|
AMLODIPINE 10 MG TABLET
|
Facility
|
OP
|
$157.45
|
|
|
Service Code
|
NDC 00904637161
|
| Hospital Charge Code |
9069
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.76 |
| Max. Negotiated Rate |
$141.71 |
| Rate for Payer: Aetna Commercial |
$133.83
|
| Rate for Payer: Aetna Medicare |
$40.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.20
|
| Rate for Payer: BCBS Complete |
$29.14
|
| Rate for Payer: BCBS MAPPO |
$39.36
|
| Rate for Payer: BCBS Trust/PPO |
$129.44
|
| Rate for Payer: BCN Commercial |
$129.44
|
| Rate for Payer: BCN Medicare Advantage |
$39.36
|
| Rate for Payer: Cash Price |
$125.96
|
| Rate for Payer: Cofinity Commercial |
$135.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.36
|
| Rate for Payer: Healthscope Commercial |
$141.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.09
|
| Rate for Payer: Mclaren Medicaid |
$27.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.33
|
| Rate for Payer: Meridian Medicaid |
$29.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$43.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.83
|
| Rate for Payer: Nomi Health Commercial |
$129.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.09
|
| Rate for Payer: PACE Senior Care Partners |
$37.39
|
| Rate for Payer: PACE SWMI |
$39.36
|
| Rate for Payer: PHP Commercial |
$133.83
|
| Rate for Payer: PHP Medicare Advantage |
$39.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$136.98
|
| Rate for Payer: Priority Health Medicare |
$39.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$109.59
|
| Rate for Payer: Railroad Medicare Medicare |
$39.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.56
|
| Rate for Payer: UHC Core |
$131.47
|
| Rate for Payer: UHC Exchange |
$39.36
|
| Rate for Payer: UHC Medicaid |
$27.76
|
| Rate for Payer: UHC Medicare Advantage |
$39.36
|
| Rate for Payer: UHCCP Medicaid |
$27.76
|
| Rate for Payer: VA VA |
$39.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.09
|
|
|
AMLODIPINE 10 MG TABLET
|
Facility
|
OP
|
$3,996.37
|
|
|
Service Code
|
NDC 00069154041
|
| Hospital Charge Code |
9069
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$704.56 |
| Max. Negotiated Rate |
$3,596.73 |
| Rate for Payer: Aetna Commercial |
$3,396.91
|
| Rate for Payer: Aetna Medicare |
$1,039.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,248.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,248.87
|
| Rate for Payer: BCBS Complete |
$739.73
|
| Rate for Payer: BCBS MAPPO |
$999.09
|
| Rate for Payer: BCBS Trust/PPO |
$3,285.42
|
| Rate for Payer: BCN Commercial |
$3,285.42
|
| Rate for Payer: BCN Medicare Advantage |
$999.09
|
| Rate for Payer: Cash Price |
$3,197.10
|
| Rate for Payer: Cofinity Commercial |
$3,436.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,197.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$999.09
|
| Rate for Payer: Healthscope Commercial |
$3,596.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,997.28
|
| Rate for Payer: Mclaren Medicaid |
$704.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,049.05
|
| Rate for Payer: Meridian Medicaid |
$739.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,148.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,099.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,396.91
|
| Rate for Payer: Nomi Health Commercial |
$3,277.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,997.28
|
| Rate for Payer: PACE Senior Care Partners |
$949.14
|
| Rate for Payer: PACE SWMI |
$999.09
|
| Rate for Payer: PHP Commercial |
$3,396.91
|
| Rate for Payer: PHP Medicare Advantage |
$999.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$704.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,476.84
|
| Rate for Payer: Priority Health Medicare |
$1,009.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,781.47
|
| Rate for Payer: Railroad Medicare Medicare |
$999.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,516.81
|
| Rate for Payer: UHC Core |
$3,336.97
|
| Rate for Payer: UHC Exchange |
$999.09
|
| Rate for Payer: UHC Medicaid |
$704.56
|
| Rate for Payer: UHC Medicare Advantage |
$999.09
|
| Rate for Payer: UHCCP Medicaid |
$704.56
|
| Rate for Payer: VA VA |
$999.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,997.28
|
|
|
AMLODIPINE 10 MG TABLET
|
Facility
|
IP
|
$40.19
|
|
|
Service Code
|
NDC 69097012805
|
| Hospital Charge Code |
9069
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.97 |
| Max. Negotiated Rate |
$36.17 |
| Rate for Payer: Aetna Commercial |
$34.16
|
| Rate for Payer: BCBS Trust/PPO |
$33.19
|
| Rate for Payer: BCN Commercial |
$33.19
|
| Rate for Payer: Cash Price |
$32.15
|
| Rate for Payer: Cofinity Commercial |
