|
PARENTERAL AMINO ACID 10 % COMBINATION NO.6 INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$43.50
|
|
|
Service Code
|
NDC 00338064406
|
| Hospital Charge Code |
117996
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.09 |
| Max. Negotiated Rate |
$39.15 |
| Rate for Payer: Aetna American Axle |
$28.27
|
| Rate for Payer: Aetna Commercial |
$36.98
|
| Rate for Payer: Aetna Medicare |
$21.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.27
|
| Rate for Payer: BCBS Complete |
$17.40
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cofinity Advantage |
$30.45
|
| Rate for Payer: Cofinity Commercial |
$37.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.80
|
| Rate for Payer: Healthscope Commercial |
$39.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.62
|
| Rate for Payer: PHP Commercial |
$36.98
|
| Rate for Payer: Priority Health SBD |
$27.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.27
|
| Rate for Payer: UHC Core |
$22.66
|
| Rate for Payer: UHC Exchange |
$17.10
|
| Rate for Payer: UMR Bronson Commercial |
$16.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.62
|
|
|
PARENTERAL AMINO ACID 10 % COMBINATION NO.6 INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$43.50
|
|
|
Service Code
|
NDC 00338064406
|
| Hospital Charge Code |
117996
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.14 |
| Max. Negotiated Rate |
$39.15 |
| Rate for Payer: Aetna American Axle |
$28.27
|
| Rate for Payer: Aetna Commercial |
$36.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.27
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cofinity Advantage |
$30.45
|
| Rate for Payer: Cofinity Commercial |
$37.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.80
|
| Rate for Payer: Healthscope Commercial |
$39.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.62
|
| Rate for Payer: PHP Commercial |
$36.98
|
| Rate for Payer: Priority Health SBD |
$27.41
|
| Rate for Payer: UMR Bronson Commercial |
$19.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.62
|
|
|
PARENTERAL AMINO ACID 10 % COMBINATION NO.7 INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,550.00
|
|
|
Service Code
|
NDC 00338113006
|
| Hospital Charge Code |
118122
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$573.50 |
| Max. Negotiated Rate |
$1,395.00 |
| Rate for Payer: Aetna American Axle |
$1,007.50
|
| Rate for Payer: Aetna Commercial |
$1,317.50
|
| Rate for Payer: Aetna Medicare |
$775.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,007.50
|
| Rate for Payer: BCBS Complete |
$620.00
|
| Rate for Payer: Cash Price |
$1,240.00
|
| Rate for Payer: Cofinity Advantage |
$1,085.00
|
| Rate for Payer: Cofinity Commercial |
$1,333.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,240.00
|
| Rate for Payer: Healthscope Commercial |
$1,395.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,085.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,162.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,240.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,317.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,162.50
|
| Rate for Payer: PHP Commercial |
$1,317.50
|
| Rate for Payer: Priority Health SBD |
$976.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,007.50
|
| Rate for Payer: UHC Core |
$807.55
|
| Rate for Payer: UHC Exchange |
$609.15
|
| Rate for Payer: UMR Bronson Commercial |
$573.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,162.50
|
|
|
PARENTERAL AMINO ACID 10 % COMBINATION NO.7 INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,550.00
|
|
|
Service Code
|
NDC 00338113006
|
| Hospital Charge Code |
118122
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$682.00 |
| Max. Negotiated Rate |
$1,395.00 |
| Rate for Payer: Aetna American Axle |
$1,007.50
|
| Rate for Payer: Aetna Commercial |
$1,317.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,007.50
|
| Rate for Payer: Cash Price |
$1,240.00
|
| Rate for Payer: Cofinity Advantage |
$1,085.00
|
| Rate for Payer: Cofinity Commercial |
$1,333.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,240.00
|
| Rate for Payer: Healthscope Commercial |
$1,395.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,085.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,162.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,317.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,162.50
|
| Rate for Payer: PHP Commercial |
$1,317.50
|
| Rate for Payer: Priority Health SBD |
$976.50
