|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$785.28
|
|
|
Service Code
|
NDC 68084041501
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$186.50 |
| Max. Negotiated Rate |
$706.75 |
| Rate for Payer: Aetna Commercial |
$667.49
|
| Rate for Payer: Aetna Medicare |
$204.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$245.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$245.40
|
| Rate for Payer: BCBS Complete |
$314.11
|
| Rate for Payer: BCBS MAPPO |
$196.32
|
| Rate for Payer: BCBS Trust/PPO |
$645.58
|
| Rate for Payer: BCN Commercial |
$610.56
|
| Rate for Payer: BCN Medicare Advantage |
$196.32
|
| Rate for Payer: Cash Price |
$628.22
|
| Rate for Payer: Cofinity Commercial |
$675.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$628.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$196.32
|
| Rate for Payer: Healthscope Commercial |
$706.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$588.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$225.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$667.49
|
| Rate for Payer: Nomi Health Commercial |
$643.93
|
| Rate for Payer: PACE Senior Care Partners |
$186.50
|
| Rate for Payer: PACE SWMI |
$196.32
|
| Rate for Payer: PHP Commercial |
$667.49
|
| Rate for Payer: PHP Medicare Advantage |
$196.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$510.43
|
| Rate for Payer: Priority Health HMO/PPO |
$683.19
|
| Rate for Payer: Priority Health Medicare |
$198.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$526.14
|
| Rate for Payer: Railroad Medicare Medicare |
$196.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$691.05
|
| Rate for Payer: UHC Core |
$655.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$196.32
|
| Rate for Payer: UHC Exchange |
$196.32
|
| Rate for Payer: UHC Medicare Advantage |
$196.32
|
| Rate for Payer: VA VA |
$196.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$588.96
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$611.52
|
|
|
Service Code
|
NDC 00904718261
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.24 |
| Max. Negotiated Rate |
$550.37 |
| Rate for Payer: Aetna Commercial |
$519.79
|
| Rate for Payer: Aetna Medicare |
$159.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.10
|
| Rate for Payer: BCBS Complete |
$244.61
|
| Rate for Payer: BCBS MAPPO |
$152.88
|
| Rate for Payer: BCBS Trust/PPO |
$502.73
|
| Rate for Payer: BCN Commercial |
$475.46
|
| Rate for Payer: BCN Medicare Advantage |
$152.88
|
| Rate for Payer: Cash Price |
$489.22
|
| Rate for Payer: Cofinity Commercial |
$525.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.88
|
| Rate for Payer: Healthscope Commercial |
$550.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$458.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$519.79
|
| Rate for Payer: Nomi Health Commercial |
$501.45
|
| Rate for Payer: PACE Senior Care Partners |
$145.24
|
| Rate for Payer: PACE SWMI |
$152.88
|
| Rate for Payer: PHP Commercial |
$519.79
|
| Rate for Payer: PHP Medicare Advantage |
$152.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.49
|
| Rate for Payer: Priority Health HMO/PPO |
$532.02
|
| Rate for Payer: Priority Health Medicare |
$154.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$409.72
|
| Rate for Payer: Railroad Medicare Medicare |
$152.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$538.14
|
| Rate for Payer: UHC Core |
$510.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.88
|
| Rate for Payer: UHC Exchange |
$152.88
|
| Rate for Payer: UHC Medicare Advantage |
$152.88
|
| Rate for Payer: VA VA |
$152.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$458.64
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$604.80
|
|
|
Service Code
|
NDC 00904636461
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.64 |
| Max. Negotiated Rate |
$544.32 |
| Rate for Payer: Aetna Commercial |
$514.08
|
| Rate for Payer: Aetna Medicare |
$157.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$189.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$189.00
|
| Rate for Payer: BCBS Complete |
$241.92
|
| Rate for Payer: BCBS MAPPO |
$151.20
|
| Rate for Payer: BCBS Trust/PPO |
