|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 12 MM-7 MM TOPICAL SPONGE
|
Facility
|
OP
|
$270.31
|
|
|
Service Code
|
NDC 63713001972
|
| Hospital Charge Code |
28018
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$64.20 |
| Max. Negotiated Rate |
$243.28 |
| Rate for Payer: Aetna Commercial |
$229.76
|
| Rate for Payer: Aetna Medicare |
$70.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$84.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$84.47
|
| Rate for Payer: BCBS Complete |
$108.12
|
| Rate for Payer: BCBS MAPPO |
$67.58
|
| Rate for Payer: BCBS Trust/PPO |
$222.22
|
| Rate for Payer: BCN Commercial |
$210.17
|
| Rate for Payer: BCN Medicare Advantage |
$67.58
|
| Rate for Payer: Cash Price |
$216.25
|
| Rate for Payer: Cofinity Commercial |
$232.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.58
|
| Rate for Payer: Healthscope Commercial |
$243.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.76
|
| Rate for Payer: Nomi Health Commercial |
$221.65
|
| Rate for Payer: PACE Senior Care Partners |
$64.20
|
| Rate for Payer: PACE SWMI |
$67.58
|
| Rate for Payer: PHP Commercial |
$229.76
|
| Rate for Payer: PHP Medicare Advantage |
$67.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.70
|
| Rate for Payer: Priority Health HMO/PPO |
$235.17
|
| Rate for Payer: Priority Health Medicare |
$68.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.11
|
| Rate for Payer: Railroad Medicare Medicare |
$67.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.87
|
| Rate for Payer: UHC Core |
$225.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.58
|
| Rate for Payer: UHC Exchange |
$67.58
|
| Rate for Payer: UHC Medicare Advantage |
$67.58
|
| Rate for Payer: VA VA |
$67.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.73
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 50 TOPICAL SPONGE
|
Facility
|
OP
|
$402.34
|
|
|
Service Code
|
NDC 00009032301
|
| Hospital Charge Code |
28024
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$95.56 |
| Max. Negotiated Rate |
$362.11 |
| Rate for Payer: Aetna Commercial |
$341.99
|
| Rate for Payer: Aetna Medicare |
$104.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$125.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$125.73
|
| Rate for Payer: BCBS Complete |
$160.94
|
| Rate for Payer: BCBS MAPPO |
$100.58
|
| Rate for Payer: BCBS Trust/PPO |
$330.76
|
| Rate for Payer: BCN Commercial |
$312.82
|
| Rate for Payer: BCN Medicare Advantage |
$100.58
|
| Rate for Payer: Cash Price |
$321.87
|
| Rate for Payer: Cofinity Commercial |
$346.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.58
|
| Rate for Payer: Healthscope Commercial |
$362.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.99
|
| Rate for Payer: Nomi Health Commercial |
$329.92
|
| Rate for Payer: PACE Senior Care Partners |
$95.56
|
| Rate for Payer: PACE SWMI |
$100.58
|
| Rate for Payer: PHP Commercial |
$341.99
|
| Rate for Payer: PHP Medicare Advantage |
$100.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.52
|
| Rate for Payer: Priority Health HMO/PPO |
$350.04
|
| Rate for Payer: Priority Health Medicare |
$101.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$269.57
|
| Rate for Payer: Railroad Medicare Medicare |
$100.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$354.06
|
| Rate for Payer: UHC Core |
$335.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.58
|
| Rate for Payer: UHC Exchange |
$100.58
|
| Rate for Payer: UHC Medicare Advantage |
$100.58
|
| Rate for Payer: VA VA |
$100.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.76
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 50 TOPICAL SPONGE
|
Facility
|
IP
|
$297.46
|
|
|
Service Code
|
NDC 63713001973
|
| Hospital Charge Code |
28024
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$193.35 |
| Max. Negotiated Rate |
$267.71 |
| Rate for Payer: Aetna Commercial |
$252.84
|
| Rate for Payer: BCBS Trust/PPO |
$242.82
|
| Rate for Payer: BCN Commercial |
$229.88
|
| Rate for Payer: Cash Price |
$237.97
|
| Rate for Payer: Cofinity Commercial |
