|
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 |
$51.00
|
| Rate for Payer: Cofinity Commercial |
$62.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.00
|
| 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 |
$51.00
|
| 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 |
$51.00
|
| Rate for Payer: Cofinity Commercial |
$62.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.00
|
| 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 |
$51.00
|
| 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
|
|
|
ASENAPINE 5 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$1,052.95
|
|
|
Service Code
|
NDC 51991035860
|
| Hospital Charge Code |
99754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$389.59 |
| Max. Negotiated Rate |
$947.66 |
| Rate for Payer: Aetna American Axle |
$684.42
|
| Rate for Payer: Aetna Commercial |
$895.01
|
| Rate for Payer: Aetna Medicare |
$526.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$684.42
|
| Rate for Payer: BCBS Complete |
$421.18
|
| Rate for Payer: Cash Price |
$842.36
|
| Rate for Payer: Cofinity Commercial |
$737.06
|
| Rate for Payer: Cofinity Commercial |
$905.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$737.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$842.36
|
| Rate for Payer: Healthscope Commercial |
$947.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$737.06
|
| 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 |
$389.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$789.71
|
|
|
ASENAPINE 5 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$722.73
|
|
|
Service Code
|
NDC 00456240506
|
| Hospital Charge Code |
99754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$318.00 |
| Max. Negotiated Rate |
$650.46 |
| Rate for Payer: Aetna American Axle |
$469.77
|
| Rate for Payer: Aetna Commercial |
$614.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$469.77
|
| 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 |
$318.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$542.05
|
|
|
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
|
OP
|
$69.29
|
|
|
Service Code
|
NDC 00456240511
|
| Hospital Charge Code |
99754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.64 |
| Max. Negotiated Rate |
$62.36 |
| Rate for Payer: Aetna American Axle |
$45.04
|
| Rate for Payer: Aetna Commercial |
$58.90
|
| Rate for Payer: Aetna Medicare |
$34.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.04
|
| Rate for Payer: BCBS Complete |
$27.72
|
| 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 |
$25.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.97
|
|
|
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 |
$361.36
|
| 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
|
|
|
ASENAPINE 5 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$123.95
|
|
|
Service Code
|
NDC 62332019810
|
| Hospital Charge Code |
99754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.86 |
| Max. Negotiated Rate |
$111.56 |
| Rate for Payer: Aetna American Axle |
$80.57
|
| Rate for Payer: Aetna Commercial |
$105.36
|
| Rate for Payer: Aetna Medicare |
$61.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.57
|
| Rate for Payer: BCBS Complete |
$49.58
|
| Rate for Payer: Cash Price |
$99.16
|
| Rate for Payer: Cofinity Commercial |
$106.60
|
| Rate for Payer: Cofinity Commercial |
$86.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.16
|
| Rate for Payer: Healthscope Commercial |
$111.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.36
|
| Rate for Payer: PHP Commercial |
$105.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.57
|
| Rate for Payer: Priority Health SBD |
$78.09
|
| Rate for Payer: UMR Bronson Commercial |
$45.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.96
|
|
|
ASENAPINE 5 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$654.24
|
|
|
Service Code
|
NDC 62332019860
|
| Hospital Charge Code |
99754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$287.87 |
| Max. Negotiated Rate |
$588.82 |
| Rate for Payer: Aetna American Axle |
$425.26
|
| Rate for Payer: Aetna Commercial |
$556.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$425.26
|
| Rate for Payer: Cash Price |
$523.39
|
| Rate for Payer: Cofinity Commercial |
$457.97
|
| Rate for Payer: Cofinity Commercial |
$562.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$457.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$523.39
|
| Rate for Payer: Healthscope Commercial |
$588.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$457.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$490.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$556.10
|
| Rate for Payer: PHP Commercial |
$556.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$425.26
|
| Rate for Payer: Priority Health SBD |
$412.17
|
| Rate for Payer: UMR Bronson Commercial |
$287.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$490.68
|
|
|
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 |
$947.66 |
| 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 |
$737.06
|
| Rate for Payer: Cofinity Commercial |
$905.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$737.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$842.36
|
| Rate for Payer: Healthscope Commercial |
$947.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$737.06
|
| 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