$34.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.15
|
| Rate for Payer: Healthscope Commercial |
$36.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.16
|
| Rate for Payer: Nomi Health Commercial |
$32.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.14
|
| Rate for Payer: PHP Commercial |
$34.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$34.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.37
|
| Rate for Payer: UHC Core |
$33.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.14
|
|
|
AMLODIPINE 2.5 MG TABLET
|
Facility
|
IP
|
$227.95
|
|
|
Service Code
|
NDC 00904636961
|
| Hospital Charge Code |
9070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.65 |
| Max. Negotiated Rate |
$205.16 |
| Rate for Payer: Aetna Commercial |
$193.76
|
| Rate for Payer: BCBS Trust/PPO |
$188.26
|
| Rate for Payer: BCN Commercial |
$188.26
|
| Rate for Payer: Cash Price |
$182.36
|
| Rate for Payer: Cofinity Commercial |
$196.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.36
|
| Rate for Payer: Healthscope Commercial |
$205.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.76
|
| Rate for Payer: Nomi Health Commercial |
$186.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.96
|
| Rate for Payer: PHP Commercial |
$193.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$198.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$158.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.60
|
| Rate for Payer: UHC Core |
$190.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.96
|
|
|
AMLODIPINE 2.5 MG TABLET
|
Facility
|
OP
|
$227.95
|
|
|
Service Code
|
NDC 00904636961
|
| Hospital Charge Code |
9070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.19 |
| Max. Negotiated Rate |
$205.16 |
| Rate for Payer: Aetna Commercial |
$193.76
|
| Rate for Payer: Aetna Medicare |
$59.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71.23
|
| Rate for Payer: BCBS Complete |
$42.19
|
| Rate for Payer: BCBS MAPPO |
$56.99
|
| Rate for Payer: BCBS Trust/PPO |
$187.40
|
| Rate for Payer: BCN Commercial |
$187.40
|
| Rate for Payer: BCN Medicare Advantage |
$56.99
|
| Rate for Payer: Cash Price |
$182.36
|
| Rate for Payer: Cofinity Commercial |
$196.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.99
|
| Rate for Payer: Healthscope Commercial |
$205.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.96
|
| Rate for Payer: Mclaren Medicaid |
$40.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.84
|
| Rate for Payer: Meridian Medicaid |
$42.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$62.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.76
|
| Rate for Payer: Nomi Health Commercial |
$186.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.96
|
| Rate for Payer: PACE Senior Care Partners |
$54.14
|
| Rate for Payer: PACE SWMI |
$56.99
|
| Rate for Payer: PHP Commercial |
$193.76
|
| Rate for Payer: PHP Medicare Advantage |
$56.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$198.32
|
| Rate for Payer: Priority Health Medicare |
$57.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$158.65
|
| Rate for Payer: Railroad Medicare Medicare |
$56.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.60
|
| Rate for Payer: UHC Core |
$190.34
|
| Rate for Payer: UHC Exchange |
$56.99
|
| Rate for Payer: UHC Medicaid |
$40.19
|
| Rate for Payer: UHC Medicare Advantage |
$56.99
|
| Rate for Payer: UHCCP Medicaid |
$40.19
|
| Rate for Payer: VA VA |
$56.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.96
|
|
|
AMLODIPINE 5 MG TABLET
|
Facility
|
IP
|
$195.05
|
|
|
Service Code
|
NDC 00904637061
|
| Hospital Charge Code |
9071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.75 |
| Max. Negotiated Rate |
$175.54 |
| Rate for Payer: Aetna Commercial |
$165.79
|
| Rate for Payer: BCBS Trust/PPO |
$161.09
|
| Rate for Payer: BCN Commercial |
$161.09
|
| Rate for Payer: Cash Price |
$156.04
|
| Rate for Payer: Cofinity Commercial |
$167.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.04
|
| Rate for Payer: Healthscope Commercial |
$175.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.79
|
| Rate for Payer: Nomi Health Commercial |
$159.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.29
|
| Rate for Payer: PHP Commercial |
$165.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$169.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$135.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.64
|
| Rate for Payer: UHC Core |
$162.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.29
|
|
|
AMLODIPINE 5 MG TABLET
|
Facility
|
OP
|
$195.05
|
|
|
Service Code
|
NDC 00904637061
|
| Hospital Charge Code |
9071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.39 |
