|
POLYSACCHARIDE IRON COMPLEX 150 MG IRON CAPSULE
|
Facility
|
OP
|
$4.19
|
|
|
Service Code
|
NDC 51991020399
|
| Hospital Charge Code |
11050
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$3.77 |
| Rate for Payer: Aetna American Axle |
$2.72
|
| Rate for Payer: Aetna Commercial |
$3.56
|
| Rate for Payer: Aetna Medicare |
$2.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.72
|
| Rate for Payer: BCBS Complete |
$1.68
|
| Rate for Payer: Cash Price |
$3.35
|
| Rate for Payer: Cofinity Advantage |
$2.93
|
| Rate for Payer: Cofinity Commercial |
$3.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.35
|
| Rate for Payer: Healthscope Commercial |
$3.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.14
|
| Rate for Payer: PHP Commercial |
$3.56
|
| Rate for Payer: Priority Health SBD |
$2.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.72
|
| Rate for Payer: UHC Core |
$2.18
|
| Rate for Payer: UHC Exchange |
$1.65
|
| Rate for Payer: UMR Bronson Commercial |
$1.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.14
|
|
|
POLYSACCHARIDE IRON COMPLEX 150 MG IRON CAPSULE
|
Facility
|
OP
|
$277.30
|
|
|
Service Code
|
NDC 00904539561
|
| Hospital Charge Code |
11050
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.60 |
| Max. Negotiated Rate |
$249.57 |
| Rate for Payer: Aetna American Axle |
$180.25
|
| Rate for Payer: Aetna Commercial |
$235.71
|
| Rate for Payer: Aetna Medicare |
$138.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.25
|
| Rate for Payer: BCBS Complete |
$110.92
|
| Rate for Payer: Cash Price |
$221.84
|
| Rate for Payer: Cofinity Advantage |
$194.11
|
| Rate for Payer: Cofinity Commercial |
$238.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.84
|
| Rate for Payer: Healthscope Commercial |
$249.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$221.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.97
|
| Rate for Payer: PHP Commercial |
$235.71
|
| Rate for Payer: Priority Health SBD |
$174.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.25
|
| Rate for Payer: UHC Core |
$144.47
|
| Rate for Payer: UHC Exchange |
$108.98
|
| Rate for Payer: UMR Bronson Commercial |
$102.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.97
|
|
|
POLYSACCHARIDE IRON COMPLEX 150 MG IRON CAPSULE
|
Facility
|
OP
|
$418.30
|
|
|
Service Code
|
NDC 51991020311
|
| Hospital Charge Code |
11050
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.77 |
| Max. Negotiated Rate |
$376.47 |
| Rate for Payer: Aetna American Axle |
$271.89
|
| Rate for Payer: Aetna Commercial |
$355.56
|
| Rate for Payer: Aetna Medicare |
$209.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.89
|
| Rate for Payer: BCBS Complete |
$167.32
|
| Rate for Payer: Cash Price |
$334.64
|
| Rate for Payer: Cofinity Advantage |
$292.81
|
| Rate for Payer: Cofinity Commercial |
$359.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$334.64
|
| Rate for Payer: Healthscope Commercial |
$376.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$292.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$313.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$334.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$355.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$313.73
|
| Rate for Payer: PHP Commercial |
$355.56
|
| Rate for Payer: Priority Health SBD |
$263.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.89
|
| Rate for Payer: UHC Core |
$217.93
|
| Rate for Payer: UHC Exchange |
$164.39
|
| Rate for Payer: UMR Bronson Commercial |
$154.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$313.73
|
|
|
POLYSACCHARIDE IRON COMPLEX 150 MG IRON CAPSULE
|
Facility
|
IP
|
$4.19
|
|
|
Service Code
|
NDC 51991020399
|
| Hospital Charge Code |
11050
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$3.77 |
| Rate for Payer: Aetna American Axle |
$2.72
|
| Rate for Payer: Aetna Commercial |
$3.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.72
|
| Rate for Payer: Cash Price |
$3.35
|
| Rate for Payer: Cofinity Advantage |
$2.93
|
| Rate for Payer: Cofinity Commercial |
$3.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.35
|
| Rate for Payer: Healthscope Commercial |
$3.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.14
|
| Rate for Payer: PHP Commercial |
$3.56
|
| Rate for Payer: Priority Health SBD |
$2.64
|
| Rate for Payer: UMR Bronson Commercial |
$1.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.14
|
|
|
POLYSACCHARIDE IRON COMPLEX 150 MG IRON CAPSULE
|
Facility
|
IP
|
$277.30
|
|
|
Service Code
|
NDC 00904539561
|
| Hospital Charge Code |
11050
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.01 |
| Max. Negotiated Rate |
$249.57 |
| Rate for Payer: Aetna American Axle |
$180.25
|
| Rate for Payer: Aetna Commercial |
$235.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.25
|