|
$123.95
|
|
|
Service Code
|
NDC 62332019810
|
| Hospital Charge Code |
99754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.54 |
| Max. Negotiated Rate |
$111.56 |
| Rate for Payer: Aetna American Axle |
$80.57
|
| Rate for Payer: Aetna Commercial |
$105.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.57
|
| Rate for Payer: Cash Price |
$99.16
|
| Rate for Payer: Cofinity Commercial |
$106.60
|
| Rate for Payer: Cofinity Commercial |
$86.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.16
|
| Rate for Payer: Healthscope Commercial |
$111.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.36
|
| Rate for Payer: PHP Commercial |
$105.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.57
|
| Rate for Payer: Priority Health SBD |
$78.09
|
| Rate for Payer: UMR Bronson Commercial |
$54.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.96
|
|
|
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
|
OP
|
$654.24
|
|
|
Service Code
|
NDC 62332019860
|
| Hospital Charge Code |
99754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$242.07 |
| Max. Negotiated Rate |
$588.82 |
| Rate for Payer: Aetna American Axle |
$425.26
|
| Rate for Payer: Aetna Commercial |
$556.10
|
| Rate for Payer: Aetna Medicare |
$327.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$425.26
|
| Rate for Payer: BCBS Complete |
$261.70
|
| Rate for Payer: Cash Price |
$523.39
|
| Rate for Payer: Cofinity Commercial |
$457.97
|
| Rate for Payer: Cofinity Commercial |
$562.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$457.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$523.39
|
| Rate for Payer: Healthscope Commercial |
$588.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$457.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$490.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$556.10
|
| Rate for Payer: PHP Commercial |
$556.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$425.26
|
| Rate for Payer: Priority Health SBD |
$412.17
|
| Rate for Payer: UMR Bronson Commercial |
$242.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$490.68
|
|
|
ASPARAGINASE ERWINIA CHRYSANTHEMI-RYWN 10 MG/0.5 ML IM SOLUTION
|
Facility
|
IP
|
$23,033.70
|
|
|
Service Code
|
HCPCS J9021
|
| Hospital Charge Code |
197812
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10,134.83 |
| Max. Negotiated Rate |
$20,730.33 |
| Rate for Payer: Aetna American Axle |
$14,971.90
|
| Rate for Payer: Aetna Commercial |
$19,578.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,971.90
|
| Rate for Payer: Cash Price |
$18,426.96
|
| Rate for Payer: Cofinity Commercial |
$16,123.59
|
| Rate for Payer: Cofinity Commercial |
$19,808.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$16,123.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18,426.96
|
| Rate for Payer: Healthscope Commercial |
$20,730.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16,123.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17,275.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19,578.64
|
| Rate for Payer: PHP Commercial |
$19,578.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14,971.90
|
| Rate for Payer: Priority Health SBD |
$14,511.23
|
| Rate for Payer: UMR Bronson Commercial |
$10,134.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17,275.28
|
|
|
ASPARAGINASE ERWINIA CHRYSANTHEMI-RYWN 10 MG/0.5 ML IM SOLUTION
|
Facility
|
OP
|
$23,033.70
|
|
|
Service Code
|
HCPCS J9021
|
| Hospital Charge Code |
197812
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.02 |
| Max. Negotiated Rate |
$20,730.33 |
| Rate for Payer: Aetna American Axle |
$14,971.90
|
| Rate for Payer: Aetna Commercial |
$19,578.64
|
| Rate for Payer: Aetna Medicare |
$56.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,971.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.68
|
| Rate for Payer: BCBS Complete |
$30.47
|
| Rate for Payer: BCBS MAPPO |
$54.14
|
| Rate for Payer: BCBS Trust/PPO |
$145.98
|
| Rate for Payer: BCN Commercial |
$145.98
|
| Rate for Payer: BCN Medicare Advantage |
$54.14
|
| Rate for Payer: Cash Price |
$18,426.96
|
| Rate for Payer: Cash Price |
$18,426.96
|
| Rate for Payer: Cofinity Commercial |
$19,808.98
|
| Rate for Payer: Cofinity Commercial |
$16,123.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$16,123.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18,426.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.14
|
| Rate for Payer: Healthscope Commercial |
$20,730.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16,123.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17,275.28
|
| Rate for Payer: Mclaren Medicaid |
$29.02
|
| Rate for Payer: Mclaren Medicare |
$54.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.85
|
| Rate for Payer: Meridian Medicaid |
$30.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19,578.64
|
| Rate for Payer: Nomi Health Commercial |
$162.42
|
| Rate for Payer: PACE Medicare |
$51.43
|
| Rate for Payer: PACE SWMI |
$54.14
|
| Rate for Payer: PHP Commercial |
$19,578.64
|
| Rate for Payer: PHP Medicare Advantage |
$54.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14,971.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$151.92
|
| Rate for Payer: Priority Health Medicare |
$54.14
|
| Rate for Payer: Priority Health Narrow Network |
$121.54
|
| Rate for Payer: Priority Health SBD |
