|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET
|
Facility
|
IP
|
$326.65
|
|
|
Service Code
|
NDC 77333093810
|
| Hospital Charge Code |
2009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$212.32 |
| Max. Negotiated Rate |
$293.98 |
| Rate for Payer: Aetna Commercial |
$277.65
|
| Rate for Payer: BCBS Trust/PPO |
$266.64
|
| Rate for Payer: BCN Commercial |
$252.44
|
| Rate for Payer: Cash Price |
$261.32
|
| Rate for Payer: Cofinity Commercial |
$280.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.32
|
| Rate for Payer: Healthscope Commercial |
$293.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.65
|
| Rate for Payer: Nomi Health Commercial |
$267.85
|
| Rate for Payer: PHP Commercial |
$277.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.32
|
| Rate for Payer: Priority Health HMO/PPO |
$284.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$218.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$287.45
|
| Rate for Payer: UHC Core |
$272.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.99
|
|
|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET
|
Facility
|
OP
|
$3.27
|
|
|
Service Code
|
NDC 77333093825
|
| Hospital Charge Code |
2009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$2.94 |
| Rate for Payer: Aetna Commercial |
$2.78
|
| Rate for Payer: Aetna Medicare |
$0.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.02
|
| Rate for Payer: BCBS Complete |
$1.31
|
| Rate for Payer: BCBS MAPPO |
$0.82
|
| Rate for Payer: BCBS Trust/PPO |
$2.69
|
| Rate for Payer: BCN Commercial |
$2.54
|
| Rate for Payer: BCN Medicare Advantage |
$0.82
|
| Rate for Payer: Cash Price |
$2.62
|
| Rate for Payer: Cofinity Commercial |
$2.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.82
|
| Rate for Payer: Healthscope Commercial |
$2.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.78
|
| Rate for Payer: Nomi Health Commercial |
$2.68
|
| Rate for Payer: PACE Senior Care Partners |
$0.78
|
| Rate for Payer: PACE SWMI |
$0.82
|
| Rate for Payer: PHP Commercial |
$2.78
|
| Rate for Payer: PHP Medicare Advantage |
$0.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.13
|
| Rate for Payer: Priority Health HMO/PPO |
$2.84
|
| Rate for Payer: Priority Health Medicare |
$0.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.19
|
| Rate for Payer: Railroad Medicare Medicare |
$0.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.88
|
| Rate for Payer: UHC Core |
$2.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.82
|
| Rate for Payer: UHC Exchange |
$0.82
|
| Rate for Payer: UHC Medicare Advantage |
$0.82
|
| Rate for Payer: VA VA |
$0.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.45
|
|
|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET
|
Facility
|
OP
|
$326.65
|
|
|
Service Code
|
NDC 77333093810
|
| Hospital Charge Code |
2009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.58 |
| Max. Negotiated Rate |
$293.98 |
| Rate for Payer: Aetna Commercial |
$277.65
|
| Rate for Payer: Aetna Medicare |
$84.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$102.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$102.08
|
| Rate for Payer: BCBS Complete |
$130.66
|
| Rate for Payer: BCBS MAPPO |
$81.66
|
| Rate for Payer: BCBS Trust/PPO |
$268.54
|
| Rate for Payer: BCN Commercial |
$253.97
|
| Rate for Payer: BCN Medicare Advantage |
$81.66
|
| Rate for Payer: Cash Price |
$261.32
|
| Rate for Payer: Cofinity Commercial |
$280.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.66
|
| Rate for Payer: Healthscope Commercial |
$293.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.65
|
| Rate for Payer: Nomi Health Commercial |
$267.85
|
| Rate for Payer: PACE Senior Care Partners |
$77.58
|
| Rate for Payer: PACE SWMI |
$81.66
|
| Rate for Payer: PHP Commercial |
$277.65
|
| Rate for Payer: PHP Medicare Advantage |
$81.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.32
|
| Rate for Payer: Priority Health HMO/PPO |
$284.19
|
| Rate for Payer: Priority Health Medicare |
$82.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$218.86
|
| Rate for Payer: Railroad Medicare Medicare |
$81.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$287.45
|
| Rate for Payer: UHC Core |
$272.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.66
|
| Rate for Payer: UHC Exchange |
$81.66
|
| Rate for Payer: UHC Medicare Advantage |
$81.66
|
