|
ARIPIPRAZOLE 5 MG TABLET
|
Facility
|
OP
|
$93.75
|
|
|
Service Code
|
NDC 27241005203
|
| Hospital Charge Code |
36438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.53 |
| Max. Negotiated Rate |
$84.38 |
| Rate for Payer: Aetna Commercial |
$79.69
|
| Rate for Payer: Aetna Medicare |
$24.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.30
|
| Rate for Payer: BCBS Complete |
$17.35
|
| Rate for Payer: BCBS MAPPO |
$23.44
|
| Rate for Payer: BCBS Trust/PPO |
$77.07
|
| Rate for Payer: BCN Commercial |
$77.07
|
| Rate for Payer: BCN Medicare Advantage |
$23.44
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cofinity Commercial |
$80.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.44
|
| Rate for Payer: Healthscope Commercial |
$84.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.31
|
| Rate for Payer: Mclaren Medicaid |
$16.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.61
|
| Rate for Payer: Meridian Medicaid |
$17.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.69
|
| Rate for Payer: Nomi Health Commercial |
$76.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.31
|
| Rate for Payer: PACE Senior Care Partners |
$22.27
|
| Rate for Payer: PACE SWMI |
$23.44
|
| Rate for Payer: PHP Commercial |
$79.69
|
| Rate for Payer: PHP Medicare Advantage |
$23.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$81.56
|
| Rate for Payer: Priority Health Medicare |
$23.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.25
|
| Rate for Payer: Railroad Medicare Medicare |
$23.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.50
|
| Rate for Payer: UHC Core |
$78.28
|
| Rate for Payer: UHC Exchange |
$23.44
|
| Rate for Payer: UHC Medicaid |
$16.53
|
| Rate for Payer: UHC Medicare Advantage |
$23.44
|
| Rate for Payer: UHCCP Medicaid |
$16.53
|
| Rate for Payer: VA VA |
$23.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.31
|
|
|
ARTIFICIAL TEARS EYE DROPS WRAPPER
|
Facility
|
IP
|
$30.42
|
|
|
Service Code
|
NDC 96295013764
|
| Hospital Charge Code |
301578
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.17 |
| Max. Negotiated Rate |
$27.38 |
| Rate for Payer: Aetna Commercial |
$25.86
|
| Rate for Payer: BCBS Trust/PPO |
$25.12
|
| Rate for Payer: BCN Commercial |
$25.12
|
| Rate for Payer: Cash Price |
$24.34
|
| Rate for Payer: Cofinity Commercial |
$26.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.34
|
| Rate for Payer: Healthscope Commercial |
$27.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.86
|
| Rate for Payer: Nomi Health Commercial |
$24.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.82
|
| Rate for Payer: PHP Commercial |
$25.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$26.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.77
|
| Rate for Payer: UHC Core |
$25.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.82
|
|
|
ARTIFICIAL TEARS EYE DROPS WRAPPER
|
Facility
|
IP
|
$25.38
|
|
|
Service Code
|
NDC 57896018105
|
| Hospital Charge Code |
301578
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.66 |
| Max. Negotiated Rate |
$22.84 |
| Rate for Payer: Aetna Commercial |
$21.57
|
| Rate for Payer: BCBS Trust/PPO |
$20.96
|
| Rate for Payer: BCN Commercial |
$20.96
|
| Rate for Payer: Cash Price |
$20.30
|
| Rate for Payer: Cofinity Commercial |
$21.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.30
|
| Rate for Payer: Healthscope Commercial |
$22.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.57
|
| Rate for Payer: Nomi Health Commercial |
$20.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.04
|
| Rate for Payer: PHP Commercial |
$21.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.33
|
| Rate for Payer: UHC Core |
$21.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
ARTIFICIAL TEARS EYE DROPS WRAPPER
|
Facility
|
OP
|
$30.42
|
|
|
Service Code
|
NDC 96295013764
|