$255.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.97
|
| Rate for Payer: Healthscope Commercial |
$267.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.84
|
| Rate for Payer: Nomi Health Commercial |
$243.92
|
| Rate for Payer: PHP Commercial |
$252.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.35
|
| Rate for Payer: Priority Health HMO/PPO |
$258.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$261.76
|
| Rate for Payer: UHC Core |
$248.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.10
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 50 TOPICAL SPONGE
|
Facility
|
OP
|
$297.46
|
|
|
Service Code
|
NDC 63713001973
|
| Hospital Charge Code |
28024
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$70.65 |
| Max. Negotiated Rate |
$267.71 |
| Rate for Payer: Aetna Commercial |
$252.84
|
| Rate for Payer: Aetna Medicare |
$77.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.96
|
| Rate for Payer: BCBS Complete |
$118.98
|
| Rate for Payer: BCBS MAPPO |
$74.36
|
| Rate for Payer: BCBS Trust/PPO |
$244.54
|
| Rate for Payer: BCN Commercial |
$231.28
|
| Rate for Payer: BCN Medicare Advantage |
$74.36
|
| Rate for Payer: Cash Price |
$237.97
|
| Rate for Payer: Cofinity Commercial |
$255.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.36
|
| Rate for Payer: Healthscope Commercial |
$267.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.84
|
| Rate for Payer: Nomi Health Commercial |
$243.92
|
| Rate for Payer: PACE Senior Care Partners |
$70.65
|
| Rate for Payer: PACE SWMI |
$74.36
|
| Rate for Payer: PHP Commercial |
$252.84
|
| Rate for Payer: PHP Medicare Advantage |
$74.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.35
|
| Rate for Payer: Priority Health HMO/PPO |
$258.79
|
| Rate for Payer: Priority Health Medicare |
$75.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.30
|
| Rate for Payer: Railroad Medicare Medicare |
$74.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$261.76
|
| Rate for Payer: UHC Core |
$248.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.36
|
| Rate for Payer: UHC Exchange |
$74.36
|
| Rate for Payer: UHC Medicare Advantage |
$74.36
|
| Rate for Payer: VA VA |
$74.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.10
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 50 TOPICAL SPONGE
|
Facility
|
IP
|
$402.34
|
|
|
Service Code
|
NDC 00009032301
|
| Hospital Charge Code |
28024
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$261.52 |
| Max. Negotiated Rate |
$362.11 |
| Rate for Payer: Aetna Commercial |
$341.99
|
| Rate for Payer: BCBS Trust/PPO |
$328.43
|
| Rate for Payer: BCN Commercial |
$310.93
|
| Rate for Payer: Cash Price |
$321.87
|
| Rate for Payer: Cofinity Commercial |
$346.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.87
|
| Rate for Payer: Healthscope Commercial |
$362.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.99
|
| Rate for Payer: Nomi Health Commercial |
$329.92
|
| Rate for Payer: PHP Commercial |
$341.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.52
|
| Rate for Payer: Priority Health HMO/PPO |
$350.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$269.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$354.06
|
| Rate for Payer: UHC Core |
$335.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.76
|
|
|
GEMFIBROZIL 600 MG TABLET
|
Facility
|
IP
|
$2.09
|
|
|
Service Code
|
NDC 60687022411
|
| Hospital Charge Code |
3378
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: Aetna Commercial |
$1.78
|
| Rate for Payer: BCBS Trust/PPO |
$1.71
|
| Rate for Payer: BCN Commercial |
$1.62
|
| Rate for Payer: Cash Price |
$1.67
|
| Rate for Payer: Cofinity Commercial |
$1.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.67
|
| Rate for Payer: Healthscope Commercial |
$1.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.78
|
| Rate for Payer: Nomi Health Commercial |
$1.71
|
| Rate for Payer: PHP Commercial |
$1.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.36
|
| Rate for Payer: Priority Health HMO/PPO |