| Max. Negotiated Rate |
$175.54 |
| Rate for Payer: Aetna Commercial |
$165.79
|
| Rate for Payer: Aetna Medicare |
$50.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.95
|
| Rate for Payer: BCBS Complete |
$36.10
|
| Rate for Payer: BCBS MAPPO |
$48.76
|
| Rate for Payer: BCBS Trust/PPO |
$160.35
|
| Rate for Payer: BCN Commercial |
$160.35
|
| Rate for Payer: BCN Medicare Advantage |
$48.76
|
| Rate for Payer: Cash Price |
$156.04
|
| Rate for Payer: Cofinity Commercial |
$167.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.76
|
| Rate for Payer: Healthscope Commercial |
$175.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.29
|
| Rate for Payer: Mclaren Medicaid |
$34.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.20
|
| Rate for Payer: Meridian Medicaid |
$36.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$53.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.79
|
| Rate for Payer: Nomi Health Commercial |
$159.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.29
|
| Rate for Payer: PACE Senior Care Partners |
$46.32
|
| Rate for Payer: PACE SWMI |
$48.76
|
| Rate for Payer: PHP Commercial |
$165.79
|
| Rate for Payer: PHP Medicare Advantage |
$48.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$169.69
|
| Rate for Payer: Priority Health Medicare |
$49.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$135.75
|
| Rate for Payer: Railroad Medicare Medicare |
$48.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.64
|
| Rate for Payer: UHC Core |
$162.87
|
| Rate for Payer: UHC Exchange |
$48.76
|
| Rate for Payer: UHC Medicaid |
$34.39
|
| Rate for Payer: UHC Medicare Advantage |
$48.76
|
| Rate for Payer: UHCCP Medicaid |
$34.39
|
| Rate for Payer: VA VA |
$48.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.29
|
|
|
AMMONIUM LACTATE 12 % LOTION
|
Facility
|
IP
|
$20.25
|
|
|
Service Code
|
NDC 00904598426
|
| Hospital Charge Code |
10380
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.09 |
| Max. Negotiated Rate |
$18.23 |
| Rate for Payer: Aetna Commercial |
$17.21
|
| Rate for Payer: BCBS Trust/PPO |
$16.72
|
| Rate for Payer: BCN Commercial |
$16.72
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cofinity Commercial |
$17.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.20
|
| Rate for Payer: Healthscope Commercial |
$18.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.21
|
| Rate for Payer: Nomi Health Commercial |
$16.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.19
|
| Rate for Payer: PHP Commercial |
$17.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.82
|
| Rate for Payer: UHC Core |
$16.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.19
|
|
|
AMMONIUM LACTATE 12 % LOTION
|
Facility
|
OP
|
$20.25
|
|
|
Service Code
|
NDC 00904598426
|
| Hospital Charge Code |
10380
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$18.23 |
| Rate for Payer: Aetna Commercial |
$17.21
|
| Rate for Payer: Aetna Medicare |
$5.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.33
|
| Rate for Payer: BCBS Complete |
$3.75
|
| Rate for Payer: BCBS MAPPO |
$5.06
|
| Rate for Payer: BCBS Trust/PPO |
$16.65
|
| Rate for Payer: BCN Commercial |
$16.65
|
| Rate for Payer: BCN Medicare Advantage |
$5.06
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cofinity Commercial |
$17.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.06
|
| Rate for Payer: Healthscope Commercial |
$18.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.19
|
| Rate for Payer: Mclaren Medicaid |
$3.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.32
|
| Rate for Payer: Meridian Medicaid |
$3.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.21
|
| Rate for Payer: Nomi Health Commercial |
$16.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.19
|
| Rate for Payer: PACE Senior Care Partners |
$4.81
|
| Rate for Payer: PACE SWMI |
$5.06
|
| Rate for Payer: PHP Commercial |
$17.21
|
| Rate for Payer: PHP Medicare Advantage |
$5.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.62
|
| Rate for Payer: Priority Health Medicare |
$5.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.09
|
| Rate for Payer: Railroad Medicare Medicare |
$5.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.82
|
| Rate for Payer: UHC Core |
$16.91
|
| Rate for Payer: UHC Exchange |
$5.06
|
| Rate for Payer: UHC Medicaid |
$3.57
|
| Rate for Payer: UHC Medicare Advantage |
$5.06
|
| Rate for Payer: UHCCP Medicaid |
$3.57
|
| Rate for Payer: VA VA |
$5.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.19
|
|
|
AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$69.56
|
|
|
Service Code
|
NDC 00781604158
|
| Hospital Charge Code |
454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.41 |