| Hospital Charge Code |
301578
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.36 |
| Max. Negotiated Rate |
$27.38 |
| Rate for Payer: Aetna Commercial |
$25.86
|
| Rate for Payer: Aetna Medicare |
$7.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.51
|
| Rate for Payer: BCBS Complete |
$5.63
|
| Rate for Payer: BCBS MAPPO |
$7.61
|
| Rate for Payer: BCBS Trust/PPO |
$25.01
|
| Rate for Payer: BCN Commercial |
$25.01
|
| Rate for Payer: BCN Medicare Advantage |
$7.61
|
| Rate for Payer: Cash Price |
$24.34
|
| Rate for Payer: Cofinity Commercial |
$26.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.61
|
| Rate for Payer: Healthscope Commercial |
$27.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.82
|
| Rate for Payer: Mclaren Medicaid |
$5.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.99
|
| Rate for Payer: Meridian Medicaid |
$5.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.86
|
| Rate for Payer: Nomi Health Commercial |
$24.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.82
|
| Rate for Payer: PACE Senior Care Partners |
$7.22
|
| Rate for Payer: PACE SWMI |
$7.61
|
| Rate for Payer: PHP Commercial |
$25.86
|
| Rate for Payer: PHP Medicare Advantage |
$7.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$26.47
|
| Rate for Payer: Priority Health Medicare |
$7.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.17
|
| Rate for Payer: Railroad Medicare Medicare |
$7.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.77
|
| Rate for Payer: UHC Core |
$25.40
|
| Rate for Payer: UHC Exchange |
$7.61
|
| Rate for Payer: UHC Medicaid |
$5.36
|
| Rate for Payer: UHC Medicare Advantage |
$7.61
|
| Rate for Payer: UHCCP Medicaid |
$5.36
|
| Rate for Payer: VA VA |
$7.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.82
|
|
|
ARTIFICIAL TEARS EYE DROPS WRAPPER
|
Facility
|
OP
|
$25.38
|
|
|
Service Code
|
NDC 57896018105
|
| Hospital Charge Code |
301578
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.47 |
| Max. Negotiated Rate |
$22.84 |
| Rate for Payer: Aetna Commercial |
$21.57
|
| Rate for Payer: Aetna Medicare |
$6.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.93
|
| Rate for Payer: BCBS Complete |
$4.70
|
| Rate for Payer: BCBS MAPPO |
$6.34
|
| Rate for Payer: BCBS Trust/PPO |
$20.86
|
| Rate for Payer: BCN Commercial |
$20.86
|
| Rate for Payer: BCN Medicare Advantage |
$6.34
|
| Rate for Payer: Cash Price |
$20.30
|
| Rate for Payer: Cofinity Commercial |
$21.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.34
|
| Rate for Payer: Healthscope Commercial |
$22.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Mclaren Medicaid |
$4.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.66
|
| Rate for Payer: Meridian Medicaid |
$4.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.57
|
| Rate for Payer: Nomi Health Commercial |
$20.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.04
|
| Rate for Payer: PACE Senior Care Partners |
$6.03
|
| Rate for Payer: PACE SWMI |
$6.34
|
| Rate for Payer: PHP Commercial |
$21.57
|
| Rate for Payer: PHP Medicare Advantage |
$6.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.08
|
| Rate for Payer: Priority Health Medicare |
$6.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.66
|
| Rate for Payer: Railroad Medicare Medicare |
$6.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.33
|
| Rate for Payer: UHC Core |
$21.19
|
| Rate for Payer: UHC Exchange |
$6.34
|
| Rate for Payer: UHC Medicaid |
$4.47
|
| Rate for Payer: UHC Medicare Advantage |
$6.34
|
| Rate for Payer: UHCCP Medicaid |
$4.47
|
| Rate for Payer: VA VA |
$6.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
ARTIFICIAL TEARS EYE DROPS WRAPPER
|
Facility
|
OP
|
$19.44
|
|
|
Service Code
|
NDC 57896018405
|
| Hospital Charge Code |
301578
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Aetna Commercial |