| Rate for Payer: VA VA |
$81.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.99
|
|
|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET
|
Facility
|
IP
|
$3.27
|
|
|
Service Code
|
NDC 77333093825
|
| Hospital Charge Code |
2009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$2.94 |
| Rate for Payer: Aetna Commercial |
$2.78
|
| Rate for Payer: BCBS Trust/PPO |
$2.67
|
| Rate for Payer: BCN Commercial |
$2.53
|
| Rate for Payer: Cash Price |
$2.62
|
| Rate for Payer: Cofinity Commercial |
$2.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.62
|
| Rate for Payer: Healthscope Commercial |
$2.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.78
|
| Rate for Payer: Nomi Health Commercial |
$2.68
|
| Rate for Payer: PHP Commercial |
$2.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.13
|
| Rate for Payer: Priority Health HMO/PPO |
$2.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.88
|
| Rate for Payer: UHC Core |
$2.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.45
|
|
|
CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET
|
Facility
|
IP
|
$133.10
|
|
|
Service Code
|
NDC 77333093710
|
| Hospital Charge Code |
2012
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.52 |
| Max. Negotiated Rate |
$119.79 |
| Rate for Payer: Aetna Commercial |
$113.14
|
| Rate for Payer: BCBS Trust/PPO |
$108.65
|
| Rate for Payer: BCN Commercial |
$102.86
|
| Rate for Payer: Cash Price |
$106.48
|
| Rate for Payer: Cofinity Commercial |
$114.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.48
|
| Rate for Payer: Healthscope Commercial |
$119.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.14
|
| Rate for Payer: Nomi Health Commercial |
$109.14
|
| Rate for Payer: PHP Commercial |
$113.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.52
|
| Rate for Payer: Priority Health HMO/PPO |
$115.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$89.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.13
|
| Rate for Payer: UHC Core |
$111.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.82
|
|
|
CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET
|
Facility
|
IP
|
$1.34
|
|
|
Service Code
|
NDC 77333093725
|
| Hospital Charge Code |
2012
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$1.21 |
| Rate for Payer: Aetna Commercial |
$1.14
|
| Rate for Payer: BCBS Trust/PPO |
$1.09
|
| Rate for Payer: BCN Commercial |
$1.04
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: Cofinity Commercial |
$1.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.07
|
| Rate for Payer: Healthscope Commercial |
$1.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.14
|
| Rate for Payer: Nomi Health Commercial |
$1.10
|
| Rate for Payer: PHP Commercial |
$1.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.87
|
| Rate for Payer: Priority Health HMO/PPO |
$1.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.18
|
| Rate for Payer: UHC Core |
$1.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.00
|
|
|
CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
NDC 79854020060
|
| Hospital Charge Code |
2012
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$170.00
|
| Rate for Payer: BCBS Trust/PPO |
$163.26
|
| Rate for Payer: BCN Commercial |
$154.56
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Commercial |
$172.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.00
|
| Rate for Payer: Healthscope Commercial |
$180.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.00
|
| Rate for Payer: Nomi Health Commercial |
$164.00
|
| Rate for Payer: PHP Commercial |
$170.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.00
|
| Rate for Payer: Priority Health HMO/PPO |
$174.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.00
|
| Rate for Payer: UHC Core |
$167.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.00
|
|
|
CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET
|
Facility
|
OP
|
$133.10
|
|
|
Service Code
|
NDC 77333093710
|
| Hospital Charge Code |
2012
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.61 |
| Max. Negotiated Rate |
$119.79 |
| Rate for Payer: Aetna Commercial |
$113.14
|
| Rate for Payer: Aetna Medicare |
$34.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.59
|
| Rate for Payer: BCBS Complete |
$53.24
|
| Rate for Payer: BCBS MAPPO |
$33.28
|
| Rate for Payer: BCBS Trust/PPO |
$109.42
|
| Rate for Payer: BCN Commercial |
$103.49