$497.21
|
| Rate for Payer: BCN Commercial |
$470.23
|
| Rate for Payer: BCN Medicare Advantage |
$151.20
|
| Rate for Payer: Cash Price |
$483.84
|
| Rate for Payer: Cofinity Commercial |
$520.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$483.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.20
|
| Rate for Payer: Healthscope Commercial |
$544.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$453.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$158.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$173.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$514.08
|
| Rate for Payer: Nomi Health Commercial |
$495.94
|
| Rate for Payer: PACE Senior Care Partners |
$143.64
|
| Rate for Payer: PACE SWMI |
$151.20
|
| Rate for Payer: PHP Commercial |
$514.08
|
| Rate for Payer: PHP Medicare Advantage |
$151.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$393.12
|
| Rate for Payer: Priority Health HMO/PPO |
$526.18
|
| Rate for Payer: Priority Health Medicare |
$152.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$405.22
|
| Rate for Payer: Railroad Medicare Medicare |
$151.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$532.22
|
| Rate for Payer: UHC Core |
$505.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$151.20
|
| Rate for Payer: UHC Exchange |
$151.20
|
| Rate for Payer: UHC Medicare Advantage |
$151.20
|
| Rate for Payer: VA VA |
$151.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$453.60
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$611.52
|
|
|
Service Code
|
NDC 00904718261
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$397.49 |
| Max. Negotiated Rate |
$550.37 |
| Rate for Payer: Aetna Commercial |
$519.79
|
| Rate for Payer: BCBS Trust/PPO |
$499.18
|
| Rate for Payer: BCN Commercial |
$472.58
|
| Rate for Payer: Cash Price |
$489.22
|
| Rate for Payer: Cofinity Commercial |
$525.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.22
|
| Rate for Payer: Healthscope Commercial |
$550.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$458.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$519.79
|
| Rate for Payer: Nomi Health Commercial |
$501.45
|
| Rate for Payer: PHP Commercial |
$519.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.49
|
| Rate for Payer: Priority Health HMO/PPO |
$532.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$409.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$538.14
|
| Rate for Payer: UHC Core |
$510.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$458.64
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$604.80
|
|
|
Service Code
|
NDC 00904636461
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$393.12 |
| Max. Negotiated Rate |
$544.32 |
| Rate for Payer: Aetna Commercial |
$514.08
|
| Rate for Payer: BCBS Trust/PPO |
$493.70
|
| Rate for Payer: BCN Commercial |
$467.39
|
| Rate for Payer: Cash Price |
$483.84
|
| Rate for Payer: Cofinity Commercial |
$520.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$483.84
|
| Rate for Payer: Healthscope Commercial |
$544.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$453.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$514.08
|
| Rate for Payer: Nomi Health Commercial |
$495.94
|
| Rate for Payer: PHP Commercial |
$514.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$393.12
|
| Rate for Payer: Priority Health HMO/PPO |
$526.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$405.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$532.22
|
| Rate for Payer: UHC Core |
$505.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$453.60
|
|
|
DOBUTAMINE 250 MG/250 ML (1 MG/ML) IN 5 % DEXTROSE INTRAVENOUS
|
Facility
|
IP
|
$87.73
|
|
|
Service Code
|
HCPCS J1250
|
| Hospital Charge Code |
15981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.02 |
| Max. Negotiated Rate |
$78.96 |
| Rate for Payer: Aetna Commercial |
$74.57
|
| Rate for Payer: BCBS Trust/PPO |
$71.61
|
| Rate for Payer: BCN Commercial |
$67.80
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cofinity Commercial |
$75.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.18
|
| Rate for Payer: Healthscope Commercial |