| Rate for Payer: Cash Price |
$221.84
|
| Rate for Payer: Cofinity Advantage |
$194.11
|
| Rate for Payer: Cofinity Commercial |
$238.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.84
|
| Rate for Payer: Healthscope Commercial |
$249.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.97
|
| Rate for Payer: PHP Commercial |
$235.71
|
| Rate for Payer: Priority Health SBD |
$174.70
|
| Rate for Payer: UMR Bronson Commercial |
$122.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.97
|
|
|
POLYSORBATE 80 SOLUTION
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
NDC 38779052608
|
| Hospital Charge Code |
6395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.90 |
| Max. Negotiated Rate |
$423.00 |
| Rate for Payer: Aetna American Axle |
$305.50
|
| Rate for Payer: Aetna Commercial |
$399.50
|
| Rate for Payer: Aetna Medicare |
$235.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.50
|
| Rate for Payer: BCBS Complete |
$188.00
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cofinity Advantage |
$329.00
|
| Rate for Payer: Cofinity Commercial |
$404.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.00
|
| Rate for Payer: Healthscope Commercial |
$423.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$329.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$352.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$376.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$352.50
|
| Rate for Payer: PHP Commercial |
$399.50
|
| Rate for Payer: Priority Health SBD |
$296.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.50
|
| Rate for Payer: UHC Core |
$244.87
|
| Rate for Payer: UHC Exchange |
$184.71
|
| Rate for Payer: UMR Bronson Commercial |
$173.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$352.50
|
|
|
POLYSORBATE 80 SOLUTION
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
NDC 38779052608
|
| Hospital Charge Code |
6395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$206.80 |
| Max. Negotiated Rate |
$423.00 |
| Rate for Payer: Aetna American Axle |
$305.50
|
| Rate for Payer: Aetna Commercial |
$399.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.50
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cofinity Advantage |
$329.00
|
| Rate for Payer: Cofinity Commercial |
$404.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.00
|
| Rate for Payer: Healthscope Commercial |
$423.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$329.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$352.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$352.50
|
| Rate for Payer: PHP Commercial |
$399.50
|
| Rate for Payer: Priority Health SBD |
$296.10
|
| Rate for Payer: UMR Bronson Commercial |
$206.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$352.50
|
|
|
POLYVINYL ALCOHOL-POVIDONE (PF) 1.4 %-0.6 % EYE DROPS IN A DROPPERETTE
|
Facility
|
OP
|
$3.12
|
|
|
Service Code
|
NDC 00023050650
|
| Hospital Charge Code |
112480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Aetna American Axle |
$2.03
|
| Rate for Payer: Aetna Commercial |
$2.65
|
| Rate for Payer: Aetna Medicare |
$1.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.03
|
| Rate for Payer: BCBS Complete |
$1.25
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cofinity Advantage |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$2.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.50
|
| Rate for Payer: Healthscope Commercial |
$2.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.34
|
| Rate for Payer: PHP Commercial |
$2.65
|
| Rate for Payer: Priority Health SBD |
$1.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.03
|
| Rate for Payer: UHC Core |
$1.63
|
| Rate for Payer: UHC Exchange |
$1.23
|
| Rate for Payer: UMR Bronson Commercial |
$1.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.34
|
|
|
POLYVINYL ALCOHOL-POVIDONE (PF) 1.4 %-0.6 % EYE DROPS IN A DROPPERETTE
|
Facility
|
IP
|
$3.12
|
|
|
Service Code
|
NDC 00023050650
|
| Hospital Charge Code |
112480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Aetna American Axle |
$2.03
|
| Rate for Payer: Aetna Commercial |
$2.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.03
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cofinity Advantage |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$2.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.50
|
| Rate for Payer: Healthscope Commercial |
$2.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.34
|
| Rate for Payer: PHP Commercial |
$2.65
|
| Rate for Payer: Priority Health SBD |
$1.97
|
| Rate for Payer: UMR Bronson Commercial |
$1.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.34
|
|
|
PORACTANT ALFA 120 MG/1.5 ML INTRATRACHEAL SUSPENSION
|
Facility
|
IP
|
$2,016.10
|
|
|
Service Code
|
NDC 10122051001
|
| Hospital Charge Code |
27047