| Max. Negotiated Rate |
$62.60 |
| Rate for Payer: Aetna Commercial |
$59.13
|
| Rate for Payer: BCBS Trust/PPO |
$57.45
|
| Rate for Payer: BCN Commercial |
$57.45
|
| Rate for Payer: Cash Price |
$55.65
|
| Rate for Payer: Cofinity Commercial |
$59.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.65
|
| Rate for Payer: Healthscope Commercial |
$62.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.13
|
| Rate for Payer: Nomi Health Commercial |
$57.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.17
|
| Rate for Payer: PHP Commercial |
$59.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.21
|
| Rate for Payer: UHC Core |
$58.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.17
|
|
|
AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$77.55
|
|
|
Service Code
|
NDC 00781604146
|
| Hospital Charge Code |
454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.97 |
| Max. Negotiated Rate |
$69.80 |
| Rate for Payer: Aetna Commercial |
$65.92
|
| Rate for Payer: BCBS Trust/PPO |
$64.05
|
| Rate for Payer: BCN Commercial |
$64.05
|
| Rate for Payer: Cash Price |
$62.04
|
| Rate for Payer: Cofinity Commercial |
$66.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.04
|
| Rate for Payer: Healthscope Commercial |
$69.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.92
|
| Rate for Payer: Nomi Health Commercial |
$63.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.16
|
| Rate for Payer: PHP Commercial |
$65.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$67.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.24
|
| Rate for Payer: UHC Core |
$64.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.16
|
|
|
AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$71.44
|
|
|
Service Code
|
NDC 00093415579
|
| Hospital Charge Code |
454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.72 |
| Max. Negotiated Rate |
$64.30 |
| Rate for Payer: Aetna Commercial |
$60.72
|
| Rate for Payer: BCBS Trust/PPO |
$59.00
|
| Rate for Payer: BCN Commercial |
$59.00
|
| Rate for Payer: Cash Price |
$57.15
|
| Rate for Payer: Cofinity Commercial |
$61.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.15
|
| Rate for Payer: Healthscope Commercial |
$64.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.72
|
| Rate for Payer: Nomi Health Commercial |
$58.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.58
|
| Rate for Payer: PHP Commercial |
$60.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$62.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.87
|
| Rate for Payer: UHC Core |
$59.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.58
|
|
|
AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$2.59
|
|
|
Service Code
|
NDC 09900000421
|
| Hospital Charge Code |
454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$2.33 |
| Rate for Payer: Aetna Commercial |
$2.20
|
| Rate for Payer: Aetna Medicare |
$0.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.81
|
| Rate for Payer: BCBS Complete |
$0.48
|
| Rate for Payer: BCBS MAPPO |
$0.65
|
| Rate for Payer: BCBS Trust/PPO |
$2.13
|
| Rate for Payer: BCN Commercial |
$2.13
|
| Rate for Payer: BCN Medicare Advantage |
$0.65
|
| Rate for Payer: Cash Price |
$2.07
|
| Rate for Payer: Cofinity Commercial |
$2.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.65
|
| Rate for Payer: Healthscope Commercial |
$2.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.94
|
| Rate for Payer: Mclaren Medicaid |
$0.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.68
|
| Rate for Payer: Meridian Medicaid |
$0.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.20
|
| Rate for Payer: Nomi Health Commercial |
$2.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.94
|
| Rate for Payer: PACE Senior Care Partners |
$0.62
|
| Rate for Payer: PACE SWMI |
$0.65
|
| Rate for Payer: PHP Commercial |
$2.20
|
| Rate for Payer: PHP Medicare Advantage |
$0.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.25
|
| Rate for Payer: Priority Health Medicare |
$0.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.80
|
| Rate for Payer: Railroad Medicare Medicare |
$0.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.28
|
| Rate for Payer: UHC Core |
$2.16
|
| Rate for Payer: UHC Exchange |
$0.65
|
| Rate for Payer: UHC Medicaid |
$0.46
|
| Rate for Payer: UHC Medicare Advantage |
$0.65
|
| Rate for Payer: UHCCP Medicaid |
$0.46
|
| Rate for Payer: VA VA |
$0.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.94
|
|
|
AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$77.55
|
|
|
Service Code
|
NDC 00781604146
|
| Hospital Charge Code |
454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.67 |
| Max. Negotiated Rate |