|
| Rate for Payer: BCN Medicare Advantage |
$33.28
|
| Rate for Payer: Cash Price |
$106.48
|
| Rate for Payer: Cofinity Commercial |
$114.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.28
|
| Rate for Payer: Healthscope Commercial |
$119.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.14
|
| Rate for Payer: Nomi Health Commercial |
$109.14
|
| Rate for Payer: PACE Senior Care Partners |
$31.61
|
| Rate for Payer: PACE SWMI |
$33.28
|
| Rate for Payer: PHP Commercial |
$113.14
|
| Rate for Payer: PHP Medicare Advantage |
$33.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.52
|
| Rate for Payer: Priority Health HMO/PPO |
$115.80
|
| Rate for Payer: Priority Health Medicare |
$33.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$89.18
|
| Rate for Payer: Railroad Medicare Medicare |
$33.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.13
|
| Rate for Payer: UHC Core |
$111.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.28
|
| Rate for Payer: UHC Exchange |
$33.28
|
| Rate for Payer: UHC Medicare Advantage |
$33.28
|
| Rate for Payer: VA VA |
$33.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.82
|
|
|
CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
NDC 79854020060
|
| Hospital Charge Code |
2012
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.50 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$170.00
|
| Rate for Payer: Aetna Medicare |
$52.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.50
|
| Rate for Payer: BCBS Complete |
$80.00
|
| Rate for Payer: BCBS MAPPO |
$50.00
|
| Rate for Payer: BCBS Trust/PPO |
$164.42
|
| Rate for Payer: BCN Commercial |
$155.50
|
| Rate for Payer: BCN Medicare Advantage |
$50.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Commercial |
$172.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.00
|
| Rate for Payer: Healthscope Commercial |
$180.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.00
|
| Rate for Payer: Nomi Health Commercial |
$164.00
|
| Rate for Payer: PACE Senior Care Partners |
$47.50
|
| Rate for Payer: PACE SWMI |
$50.00
|
| Rate for Payer: PHP Commercial |
$170.00
|
| Rate for Payer: PHP Medicare Advantage |
$50.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.00
|
| Rate for Payer: Priority Health HMO/PPO |
$174.00
|
| Rate for Payer: Priority Health Medicare |
$50.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.00
|
| Rate for Payer: Railroad Medicare Medicare |
$50.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.00
|
| Rate for Payer: UHC Core |
$167.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.00
|
| Rate for Payer: UHC Exchange |
$50.00
|
| Rate for Payer: UHC Medicare Advantage |
$50.00
|
| Rate for Payer: VA VA |
$50.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.00
|
|
|
CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET
|
Facility
|
OP
|
$1.34
|
|
|
Service Code
|
NDC 77333093725
|
| Hospital Charge Code |
2012
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.21 |
| Rate for Payer: Aetna Commercial |
$1.14
|
| Rate for Payer: Aetna Medicare |
$0.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.42
|
| Rate for Payer: BCBS Complete |
$0.54
|
| Rate for Payer: BCBS MAPPO |
$0.34
|
| Rate for Payer: BCBS Trust/PPO |
$1.10
|
| Rate for Payer: BCN Commercial |
$1.04
|
| Rate for Payer: BCN Medicare Advantage |
$0.34
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: Cofinity Commercial |
$1.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.34
|
| Rate for Payer: Healthscope Commercial |
$1.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.14
|
| Rate for Payer: Nomi Health Commercial |
$1.10
|
| Rate for Payer: PACE Senior Care Partners |
$0.32
|
| Rate for Payer: PACE SWMI |
$0.34
|
| Rate for Payer: PHP Commercial |
$1.14
|
| Rate for Payer: PHP Medicare Advantage |
$0.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.87
|
| Rate for Payer: Priority Health HMO/PPO |
$1.17
|
| Rate for Payer: Priority Health Medicare |
$0.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.90
|
| Rate for Payer: Railroad Medicare Medicare |
$0.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.18
|
| Rate for Payer: UHC Core |
$1.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.34
|
| Rate for Payer: UHC Exchange |
$0.34
|
| Rate for Payer: UHC Medicare Advantage |
$0.34
|
| Rate for Payer: VA VA |
$0.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.00