$78.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.57
|
| Rate for Payer: Nomi Health Commercial |
$71.94
|
| Rate for Payer: PHP Commercial |
$74.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.02
|
| Rate for Payer: Priority Health HMO/PPO |
$76.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.20
|
| Rate for Payer: UHC Core |
$73.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.80
|
|
|
DOBUTAMINE 250 MG/250 ML (1 MG/ML) IN 5 % DEXTROSE INTRAVENOUS
|
Facility
|
OP
|
$87.73
|
|
|
Service Code
|
HCPCS J1250
|
| Hospital Charge Code |
15981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.84 |
| Max. Negotiated Rate |
$78.96 |
| Rate for Payer: Aetna Commercial |
$74.57
|
| Rate for Payer: Aetna Medicare |
$22.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.42
|
| Rate for Payer: BCBS Complete |
$35.09
|
| Rate for Payer: BCBS MAPPO |
$21.93
|
| Rate for Payer: BCBS Trust/PPO |
$72.12
|
| Rate for Payer: BCN Commercial |
$68.21
|
| Rate for Payer: BCN Medicare Advantage |
$21.93
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cofinity Commercial |
$75.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.93
|
| Rate for Payer: Healthscope Commercial |
$78.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.57
|
| Rate for Payer: Nomi Health Commercial |
$71.94
|
| Rate for Payer: PACE Senior Care Partners |
$20.84
|
| Rate for Payer: PACE SWMI |
$21.93
|
| Rate for Payer: PHP Commercial |
$74.57
|
| Rate for Payer: PHP Medicare Advantage |
$21.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.02
|
| Rate for Payer: Priority Health HMO/PPO |
$76.33
|
| Rate for Payer: Priority Health Medicare |
$22.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.78
|
| Rate for Payer: Railroad Medicare Medicare |
$21.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.20
|
| Rate for Payer: UHC Core |
$73.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.93
|
| Rate for Payer: UHC Exchange |
$21.93
|
| Rate for Payer: UHC Medicare Advantage |
$21.93
|
| Rate for Payer: VA VA |
$21.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.80
|
|
|
DOBUTAMINE 500 MG/250 ML (2,000 MCG/ML) IN 5 % DEXTROSE IV
|
Facility
|
IP
|
$96.39
|
|
|
Service Code
|
HCPCS J1250
|
| Hospital Charge Code |
18315
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.65 |
| Max. Negotiated Rate |
$86.75 |
| Rate for Payer: Aetna Commercial |
$81.93
|
| Rate for Payer: BCBS Trust/PPO |
$78.68
|
| Rate for Payer: BCN Commercial |
$74.49
|
| Rate for Payer: Cash Price |
$77.11
|
| Rate for Payer: Cofinity Commercial |
$82.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.11
|
| Rate for Payer: Healthscope Commercial |
$86.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.93
|
| Rate for Payer: Nomi Health Commercial |
$79.04
|
| Rate for Payer: PHP Commercial |
$81.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.65
|
| Rate for Payer: Priority Health HMO/PPO |
$83.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.82
|
| Rate for Payer: UHC Core |
$80.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.29
|
|
|
DOBUTAMINE 500 MG/250 ML (2,000 MCG/ML) IN 5 % DEXTROSE IV
|
Facility
|
OP
|
$96.39
|
|
|
Service Code
|
HCPCS J1250
|
| Hospital Charge Code |
18315
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.89 |
| Max. Negotiated Rate |
$86.75 |
| Rate for Payer: Aetna Commercial |
$81.93
|
| Rate for Payer: Aetna Medicare |
$25.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.12
|
| Rate for Payer: BCBS Complete |
$38.56
|
| Rate for Payer: BCBS MAPPO |
$24.10
|
| Rate for Payer: BCBS Trust/PPO |
$79.24
|
| Rate for Payer: BCN Commercial |
$74.94
|
| Rate for Payer: BCN Medicare Advantage |
$24.10
|
| Rate for Payer: Cash Price |
$77.11
|
| Rate for Payer: Cofinity Commercial |
$82.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.10
|
| Rate for Payer: Healthscope Commercial |
$86.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.93
|
| Rate for Payer: Nomi Health Commercial |
$79.04
|
| Rate for Payer: PACE Senior Care Partners |
$22.89
|
| Rate for Payer: PACE SWMI |
$24.10
|
| Rate for Payer: PHP Commercial |
$81.93
|
| Rate for Payer: PHP Medicare Advantage |
$24.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.65