$69.80 |
| Rate for Payer: Aetna Commercial |
$65.92
|
| Rate for Payer: Aetna Medicare |
$20.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.23
|
| Rate for Payer: BCBS Complete |
$14.35
|
| Rate for Payer: BCBS MAPPO |
$19.39
|
| Rate for Payer: BCBS Trust/PPO |
$63.75
|
| Rate for Payer: BCN Commercial |
$63.75
|
| Rate for Payer: BCN Medicare Advantage |
$19.39
|
| Rate for Payer: Cash Price |
$62.04
|
| Rate for Payer: Cofinity Commercial |
$66.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.39
|
| Rate for Payer: Healthscope Commercial |
$69.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.16
|
| Rate for Payer: Mclaren Medicaid |
$13.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.36
|
| Rate for Payer: Meridian Medicaid |
$14.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.92
|
| Rate for Payer: Nomi Health Commercial |
$63.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.16
|
| Rate for Payer: PACE Senior Care Partners |
$18.42
|
| Rate for Payer: PACE SWMI |
$19.39
|
| Rate for Payer: PHP Commercial |
$65.92
|
| Rate for Payer: PHP Medicare Advantage |
$19.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$67.47
|
| Rate for Payer: Priority Health Medicare |
$19.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.97
|
| Rate for Payer: Railroad Medicare Medicare |
$19.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.24
|
| Rate for Payer: UHC Core |
$64.75
|
| Rate for Payer: UHC Exchange |
$19.39
|
| Rate for Payer: UHC Medicaid |
$13.67
|
| Rate for Payer: UHC Medicare Advantage |
$19.39
|
| Rate for Payer: UHCCP Medicaid |
$13.67
|
| Rate for Payer: VA VA |
$19.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.16
|
|
|
AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$56.40
|
|
|
Service Code
|
NDC 00143988980
|
| Hospital Charge Code |
454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$50.76 |
| Rate for Payer: Aetna Commercial |
$47.94
|
| Rate for Payer: Aetna Medicare |
$14.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.62
|
| Rate for Payer: BCBS Complete |
$10.44
|
| Rate for Payer: BCBS MAPPO |
$14.10
|
| Rate for Payer: BCBS Trust/PPO |
$46.37
|
| Rate for Payer: BCN Commercial |
$46.37
|
| Rate for Payer: BCN Medicare Advantage |
$14.10
|
| Rate for Payer: Cash Price |
$45.12
|
| Rate for Payer: Cofinity Commercial |
$48.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.10
|
| Rate for Payer: Healthscope Commercial |
$50.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.30
|
| Rate for Payer: Mclaren Medicaid |
$9.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.80
|
| Rate for Payer: Meridian Medicaid |
$10.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.94
|
| Rate for Payer: Nomi Health Commercial |
$46.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.30
|
| Rate for Payer: PACE Senior Care Partners |
$13.39
|
| Rate for Payer: PACE SWMI |
$14.10
|
| Rate for Payer: PHP Commercial |
$47.94
|
| Rate for Payer: PHP Medicare Advantage |
$14.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$49.07
|
| Rate for Payer: Priority Health Medicare |
$14.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.25
|
| Rate for Payer: Railroad Medicare Medicare |
$14.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.63
|
| Rate for Payer: UHC Core |
$47.09
|
| Rate for Payer: UHC Exchange |
$14.10
|
| Rate for Payer: UHC Medicaid |
$9.94
|
| Rate for Payer: UHC Medicare Advantage |
$14.10
|
| Rate for Payer: UHCCP Medicaid |
$9.94
|
| Rate for Payer: VA VA |
$14.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.30
|
|
|
AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$56.40
|
|
|
Service Code
|
NDC 00143988980
|
| Hospital Charge Code |
454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.25 |
| Max. Negotiated Rate |
$50.76 |
| Rate for Payer: Aetna Commercial |
$47.94
|
| Rate for Payer: BCBS Trust/PPO |
$46.58
|
| Rate for Payer: BCN Commercial |
$46.58
|
| Rate for Payer: Cash Price |
$45.12
|
| Rate for Payer: Cofinity Commercial |
$48.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.12
|
| Rate for Payer: Healthscope Commercial |
$50.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.94
|
| Rate for Payer: Nomi Health Commercial |
$46.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.30
|
| Rate for Payer: PHP Commercial |
$47.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$49.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.63
|
| Rate for Payer: UHC Core |
$47.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.30
|
|
|
AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$67.68
|
|
|
Service Code
|
NDC 65862070780
|
| Hospital Charge Code |