$1.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.84
|
| Rate for Payer: UHC Core |
$1.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.57
|
|
|
GEMFIBROZIL 600 MG TABLET
|
Facility
|
OP
|
$208.05
|
|
|
Service Code
|
NDC 60687022401
|
| Hospital Charge Code |
3378
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.41 |
| Max. Negotiated Rate |
$187.24 |
| Rate for Payer: Aetna Commercial |
$176.84
|
| Rate for Payer: Aetna Medicare |
$54.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.02
|
| Rate for Payer: BCBS Complete |
$83.22
|
| Rate for Payer: BCBS MAPPO |
$52.01
|
| Rate for Payer: BCBS Trust/PPO |
$171.04
|
| Rate for Payer: BCN Commercial |
$161.76
|
| Rate for Payer: BCN Medicare Advantage |
$52.01
|
| Rate for Payer: Cash Price |
$166.44
|
| Rate for Payer: Cofinity Commercial |
$178.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.01
|
| Rate for Payer: Healthscope Commercial |
$187.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.84
|
| Rate for Payer: Nomi Health Commercial |
$170.60
|
| Rate for Payer: PACE Senior Care Partners |
$49.41
|
| Rate for Payer: PACE SWMI |
$52.01
|
| Rate for Payer: PHP Commercial |
$176.84
|
| Rate for Payer: PHP Medicare Advantage |
$52.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.23
|
| Rate for Payer: Priority Health HMO/PPO |
$181.00
|
| Rate for Payer: Priority Health Medicare |
$52.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.39
|
| Rate for Payer: Railroad Medicare Medicare |
$52.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.08
|
| Rate for Payer: UHC Core |
$173.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.01
|
| Rate for Payer: UHC Exchange |
$52.01
|
| Rate for Payer: UHC Medicare Advantage |
$52.01
|
| Rate for Payer: VA VA |
$52.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.04
|
|
|
GEMFIBROZIL 600 MG TABLET
|
Facility
|
OP
|
$2.09
|
|
|
Service Code
|
NDC 60687022411
|
| Hospital Charge Code |
3378
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: Aetna Commercial |
$1.78
|
| Rate for Payer: Aetna Medicare |
$0.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.65
|
| Rate for Payer: BCBS Complete |
$0.84
|
| Rate for Payer: BCBS MAPPO |
$0.52
|
| Rate for Payer: BCBS Trust/PPO |
$1.72
|
| Rate for Payer: BCN Commercial |
$1.62
|
| Rate for Payer: BCN Medicare Advantage |
$0.52
|
| Rate for Payer: Cash Price |
$1.67
|
| Rate for Payer: Cofinity Commercial |
$1.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.52
|
| Rate for Payer: Healthscope Commercial |
$1.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.78
|
| Rate for Payer: Nomi Health Commercial |
$1.71
|
| Rate for Payer: PACE Senior Care Partners |
$0.50
|
| Rate for Payer: PACE SWMI |
$0.52
|
| Rate for Payer: PHP Commercial |
$1.78
|
| Rate for Payer: PHP Medicare Advantage |
$0.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.36
|
| Rate for Payer: Priority Health HMO/PPO |
$1.82
|
| Rate for Payer: Priority Health Medicare |
$0.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.40
|
| Rate for Payer: Railroad Medicare Medicare |
$0.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.84
|
| Rate for Payer: UHC Core |
$1.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.52
|
| Rate for Payer: UHC Exchange |
$0.52
|
| Rate for Payer: UHC Medicare Advantage |
$0.52
|
| Rate for Payer: VA VA |
$0.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.57
|
|
|
GEMFIBROZIL 600 MG TABLET
|
Facility
|
IP
|
$208.05
|
|
|
Service Code
|
NDC 60687022401
|
| Hospital Charge Code |
3378
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.23 |
| Max. Negotiated Rate |
$187.24 |
| Rate for Payer: Aetna Commercial |
$176.84
|
| Rate for Payer: BCBS Trust/PPO |
$169.83
|
| Rate for Payer: BCN Commercial |
$160.78
|
| Rate for Payer: Cash Price |
$166.44
|
| Rate for Payer: Cofinity Commercial |
$178.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.44
|
| Rate for Payer: Healthscope Commercial |
$187.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.84
|
| Rate for Payer: Nomi Health Commercial |
$170.60
|
| Rate for Payer: PHP Commercial |