|
| Rate for Payer: Priority Health HMO/PPO |
$83.86
|
| Rate for Payer: Priority Health Medicare |
$24.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.58
|
| Rate for Payer: Railroad Medicare Medicare |
$24.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.82
|
| Rate for Payer: UHC Core |
$80.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.10
|
| Rate for Payer: UHC Exchange |
$24.10
|
| Rate for Payer: UHC Medicare Advantage |
$24.10
|
| Rate for Payer: VA VA |
$24.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.29
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
OP
|
$100.80
|
|
|
Service Code
|
NDC 00904699860
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.94 |
| Max. Negotiated Rate |
$90.72 |
| Rate for Payer: Aetna Commercial |
$85.68
|
| Rate for Payer: Aetna Medicare |
$26.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.50
|
| Rate for Payer: BCBS Complete |
$40.32
|
| Rate for Payer: BCBS MAPPO |
$25.20
|
| Rate for Payer: BCBS Trust/PPO |
$82.87
|
| Rate for Payer: BCN Commercial |
$78.37
|
| Rate for Payer: BCN Medicare Advantage |
$25.20
|
| Rate for Payer: Cash Price |
$80.64
|
| Rate for Payer: Cofinity Commercial |
$86.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.20
|
| Rate for Payer: Healthscope Commercial |
$90.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.68
|
| Rate for Payer: Nomi Health Commercial |
$82.66
|
| Rate for Payer: PACE Senior Care Partners |
$23.94
|
| Rate for Payer: PACE SWMI |
$25.20
|
| Rate for Payer: PHP Commercial |
$85.68
|
| Rate for Payer: PHP Medicare Advantage |
$25.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.52
|
| Rate for Payer: Priority Health HMO/PPO |
$87.70
|
| Rate for Payer: Priority Health Medicare |
$25.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.54
|
| Rate for Payer: Railroad Medicare Medicare |
$25.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.70
|
| Rate for Payer: UHC Core |
$84.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.20
|
| Rate for Payer: UHC Exchange |
$25.20
|
| Rate for Payer: UHC Medicare Advantage |
$25.20
|
| Rate for Payer: VA VA |
$25.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.60
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
NDC 63739047810
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.89 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Aetna Commercial |
$160.65
|
| Rate for Payer: Aetna Medicare |
$49.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$59.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$59.06
|
| Rate for Payer: BCBS Complete |
$75.60
|
| Rate for Payer: BCBS MAPPO |
$47.25
|
| Rate for Payer: BCBS Trust/PPO |
$155.38
|
| Rate for Payer: BCN Commercial |
$146.95
|
| Rate for Payer: BCN Medicare Advantage |
$47.25
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cofinity Commercial |
$162.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.25
|
| Rate for Payer: Healthscope Commercial |
$170.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.65
|
| Rate for Payer: Nomi Health Commercial |
$154.98
|
| Rate for Payer: PACE Senior Care Partners |
$44.89
|
| Rate for Payer: PACE SWMI |
$47.25
|
| Rate for Payer: PHP Commercial |
$160.65
|
| Rate for Payer: PHP Medicare Advantage |
$47.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.85
|
| Rate for Payer: Priority Health HMO/PPO |
$164.43
|
| Rate for Payer: Priority Health Medicare |
$47.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.63
|
| Rate for Payer: Railroad Medicare Medicare |
$47.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.32
|
| Rate for Payer: UHC Core |
$157.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.25
|
| Rate for Payer: UHC Exchange |
$47.25
|
| Rate for Payer: UHC Medicare Advantage |
$47.25
|
| Rate for Payer: VA VA |
$47.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.75
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
NDC 00904718361
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna Commercial |
$153.00
|
| Rate for Payer: BCBS Trust/PPO |
$146.93
|
| Rate for Payer: BCN Commercial |
$139.10
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$154.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.00