|
| Rate for Payer: UMR Bronson Commercial |
$682.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,162.50
|
|
|
PARENTERAL AMINO ACID 10 % COMBINATION NO.7 INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
NDC 00338113004
|
| Hospital Charge Code |
118122
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$333.00 |
| Max. Negotiated Rate |
$810.00 |
| Rate for Payer: Aetna American Axle |
$585.00
|
| Rate for Payer: Aetna Commercial |
$765.00
|
| Rate for Payer: Aetna Medicare |
$450.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$585.00
|
| Rate for Payer: BCBS Complete |
$360.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cofinity Advantage |
$630.00
|
| Rate for Payer: Cofinity Commercial |
$774.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$720.00
|
| Rate for Payer: Healthscope Commercial |
$810.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$630.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$675.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$720.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$765.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$675.00
|
| Rate for Payer: PHP Commercial |
$765.00
|
| Rate for Payer: Priority Health SBD |
$567.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$585.00
|
| Rate for Payer: UHC Core |
$468.90
|
| Rate for Payer: UHC Exchange |
$353.70
|
| Rate for Payer: UMR Bronson Commercial |
$333.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$675.00
|
|
|
PARENTERAL AMINO ACID 10 % COMBINATION NO.7 INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
NDC 00338113004
|
| Hospital Charge Code |
118122
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$396.00 |
| Max. Negotiated Rate |
$810.00 |
| Rate for Payer: Aetna American Axle |
$585.00
|
| Rate for Payer: Aetna Commercial |
$765.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$585.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cofinity Advantage |
$630.00
|
| Rate for Payer: Cofinity Commercial |
$774.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$720.00
|
| Rate for Payer: Healthscope Commercial |
$810.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$630.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$675.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$765.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$675.00
|
| Rate for Payer: PHP Commercial |
$765.00
|
| Rate for Payer: Priority Health SBD |
$567.00
|
| Rate for Payer: UMR Bronson Commercial |
$396.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$675.00
|
|
|
PARENTERAL AMINO ACID 15 % COMBINATION NO.5 INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$87.73
|
|
|
Service Code
|
NDC 00338050203
|
| Hospital Charge Code |
188047
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.60 |
| Max. Negotiated Rate |
$78.96 |
| Rate for Payer: Aetna American Axle |
$57.02
|
| Rate for Payer: Aetna Commercial |
$74.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.02
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cofinity Advantage |
$61.41
|
| Rate for Payer: Cofinity Commercial |
$75.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.18
|
| Rate for Payer: Healthscope Commercial |
$78.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.80
|
| Rate for Payer: PHP Commercial |
$74.57
|
| Rate for Payer: Priority Health SBD |
$55.27
|
| Rate for Payer: UMR Bronson Commercial |
$38.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.80
|
|
|
PARENTERAL AMINO ACID 15 % COMBINATION NO.5 INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$87.73
|
|
|
Service Code
|
NDC 00338050203
|
| Hospital Charge Code |
188047
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.46 |
| Max. Negotiated Rate |
$78.96 |
| Rate for Payer: Aetna American Axle |
$57.02
|
| Rate for Payer: Aetna Commercial |
$74.57
|
| Rate for Payer: Aetna Medicare |
$43.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.02
|
| Rate for Payer: BCBS Complete |
$35.09
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cofinity Advantage |
$61.41
|
| Rate for Payer: Cofinity Commercial |
$75.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.18
|
| Rate for Payer: Healthscope Commercial |
$78.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.80
|
| Rate for Payer: PHP Commercial |
$74.57
|
| Rate for Payer: Priority Health SBD |
$55.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.02
|
| Rate for Payer: UHC Core |
$45.71
|
| Rate for Payer: UHC Exchange |