$176.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.23
|
| Rate for Payer: Priority Health HMO/PPO |
$181.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.08
|
| Rate for Payer: UHC Core |
$173.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.04
|
|
|
GENTAMICIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$19.22
|
|
|
Service Code
|
NDC 61314063305
|
| Hospital Charge Code |
3428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.56 |
| Max. Negotiated Rate |
$17.30 |
| Rate for Payer: Aetna Commercial |
$16.34
|
| Rate for Payer: Aetna Medicare |
$5.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.01
|
| Rate for Payer: BCBS Complete |
$7.69
|
| Rate for Payer: BCBS MAPPO |
$4.80
|
| Rate for Payer: BCBS Trust/PPO |
$15.80
|
| Rate for Payer: BCN Commercial |
$14.94
|
| Rate for Payer: BCN Medicare Advantage |
$4.80
|
| Rate for Payer: Cash Price |
$15.38
|
| Rate for Payer: Cofinity Commercial |
$16.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.80
|
| Rate for Payer: Healthscope Commercial |
$17.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.34
|
| Rate for Payer: Nomi Health Commercial |
$15.76
|
| Rate for Payer: PACE Senior Care Partners |
$4.56
|
| Rate for Payer: PACE SWMI |
$4.80
|
| Rate for Payer: PHP Commercial |
$16.34
|
| Rate for Payer: PHP Medicare Advantage |
$4.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.49
|
| Rate for Payer: Priority Health HMO/PPO |
$16.72
|
| Rate for Payer: Priority Health Medicare |
$4.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.88
|
| Rate for Payer: Railroad Medicare Medicare |
$4.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.91
|
| Rate for Payer: UHC Core |
$16.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.80
|
| Rate for Payer: UHC Exchange |
$4.80
|
| Rate for Payer: UHC Medicare Advantage |
$4.80
|
| Rate for Payer: VA VA |
$4.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.42
|
|
|
GENTAMICIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$18.23
|
|
|
Service Code
|
NDC 60758018805
|
| Hospital Charge Code |
3428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.33 |
| Max. Negotiated Rate |
$16.41 |
| Rate for Payer: Aetna Commercial |
$15.50
|
| Rate for Payer: Aetna Medicare |
$4.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.70
|
| Rate for Payer: BCBS Complete |
$7.29
|
| Rate for Payer: BCBS MAPPO |
$4.56
|
| Rate for Payer: BCBS Trust/PPO |
$14.99
|
| Rate for Payer: BCN Commercial |
$14.17
|
| Rate for Payer: BCN Medicare Advantage |
$4.56
|
| Rate for Payer: Cash Price |
$14.58
|
| Rate for Payer: Cofinity Commercial |
$15.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.56
|
| Rate for Payer: Healthscope Commercial |
$16.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.50
|
| Rate for Payer: Nomi Health Commercial |
$14.95
|
| Rate for Payer: PACE Senior Care Partners |
$4.33
|
| Rate for Payer: PACE SWMI |
$4.56
|
| Rate for Payer: PHP Commercial |
$15.50
|
| Rate for Payer: PHP Medicare Advantage |
$4.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.85
|
| Rate for Payer: Priority Health HMO/PPO |
$15.86
|
| Rate for Payer: Priority Health Medicare |
$4.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.21
|
| Rate for Payer: Railroad Medicare Medicare |
$4.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.04
|
| Rate for Payer: UHC Core |
$15.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.56
|
| Rate for Payer: UHC Exchange |
$4.56
|
| Rate for Payer: UHC Medicare Advantage |
$4.56
|
| Rate for Payer: VA VA |
$4.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.67
|
|
|
GENTAMICIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$18.23
|
|
|
Service Code
|
NDC 60758018805
|
| Hospital Charge Code |
3428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$16.41 |
| Rate for Payer: Aetna Commercial |
$15.50
|
| Rate for Payer: BCBS Trust/PPO |
$14.88
|
| Rate for Payer: BCN Commercial |
$14.09
|
| Rate for Payer: Cash Price |
$14.58
|
| Rate for Payer: Cofinity Commercial |
$15.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.58