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
OP
|
$18.86
|
|
|
Service Code
|
NDC 17478010002
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$16.97 |
| Rate for Payer: Aetna Commercial |
$16.03
|
| Rate for Payer: Aetna Medicare |
$4.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.89
|
| Rate for Payer: BCBS Complete |
$7.54
|
| Rate for Payer: BCBS MAPPO |
$4.72
|
| Rate for Payer: BCBS Trust/PPO |
$15.50
|
| Rate for Payer: BCN Commercial |
$14.66
|
| Rate for Payer: BCN Medicare Advantage |
$4.72
|
| Rate for Payer: Cash Price |
$15.09
|
| Rate for Payer: Cofinity Commercial |
$16.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.72
|
| Rate for Payer: Healthscope Commercial |
$16.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.03
|
| Rate for Payer: Nomi Health Commercial |
$15.47
|
| Rate for Payer: PACE Senior Care Partners |
$4.48
|
| Rate for Payer: PACE SWMI |
$4.72
|
| Rate for Payer: PHP Commercial |
$16.03
|
| Rate for Payer: PHP Medicare Advantage |
$4.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.26
|
| Rate for Payer: Priority Health HMO/PPO |
$16.41
|
| Rate for Payer: Priority Health Medicare |
$4.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.64
|
| Rate for Payer: Railroad Medicare Medicare |
$4.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.60
|
| Rate for Payer: UHC Core |
$15.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.72
|
| Rate for Payer: UHC Exchange |
$4.72
|
| Rate for Payer: UHC Medicare Advantage |
$4.72
|
| Rate for Payer: VA VA |
$4.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.14
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
IP
|
$15.21
|
|
|
Service Code
|
NDC 61314039601
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.89 |
| Max. Negotiated Rate |
$13.69 |
| Rate for Payer: Aetna Commercial |
$12.93
|
| Rate for Payer: BCBS Trust/PPO |
$12.42
|
| Rate for Payer: BCN Commercial |
$11.75
|
| Rate for Payer: Cash Price |
$12.17
|
| Rate for Payer: Cofinity Commercial |
$13.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.17
|
| Rate for Payer: Healthscope Commercial |
$13.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.93
|
| Rate for Payer: Nomi Health Commercial |
$12.47
|
| Rate for Payer: PHP Commercial |
$12.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.89
|
| Rate for Payer: Priority Health HMO/PPO |
$13.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.38
|
| Rate for Payer: UHC Core |
$12.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.41
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
OP
|
$40.25
|
|
|
Service Code
|
NDC 24208073501
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.56 |
| Max. Negotiated Rate |
$36.22 |
| Rate for Payer: Aetna Commercial |
$34.21
|
| Rate for Payer: Aetna Medicare |
$10.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.58
|
| Rate for Payer: BCBS Complete |
$16.10
|
| Rate for Payer: BCBS MAPPO |
$10.06
|
| Rate for Payer: BCBS Trust/PPO |
$33.09
|
| Rate for Payer: BCN Commercial |
$31.29
|
| Rate for Payer: BCN Medicare Advantage |
$10.06
|
| Rate for Payer: Cash Price |
$32.20
|
| Rate for Payer: Cofinity Commercial |
$34.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.06
|
| Rate for Payer: Healthscope Commercial |
$36.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.21
|
| Rate for Payer: Nomi Health Commercial |
$33.00
|
| Rate for Payer: PACE Senior Care Partners |
$9.56
|
| Rate for Payer: PACE SWMI |
$10.06
|
| Rate for Payer: PHP Commercial |
$34.21
|
| Rate for Payer: PHP Medicare Advantage |
$10.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.16
|
| Rate for Payer: Priority Health HMO/PPO |
$35.02
|
| Rate for Payer: Priority Health Medicare |
$10.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.97
|
| Rate for Payer: Railroad Medicare Medicare |
$10.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.42
|
| Rate for Payer: UHC Core |
$33.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.06
|
| Rate for Payer: UHC Exchange |
$10.06
|
| Rate for Payer: UHC Medicare Advantage |
$10.06
|
| Rate for Payer: VA VA |
$10.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.19
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
IP
|
$18.86
|
|
|
Service Code
|
NDC 17478010002
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.26 |
| Max. Negotiated Rate |
$16.97 |