$34.48
|
| Rate for Payer: UMR Bronson Commercial |
$32.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.80
|
|
|
PARENTERAL AMINO ACID 15 % COMBINATION NO.5 INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$72.50
|
|
|
Service Code
|
NDC 00338050206
|
| Hospital Charge Code |
188047
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.90 |
| Max. Negotiated Rate |
$65.25 |
| Rate for Payer: Aetna American Axle |
$47.12
|
| Rate for Payer: Aetna Commercial |
$61.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.12
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cofinity Advantage |
$50.75
|
| Rate for Payer: Cofinity Commercial |
$62.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.00
|
| Rate for Payer: Healthscope Commercial |
$65.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.38
|
| Rate for Payer: PHP Commercial |
$61.62
|
| Rate for Payer: Priority Health SBD |
$45.67
|
| Rate for Payer: UMR Bronson Commercial |
$31.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.38
|
|
|
PARENTERAL AMINO ACID 15 % COMBINATION NO.5 INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$72.50
|
|
|
Service Code
|
NDC 00338050206
|
| Hospital Charge Code |
188047
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.82 |
| Max. Negotiated Rate |
$65.25 |
| Rate for Payer: Aetna American Axle |
$47.12
|
| Rate for Payer: Aetna Commercial |
$61.62
|
| Rate for Payer: Aetna Medicare |
$36.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.12
|
| Rate for Payer: BCBS Complete |
$29.00
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cofinity Advantage |
$50.75
|
| Rate for Payer: Cofinity Commercial |
$62.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.00
|
| Rate for Payer: Healthscope Commercial |
$65.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.38
|
| Rate for Payer: PHP Commercial |
$61.62
|
| Rate for Payer: Priority Health SBD |
$45.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.12
|
| Rate for Payer: UHC Core |
$37.77
|
| Rate for Payer: UHC Exchange |
$28.49
|
| Rate for Payer: UMR Bronson Commercial |
$26.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.38
|
|
|
PARENTERAL AMINO ACID 8.5 % COMBINATION NO.3 INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$11.60
|
|
|
Service Code
|
NDC 00409416203
|
| Hospital Charge Code |
172719
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$10.44 |
| Rate for Payer: Aetna American Axle |
$7.54
|
| Rate for Payer: Aetna Commercial |
$9.86
|
| Rate for Payer: Aetna Medicare |
$5.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.54
|
| Rate for Payer: BCBS Complete |
$4.64
|
| Rate for Payer: Cash Price |
$9.28
|
| Rate for Payer: Cofinity Advantage |
$8.12
|
| Rate for Payer: Cofinity Commercial |
$9.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.28
|
| Rate for Payer: Healthscope Commercial |
$10.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.70
|
| Rate for Payer: PHP Commercial |
$9.86
|
| Rate for Payer: Priority Health SBD |
$7.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.54
|
| Rate for Payer: UHC Core |
$6.04
|
| Rate for Payer: UHC Exchange |
$4.56
|
| Rate for Payer: UMR Bronson Commercial |
$4.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.70
|
|
|
PARENTERAL AMINO ACID 8.5 % COMBINATION NO.3 INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$11.60
|
|
|
Service Code
|
NDC 409416203
|
| Hospital Charge Code |
172719
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$10.44 |
| Rate for Payer: Aetna American Axle |
$7.54
|
| Rate for Payer: Aetna Commercial |
$9.86
|
| Rate for Payer: Aetna Medicare |
$5.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.54
|
| Rate for Payer: BCBS Complete |
$4.64
|
| Rate for Payer: Cash Price |
$9.28
|
| Rate for Payer: Cofinity Advantage |
$8.12
|
| Rate for Payer: Cofinity Commercial |
$9.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.28
|
| Rate for Payer: Healthscope Commercial |
$10.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.70
|
| Rate for Payer: PHP Commercial |
$9.86
|
| Rate for Payer: Priority Health SBD |
$7.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.54
|
| Rate for Payer: UHC Core |
$6.04
|
| Rate for Payer: UHC Exchange |
$4.56
|
| Rate for Payer: UMR Bronson Commercial |
$4.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.70
|
|
|
PARENTERAL AMINO ACID 8.5 % COMBINATION NO.3 INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$11.60
|
|
|
Service Code
|