|
| Rate for Payer: Healthscope Commercial |
$16.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.50
|
| Rate for Payer: Nomi Health Commercial |
$14.95
|
| Rate for Payer: PHP Commercial |
$15.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.85
|
| Rate for Payer: Priority Health HMO/PPO |
$15.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.04
|
| Rate for Payer: UHC Core |
$15.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.67
|
|
|
GENTAMICIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$116.24
|
|
|
Service Code
|
NDC 24208058060
|
| Hospital Charge Code |
3428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.56 |
| Max. Negotiated Rate |
$104.62 |
| Rate for Payer: Aetna Commercial |
$98.80
|
| Rate for Payer: BCBS Trust/PPO |
$94.89
|
| Rate for Payer: BCN Commercial |
$89.83
|
| Rate for Payer: Cash Price |
$92.99
|
| Rate for Payer: Cofinity Commercial |
$99.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.99
|
| Rate for Payer: Healthscope Commercial |
$104.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.80
|
| Rate for Payer: Nomi Health Commercial |
$95.32
|
| Rate for Payer: PHP Commercial |
$98.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.56
|
| Rate for Payer: Priority Health HMO/PPO |
$101.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.29
|
| Rate for Payer: UHC Core |
$97.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.18
|
|
|
GENTAMICIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$116.24
|
|
|
Service Code
|
NDC 24208058060
|
| Hospital Charge Code |
3428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.61 |
| Max. Negotiated Rate |
$104.62 |
| Rate for Payer: Aetna Commercial |
$98.80
|
| Rate for Payer: Aetna Medicare |
$30.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.32
|
| Rate for Payer: BCBS Complete |
$46.50
|
| Rate for Payer: BCBS MAPPO |
$29.06
|
| Rate for Payer: BCBS Trust/PPO |
$95.56
|
| Rate for Payer: BCN Commercial |
$90.38
|
| Rate for Payer: BCN Medicare Advantage |
$29.06
|
| Rate for Payer: Cash Price |
$92.99
|
| Rate for Payer: Cofinity Commercial |
$99.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.06
|
| Rate for Payer: Healthscope Commercial |
$104.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.80
|
| Rate for Payer: Nomi Health Commercial |
$95.32
|
| Rate for Payer: PACE Senior Care Partners |
$27.61
|
| Rate for Payer: PACE SWMI |
$29.06
|
| Rate for Payer: PHP Commercial |
$98.80
|
| Rate for Payer: PHP Medicare Advantage |
$29.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.56
|
| Rate for Payer: Priority Health HMO/PPO |
$101.13
|
| Rate for Payer: Priority Health Medicare |
$29.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.88
|
| Rate for Payer: Railroad Medicare Medicare |
$29.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.29
|
| Rate for Payer: UHC Core |
$97.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.06
|
| Rate for Payer: UHC Exchange |
$29.06
|
| Rate for Payer: UHC Medicare Advantage |
$29.06
|
| Rate for Payer: VA VA |
$29.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.18
|
|
|
GENTAMICIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$19.22
|
|
|
Service Code
|
NDC 61314063305
|
| Hospital Charge Code |
3428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.49 |
| Max. Negotiated Rate |
$17.30 |
| Rate for Payer: Aetna Commercial |
$16.34
|
| Rate for Payer: BCBS Trust/PPO |
$15.69
|
| Rate for Payer: BCN Commercial |
$14.85
|
| Rate for Payer: Cash Price |
$15.38
|
| Rate for Payer: Cofinity Commercial |
$16.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.38
|
| Rate for Payer: Healthscope Commercial |
$17.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.34
|
| Rate for Payer: Nomi Health Commercial |
$15.76
|
| Rate for Payer: PHP Commercial |
$16.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.49
|
| Rate for Payer: Priority Health HMO/PPO |
$16.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.91
|
| Rate for Payer: UHC Core |
$16.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.42