| Rate for Payer: Aetna Commercial |
$16.03
|
| Rate for Payer: BCBS Trust/PPO |
$15.40
|
| Rate for Payer: BCN Commercial |
$14.58
|
| Rate for Payer: Cash Price |
$15.09
|
| Rate for Payer: Cofinity Commercial |
$16.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.09
|
| Rate for Payer: Healthscope Commercial |
$16.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.03
|
| Rate for Payer: Nomi Health Commercial |
$15.47
|
| Rate for Payer: PHP Commercial |
$16.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.26
|
| Rate for Payer: Priority Health HMO/PPO |
$16.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.60
|
| Rate for Payer: UHC Core |
$15.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.14
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
IP
|
$40.25
|
|
|
Service Code
|
NDC 24208073501
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.16 |
| Max. Negotiated Rate |
$36.22 |
| Rate for Payer: Aetna Commercial |
$34.21
|
| Rate for Payer: BCBS Trust/PPO |
$32.86
|
| Rate for Payer: BCN Commercial |
$31.11
|
| Rate for Payer: Cash Price |
$32.20
|
| Rate for Payer: Cofinity Commercial |
$34.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.20
|
| Rate for Payer: Healthscope Commercial |
$36.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.21
|
| Rate for Payer: Nomi Health Commercial |
$33.00
|
| Rate for Payer: PHP Commercial |
$34.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.16
|
| Rate for Payer: Priority Health HMO/PPO |
$35.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.42
|
| Rate for Payer: UHC Core |
$33.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.19
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
OP
|
$15.21
|
|
|
Service Code
|
NDC 61314039601
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$13.69 |
| Rate for Payer: Aetna Commercial |
$12.93
|
| Rate for Payer: Aetna Medicare |
$3.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.75
|
| Rate for Payer: BCBS Complete |
$6.08
|
| Rate for Payer: BCBS MAPPO |
$3.80
|
| Rate for Payer: BCBS Trust/PPO |
$12.50
|
| Rate for Payer: BCN Commercial |
$11.83
|
| Rate for Payer: BCN Medicare Advantage |
$3.80
|
| Rate for Payer: Cash Price |
$12.17
|
| Rate for Payer: Cofinity Commercial |
$13.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$13.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.93
|
| Rate for Payer: Nomi Health Commercial |
$12.47
|
| Rate for Payer: PACE Senior Care Partners |
$3.61
|
| Rate for Payer: PACE SWMI |
$3.80
|
| Rate for Payer: PHP Commercial |
$12.93
|
| Rate for Payer: PHP Medicare Advantage |
$3.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.89
|
| Rate for Payer: Priority Health HMO/PPO |
$13.23
|
| Rate for Payer: Priority Health Medicare |
$3.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.19
|
| Rate for Payer: Railroad Medicare Medicare |
$3.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.38
|
| Rate for Payer: UHC Core |
$12.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.80
|
| Rate for Payer: UHC Exchange |
$3.80
|
| Rate for Payer: UHC Medicare Advantage |
$3.80
|
| Rate for Payer: VA VA |
$3.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.41
|
|
|
CYCLOPENTOLATE-PHENYLEPHRINE 0.2 %-1 % EYE DROPS
|
Facility
|
OP
|
$103.92
|
|
|
Service Code
|
NDC 00065035902
|
| Hospital Charge Code |
9701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.68 |
| Max. Negotiated Rate |
$93.53 |
| Rate for Payer: Aetna Commercial |
$88.33
|
| Rate for Payer: Aetna Medicare |
$27.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.48
|
| Rate for Payer: BCBS Complete |
$41.57
|
| Rate for Payer: BCBS MAPPO |
$25.98
|
| Rate for Payer: BCBS Trust/PPO |
$85.43
|
| Rate for Payer: BCN Commercial |
$80.80
|
| Rate for Payer: BCN Medicare Advantage |
$25.98
|
| Rate for Payer: Cash Price |
$83.14
|
| Rate for Payer: Cofinity Commercial |
$89.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.98
|
| Rate for Payer: Healthscope Commercial |
$93.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.33
|
| Rate for Payer: Nomi Health Commercial |
$85.21
|
| Rate for Payer: PACE Senior Care Partners |
$24.68
|
| Rate for Payer: PACE SWMI |
$25.98
|
| Rate for Payer: PHP Commercial |
$88.33
|
| Rate for Payer: PHP Medicare Advantage |
$25.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.55
|
| Rate for Payer: Priority Health HMO/PPO |