|
| Rate for Payer: Healthscope Commercial |
$162.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.00
|
| Rate for Payer: Nomi Health Commercial |
$147.60
|
| Rate for Payer: PHP Commercial |
$153.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.00
|
| Rate for Payer: Priority Health HMO/PPO |
$156.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$120.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.40
|
| Rate for Payer: UHC Core |
$150.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.00
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
IP
|
$188.10
|
|
|
Service Code
|
NDC 60687012901
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.27 |
| Max. Negotiated Rate |
$169.29 |
| Rate for Payer: Aetna Commercial |
$159.88
|
| Rate for Payer: BCBS Trust/PPO |
$153.55
|
| Rate for Payer: BCN Commercial |
$145.36
|
| Rate for Payer: Cash Price |
$150.48
|
| Rate for Payer: Cofinity Commercial |
$161.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.48
|
| Rate for Payer: Healthscope Commercial |
$169.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.88
|
| Rate for Payer: Nomi Health Commercial |
$154.24
|
| Rate for Payer: PHP Commercial |
$159.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.27
|
| Rate for Payer: Priority Health HMO/PPO |
$163.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.53
|
| Rate for Payer: UHC Core |
$157.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.07
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
OP
|
$1.89
|
|
|
Service Code
|
NDC 60687012911
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Aetna Commercial |
$1.61
|
| Rate for Payer: Aetna Medicare |
$0.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.59
|
| Rate for Payer: BCBS Complete |
$0.76
|
| Rate for Payer: BCBS MAPPO |
$0.47
|
| Rate for Payer: BCBS Trust/PPO |
$1.55
|
| Rate for Payer: BCN Commercial |
$1.47
|
| Rate for Payer: BCN Medicare Advantage |
$0.47
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Cofinity Commercial |
$1.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.47
|
| Rate for Payer: Healthscope Commercial |
$1.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.61
|
| Rate for Payer: Nomi Health Commercial |
$1.55
|
| Rate for Payer: PACE Senior Care Partners |
$0.45
|
| Rate for Payer: PACE SWMI |
$0.47
|
| Rate for Payer: PHP Commercial |
$1.61
|
| Rate for Payer: PHP Medicare Advantage |
$0.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.23
|
| Rate for Payer: Priority Health HMO/PPO |
$1.64
|
| Rate for Payer: Priority Health Medicare |
$0.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.27
|
| Rate for Payer: Railroad Medicare Medicare |
$0.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.66
|
| Rate for Payer: UHC Core |
$1.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.47
|
| Rate for Payer: UHC Exchange |
$0.47
|
| Rate for Payer: UHC Medicare Advantage |
$0.47
|
| Rate for Payer: VA VA |
$0.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.42
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
OP
|
$188.10
|
|
|
Service Code
|
NDC 60687012901
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.67 |
| Max. Negotiated Rate |
$169.29 |
| Rate for Payer: Aetna Commercial |
$159.88
|
| Rate for Payer: Aetna Medicare |
$48.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.78
|
| Rate for Payer: BCBS Complete |
$75.24
|
| Rate for Payer: BCBS MAPPO |
$47.02
|
| Rate for Payer: BCBS Trust/PPO |
$154.64
|
| Rate for Payer: BCN Commercial |
$146.25
|
| Rate for Payer: BCN Medicare Advantage |
$47.02
|
| Rate for Payer: Cash Price |
$150.48
|
| Rate for Payer: Cofinity Commercial |
$161.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.02
|
| Rate for Payer: Healthscope Commercial |
$169.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.88
|
| Rate for Payer: Nomi Health Commercial |
$154.24
|
| Rate for Payer: PACE Senior Care Partners |
$44.67
|
| Rate for Payer: PACE SWMI |
$47.02
|
| Rate for Payer: PHP Commercial |
$159.88
|
| Rate for Payer: PHP Medicare Advantage |
$47.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.27
|