|
|
|
GENTAMICIN 40 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$34.65
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
3426
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$31.18 |
| Rate for Payer: Aetna Commercial |
$29.45
|
| Rate for Payer: Aetna Medicare |
$9.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.83
|
| Rate for Payer: BCBS Complete |
$13.86
|
| Rate for Payer: BCBS MAPPO |
$8.66
|
| Rate for Payer: BCBS Trust/PPO |
$28.49
|
| Rate for Payer: BCN Commercial |
$26.94
|
| Rate for Payer: BCN Medicare Advantage |
$8.66
|
| Rate for Payer: Cash Price |
$27.72
|
| Rate for Payer: Cofinity Commercial |
$29.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.66
|
| Rate for Payer: Healthscope Commercial |
$31.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.45
|
| Rate for Payer: Nomi Health Commercial |
$28.41
|
| Rate for Payer: PACE Senior Care Partners |
$8.23
|
| Rate for Payer: PACE SWMI |
$8.66
|
| Rate for Payer: PHP Commercial |
$29.45
|
| Rate for Payer: PHP Medicare Advantage |
$8.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.52
|
| Rate for Payer: Priority Health HMO/PPO |
$30.15
|
| Rate for Payer: Priority Health Medicare |
$8.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.22
|
| Rate for Payer: Railroad Medicare Medicare |
$8.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.49
|
| Rate for Payer: UHC Core |
$28.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.66
|
| Rate for Payer: UHC Exchange |
$8.66
|
| Rate for Payer: UHC Medicare Advantage |
$8.66
|
| Rate for Payer: VA VA |
$8.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.99
|
|
|
GENTAMICIN 40 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$34.65
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
3426
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.52 |
| Max. Negotiated Rate |
$31.18 |
| Rate for Payer: Aetna Commercial |
$29.45
|
| Rate for Payer: BCBS Trust/PPO |
$28.28
|
| Rate for Payer: BCN Commercial |
$26.78
|
| Rate for Payer: Cash Price |
$27.72
|
| Rate for Payer: Cofinity Commercial |
$29.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.72
|
| Rate for Payer: Healthscope Commercial |
$31.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.45
|
| Rate for Payer: Nomi Health Commercial |
$28.41
|
| Rate for Payer: PHP Commercial |
$29.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.52
|
| Rate for Payer: Priority Health HMO/PPO |
$30.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.49
|
| Rate for Payer: UHC Core |
$28.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.99
|
|
|
GLIMEPIRIDE 1 MG TABLET
|
Facility
|
OP
|
$195.05
|
|
|
Service Code
|
NDC 16729000101
|
| Hospital Charge Code |
16355
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.32 |
| 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 |
$78.02
|
| Rate for Payer: BCBS MAPPO |
$48.76
|
| Rate for Payer: BCBS Trust/PPO |
$160.35
|
| Rate for Payer: BCN Commercial |
$151.65
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.79
|
| Rate for Payer: Nomi Health Commercial |
$159.94
|
| 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 Cigna Priority Health |
$126.78
|
| Rate for Payer: Priority Health HMO/PPO |
$169.69
|
| Rate for Payer: Priority Health Medicare |
$49.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.68
|
| 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 Dual Complete DSNP |
$48.76
|
| Rate for Payer: UHC Exchange |
$48.76
|
| Rate for Payer: UHC Medicare Advantage |
$48.76
|
| Rate for Payer: VA VA |
$48.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.29
|
|
|
GLIMEPIRIDE 1 MG TABLET
|
Facility
|
OP
|
$3.57
|
|
|
Service Code
|
NDC 50268035811
|
| Hospital Charge Code |
16355
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$3.21 |
| Rate for Payer: Aetna Commercial |
$3.03
|
| Rate for Payer: Aetna Medicare |
$0.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.12
|
| Rate for Payer: BCBS Complete |
$1.43
|
| Rate for Payer: BCBS MAPPO |
$0.89
|
| Rate for Payer: BCBS Trust/PPO |
$2.93