454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.11 |
| Max. Negotiated Rate |
$60.91 |
| Rate for Payer: Aetna Commercial |
$57.53
|
| Rate for Payer: BCBS Trust/PPO |
$55.90
|
| Rate for Payer: BCN Commercial |
$55.90
|
| Rate for Payer: Cash Price |
$54.14
|
| Rate for Payer: Cofinity Commercial |
$58.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.14
|
| Rate for Payer: Healthscope Commercial |
$60.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.53
|
| Rate for Payer: Nomi Health Commercial |
$55.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.76
|
| Rate for Payer: PHP Commercial |
$57.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$58.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.56
|
| Rate for Payer: UHC Core |
$56.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.76
|
|
|
AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$91.65
|
|
|
Service Code
|
NDC 00781604155
|
| Hospital Charge Code |
454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.79 |
| Max. Negotiated Rate |
$82.48 |
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: BCBS Trust/PPO |
$75.69
|
| Rate for Payer: BCN Commercial |
$75.69
|
| Rate for Payer: Cash Price |
$73.32
|
| Rate for Payer: Cofinity Commercial |
$78.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.32
|
| Rate for Payer: Healthscope Commercial |
$82.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.90
|
| Rate for Payer: Nomi Health Commercial |
$75.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.74
|
| Rate for Payer: PHP Commercial |
$77.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$79.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.65
|
| Rate for Payer: UHC Core |
$76.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.74
|
|
|
AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$67.68
|
|
|
Service Code
|
NDC 65862070780
|
| Hospital Charge Code |
454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$60.91 |
| Rate for Payer: Aetna Commercial |
$57.53
|
| Rate for Payer: Aetna Medicare |
$17.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.15
|
| Rate for Payer: BCBS Complete |
$12.53
|
| Rate for Payer: BCBS MAPPO |
$16.92
|
| Rate for Payer: BCBS Trust/PPO |
$55.64
|
| Rate for Payer: BCN Commercial |
$55.64
|
| Rate for Payer: BCN Medicare Advantage |
$16.92
|
| Rate for Payer: Cash Price |
$54.14
|
| Rate for Payer: Cofinity Commercial |
$58.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.92
|
| Rate for Payer: Healthscope Commercial |
$60.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.76
|
| Rate for Payer: Mclaren Medicaid |
$11.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.77
|
| Rate for Payer: Meridian Medicaid |
$12.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.53
|
| Rate for Payer: Nomi Health Commercial |
$55.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.76
|
| Rate for Payer: PACE Senior Care Partners |
$16.07
|
| Rate for Payer: PACE SWMI |
$16.92
|
| Rate for Payer: PHP Commercial |
$57.53
|
| Rate for Payer: PHP Medicare Advantage |
$16.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$58.88
|
| Rate for Payer: Priority Health Medicare |
$17.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.11
|
| Rate for Payer: Railroad Medicare Medicare |
$16.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.56
|
| Rate for Payer: UHC Core |
$56.51
|
| Rate for Payer: UHC Exchange |
$16.92
|
| Rate for Payer: UHC Medicaid |
$11.93
|
| Rate for Payer: UHC Medicare Advantage |
$16.92
|
| Rate for Payer: UHCCP Medicaid |
$11.93
|
| Rate for Payer: VA VA |
$16.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.76
|
|
|
AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$2.59
|
|
|
Service Code
|
NDC 09900000421
|
| Hospital Charge Code |
454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$2.33 |
| Rate for Payer: Aetna Commercial |
$2.20
|
| Rate for Payer: BCBS Trust/PPO |
$2.14
|
| Rate for Payer: BCN Commercial |
$2.14
|
| Rate for Payer: Cash Price |
$2.07
|
| Rate for Payer: Cofinity Commercial |
$2.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.07
|
| Rate for Payer: Healthscope Commercial |
$2.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.20
|
| Rate for Payer: Nomi Health Commercial |
$2.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.94
|
| Rate for Payer: PHP Commercial |
$2.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.28
|
| Rate for Payer: UHC Core |
$2.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.94
|
|
|
AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$71.44
|
|
|
Service Code
|
NDC 00093415579
|
| Hospital Charge Code |
454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.59 |
| Max. Negotiated Rate |