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$887.08 |
| Max. Negotiated Rate |
$1,814.49 |
| Rate for Payer: Aetna American Axle |
$1,310.46
|
| Rate for Payer: Aetna Commercial |
$1,713.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,310.46
|
| Rate for Payer: Cash Price |
$1,612.88
|
| Rate for Payer: Cofinity Advantage |
$1,411.27
|
| Rate for Payer: Cofinity Commercial |
$1,733.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,612.88
|
| Rate for Payer: Healthscope Commercial |
$1,814.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,411.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,512.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,713.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,512.08
|
| Rate for Payer: PHP Commercial |
$1,713.68
|
| Rate for Payer: Priority Health SBD |
$1,270.14
|
| Rate for Payer: UMR Bronson Commercial |
$887.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,512.08
|
|
|
PORACTANT ALFA 120 MG/1.5 ML INTRATRACHEAL SUSPENSION
|
Facility
|
OP
|
$2,016.10
|
|
|
Service Code
|
NDC 10122051001
|
| Hospital Charge Code |
27047
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$745.96 |
| Max. Negotiated Rate |
$1,814.49 |
| Rate for Payer: Aetna American Axle |
$1,310.46
|
| Rate for Payer: Aetna Commercial |
$1,713.68
|
| Rate for Payer: Aetna Medicare |
$1,008.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,310.46
|
| Rate for Payer: BCBS Complete |
$806.44
|
| Rate for Payer: Cash Price |
$1,612.88
|
| Rate for Payer: Cofinity Advantage |
$1,411.27
|
| Rate for Payer: Cofinity Commercial |
$1,733.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,612.88
|
| Rate for Payer: Healthscope Commercial |
$1,814.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,411.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,512.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,612.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,713.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,512.08
|
| Rate for Payer: PHP Commercial |
$1,713.68
|
| Rate for Payer: Priority Health SBD |
$1,270.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,310.46
|
| Rate for Payer: UHC Core |
$1,050.39
|
| Rate for Payer: UHC Exchange |
$792.33
|
| Rate for Payer: UMR Bronson Commercial |
$745.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,512.08
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$14,148.73
|
|
|
Service Code
|
NDC 00085432402
|
| Hospital Charge Code |
169019
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5,235.03 |
| Max. Negotiated Rate |
$12,733.86 |
| Rate for Payer: Aetna American Axle |
$9,196.67
|
| Rate for Payer: Aetna Commercial |
$12,026.42
|
| Rate for Payer: Aetna Medicare |
$7,074.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,196.67
|
| Rate for Payer: BCBS Complete |
$5,659.49
|
| Rate for Payer: Cash Price |
$11,318.98
|
| Rate for Payer: Cofinity Advantage |
$9,904.11
|
| Rate for Payer: Cofinity Commercial |
$12,167.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,318.98
|
| Rate for Payer: Healthscope Commercial |
$12,733.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,904.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,611.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,318.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,026.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,611.55
|
| Rate for Payer: PHP Commercial |
$12,026.42
|
| Rate for Payer: Priority Health SBD |
$8,913.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,196.67
|
| Rate for Payer: UHC Core |
$7,371.49
|
| Rate for Payer: UHC Exchange |
$5,560.45
|
| Rate for Payer: UMR Bronson Commercial |
$5,235.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,611.55
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$860.25
|
|
|
Service Code
|
NDC 00527213335
|
| Hospital Charge Code |
169019
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$378.51 |
| Max. Negotiated Rate |
$774.23 |
| Rate for Payer: Aetna American Axle |
$559.16
|
| Rate for Payer: Aetna Commercial |
$731.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$559.16
|
| Rate for Payer: Cash Price |
$688.20
|
| Rate for Payer: Cofinity Advantage |
$602.17
|
| Rate for Payer: Cofinity Commercial |
$739.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$688.20
|
| Rate for Payer: Healthscope Commercial |
$774.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$602.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$645.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$731.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$645.19
|
| Rate for Payer: PHP Commercial |
$731.21
|
| Rate for Payer: Priority Health SBD |
$541.96
|
| Rate for Payer: UMR Bronson Commercial |
$378.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$645.19