$90.41
|
| Rate for Payer: Priority Health Medicare |
$26.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.63
|
| Rate for Payer: Railroad Medicare Medicare |
$25.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.45
|
| Rate for Payer: UHC Core |
$86.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.98
|
| Rate for Payer: UHC Exchange |
$25.98
|
| Rate for Payer: UHC Medicare Advantage |
$25.98
|
| Rate for Payer: VA VA |
$25.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.94
|
|
|
CYCLOPENTOLATE-PHENYLEPHRINE 0.2 %-1 % EYE DROPS
|
Facility
|
IP
|
$103.92
|
|
|
Service Code
|
NDC 00065035902
|
| Hospital Charge Code |
9701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.55 |
| Max. Negotiated Rate |
$93.53 |
| Rate for Payer: Aetna Commercial |
$88.33
|
| Rate for Payer: BCBS Trust/PPO |
$84.83
|
| Rate for Payer: BCN Commercial |
$80.31
|
| Rate for Payer: Cash Price |
$83.14
|
| Rate for Payer: Cofinity Commercial |
$89.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.14
|
| Rate for Payer: Healthscope Commercial |
$93.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.33
|
| Rate for Payer: Nomi Health Commercial |
$85.21
|
| Rate for Payer: PHP Commercial |
$88.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.55
|
| Rate for Payer: Priority Health HMO/PPO |
$90.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.45
|
| Rate for Payer: UHC Core |
$86.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.94
|
|
|
CYCLOSPORINE MODIFIED 25 MG CAPSULE
|
Facility
|
IP
|
$121.70
|
|
|
Service Code
|
HCPCS J7515
|
| Hospital Charge Code |
28842
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.10 |
| Max. Negotiated Rate |
$109.53 |
| Rate for Payer: Aetna Commercial |
$103.44
|
| Rate for Payer: Aetna Commercial |
$3.45
|
| Rate for Payer: BCBS Trust/PPO |
$99.34
|
| Rate for Payer: BCBS Trust/PPO |
$3.31
|
| Rate for Payer: BCN Commercial |
$94.05
|
| Rate for Payer: BCN Commercial |
$3.14
|
| Rate for Payer: Cash Price |
$97.36
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Cofinity Commercial |
$3.49
|
| Rate for Payer: Cofinity Commercial |
$104.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.36
|
| Rate for Payer: Healthscope Commercial |
$109.53
|
| Rate for Payer: Healthscope Commercial |
$3.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.45
|
| Rate for Payer: Nomi Health Commercial |
$99.79
|
| Rate for Payer: Nomi Health Commercial |
$3.33
|
| Rate for Payer: PHP Commercial |
$103.44
|
| Rate for Payer: PHP Commercial |
$3.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.10
|
| Rate for Payer: Priority Health HMO/PPO |
$3.53
|
| Rate for Payer: Priority Health HMO/PPO |
$105.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.57
|
| Rate for Payer: UHC Core |
$101.62
|
| Rate for Payer: UHC Core |
$3.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.04
|
|
|
CYCLOSPORINE MODIFIED 25 MG CAPSULE
|
Facility
|
OP
|
$4.06
|
|
|
Service Code
|
HCPCS J7515
|
| Hospital Charge Code |
28842
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$3.65 |
| Rate for Payer: Aetna Commercial |
$3.45
|
| Rate for Payer: Aetna Commercial |
$103.44
|
| Rate for Payer: Aetna Medicare |
$1.06
|
| Rate for Payer: Aetna Medicare |
$31.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.03
|
| Rate for Payer: BCBS Complete |
$48.68
|
| Rate for Payer: BCBS Complete |
$1.62
|
| Rate for Payer: BCBS MAPPO |
$30.42
|
| Rate for Payer: BCBS MAPPO |
$1.02
|
| Rate for Payer: BCBS Trust/PPO |
$3.34
|
| Rate for Payer: BCBS Trust/PPO |
$100.05
|
| Rate for Payer: BCN Commercial |
$3.16
|
| Rate for Payer: BCN Commercial |
$94.62
|
| Rate for Payer: BCN Medicare Advantage |
$1.02
|
| Rate for Payer: BCN Medicare Advantage |
$30.42
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Cash Price |
$97.36
|
| Rate for Payer: Cofinity Commercial |
$104.66
|
| Rate for Payer: Cofinity Commercial |
$3.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.02
|
| Rate for Payer: Healthscope Commercial |
$109.53
|
| Rate for Payer: Healthscope Commercial |
$3.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.44
|
| Rate for Payer: Nomi Health Commercial |
$3.33
|
| Rate for Payer: Nomi Health Commercial |
$99.79
|
| Rate for Payer: PACE Senior Care Partners |
$0.96
|
| Rate for Payer: PACE Senior Care Partners |
$28.90
|
| Rate for Payer: PACE SWMI |
$1.02
|
| Rate for Payer: PACE SWMI |