| Rate for Payer: Priority Health HMO/PPO |
$163.65
|
| Rate for Payer: Priority Health Medicare |
$47.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.03
|
| Rate for Payer: Railroad Medicare Medicare |
$47.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.53
|
| Rate for Payer: UHC Core |
$157.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.02
|
| Rate for Payer: UHC Exchange |
$47.02
|
| Rate for Payer: UHC Medicare Advantage |
$47.02
|
| Rate for Payer: VA VA |
$47.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.07
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
IP
|
$100.80
|
|
|
Service Code
|
NDC 00904699860
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.52 |
| Max. Negotiated Rate |
$90.72 |
| Rate for Payer: Aetna Commercial |
$85.68
|
| Rate for Payer: BCBS Trust/PPO |
$82.28
|
| Rate for Payer: BCN Commercial |
$77.90
|
| Rate for Payer: Cash Price |
$80.64
|
| Rate for Payer: Cofinity Commercial |
$86.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.64
|
| Rate for Payer: Healthscope Commercial |
$90.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.68
|
| Rate for Payer: Nomi Health Commercial |
$82.66
|
| Rate for Payer: PHP Commercial |
$85.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.52
|
| Rate for Payer: Priority Health HMO/PPO |
$87.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.70
|
| Rate for Payer: UHC Core |
$84.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.60
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
IP
|
$1.89
|
|
|
Service Code
|
NDC 60687012911
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Aetna Commercial |
$1.61
|
| Rate for Payer: BCBS Trust/PPO |
$1.54
|
| Rate for Payer: BCN Commercial |
$1.46
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Cofinity Commercial |
$1.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.51
|
| Rate for Payer: Healthscope Commercial |
$1.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.61
|
| Rate for Payer: Nomi Health Commercial |
$1.55
|
| Rate for Payer: PHP Commercial |
$1.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.23
|
| Rate for Payer: Priority Health HMO/PPO |
$1.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.66
|
| Rate for Payer: UHC Core |
$1.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.42
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
NDC 63739047810
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.85 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Aetna Commercial |
$160.65
|
| Rate for Payer: BCBS Trust/PPO |
$154.28
|
| Rate for Payer: BCN Commercial |
$146.06
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cofinity Commercial |
$162.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.20
|
| Rate for Payer: Healthscope Commercial |
$170.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.65
|
| Rate for Payer: Nomi Health Commercial |
$154.98
|
| Rate for Payer: PHP Commercial |
$160.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.85
|
| Rate for Payer: Priority Health HMO/PPO |
$164.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.32
|
| Rate for Payer: UHC Core |
$157.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.75
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
NDC 00904718361
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.75 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna Commercial |
$153.00
|
| Rate for Payer: Aetna Medicare |
$46.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.25
|
| Rate for Payer: BCBS Complete |
$72.00
|
| Rate for Payer: BCBS MAPPO |
$45.00
|
| Rate for Payer: BCBS Trust/PPO |
$147.98
|
| Rate for Payer: BCN Commercial |
$139.95
|
| Rate for Payer: BCN Medicare Advantage |
$45.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$154.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.00
|
| Rate for Payer: Healthscope Commercial |
$162.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.00
|
| Rate for Payer: Nomi Health Commercial |
$147.60
|
| Rate for Payer: PACE Senior Care Partners |
$42.75
|
| Rate for Payer: PACE SWMI |
$45.00
|
| Rate for Payer: PHP Commercial |
$153.00
|
| Rate for Payer: PHP Medicare Advantage |