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$1,548.45
|
|
|
Service Code
|
NDC 70748025807
|
| Hospital Charge Code |
169019
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$681.32 |
| Max. Negotiated Rate |
$1,393.61 |
| Rate for Payer: Aetna American Axle |
$1,006.49
|
| Rate for Payer: Aetna Commercial |
$1,316.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,006.49
|
| Rate for Payer: Cash Price |
$1,238.76
|
| Rate for Payer: Cofinity Advantage |
$1,083.91
|
| Rate for Payer: Cofinity Commercial |
$1,331.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,238.76
|
| Rate for Payer: Healthscope Commercial |
$1,393.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,083.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,161.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,316.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,161.34
|
| Rate for Payer: PHP Commercial |
$1,316.18
|
| Rate for Payer: Priority Health SBD |
$975.52
|
| Rate for Payer: UMR Bronson Commercial |
$681.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,161.34
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$4,160.51
|
|
|
Service Code
|
NDC 60687052321
|
| Hospital Charge Code |
169019
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,830.62 |
| Max. Negotiated Rate |
$3,744.46 |
| Rate for Payer: Aetna American Axle |
$2,704.33
|
| Rate for Payer: Aetna Commercial |
$3,536.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,704.33
|
| Rate for Payer: Cash Price |
$3,328.41
|
| Rate for Payer: Cofinity Advantage |
$2,912.36
|
| Rate for Payer: Cofinity Commercial |
$3,578.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,328.41
|
| Rate for Payer: Healthscope Commercial |
$3,744.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,912.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,120.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,536.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,120.38
|
| Rate for Payer: PHP Commercial |
$3,536.43
|
| Rate for Payer: Priority Health SBD |
$2,621.12
|
| Rate for Payer: UMR Bronson Commercial |
$1,830.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,120.38
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$138.69
|
|
|
Service Code
|
NDC 60687052311
|
| Hospital Charge Code |
169019
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.32 |
| Max. Negotiated Rate |
$124.82 |
| Rate for Payer: Aetna American Axle |
$90.15
|
| Rate for Payer: Aetna Commercial |
$117.89
|
| Rate for Payer: Aetna Medicare |
$69.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.15
|
| Rate for Payer: BCBS Complete |
$55.48
|
| Rate for Payer: Cash Price |
$110.95
|
| Rate for Payer: Cofinity Advantage |
$97.08
|
| Rate for Payer: Cofinity Commercial |
$119.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.95
|
| Rate for Payer: Healthscope Commercial |
$124.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.02
|
| Rate for Payer: PHP Commercial |
$117.89
|
| Rate for Payer: Priority Health SBD |
$87.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.15
|
| Rate for Payer: UHC Core |
$72.26
|
| Rate for Payer: UHC Exchange |
$54.51
|
| Rate for Payer: UMR Bronson Commercial |
$51.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.02
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$3,337.77
|
|
|
Service Code
|
NDC 00254204502
|
| Hospital Charge Code |
169019
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,468.62 |
| Max. Negotiated Rate |
$3,003.99 |
| Rate for Payer: Aetna American Axle |
$2,169.55
|
| Rate for Payer: Aetna Commercial |
$2,837.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,169.55
|
| Rate for Payer: Cash Price |
$2,670.22
|
| Rate for Payer: Cofinity Advantage |
$2,336.44
|
| Rate for Payer: Cofinity Commercial |
$2,870.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,670.22
|
| Rate for Payer: Healthscope Commercial |
$3,003.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,336.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,503.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,837.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,503.33
|
| Rate for Payer: PHP Commercial |
$2,837.10
|
| Rate for Payer: Priority Health SBD |
$2,102.80
|
| Rate for Payer: UMR Bronson Commercial |
$1,468.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,503.33
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$468.00
|
|
|
Service Code
|
NDC 72205016860
|
| Hospital Charge Code |
169019
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$205.92 |
| Max. Negotiated Rate |
$421.20 |
| Rate for Payer: Aetna American Axle |
$304.20
|
| Rate for Payer: Aetna Commercial |
$397.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.20
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Cofinity Advantage |
$327.60
|