NDC 00409416203
|
| Hospital Charge Code |
172719
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$10.44 |
| Rate for Payer: Aetna American Axle |
$7.54
|
| Rate for Payer: Aetna Commercial |
$9.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.54
|
| Rate for Payer: Cash Price |
$9.28
|
| Rate for Payer: Cofinity Advantage |
$8.12
|
| Rate for Payer: Cofinity Commercial |
$9.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.28
|
| Rate for Payer: Healthscope Commercial |
$10.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.70
|
| Rate for Payer: PHP Commercial |
$9.86
|
| Rate for Payer: Priority Health SBD |
$7.31
|
| Rate for Payer: UMR Bronson Commercial |
$5.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.70
|
|
|
PARICALCITOL 1 MCG CAPSULE
|
Facility
|
OP
|
$133.92
|
|
|
Service Code
|
NDC 49483068703
|
| Hospital Charge Code |
41497
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.55 |
| Max. Negotiated Rate |
$120.53 |
| Rate for Payer: Aetna American Axle |
$87.05
|
| Rate for Payer: Aetna Commercial |
$113.83
|
| Rate for Payer: Aetna Medicare |
$66.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.05
|
| Rate for Payer: BCBS Complete |
$53.57
|
| Rate for Payer: Cash Price |
$107.14
|
| Rate for Payer: Cofinity Advantage |
$93.74
|
| Rate for Payer: Cofinity Commercial |
$115.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.14
|
| Rate for Payer: Healthscope Commercial |
$120.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.44
|
| Rate for Payer: PHP Commercial |
$113.83
|
| Rate for Payer: Priority Health SBD |
$84.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.05
|
| Rate for Payer: UHC Core |
$69.77
|
| Rate for Payer: UHC Exchange |
$52.63
|
| Rate for Payer: UMR Bronson Commercial |
$49.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.44
|
|
|
PARICALCITOL 1 MCG CAPSULE
|
Facility
|
IP
|
$133.92
|
|
|
Service Code
|
NDC 49483068703
|
| Hospital Charge Code |
41497
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.92 |
| Max. Negotiated Rate |
$120.53 |
| Rate for Payer: Aetna American Axle |
$87.05
|
| Rate for Payer: Aetna Commercial |
$113.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.05
|
| Rate for Payer: Cash Price |
$107.14
|
| Rate for Payer: Cofinity Advantage |
$93.74
|
| Rate for Payer: Cofinity Commercial |
$115.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.14
|
| Rate for Payer: Healthscope Commercial |
$120.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.44
|
| Rate for Payer: PHP Commercial |
$113.83
|
| Rate for Payer: Priority Health SBD |
$84.37
|
| Rate for Payer: UMR Bronson Commercial |
$58.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.44
|
|
|
PARICALCITOL 1 MCG CAPSULE
|
Facility
|
IP
|
$245.81
|
|
|
Service Code
|
NDC 69452014513
|
| Hospital Charge Code |
41497
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.16 |
| Max. Negotiated Rate |
$221.23 |
| Rate for Payer: Aetna American Axle |
$159.78
|
| Rate for Payer: Aetna Commercial |
$208.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.78
|
| Rate for Payer: Cash Price |
$196.65
|
| Rate for Payer: Cofinity Advantage |
$172.07
|
| Rate for Payer: Cofinity Commercial |
$211.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.65
|
| Rate for Payer: Healthscope Commercial |
$221.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$184.36
|
| Rate for Payer: PHP Commercial |
$208.94
|
| Rate for Payer: Priority Health SBD |
$154.86
|
| Rate for Payer: UMR Bronson Commercial |
$108.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.36
|
|
|
PARICALCITOL 1 MCG CAPSULE
|
Facility
|
OP
|
$245.81
|
|
|
Service Code
|
NDC 69452014513
|
| Hospital Charge Code |
41497
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.95 |
| Max. Negotiated Rate |
$221.23 |
| Rate for Payer: Aetna American Axle |
$159.78
|
| Rate for Payer: Aetna Commercial |
$208.94
|
| Rate for Payer: Aetna Medicare |
$122.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.78
|
| Rate for Payer: BCBS Complete |
$98.32
|
| Rate for Payer: Cash Price |
$196.65
|
| Rate for Payer: Cofinity Advantage |
$172.07
|
| Rate for Payer: Cofinity Commercial |
$211.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.65
|
| Rate for Payer: Healthscope Commercial |
$221.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$196.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$184.36
|
| Rate for Payer: PHP Commercial |
$208.94
|
| Rate for Payer: Priority Health SBD |