$45.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.00
|
| Rate for Payer: Priority Health HMO/PPO |
$156.60
|
| Rate for Payer: Priority Health Medicare |
$45.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$120.60
|
| Rate for Payer: Railroad Medicare Medicare |
$45.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.40
|
| Rate for Payer: UHC Core |
$150.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.00
|
| Rate for Payer: UHC Exchange |
$45.00
|
| Rate for Payer: UHC Medicare Advantage |
$45.00
|
| Rate for Payer: VA VA |
$45.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.00
|
|
|
DONEPEZIL 10 MG TABLET
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
NDC 60687030301
|
| Hospital Charge Code |
18787
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.97 |
| Max. Negotiated Rate |
$253.80 |
| Rate for Payer: Aetna Commercial |
$239.70
|
| Rate for Payer: Aetna Medicare |
$73.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$88.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$88.12
|
| Rate for Payer: BCBS Complete |
$112.80
|
| Rate for Payer: BCBS MAPPO |
$70.50
|
| Rate for Payer: BCBS Trust/PPO |
$231.83
|
| Rate for Payer: BCN Commercial |
$219.25
|
| Rate for Payer: BCN Medicare Advantage |
$70.50
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cofinity Commercial |
$242.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.50
|
| Rate for Payer: Healthscope Commercial |
$253.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.70
|
| Rate for Payer: Nomi Health Commercial |
$231.24
|
| Rate for Payer: PACE Senior Care Partners |
$66.97
|
| Rate for Payer: PACE SWMI |
$70.50
|
| Rate for Payer: PHP Commercial |
$239.70
|
| Rate for Payer: PHP Medicare Advantage |
$70.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.30
|
| Rate for Payer: Priority Health HMO/PPO |
$245.34
|
| Rate for Payer: Priority Health Medicare |
$71.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$188.94
|
| Rate for Payer: Railroad Medicare Medicare |
$70.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.16
|
| Rate for Payer: UHC Core |
$235.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.50
|
| Rate for Payer: UHC Exchange |
$70.50
|
| Rate for Payer: UHC Medicare Advantage |
$70.50
|
| Rate for Payer: VA VA |
$70.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.50
|
|
|
DONEPEZIL 10 MG TABLET
|
Facility
|
IP
|
$69.80
|
|
|
Service Code
|
NDC 43547027609
|
| Hospital Charge Code |
18787
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.37 |
| Max. Negotiated Rate |
$62.82 |
| Rate for Payer: Aetna Commercial |
$59.33
|
| Rate for Payer: BCBS Trust/PPO |
$56.98
|
| Rate for Payer: BCN Commercial |
$53.94
|
| Rate for Payer: Cash Price |
$55.84
|
| Rate for Payer: Cofinity Commercial |
$60.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.84
|
| Rate for Payer: Healthscope Commercial |
$62.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.33
|
| Rate for Payer: Nomi Health Commercial |
$57.24
|
| Rate for Payer: PHP Commercial |
$59.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.37
|
| Rate for Payer: Priority Health HMO/PPO |
$60.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.42
|
| Rate for Payer: UHC Core |
$58.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.35
|
|
|
DONEPEZIL 10 MG TABLET
|
Facility
|
OP
|
$225.60
|
|
|
Service Code
|
NDC 00904647861
|
| Hospital Charge Code |
18787
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.58 |
| Max. Negotiated Rate |
$203.04 |
| Rate for Payer: Aetna Commercial |
$191.76
|
| Rate for Payer: Aetna Medicare |
$58.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70.50
|
| Rate for Payer: BCBS Complete |
$90.24
|
| Rate for Payer: BCBS MAPPO |
$56.40
|
| Rate for Payer: BCBS Trust/PPO |
$185.47
|
| Rate for Payer: BCN Commercial |
$175.40
|
| Rate for Payer: BCN Medicare Advantage |
$56.40
|
| Rate for Payer: Cash Price |
$180.48
|
| Rate for Payer: Cofinity Commercial |
$194.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.40
|
| Rate for Payer: Healthscope Commercial |
$203.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.76
|
| Rate for Payer: Nomi Health Commercial |
$184.99
|