|
| Rate for Payer: BCN Commercial |
$2.78
|
| Rate for Payer: BCN Medicare Advantage |
$0.89
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Cofinity Commercial |
$3.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.89
|
| Rate for Payer: Healthscope Commercial |
$3.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.03
|
| Rate for Payer: Nomi Health Commercial |
$2.93
|
| Rate for Payer: PACE Senior Care Partners |
$0.85
|
| Rate for Payer: PACE SWMI |
$0.89
|
| Rate for Payer: PHP Commercial |
$3.03
|
| Rate for Payer: PHP Medicare Advantage |
$0.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.32
|
| Rate for Payer: Priority Health HMO/PPO |
$3.11
|
| Rate for Payer: Priority Health Medicare |
$0.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.39
|
| Rate for Payer: Railroad Medicare Medicare |
$0.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.14
|
| Rate for Payer: UHC Core |
$2.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.89
|
| Rate for Payer: UHC Exchange |
$0.89
|
| Rate for Payer: UHC Medicare Advantage |
$0.89
|
| Rate for Payer: VA VA |
$0.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.68
|
|
|
GLIMEPIRIDE 1 MG TABLET
|
Facility
|
OP
|
$178.13
|
|
|
Service Code
|
NDC 50268035815
|
| Hospital Charge Code |
16355
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.31 |
| Max. Negotiated Rate |
$160.32 |
| Rate for Payer: Aetna Commercial |
$151.41
|
| Rate for Payer: Aetna Medicare |
$46.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.67
|
| Rate for Payer: BCBS Complete |
$71.25
|
| Rate for Payer: BCBS MAPPO |
$44.53
|
| Rate for Payer: BCBS Trust/PPO |
$146.44
|
| Rate for Payer: BCN Commercial |
$138.50
|
| Rate for Payer: BCN Medicare Advantage |
$44.53
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cofinity Commercial |
$153.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.53
|
| Rate for Payer: Healthscope Commercial |
$160.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.41
|
| Rate for Payer: Nomi Health Commercial |
$146.07
|
| Rate for Payer: PACE Senior Care Partners |
$42.31
|
| Rate for Payer: PACE SWMI |
$44.53
|
| Rate for Payer: PHP Commercial |
$151.41
|
| Rate for Payer: PHP Medicare Advantage |
$44.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.78
|
| Rate for Payer: Priority Health HMO/PPO |
$154.97
|
| Rate for Payer: Priority Health Medicare |
$44.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$119.35
|
| Rate for Payer: Railroad Medicare Medicare |
$44.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.75
|
| Rate for Payer: UHC Core |
$148.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.53
|
| Rate for Payer: UHC Exchange |
$44.53
|
| Rate for Payer: UHC Medicare Advantage |
$44.53
|
| Rate for Payer: VA VA |
$44.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.60
|
|
|
GLIMEPIRIDE 1 MG TABLET
|
Facility
|
IP
|
$3.57
|
|
|
Service Code
|
NDC 50268035811
|
| Hospital Charge Code |
16355
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$3.21 |
| Rate for Payer: Aetna Commercial |
$3.03
|
| Rate for Payer: BCBS Trust/PPO |
$2.91
|
| Rate for Payer: BCN Commercial |
$2.76
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Cofinity Commercial |
$3.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.86
|
| Rate for Payer: Healthscope Commercial |
$3.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.03
|
| Rate for Payer: Nomi Health Commercial |
$2.93
|
| Rate for Payer: PHP Commercial |
$3.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.32
|
| Rate for Payer: Priority Health HMO/PPO |
$3.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.14
|
| Rate for Payer: UHC Core |
$2.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.68
|
|
|
GLIMEPIRIDE 1 MG TABLET
|
Facility
|
IP
|
$195.05
|
|
|
Service Code
|
NDC 16729000101
|
| Hospital Charge Code |
16355
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.78 |
| Max. Negotiated Rate |
$175.54 |
| Rate for Payer: Aetna Commercial |
$165.79
|
| Rate for Payer: BCBS Trust/PPO |
$159.22
|
| Rate for Payer: BCN Commercial |