$154.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.78
|
| Rate for Payer: UHC Core |
$128.07
|
| Rate for Payer: UHC Exchange |
$96.60
|
| Rate for Payer: UMR Bronson Commercial |
$90.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.36
|
|
|
PARICALCITOL 2 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$27.53
|
|
|
Service Code
|
HCPCS J2501
|
| Hospital Charge Code |
31688
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$24.78 |
| Rate for Payer: Aetna American Axle |
$17.89
|
| Rate for Payer: Aetna American Axle |
$18.01
|
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Aetna Commercial |
$23.55
|
| Rate for Payer: Aetna Medicare |
$13.77
|
| Rate for Payer: Aetna Medicare |
$13.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.01
|
| Rate for Payer: BCBS Complete |
$11.08
|
| Rate for Payer: BCBS Complete |
$11.01
|
| Rate for Payer: BCBS Trust/PPO |
$3.12
|
| Rate for Payer: BCBS Trust/PPO |
$3.12
|
| Rate for Payer: BCN Commercial |
$3.12
|
| Rate for Payer: BCN Commercial |
$3.12
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Cash Price |
$22.17
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Cash Price |
$22.17
|
| Rate for Payer: Cofinity Advantage |
$19.27
|
| Rate for Payer: Cofinity Advantage |
$19.40
|
| Rate for Payer: Cofinity Commercial |
$23.68
|
| Rate for Payer: Cofinity Commercial |
$23.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.17
|
| Rate for Payer: Healthscope Commercial |
$24.78
|
| Rate for Payer: Healthscope Commercial |
$24.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.65
|
| Rate for Payer: PHP Commercial |
$23.40
|
| Rate for Payer: PHP Commercial |
$23.55
|
| Rate for Payer: Priority Health SBD |
$17.34
|
| Rate for Payer: Priority Health SBD |
$17.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.60
|
| Rate for Payer: UHC Core |
$1.60
|
| Rate for Payer: UHC Core |
$1.60
|
| Rate for Payer: UHC Exchange |
$1.60
|
| Rate for Payer: UHC Exchange |
$1.60
|
| Rate for Payer: UMR Bronson Commercial |
$10.19
|
| Rate for Payer: UMR Bronson Commercial |
$10.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.78
|
|
|
PARICALCITOL 2 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$27.53
|
|
|
Service Code
|
HCPCS J2501
|
| Hospital Charge Code |
31688
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$24.78 |
| Rate for Payer: Aetna American Axle |
$17.89
|
| Rate for Payer: Aetna American Axle |
$18.01
|
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Aetna Commercial |
$23.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.01
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Cash Price |
$22.17
|
| Rate for Payer: Cofinity Advantage |
$19.40
|
| Rate for Payer: Cofinity Advantage |
$19.27
|
| Rate for Payer: Cofinity Commercial |
$23.83
|
| Rate for Payer: Cofinity Commercial |
$23.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.17
|
| Rate for Payer: Healthscope Commercial |
$24.78
|
| Rate for Payer: Healthscope Commercial |
$24.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.78
|
| Rate for Payer: PHP Commercial |
$23.40
|
| Rate for Payer: PHP Commercial |
$23.55
|
| Rate for Payer: Priority Health SBD |
$17.46
|
| Rate for Payer: Priority Health SBD |
$17.34
|
| Rate for Payer: UMR Bronson Commercial |
$12.11
|
| Rate for Payer: UMR Bronson Commercial |
$12.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.78
|
|
|
PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$41.39
|
|
|
Service Code
|
HCPCS J2501
|
| Hospital Charge Code |
22960
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$37.25 |
| Rate for Payer: Aetna American Axle |
$26.90
|
| Rate for Payer: Aetna Commercial |
$35.18
|
| Rate for Payer: Aetna Medicare |
$20.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.90
|
| Rate for Payer: BCBS Complete |
$16.56
|
| Rate for Payer: BCBS Trust/PPO |
$3.12
|
| Rate for Payer: BCN Commercial |
$3.12
|
| Rate for Payer: Cash Price |
$33.11
|
| Rate for Payer: Cash Price |
$33.11
|
| Rate for Payer: Cofinity Advantage |
$28.97
|
| Rate for Payer: Cofinity Commercial |
$35.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.11
|
| Rate for Payer: Healthscope Commercial |
$37.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.04
|
| Rate for Payer: PHP Commercial |
$35.18
|
| Rate for Payer: Priority Health SBD |
$26.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.60
|
| Rate for Payer: UHC Core |
$1.60
|
| Rate for Payer: UHC Exchange |
$1.60
|