| Rate for Payer: Cofinity Commercial |
$402.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.40
|
| Rate for Payer: Healthscope Commercial |
$421.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$351.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.00
|
| Rate for Payer: PHP Commercial |
$397.80
|
| Rate for Payer: Priority Health SBD |
$294.84
|
| Rate for Payer: UMR Bronson Commercial |
$205.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$351.00
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$4,160.51
|
|
|
Service Code
|
NDC 60687052321
|
| Hospital Charge Code |
169019
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,539.39 |
| Max. Negotiated Rate |
$3,744.46 |
| Rate for Payer: Aetna American Axle |
$2,704.33
|
| Rate for Payer: Aetna Commercial |
$3,536.43
|
| Rate for Payer: Aetna Medicare |
$2,080.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,704.33
|
| Rate for Payer: BCBS Complete |
$1,664.20
|
| Rate for Payer: Cash Price |
$3,328.41
|
| Rate for Payer: Cofinity Advantage |
$2,912.36
|
| Rate for Payer: Cofinity Commercial |
$3,578.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,328.41
|
| Rate for Payer: Healthscope Commercial |
$3,744.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,912.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,120.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,328.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,536.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,120.38
|
| Rate for Payer: PHP Commercial |
$3,536.43
|
| Rate for Payer: Priority Health SBD |
$2,621.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,704.33
|
| Rate for Payer: UHC Core |
$2,167.63
|
| Rate for Payer: UHC Exchange |
$1,635.08
|
| Rate for Payer: UMR Bronson Commercial |
$1,539.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,120.38
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$14,148.73
|
|
|
Service Code
|
NDC 85432402
|
| Hospital Charge Code |
169019
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5,235.03 |
| Max. Negotiated Rate |
$12,733.86 |
| Rate for Payer: Aetna American Axle |
$9,196.67
|
| Rate for Payer: Aetna Commercial |
$12,026.42
|
| Rate for Payer: Aetna Medicare |
$7,074.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,196.67
|
| Rate for Payer: BCBS Complete |
$5,659.49
|
| Rate for Payer: Cash Price |
$11,318.98
|
| Rate for Payer: Cofinity Advantage |
$9,904.11
|
| Rate for Payer: Cofinity Commercial |
$12,167.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,318.98
|
| Rate for Payer: Healthscope Commercial |
$12,733.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,904.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,611.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,318.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,026.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,611.55
|
| Rate for Payer: PHP Commercial |
$12,026.42
|
| Rate for Payer: Priority Health SBD |
$8,913.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,196.67
|
| Rate for Payer: UHC Core |
$7,371.49
|
| Rate for Payer: UHC Exchange |
$5,560.45
|
| Rate for Payer: UMR Bronson Commercial |
$5,235.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,611.55
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$1,761.06
|
|
|
Service Code
|
NDC 00904714910
|
| Hospital Charge Code |
169019
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$774.87 |
| Max. Negotiated Rate |
$1,584.95 |
| Rate for Payer: Aetna American Axle |
$1,144.69
|
| Rate for Payer: Aetna Commercial |
$1,496.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,144.69
|
| Rate for Payer: Cash Price |
$1,408.85
|
| Rate for Payer: Cofinity Advantage |
$1,232.74
|
| Rate for Payer: Cofinity Commercial |
$1,514.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,408.85
|
| Rate for Payer: Healthscope Commercial |
$1,584.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,232.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,320.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,496.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,320.80
|
| Rate for Payer: PHP Commercial |
$1,496.90
|
| Rate for Payer: Priority Health SBD |
$1,109.47
|
| Rate for Payer: UMR Bronson Commercial |
$774.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,320.80
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$860.25
|
|
|
Service Code
|
NDC 00527213335
|
| Hospital Charge Code |
169019
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$318.29 |
| Max. Negotiated Rate |
$774.23 |
| Rate for Payer: Aetna American Axle |
$559.16
|
| Rate for Payer: Aetna Commercial |
$731.21
|
| Rate for Payer: Aetna Medicare |
$430.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$559.16
|
| Rate for Payer: BCBS Complete |
$344.10
|
| Rate for Payer: Cash Price |