$64.30 |
| Rate for Payer: Aetna Commercial |
$60.72
|
| Rate for Payer: Aetna Medicare |
$18.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.32
|
| Rate for Payer: BCBS Complete |
$13.22
|
| Rate for Payer: BCBS MAPPO |
$17.86
|
| Rate for Payer: BCBS Trust/PPO |
$58.73
|
| Rate for Payer: BCN Commercial |
$58.73
|
| Rate for Payer: BCN Medicare Advantage |
$17.86
|
| Rate for Payer: Cash Price |
$57.15
|
| Rate for Payer: Cofinity Commercial |
$61.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.86
|
| Rate for Payer: Healthscope Commercial |
$64.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.58
|
| Rate for Payer: Mclaren Medicaid |
$12.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.75
|
| Rate for Payer: Meridian Medicaid |
$13.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.72
|
| Rate for Payer: Nomi Health Commercial |
$58.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.58
|
| Rate for Payer: PACE Senior Care Partners |
$16.97
|
| Rate for Payer: PACE SWMI |
$17.86
|
| Rate for Payer: PHP Commercial |
$60.72
|
| Rate for Payer: PHP Medicare Advantage |
$17.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$62.15
|
| Rate for Payer: Priority Health Medicare |
$18.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.72
|
| Rate for Payer: Railroad Medicare Medicare |
$17.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.87
|
| Rate for Payer: UHC Core |
$59.65
|
| Rate for Payer: UHC Exchange |
$17.86
|
| Rate for Payer: UHC Medicaid |
$12.59
|
| Rate for Payer: UHC Medicare Advantage |
$17.86
|
| Rate for Payer: UHCCP Medicaid |
$12.59
|
| Rate for Payer: VA VA |
$17.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.58
|
|
|
AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$69.56
|
|
|
Service Code
|
NDC 00781604158
|
| Hospital Charge Code |
454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.26 |
| Max. Negotiated Rate |
$62.60 |
| Rate for Payer: Aetna Commercial |
$59.13
|
| Rate for Payer: Aetna Medicare |
$18.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.74
|
| Rate for Payer: BCBS Complete |
$12.88
|
| Rate for Payer: BCBS MAPPO |
$17.39
|
| Rate for Payer: BCBS Trust/PPO |
$57.19
|
| Rate for Payer: BCN Commercial |
$57.19
|
| Rate for Payer: BCN Medicare Advantage |
$17.39
|
| Rate for Payer: Cash Price |
$55.65
|
| Rate for Payer: Cofinity Commercial |
$59.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.39
|
| Rate for Payer: Healthscope Commercial |
$62.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.17
|
| Rate for Payer: Mclaren Medicaid |
$12.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.26
|
| Rate for Payer: Meridian Medicaid |
$12.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.13
|
| Rate for Payer: Nomi Health Commercial |
$57.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.17
|
| Rate for Payer: PACE Senior Care Partners |
$16.52
|
| Rate for Payer: PACE SWMI |
$17.39
|
| Rate for Payer: PHP Commercial |
$59.13
|
| Rate for Payer: PHP Medicare Advantage |
$17.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.52
|
| Rate for Payer: Priority Health Medicare |
$17.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.41
|
| Rate for Payer: Railroad Medicare Medicare |
$17.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.21
|
| Rate for Payer: UHC Core |
$58.08
|
| Rate for Payer: UHC Exchange |
$17.39
|
| Rate for Payer: UHC Medicaid |
$12.26
|
| Rate for Payer: UHC Medicare Advantage |
$17.39
|
| Rate for Payer: UHCCP Medicaid |
$12.26
|
| Rate for Payer: VA VA |
$17.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.17
|
|
|
AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$91.65
|
|
|
Service Code
|
NDC 00781604155
|
| Hospital Charge Code |
454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.16 |
| Max. Negotiated Rate |
$82.48 |
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: Aetna Medicare |
$23.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.64
|
| Rate for Payer: BCBS Complete |
$16.96
|
| Rate for Payer: BCBS MAPPO |
$22.91
|
| Rate for Payer: BCBS Trust/PPO |
$75.35
|
| Rate for Payer: BCN Commercial |
$75.35
|
| Rate for Payer: BCN Medicare Advantage |
$22.91
|
| Rate for Payer: Cash Price |
$73.32
|
| Rate for Payer: Cofinity Commercial |
$78.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.91
|
| Rate for Payer: Healthscope Commercial |
$82.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.74
|
| Rate for Payer: Mclaren Medicaid |
$16.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.06
|
| Rate for Payer: Meridian Medicaid |
$16.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.90
|
| Rate for Payer: Nomi Health Commercial |