| Rate for Payer: UMR Bronson Commercial |
$15.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.04
|
|
|
PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$41.39
|
|
|
Service Code
|
HCPCS J2501
|
| Hospital Charge Code |
22960
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.21 |
| Max. Negotiated Rate |
$37.25 |
| Rate for Payer: Aetna American Axle |
$26.90
|
| Rate for Payer: Aetna Commercial |
$35.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.90
|
| Rate for Payer: Cash Price |
$33.11
|
| Rate for Payer: Cofinity Advantage |
$28.97
|
| Rate for Payer: Cofinity Commercial |
$35.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.11
|
| Rate for Payer: Healthscope Commercial |
$37.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.04
|
| Rate for Payer: PHP Commercial |
$35.18
|
| Rate for Payer: Priority Health SBD |
$26.08
|
| Rate for Payer: UMR Bronson Commercial |
$18.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.04
|
|
|
PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN OR CALLUS); 2 TO 4 LESIONS
|
Facility
|
OP
|
$646.50
|
|
|
Service Code
|
CPT 11056
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$95.91 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$95.91
|
| Rate for Payer: BCN Commercial |
$95.91
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Mclaren Medicaid |
$199.91
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$209.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.50
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN OR CALLUS); SINGLE LESION
|
Facility
|
OP
|
$646.50
|
|
|
Service Code
|
CPT 11055
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$81.48 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$81.48
|
| Rate for Payer: BCN Commercial |
$81.48
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Mclaren Medicaid |
$199.91
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$209.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.50
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
PAROXETINE 10 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$1,959.60
|
|
|
Service Code
|
NDC 60505040205
|
| Hospital Charge Code |
22959
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$1,763.64 |
| Rate for Payer: Aetna American Axle |
$1,273.74
|
| Rate for Payer: Aetna Commercial |
$1,665.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,273.74
|
| Rate for Payer: Cash Price |
$1,567.68
|
| Rate for Payer: Cofinity Advantage |
$1,371.72
|
| Rate for Payer: Cofinity Commercial |
$1,685.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,567.68
|
| Rate for Payer: Healthscope Commercial |
$1,763.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,371.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,469.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,665.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,469.70
|
| Rate for Payer: PHP Commercial |
$1,665.66
|
| Rate for Payer: Priority Health SBD |
$1,234.55
|
| Rate for Payer: UMR Bronson Commercial |
$862.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,469.70
|
|
|
PAROXETINE 10 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$1,959.60
|
|
|
Service Code
|
NDC 60505040205
|
| Hospital Charge Code |
22959
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$725.05 |
| Max. Negotiated Rate |
$1,763.64 |
| Rate for Payer: Aetna American Axle |
$1,273.74
|
| Rate for Payer: Aetna Commercial |
$1,665.66
|
| Rate for Payer: Aetna Medicare |
$979.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,273.74
|
| Rate for Payer: BCBS Complete |
$783.84
|
| Rate for Payer: Cash Price |
$1,567.68
|
| Rate for Payer: Cofinity Advantage |
$1,371.72
|
| Rate for Payer: Cofinity Commercial |
$1,685.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,567.68
|
| Rate for Payer: Healthscope Commercial |
$1,763.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,371.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,469.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,567.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,665.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,469.70
|
| Rate for Payer: PHP Commercial |
$1,665.66
|
| Rate for Payer: Priority Health SBD |
$1,234.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,273.74
|
| Rate for Payer: UHC Core |
$1,020.95
|
| Rate for Payer: UHC Exchange |
$770.12
|
| Rate for Payer: UMR Bronson Commercial |
$725.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,469.70
|
|