$16.52
|
| Rate for Payer: Aetna Medicare |
$5.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.08
|
| Rate for Payer: BCBS Complete |
$3.60
|
| Rate for Payer: BCBS MAPPO |
$4.86
|
| Rate for Payer: BCBS Trust/PPO |
$15.98
|
| Rate for Payer: BCN Commercial |
$15.98
|
| Rate for Payer: BCN Medicare Advantage |
$4.86
|
| Rate for Payer: Cash Price |
$15.55
|
| Rate for Payer: Cofinity Commercial |
$16.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.86
|
| Rate for Payer: Healthscope Commercial |
$17.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.58
|
| Rate for Payer: Mclaren Medicaid |
$3.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.10
|
| Rate for Payer: Meridian Medicaid |
$3.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.52
|
| Rate for Payer: Nomi Health Commercial |
$15.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.58
|
| Rate for Payer: PACE Senior Care Partners |
$4.62
|
| Rate for Payer: PACE SWMI |
$4.86
|
| Rate for Payer: PHP Commercial |
$16.52
|
| Rate for Payer: PHP Medicare Advantage |
$4.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.91
|
| Rate for Payer: Priority Health Medicare |
$4.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.53
|
| Rate for Payer: Railroad Medicare Medicare |
$4.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.11
|
| Rate for Payer: UHC Core |
$16.23
|
| Rate for Payer: UHC Exchange |
$4.86
|
| Rate for Payer: UHC Medicaid |
$3.43
|
| Rate for Payer: UHC Medicare Advantage |
$4.86
|
| Rate for Payer: UHCCP Medicaid |
$3.43
|
| Rate for Payer: VA VA |
$4.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.58
|
|
|
ARTIFICIAL TEARS EYE DROPS WRAPPER
|
Facility
|
IP
|
$19.44
|
|
|
Service Code
|
NDC 57896018405
|
| Hospital Charge Code |
301578
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Aetna Commercial |
$16.52
|
| Rate for Payer: BCBS Trust/PPO |
$16.06
|
| Rate for Payer: BCN Commercial |
$16.06
|
| Rate for Payer: Cash Price |
$15.55
|
| Rate for Payer: Cofinity Commercial |
$16.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.55
|
| Rate for Payer: Healthscope Commercial |
$17.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.52
|
| Rate for Payer: Nomi Health Commercial |
$15.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.58
|
| Rate for Payer: PHP Commercial |
$16.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.11
|
| Rate for Payer: UHC Core |
$16.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.58
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG TABLET
|
Facility
|
OP
|
$72.85
|
|
|
Service Code
|
NDC 00904052361
|
| Hospital Charge Code |
664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.84 |
| Max. Negotiated Rate |
$65.56 |
| Rate for Payer: Aetna Commercial |
$61.92
|
| Rate for Payer: Aetna Medicare |
$18.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.77
|
| Rate for Payer: BCBS Complete |
$13.48
|
| Rate for Payer: BCBS MAPPO |
$18.21
|
| Rate for Payer: BCBS Trust/PPO |
$59.89
|
| Rate for Payer: BCN Commercial |
$59.89
|
| Rate for Payer: BCN Medicare Advantage |
$18.21
|
| Rate for Payer: Cash Price |
$58.28
|
| Rate for Payer: Cofinity Commercial |
$62.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.21
|
| Rate for Payer: Healthscope Commercial |
$65.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.64
|
| Rate for Payer: Mclaren Medicaid |
$12.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.12
|
| Rate for Payer: Meridian Medicaid |
$13.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.92
|
| Rate for Payer: Nomi Health Commercial |
$59.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.64
|
| Rate for Payer: PACE Senior Care Partners |
$17.30
|
| Rate for Payer: PACE SWMI |
$18.21
|
| Rate for Payer: PHP Commercial |
$61.92
|
| Rate for Payer: PHP Medicare Advantage |
$18.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$63.38