$75.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.74
|
| Rate for Payer: PACE Senior Care Partners |
$21.77
|
| Rate for Payer: PACE SWMI |
$22.91
|
| Rate for Payer: PHP Commercial |
$77.90
|
| Rate for Payer: PHP Medicare Advantage |
$22.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$79.74
|
| Rate for Payer: Priority Health Medicare |
$23.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.79
|
| Rate for Payer: Railroad Medicare Medicare |
$22.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.65
|
| Rate for Payer: UHC Core |
$76.53
|
| Rate for Payer: UHC Exchange |
$22.91
|
| Rate for Payer: UHC Medicaid |
$16.16
|
| Rate for Payer: UHC Medicare Advantage |
$22.91
|
| Rate for Payer: UHCCP Medicaid |
$16.16
|
| Rate for Payer: VA VA |
$22.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.74
|
|
|
AMOXICILLIN 250 MG CAPSULE
|
Facility
|
OP
|
$166.85
|
|
|
Service Code
|
NDC 00781202001
|
| Hospital Charge Code |
450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.42 |
| Max. Negotiated Rate |
$150.16 |
| Rate for Payer: Aetna Commercial |
$141.82
|
| Rate for Payer: Aetna Medicare |
$43.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.14
|
| Rate for Payer: BCBS Complete |
$30.88
|
| Rate for Payer: BCBS MAPPO |
$41.71
|
| Rate for Payer: BCBS Trust/PPO |
$137.17
|
| Rate for Payer: BCN Commercial |
$137.17
|
| Rate for Payer: BCN Medicare Advantage |
$41.71
|
| Rate for Payer: Cash Price |
$133.48
|
| Rate for Payer: Cofinity Commercial |
$143.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.71
|
| Rate for Payer: Healthscope Commercial |
$150.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.14
|
| Rate for Payer: Mclaren Medicaid |
$29.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.80
|
| Rate for Payer: Meridian Medicaid |
$30.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$45.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.82
|
| Rate for Payer: Nomi Health Commercial |
$136.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.14
|
| Rate for Payer: PACE Senior Care Partners |
$39.63
|
| Rate for Payer: PACE SWMI |
$41.71
|
| Rate for Payer: PHP Commercial |
$141.82
|
| Rate for Payer: PHP Medicare Advantage |
$41.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$145.16
|
| Rate for Payer: Priority Health Medicare |
$42.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$116.13
|
| Rate for Payer: Railroad Medicare Medicare |
$41.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.83
|
| Rate for Payer: UHC Core |
$139.32
|
| Rate for Payer: UHC Exchange |
$41.71
|
| Rate for Payer: UHC Medicaid |
$29.42
|
| Rate for Payer: UHC Medicare Advantage |
$41.71
|
| Rate for Payer: UHCCP Medicaid |
$29.42
|
| Rate for Payer: VA VA |
$41.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.14
|
|
|
AMOXICILLIN 250 MG CAPSULE
|
Facility
|
OP
|
$110.45
|
|
|
Service Code
|
NDC 65862001601
|
| Hospital Charge Code |
450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.47 |
| Max. Negotiated Rate |
$99.41 |
| Rate for Payer: Aetna Commercial |
$93.88
|
| Rate for Payer: Aetna Medicare |
$28.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.52
|
| Rate for Payer: BCBS Complete |
$20.44
|
| Rate for Payer: BCBS MAPPO |
$27.61
|
| Rate for Payer: BCBS Trust/PPO |
$90.80
|
| Rate for Payer: BCN Commercial |
$90.80
|
| Rate for Payer: BCN Medicare Advantage |
$27.61
|
| Rate for Payer: Cash Price |
$88.36
|
| Rate for Payer: Cofinity Commercial |
$94.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.61
|
| Rate for Payer: Healthscope Commercial |
$99.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.84
|
| Rate for Payer: Mclaren Medicaid |
$19.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.99
|
| Rate for Payer: Meridian Medicaid |
$20.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.88
|
| Rate for Payer: Nomi Health Commercial |
$90.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.84
|
| Rate for Payer: PACE Senior Care Partners |
$26.23
|
| Rate for Payer: PACE SWMI |
$27.61
|
| Rate for Payer: PHP Commercial |
$93.88
|
| Rate for Payer: PHP Medicare Advantage |
$27.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$96.09
|
| Rate for Payer: Priority Health Medicare |
$27.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.87
|
| Rate for Payer: Railroad Medicare Medicare |
$27.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.20
|
| Rate for Payer: UHC Core |
$92.23
|
| Rate for Payer: UHC Exchange |
$27.61
|
| Rate for Payer: UHC Medicaid |
$19.47
|
| Rate for Payer: UHC Medicare Advantage |
$27.61
|
| Rate for Payer: UHCCP Medicaid |
$19.47
|
| Rate for Payer: VA VA |
$27.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.84
|
|