$14,511.23
|
| Rate for Payer: Railroad Medicare Medicare |
$54.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$152.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.14
|
| Rate for Payer: UHC Exchange |
$103.47
|
| Rate for Payer: UHC Medicare Advantage |
$54.14
|
| Rate for Payer: UHCCP Medicaid |
$29.02
|
| Rate for Payer: UMR Bronson Commercial |
$8,522.47
|
| Rate for Payer: VA VA |
$54.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17,275.28
|
|
|
ASPIRATION OF BLADDER; WITH INSERTION OF SUPRAPUBIC CATHETER
|
Facility
|
OP
|
$6,308.24
|
|
|
Service Code
|
CPT 51102
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$136.41 |
| Max. Negotiated Rate |
$6,308.24 |
| Rate for Payer: Aetna Medicare |
$2,087.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,508.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,508.86
|
| Rate for Payer: BCBS Complete |
$1,129.59
|
| Rate for Payer: BCBS MAPPO |
$2,007.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,439.79
|
| Rate for Payer: BCN Commercial |
$1,439.79
|
| Rate for Payer: BCN Medicare Advantage |
$2,007.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,007.09
|
| Rate for Payer: Mclaren Medicaid |
$1,075.80
|
| Rate for Payer: Mclaren Medicare |
$2,007.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,107.44
|
| Rate for Payer: Meridian Medicaid |
$1,129.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,308.15
|
| Rate for Payer: Nomi Health Commercial |
$4,214.89
|
| Rate for Payer: PACE Medicare |
$1,906.74
|
| Rate for Payer: PACE SWMI |
$2,007.09
|
| Rate for Payer: PHP Medicare Advantage |
$2,007.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,308.24
|
| Rate for Payer: Priority Health Medicare |
$2,007.09
|
| Rate for Payer: Priority Health Narrow Network |
$5,046.59
|
| Rate for Payer: Railroad Medicare Medicare |
$2,007.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.05
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,007.09
|
| Rate for Payer: UHC Exchange |
$136.41
|
| Rate for Payer: UHC Medicare Advantage |
$2,007.09
|
| Rate for Payer: UHCCP Medicaid |
$1,075.80
|
| Rate for Payer: VA VA |
$2,007.09
|
|
|
ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE
|
Facility
|
OP
|
$291.46
|
|
|
Service Code
|
NDC 65162059606
|
| Hospital Charge Code |
27644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.84 |
| Max. Negotiated Rate |
$262.31 |
| Rate for Payer: Aetna American Axle |
$189.45
|
| Rate for Payer: Aetna Commercial |
$247.74
|
| Rate for Payer: Aetna Medicare |
$145.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.45
|
| Rate for Payer: BCBS Complete |
$116.58
|
| Rate for Payer: Cash Price |
$233.17
|
| Rate for Payer: Cofinity Commercial |
$204.02
|
| Rate for Payer: Cofinity Commercial |
$250.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$204.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.17
|
| Rate for Payer: Healthscope Commercial |
$262.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$204.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.74
|
| Rate for Payer: PHP Commercial |
$247.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.45
|
| Rate for Payer: Priority Health SBD |
$183.62
|
| Rate for Payer: UMR Bronson Commercial |
$107.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.60
|
|
|
ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE
|
Facility
|
IP
|
$291.46
|
|
|
Service Code
|
NDC 65162059606
|
| Hospital Charge Code |
27644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.24 |
| Max. Negotiated Rate |
$262.31 |
| Rate for Payer: Aetna American Axle |
$189.45
|
| Rate for Payer: Aetna Commercial |
$247.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.45
|
| Rate for Payer: Cash Price |
$233.17
|
| Rate for Payer: Cofinity Commercial |
$204.02
|
| Rate for Payer: Cofinity Commercial |
$250.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$204.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.17
|
| Rate for Payer: Healthscope Commercial |
$262.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$204.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.74
|
| Rate for Payer: PHP Commercial |
$247.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.45
|
| Rate for Payer: Priority Health SBD |
$183.62
|
| Rate for Payer: UMR Bronson Commercial |
$128.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.60
|
|
|
ASPIRIN 300 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$39.79
|
|
|
Service Code
|
NDC 00574703412
|
| Hospital Charge Code |
693
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.72 |
| Max. Negotiated Rate |
$35.81 |
| Rate for Payer: Aetna American Axle |
$25.86
|
| Rate for Payer: Aetna Commercial |
$33.82
|
| Rate for Payer: Aetna Medicare |
$19.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.86
|
| Rate for Payer: BCBS Complete |
$15.92
|
| Rate for Payer: Cash Price |
$31.83
|
| Rate for Payer: Cofinity Commercial |
$27.85
|
| Rate for Payer: Cofinity Commercial |
$34.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.83
|
| Rate for Payer: Healthscope Commercial |
$35.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.82
|
| Rate for Payer: PHP Commercial |
$33.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.86
|
| Rate for Payer: Priority Health SBD |
$25.07
|
| Rate for Payer: UMR Bronson Commercial |