$30.42
|
| Rate for Payer: PHP Commercial |
$3.45
|
| Rate for Payer: PHP Commercial |
$103.44
|
| Rate for Payer: PHP Medicare Advantage |
$30.42
|
| Rate for Payer: PHP Medicare Advantage |
$1.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.10
|
| Rate for Payer: Priority Health HMO/PPO |
$105.88
|
| Rate for Payer: Priority Health HMO/PPO |
$3.53
|
| Rate for Payer: Priority Health Medicare |
$1.03
|
| Rate for Payer: Priority Health Medicare |
$30.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.54
|
| Rate for Payer: Railroad Medicare Medicare |
$30.42
|
| Rate for Payer: Railroad Medicare Medicare |
$1.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.57
|
| Rate for Payer: UHC Core |
$3.39
|
| Rate for Payer: UHC Core |
$101.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.42
|
| Rate for Payer: UHC Exchange |
$30.42
|
| Rate for Payer: UHC Exchange |
$1.02
|
| Rate for Payer: UHC Medicare Advantage |
$30.42
|
| Rate for Payer: UHC Medicare Advantage |
$1.02
|
| Rate for Payer: VA VA |
$30.42
|
| Rate for Payer: VA VA |
$1.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.28
|
|
|
DABIGATRAN ETEXILATE 75 MG CAPSULE
|
Facility
|
IP
|
$679.99
|
|
|
Service Code
|
NDC 00597035556
|
| Hospital Charge Code |
106490
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$441.99 |
| Max. Negotiated Rate |
$611.99 |
| Rate for Payer: Aetna Commercial |
$577.99
|
| Rate for Payer: BCBS Trust/PPO |
$555.08
|
| Rate for Payer: BCN Commercial |
$525.50
|
| Rate for Payer: Cash Price |
$543.99
|
| Rate for Payer: Cofinity Commercial |
$584.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$543.99
|
| Rate for Payer: Healthscope Commercial |
$611.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$509.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$577.99
|
| Rate for Payer: Nomi Health Commercial |
$557.59
|
| Rate for Payer: PHP Commercial |
$577.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$441.99
|
| Rate for Payer: Priority Health HMO/PPO |
$591.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$455.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$598.39
|
| Rate for Payer: UHC Core |
$567.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$509.99
|
|
|
DABIGATRAN ETEXILATE 75 MG CAPSULE
|
Facility
|
OP
|
$679.99
|
|
|
Service Code
|
NDC 00597035556
|
| Hospital Charge Code |
106490
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.50 |
| Max. Negotiated Rate |
$611.99 |
| Rate for Payer: Aetna Commercial |
$577.99
|
| Rate for Payer: Aetna Medicare |
$176.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$212.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$212.50
|
| Rate for Payer: BCBS Complete |
$272.00
|
| Rate for Payer: BCBS MAPPO |
$170.00
|
| Rate for Payer: BCBS Trust/PPO |
$559.02
|
| Rate for Payer: BCN Commercial |
$528.69
|
| Rate for Payer: BCN Medicare Advantage |
$170.00
|
| Rate for Payer: Cash Price |
$543.99
|
| Rate for Payer: Cofinity Commercial |
$584.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$543.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$170.00
|
| Rate for Payer: Healthscope Commercial |
$611.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$509.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$577.99
|
| Rate for Payer: Nomi Health Commercial |
$557.59
|
| Rate for Payer: PACE Senior Care Partners |
$161.50
|
| Rate for Payer: PACE SWMI |
$170.00
|
| Rate for Payer: PHP Commercial |
$577.99
|
| Rate for Payer: PHP Medicare Advantage |
$170.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$441.99
|
| Rate for Payer: Priority Health HMO/PPO |
$591.59
|
| Rate for Payer: Priority Health Medicare |
$171.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$455.59
|
| Rate for Payer: Railroad Medicare Medicare |
$170.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$598.39
|
| Rate for Payer: UHC Core |
$567.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$170.00
|
| Rate for Payer: UHC Exchange |
$170.00
|
| Rate for Payer: UHC Medicare Advantage |
$170.00
|
| Rate for Payer: VA VA |
$170.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$509.99
|
|
|
DANTROLENE 20 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$218.92
|
|
|
Service Code
|
NDC 27505000367
|
| Hospital Charge Code |
9716
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$142.30 |
| Max. Negotiated Rate |
$197.03 |