$688.20
|
| Rate for Payer: Cofinity Advantage |
$602.17
|
| Rate for Payer: Cofinity Commercial |
$739.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$688.20
|
| Rate for Payer: Healthscope Commercial |
$774.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$602.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$645.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$688.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$731.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$645.19
|
| Rate for Payer: PHP Commercial |
$731.21
|
| Rate for Payer: Priority Health SBD |
$541.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$559.16
|
| Rate for Payer: UHC Core |
$448.19
|
| Rate for Payer: UHC Exchange |
$338.08
|
| Rate for Payer: UMR Bronson Commercial |
$318.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$645.19
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$3,337.77
|
|
|
Service Code
|
NDC 254204502
|
| Hospital Charge Code |
169019
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,234.97 |
| Max. Negotiated Rate |
$3,003.99 |
| Rate for Payer: Aetna American Axle |
$2,169.55
|
| Rate for Payer: Aetna Commercial |
$2,837.10
|
| Rate for Payer: Aetna Medicare |
$1,668.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,169.55
|
| Rate for Payer: BCBS Complete |
$1,335.11
|
| Rate for Payer: Cash Price |
$2,670.22
|
| Rate for Payer: Cofinity Advantage |
$2,336.44
|
| Rate for Payer: Cofinity Commercial |
$2,870.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,670.22
|
| Rate for Payer: Healthscope Commercial |
$3,003.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,336.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,503.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,670.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,837.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,503.33
|
| Rate for Payer: PHP Commercial |
$2,837.10
|
| Rate for Payer: Priority Health SBD |
$2,102.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,169.55
|
| Rate for Payer: UHC Core |
$1,738.98
|
| Rate for Payer: UHC Exchange |
$1,311.74
|
| Rate for Payer: UMR Bronson Commercial |
$1,234.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,503.33
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$468.00
|
|
|
Service Code
|
NDC 72205016860
|
| Hospital Charge Code |
169019
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.16 |
| Max. Negotiated Rate |
$421.20 |
| Rate for Payer: Aetna American Axle |
$304.20
|
| Rate for Payer: Aetna Commercial |
$397.80
|
| Rate for Payer: Aetna Medicare |
$234.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.20
|
| Rate for Payer: BCBS Complete |
$187.20
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Cofinity Advantage |
$327.60
|
| Rate for Payer: Cofinity Commercial |
$402.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.40
|
| Rate for Payer: Healthscope Commercial |
$421.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$351.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$374.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.00
|
| Rate for Payer: PHP Commercial |
$397.80
|
| Rate for Payer: Priority Health SBD |
$294.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$304.20
|
| Rate for Payer: UHC Core |
$243.83
|
| Rate for Payer: UHC Exchange |
$183.92
|
| Rate for Payer: UMR Bronson Commercial |
$173.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$351.00
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$1,548.45
|
|
|
Service Code
|
NDC 70748025807
|
| Hospital Charge Code |
169019
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$572.93 |
| Max. Negotiated Rate |
$1,393.61 |
| Rate for Payer: Aetna American Axle |
$1,006.49
|
| Rate for Payer: Aetna Commercial |
$1,316.18
|
| Rate for Payer: Aetna Medicare |
$774.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,006.49
|
| Rate for Payer: BCBS Complete |
$619.38
|
| Rate for Payer: Cash Price |
$1,238.76
|
| Rate for Payer: Cofinity Advantage |
$1,083.91
|
| Rate for Payer: Cofinity Commercial |
$1,331.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,238.76
|
| Rate for Payer: Healthscope Commercial |
$1,393.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,083.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,161.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,238.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,316.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,161.34
|
| Rate for Payer: PHP Commercial |
$1,316.18
|
| Rate for Payer: Priority Health SBD |
$975.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,006.49
|
| Rate for Payer: UHC Core |
$806.74
|
| Rate for Payer: UHC Exchange |
$608.54
|
| Rate for Payer: UMR Bronson Commercial |
$572.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,161.34
|
|
