
| Rate for Payer: PHP Commercial |
$247.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.33
|
| Rate for Payer: Priority Health SBD |
$183.51
|
| Rate for Payer: UMR Bronson Commercial |
$107.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.46
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,119.85
|
|
|
Service Code
|
NDC 67157010151
|
| Hospital Charge Code |
186102
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$414.34 |
| Max. Negotiated Rate |
$1,007.87 |
| Rate for Payer: Aetna American Axle |
$727.90
|
| Rate for Payer: Aetna Commercial |
$951.87
|
| Rate for Payer: Aetna Medicare |
$559.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$727.90
|
| Rate for Payer: BCBS Complete |
$447.94
|
| Rate for Payer: Cash Price |
$895.88
|
| Rate for Payer: Cofinity Commercial |
$783.89
|
| Rate for Payer: Cofinity Commercial |
$963.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$783.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$895.88
|
| Rate for Payer: Healthscope Commercial |
$1,007.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$783.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$839.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$951.87
|
| Rate for Payer: PHP Commercial |
$951.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$727.90
|
| Rate for Payer: Priority Health SBD |
$705.51
|
| Rate for Payer: UMR Bronson Commercial |
$414.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$839.89
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,119.85
|
|
|
Service Code
|
NDC 67157010150
|
| Hospital Charge Code |
186102
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$414.34 |
| Max. Negotiated Rate |
$1,007.87 |
| Rate for Payer: Aetna American Axle |
$727.90
|
| Rate for Payer: Aetna Commercial |
$951.87
|
| Rate for Payer: Aetna Medicare |
$559.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$727.90
|
| Rate for Payer: BCBS Complete |
$447.94
|
| Rate for Payer: Cash Price |
$895.88
|
| Rate for Payer: Cofinity Commercial |
$783.89
|
| Rate for Payer: Cofinity Commercial |
$963.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$783.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$895.88
|
| Rate for Payer: Healthscope Commercial |
$1,007.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$783.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$839.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$951.87
|
| Rate for Payer: PHP Commercial |
$951.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$727.90
|
| Rate for Payer: Priority Health SBD |
$705.51
|
| Rate for Payer: UMR Bronson Commercial |
$414.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$839.89
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG TABLET
|
Facility
|
OP
|
$72.85
|
|
|
Service Code
|
NDC 00904052360
|
| Hospital Charge Code |
664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$65.56 |
| Rate for Payer: Aetna American Axle |
$47.35
|
| Rate for Payer: Aetna Commercial |
$61.92
|
| Rate for Payer: Aetna Medicare |
$36.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.35
|
| Rate for Payer: BCBS Complete |
$29.14
|
| Rate for Payer: Cash Price |
$58.28
|
| Rate for Payer: Cofinity Commercial |
$50.99
|
| Rate for Payer: Cofinity Commercial |
$62.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.28
|
| Rate for Payer: Healthscope Commercial |
$65.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.92
|
| Rate for Payer: PHP Commercial |
$61.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.35
|
| Rate for Payer: Priority Health SBD |
$45.90
|
| Rate for Payer: UMR Bronson Commercial |
$26.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.64
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG TABLET
|
Facility
|
IP
|
$72.85
|
|
|
Service Code
|
NDC 00904052360
|
| Hospital Charge Code |
664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.05 |
| Max. Negotiated Rate |
$65.56 |
| Rate for Payer: Aetna American Axle |
$47.35
|
| Rate for Payer: Aetna Commercial |
$61.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.35
|
| Rate for Payer: Cash Price |
$58.28
|
| Rate for Payer: Cofinity Commercial |
$50.99
|
| Rate for Payer: Cofinity Commercial |
$62.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.28
|
| Rate for Payer: Healthscope Commercial |
$65.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.92
|
| Rate for Payer: PHP Commercial |
$61.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.35
|
| Rate for Payer: Priority Health SBD |
$45.90
|
| Rate for Payer: UMR Bronson Commercial |
$32.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.64
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG TABLET
|
Facility
|
OP
|
$70.50
|
|
|
Service Code
|
NDC 00904052361
|
| Hospital Charge Code |
664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.09 |
| Max. Negotiated Rate |
$63.45 |
| Rate for Payer: Aetna American Axle |
$45.83
|
| Rate for Payer: Aetna Commercial |
$59.92
|
| Rate for Payer: Aetna Medicare |
$35.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.83
|
| Rate for Payer: BCBS Complete |
$28.20
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cofinity Commercial |
$49.35
|
| Rate for Payer: Cofinity Commercial |
$60.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.40
|
| Rate for Payer: Healthscope Commercial |
$63.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.92
|
| Rate for Payer: PHP Commercial |
$59.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.83
|
| Rate for Payer: Priority Health SBD |
$44.41
|
| Rate for Payer: UMR Bronson Commercial |
$26.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.88
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG TABLET
|
Facility
|
IP
|
$70.50
|
|
|
Service Code
|
NDC 00904052361
|
| Hospital Charge Code |
664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.02 |
| Max. Negotiated Rate |
$63.45 |
| Rate for Payer: Aetna American Axle |
$45.83
|
| Rate for Payer: Aetna Commercial |
$59.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.83
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cofinity Commercial |
$49.35
|
| Rate for Payer: Cofinity Commercial |