| Rate for Payer: Aetna Commercial |
$186.08
|
| Rate for Payer: BCBS Trust/PPO |
$178.70
|
| Rate for Payer: BCN Commercial |
$169.18
|
| Rate for Payer: Cash Price |
$175.14
|
| Rate for Payer: Cofinity Commercial |
$188.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.14
|
| Rate for Payer: Healthscope Commercial |
$197.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.08
|
| Rate for Payer: Nomi Health Commercial |
$179.51
|
| Rate for Payer: PHP Commercial |
$186.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.30
|
| Rate for Payer: Priority Health HMO/PPO |
$190.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$146.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.65
|
| Rate for Payer: UHC Core |
$182.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.19
|
|
|
DANTROLENE 20 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$218.92
|
|
|
Service Code
|
NDC 27505000367
|
| Hospital Charge Code |
9716
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$51.99 |
| Max. Negotiated Rate |
$197.03 |
| Rate for Payer: Aetna Commercial |
$186.08
|
| Rate for Payer: Aetna Medicare |
$56.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.41
|
| Rate for Payer: BCBS Complete |
$87.57
|
| Rate for Payer: BCBS MAPPO |
$54.73
|
| Rate for Payer: BCBS Trust/PPO |
$179.97
|
| Rate for Payer: BCN Commercial |
$170.21
|
| Rate for Payer: BCN Medicare Advantage |
$54.73
|
| Rate for Payer: Cash Price |
$175.14
|
| Rate for Payer: Cofinity Commercial |
$188.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.73
|
| Rate for Payer: Healthscope Commercial |
$197.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.08
|
| Rate for Payer: Nomi Health Commercial |
$179.51
|
| Rate for Payer: PACE Senior Care Partners |
$51.99
|
| Rate for Payer: PACE SWMI |
$54.73
|
| Rate for Payer: PHP Commercial |
$186.08
|
| Rate for Payer: PHP Medicare Advantage |
$54.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.30
|
| Rate for Payer: Priority Health HMO/PPO |
$190.46
|
| Rate for Payer: Priority Health Medicare |
$55.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$146.68
|
| Rate for Payer: Railroad Medicare Medicare |
$54.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.65
|
| Rate for Payer: UHC Core |
$182.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.73
|
| Rate for Payer: UHC Exchange |
$54.73
|
| Rate for Payer: UHC Medicare Advantage |
$54.73
|
| Rate for Payer: VA VA |
$54.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.19
|
|
|
DAPAGLIFLOZIN PROPANEDIOL 10 MG TABLET
|
Facility
|
OP
|
$1,400.16
|
|
|
Service Code
|
NDC 00310621039
|
| Hospital Charge Code |
169524
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$332.54 |
| Max. Negotiated Rate |
$1,260.14 |
| Rate for Payer: Aetna Commercial |
$1,190.14
|
| Rate for Payer: Aetna Medicare |
$364.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.55
|
| Rate for Payer: BCBS Complete |
$560.06
|
| Rate for Payer: BCBS MAPPO |
$350.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,151.07
|
| Rate for Payer: BCN Commercial |
$1,088.62
|
| Rate for Payer: BCN Medicare Advantage |
$350.04
|
| Rate for Payer: Cash Price |
$1,120.13
|
| Rate for Payer: Cofinity Commercial |
$1,204.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,120.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$350.04
|
| Rate for Payer: Healthscope Commercial |
$1,260.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,050.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,190.14
|
| Rate for Payer: Nomi Health Commercial |
$1,148.13
|
| Rate for Payer: PACE Senior Care Partners |
$332.54
|
| Rate for Payer: PACE SWMI |
$350.04
|
| Rate for Payer: PHP Commercial |
$1,190.14
|
| Rate for Payer: PHP Medicare Advantage |
$350.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$910.10
|
| Rate for Payer: Priority Health HMO/PPO |
$1,218.14
|
| Rate for Payer: Priority Health Medicare |
$353.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$938.11
|
| Rate for Payer: Railroad Medicare Medicare |
$350.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,232.14
|
| Rate for Payer: UHC Core |
$1,169.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$350.04
|
| Rate for Payer: UHC Exchange |
$350.04
|
| Rate for Payer: UHC Medicare Advantage |
$350.04
|
| Rate for Payer: VA VA |
$350.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,050.12
|
|