$14.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.84
|
|
|
ASPIRIN 300 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$39.79
|
|
|
Service Code
|
NDC 00574703412
|
| Hospital Charge Code |
693
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.51 |
| Max. Negotiated Rate |
$35.81 |
| Rate for Payer: Aetna American Axle |
$25.86
|
| Rate for Payer: Aetna Commercial |
$33.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.86
|
| Rate for Payer: Cash Price |
$31.83
|
| Rate for Payer: Cofinity Commercial |
$27.85
|
| Rate for Payer: Cofinity Commercial |
$34.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.83
|
| Rate for Payer: Healthscope Commercial |
$35.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.82
|
| Rate for Payer: PHP Commercial |
$33.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.86
|
| Rate for Payer: Priority Health SBD |
$25.07
|
| Rate for Payer: UMR Bronson Commercial |
$17.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.84
|
|
|
ASPIRIN 325 MG TABLET
|
Facility
|
OP
|
$544.50
|
|
|
Service Code
|
NDC 66553000101
|
| Hospital Charge Code |
681
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$201.46 |
| Max. Negotiated Rate |
$490.05 |
| Rate for Payer: Aetna American Axle |
$353.92
|
| Rate for Payer: Aetna Commercial |
$462.82
|
| Rate for Payer: Aetna Medicare |
$272.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$353.92
|
| Rate for Payer: BCBS Complete |
$217.80
|
| Rate for Payer: Cash Price |
$435.60
|
| Rate for Payer: Cofinity Commercial |
$381.15
|
| Rate for Payer: Cofinity Commercial |
$468.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$381.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$435.60
|
| Rate for Payer: Healthscope Commercial |
$490.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$381.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$408.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$462.82
|
| Rate for Payer: PHP Commercial |
$462.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$353.92
|
| Rate for Payer: Priority Health SBD |
$343.04
|
| Rate for Payer: UMR Bronson Commercial |
$201.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$408.38
|
|
|
ASPIRIN 325 MG TABLET
|
Facility
|
IP
|
$544.50
|
|
|
Service Code
|
NDC 66553000101
|
| Hospital Charge Code |
681
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$239.58 |
| Max. Negotiated Rate |
$490.05 |
| Rate for Payer: Aetna American Axle |
$353.92
|
| Rate for Payer: Aetna Commercial |
$462.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$353.92
|
| Rate for Payer: Cash Price |
$435.60
|
| Rate for Payer: Cofinity Commercial |
$381.15
|
| Rate for Payer: Cofinity Commercial |
$468.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$381.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$435.60
|
| Rate for Payer: Healthscope Commercial |
$490.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$381.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$408.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$462.82
|
| Rate for Payer: PHP Commercial |
$462.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$353.92
|
| Rate for Payer: Priority Health SBD |
$343.04
|
| Rate for Payer: UMR Bronson Commercial |
$239.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$408.38
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
IP
|
$45.36
|
|
|
Service Code
|
NDC 00904404073
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.96 |
| Max. Negotiated Rate |
$40.82 |
| Rate for Payer: Aetna American Axle |
$29.48
|
| Rate for Payer: Aetna Commercial |
$38.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.48
|
| Rate for Payer: Cash Price |
$36.29
|
| Rate for Payer: Cofinity Commercial |
$31.75
|
| Rate for Payer: Cofinity Commercial |
$39.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.29
|
| Rate for Payer: Healthscope Commercial |
$40.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.56
|
| Rate for Payer: PHP Commercial |
$38.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.48
|
| Rate for Payer: Priority Health SBD |
$28.58
|
| Rate for Payer: UMR Bronson Commercial |
$19.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.02
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
OP
|
$441.00
|
|
|
Service Code
|
NDC 00904679480
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.17 |
| Max. Negotiated Rate |
$396.90 |
| Rate for Payer: Aetna American Axle |
$286.65
|
| Rate for Payer: Aetna Commercial |
$374.85
|
| Rate for Payer: Aetna Medicare |
$220.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$286.65
|
| Rate for Payer: BCBS Complete |
$176.40
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cofinity Commercial |
$308.70
|
| Rate for Payer: Cofinity Commercial |
$379.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$308.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$352.80
|
| Rate for Payer: Healthscope Commercial |
$396.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$308.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$330.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$374.85
|
| Rate for Payer: PHP Commercial |
$374.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$286.65
|
| Rate for Payer: Priority Health SBD |
$277.83
|
| Rate for Payer: UMR Bronson Commercial |
$163.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$330.75
|
|