$60.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.40
|
| Rate for Payer: Healthscope Commercial |
$63.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.92
|
| Rate for Payer: PHP Commercial |
$59.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.83
|
| Rate for Payer: Priority Health SBD |
$44.41
|
| Rate for Payer: UMR Bronson Commercial |
$31.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.88
|
|
|
ASENAPINE 5 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$4,336.33
|
|
|
Service Code
|
NDC 00456240560
|
| Hospital Charge Code |
99754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,604.44 |
| Max. Negotiated Rate |
$3,902.70 |
| Rate for Payer: Aetna American Axle |
$2,818.61
|
| Rate for Payer: Aetna Commercial |
$3,685.88
|
| Rate for Payer: Aetna Medicare |
$2,168.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,818.61
|
| Rate for Payer: BCBS Complete |
$1,734.53
|
| Rate for Payer: Cash Price |
$3,469.06
|
| Rate for Payer: Cofinity Commercial |
$3,035.43
|
| Rate for Payer: Cofinity Commercial |
$3,729.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,035.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,469.06
|
| Rate for Payer: Healthscope Commercial |
$3,902.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,035.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,252.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,685.88
|
| Rate for Payer: PHP Commercial |
$3,685.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,818.61
|
| Rate for Payer: Priority Health SBD |
$2,731.89
|
| Rate for Payer: UMR Bronson Commercial |
$1,604.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,252.25
|
|
|
ASENAPINE 5 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$1,052.95
|
|
|
Service Code
|
NDC 51991035860
|
| Hospital Charge Code |
99754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$463.30 |
| Max. Negotiated Rate |
$947.65 |
| Rate for Payer: Aetna American Axle |
$684.42
|
| Rate for Payer: Aetna Commercial |
$895.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$684.42
|
| Rate for Payer: Cash Price |
$842.36
|
| Rate for Payer: Cofinity Commercial |
$737.07
|
| Rate for Payer: Cofinity Commercial |
$905.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$737.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$842.36
|
| Rate for Payer: Healthscope Commercial |
$947.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$737.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$789.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$895.01
|
| Rate for Payer: PHP Commercial |
$895.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$684.42
|
| Rate for Payer: Priority Health SBD |
$663.36
|
| Rate for Payer: UMR Bronson Commercial |
$463.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$789.71
|
|
|
ASENAPINE 5 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$4,336.33
|
|
|
Service Code
|
NDC 00456240560
|
| Hospital Charge Code |
99754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,907.99 |
| Max. Negotiated Rate |
$3,902.70 |
| Rate for Payer: Aetna American Axle |
$2,818.61
|
| Rate for Payer: Aetna Commercial |
$3,685.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,818.61
|
| Rate for Payer: Cash Price |
$3,469.06
|
| Rate for Payer: Cofinity Commercial |
$3,035.43
|
| Rate for Payer: Cofinity Commercial |
$3,729.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,035.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,469.06
|
| Rate for Payer: Healthscope Commercial |
$3,902.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,035.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,252.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,685.88
|
| Rate for Payer: PHP Commercial |
$3,685.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,818.61
|
| Rate for Payer: Priority Health SBD |
$2,731.89
|
| Rate for Payer: UMR Bronson Commercial |
$1,907.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,252.25
|
|
|
ASENAPINE 5 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$69.29
|
|
|
Service Code
|
NDC 00456240511
|
| Hospital Charge Code |
99754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.49 |
| Max. Negotiated Rate |
$62.36 |
| Rate for Payer: Aetna American Axle |
$45.04
|
| Rate for Payer: Aetna Commercial |
$58.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.04
|
| Rate for Payer: Cash Price |
$55.43
|
| Rate for Payer: Cofinity Commercial |
$48.50
|
| Rate for Payer: Cofinity Commercial |
$59.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.43
|
| Rate for Payer: Healthscope Commercial |
$62.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.90
|
| Rate for Payer: PHP Commercial |
$58.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.04
|
| Rate for Payer: Priority Health SBD |
$43.65
|
| Rate for Payer: UMR Bronson Commercial |
$30.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.97
|
|
|
ASENAPINE 5 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$722.73
|
|
|
Service Code
|
NDC 00456240506
|
| Hospital Charge Code |
99754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$267.41 |
| Max. Negotiated Rate |
$650.46 |
| Rate for Payer: Aetna American Axle |
$469.77
|
| Rate for Payer: Aetna Commercial |
$614.32
|
| Rate for Payer: Aetna Medicare |
$361.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$469.77
|
| Rate for Payer: BCBS Complete |
$289.09
|
| Rate for Payer: Cash Price |
$578.18
|
| Rate for Payer: Cofinity Commercial |
$505.91
|
| Rate for Payer: Cofinity Commercial |
$621.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$505.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$578.18
|
| Rate for Payer: Healthscope Commercial |
$650.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$505.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$542.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$614.32
|
| Rate for Payer: PHP Commercial |
$614.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$469.77
|
| Rate for Payer: Priority Health SBD |
$455.32
|
| Rate for Payer: UMR Bronson Commercial |
$267.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$542.05
|
|