$150.73
|
| 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: PHP Commercial |
$165.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.78
|
| Rate for Payer: Priority Health HMO/PPO |
$169.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.68
|
| 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
|
|
|
GLIMEPIRIDE 1 MG TABLET
|
Facility
|
IP
|
$178.13
|
|
|
Service Code
|
NDC 50268035815
|
| Hospital Charge Code |
16355
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.78 |
| Max. Negotiated Rate |
$160.32 |
| Rate for Payer: Aetna Commercial |
$151.41
|
| Rate for Payer: BCBS Trust/PPO |
$145.41
|
| Rate for Payer: BCN Commercial |
$137.66
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cofinity Commercial |
$153.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.50
|
| Rate for Payer: Healthscope Commercial |
$160.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.41
|
| Rate for Payer: Nomi Health Commercial |
$146.07
|
| Rate for Payer: PHP Commercial |
$151.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.78
|
| Rate for Payer: Priority Health HMO/PPO |
$154.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$119.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.75
|
| Rate for Payer: UHC Core |
$148.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.60
|
|
|
GLIMEPIRIDE 4 MG TABLET
|
Facility
|
IP
|
$241.30
|
|
|
Service Code
|
NDC 16729000301
|
| Hospital Charge Code |
16357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.84 |
| Max. Negotiated Rate |
$217.17 |
| Rate for Payer: Aetna Commercial |
$205.10
|
| Rate for Payer: BCBS Trust/PPO |
$196.97
|
| Rate for Payer: BCN Commercial |
$186.48
|
| Rate for Payer: Cash Price |
$193.04
|
| Rate for Payer: Cofinity Commercial |
$207.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.04
|
| Rate for Payer: Healthscope Commercial |
$217.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.10
|
| Rate for Payer: Nomi Health Commercial |
$197.87
|
| Rate for Payer: PHP Commercial |
$205.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.84
|
| Rate for Payer: Priority Health HMO/PPO |
$209.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$161.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.34
|
| Rate for Payer: UHC Core |
$201.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.98
|
|
|
GLIMEPIRIDE 4 MG TABLET
|
Facility
|
OP
|
$241.30
|
|
|
Service Code
|
NDC 16729000301
|
| Hospital Charge Code |
16357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.31 |
| Max. Negotiated Rate |
$217.17 |
| Rate for Payer: Aetna Commercial |
$205.10
|
| Rate for Payer: Aetna Medicare |
$62.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$75.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$75.41
|
| Rate for Payer: BCBS Complete |
$96.52
|
| Rate for Payer: BCBS MAPPO |
$60.32
|
| Rate for Payer: BCBS Trust/PPO |
$198.37
|
| Rate for Payer: BCN Commercial |
$187.61
|
| Rate for Payer: BCN Medicare Advantage |
$60.32
|
| Rate for Payer: Cash Price |
$193.04
|
| Rate for Payer: Cofinity Commercial |
$207.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.32
|
| Rate for Payer: Healthscope Commercial |
$217.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.10
|
| Rate for Payer: Nomi Health Commercial |
$197.87
|
| Rate for Payer: PACE Senior Care Partners |
$57.31
|
| Rate for Payer: PACE SWMI |
$60.32
|
| Rate for Payer: PHP Commercial |
$205.10
|
| Rate for Payer: PHP Medicare Advantage |
$60.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.84
|
| Rate for Payer: Priority Health HMO/PPO |
$209.93
|
| Rate for Payer: Priority Health Medicare |
$60.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$161.67
|
| Rate for Payer: Railroad Medicare Medicare |
$60.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.34
|
| Rate for Payer: UHC Core |
$201.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.32
|
| Rate for Payer: UHC Exchange |
$60.32
|
| Rate for Payer: UHC Medicare Advantage |
$60.32
|
| Rate for Payer: VA VA |
$60.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.98
|
|