| Rate for Payer: PACE Senior Care Partners |
$53.58
|
| Rate for Payer: PACE SWMI |
$56.40
|
| Rate for Payer: PHP Commercial |
$191.76
|
| Rate for Payer: PHP Medicare Advantage |
$56.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.64
|
| Rate for Payer: Priority Health HMO/PPO |
$196.27
|
| Rate for Payer: Priority Health Medicare |
$56.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.15
|
| Rate for Payer: Railroad Medicare Medicare |
$56.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.53
|
| Rate for Payer: UHC Core |
$188.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.40
|
| Rate for Payer: UHC Exchange |
$56.40
|
| Rate for Payer: UHC Medicare Advantage |
$56.40
|
| Rate for Payer: VA VA |
$56.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.20
|
|
|
DONEPEZIL 10 MG TABLET
|
Facility
|
IP
|
$225.60
|
|
|
Service Code
|
NDC 00904647861
|
| Hospital Charge Code |
18787
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.64 |
| Max. Negotiated Rate |
$203.04 |
| Rate for Payer: Aetna Commercial |
$191.76
|
| Rate for Payer: BCBS Trust/PPO |
$184.16
|
| Rate for Payer: BCN Commercial |
$174.34
|
| Rate for Payer: Cash Price |
$180.48
|
| Rate for Payer: Cofinity Commercial |
$194.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.48
|
| Rate for Payer: Healthscope Commercial |
$203.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.76
|
| Rate for Payer: Nomi Health Commercial |
$184.99
|
| Rate for Payer: PHP Commercial |
$191.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.64
|
| Rate for Payer: Priority Health HMO/PPO |
$196.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.53
|
| Rate for Payer: UHC Core |
$188.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.20
|
|
|
DONEPEZIL 10 MG TABLET
|
Facility
|
IP
|
$2.82
|
|
|
Service Code
|
NDC 60687030311
|
| Hospital Charge Code |
18787
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Aetna Commercial |
$2.40
|
| Rate for Payer: BCBS Trust/PPO |
$2.30
|
| Rate for Payer: BCN Commercial |
$2.18
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cofinity Commercial |
$2.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.26
|
| Rate for Payer: Healthscope Commercial |
$2.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.40
|
| Rate for Payer: Nomi Health Commercial |
$2.31
|
| Rate for Payer: PHP Commercial |
$2.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.83
|
| Rate for Payer: Priority Health HMO/PPO |
$2.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.48
|
| Rate for Payer: UHC Core |
$2.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.12
|
|
|
DONEPEZIL 10 MG TABLET
|
Facility
|
OP
|
$2.82
|
|
|
Service Code
|
NDC 60687030311
|
| Hospital Charge Code |
18787
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Aetna Commercial |
$2.40
|
| Rate for Payer: Aetna Medicare |
$0.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.88
|
| Rate for Payer: BCBS Complete |
$1.13
|
| Rate for Payer: BCBS MAPPO |
$0.71
|
| Rate for Payer: BCBS Trust/PPO |
$2.32
|
| Rate for Payer: BCN Commercial |
$2.19
|
| Rate for Payer: BCN Medicare Advantage |
$0.71
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cofinity Commercial |
$2.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.71
|
| Rate for Payer: Healthscope Commercial |
$2.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.40
|
| Rate for Payer: Nomi Health Commercial |
$2.31
|
| Rate for Payer: PACE Senior Care Partners |
$0.67
|
| Rate for Payer: PACE SWMI |
$0.71
|
| Rate for Payer: PHP Commercial |
$2.40
|
| Rate for Payer: PHP Medicare Advantage |
$0.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.83
|
| Rate for Payer: Priority Health HMO/PPO |
$2.45
|
| Rate for Payer: Priority Health Medicare |
$0.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.89
|
| Rate for Payer: Railroad Medicare Medicare |
$0.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.48
|
| Rate for Payer: UHC Core |
$2.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.71
|
| Rate for Payer: UHC Exchange |
$0.71
|
| Rate for Payer: UHC Medicare Advantage |
$0.71
|
| Rate for Payer: VA VA |
$0.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.12
|
|