|
| Rate for Payer: Priority Health Medicare |
$18.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.70
|
| Rate for Payer: Railroad Medicare Medicare |
$18.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.11
|
| Rate for Payer: UHC Core |
$60.83
|
| Rate for Payer: UHC Exchange |
$18.21
|
| Rate for Payer: UHC Medicaid |
$12.84
|
| Rate for Payer: UHC Medicare Advantage |
$18.21
|
| Rate for Payer: UHCCP Medicaid |
$12.84
|
| Rate for Payer: VA VA |
$18.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.64
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG TABLET
|
Facility
|
IP
|
$72.85
|
|
|
Service Code
|
NDC 00904052361
|
| Hospital Charge Code |
664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.70 |
| Max. Negotiated Rate |
$65.56 |
| Rate for Payer: Aetna Commercial |
$61.92
|
| Rate for Payer: BCBS Trust/PPO |
$60.17
|
| Rate for Payer: BCN Commercial |
$60.17
|
| Rate for Payer: Cash Price |
$58.28
|
| Rate for Payer: Cofinity Commercial |
$62.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.28
|
| Rate for Payer: Healthscope Commercial |
$65.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.92
|
| Rate for Payer: Nomi Health Commercial |
$59.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.64
|
| Rate for Payer: PHP Commercial |
$61.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$63.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.11
|
| Rate for Payer: UHC Core |
$60.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.64
|
|
|
ASPIRIN 300 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$42.78
|
|
|
Service Code
|
NDC 00574703412
|
| Hospital Charge Code |
693
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$38.50 |
| Rate for Payer: Aetna Commercial |
$36.36
|
| Rate for Payer: Aetna Medicare |
$11.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.37
|
| Rate for Payer: BCBS Complete |
$7.92
|
| Rate for Payer: BCBS MAPPO |
$10.70
|
| Rate for Payer: BCBS Trust/PPO |
$35.17
|
| Rate for Payer: BCN Commercial |
$35.17
|
| Rate for Payer: BCN Medicare Advantage |
$10.70
|
| Rate for Payer: Cash Price |
$34.22
|
| Rate for Payer: Cofinity Commercial |
$36.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.70
|
| Rate for Payer: Healthscope Commercial |
$38.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.09
|
| Rate for Payer: Mclaren Medicaid |
$7.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.23
|
| Rate for Payer: Meridian Medicaid |
$7.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.36
|
| Rate for Payer: Nomi Health Commercial |
$35.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.09
|
| Rate for Payer: PACE Senior Care Partners |
$10.16
|
| Rate for Payer: PACE SWMI |
$10.70
|
| Rate for Payer: PHP Commercial |
$36.36
|
| Rate for Payer: PHP Medicare Advantage |
$10.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$37.22
|
| Rate for Payer: Priority Health Medicare |
$10.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.77
|
| Rate for Payer: Railroad Medicare Medicare |
$10.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.65
|
| Rate for Payer: UHC Core |
$35.72
|
| Rate for Payer: UHC Exchange |
$10.70
|
| Rate for Payer: UHC Medicaid |
$7.54
|
| Rate for Payer: UHC Medicare Advantage |
$10.70
|
| Rate for Payer: UHCCP Medicaid |
$7.54
|
| Rate for Payer: VA VA |
$10.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.09
|
|
|
ASPIRIN 300 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$42.78
|
|
|
Service Code
|
NDC 00574703412
|
| Hospital Charge Code |
693
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.77 |
| Max. Negotiated Rate |
$38.50 |
| Rate for Payer: Aetna Commercial |
$36.36
|
| Rate for Payer: BCBS Trust/PPO |
$35.33
|
| Rate for Payer: BCN Commercial |
$35.33
|
| Rate for Payer: Cash Price |
$34.22
|
| Rate for Payer: Cofinity Commercial |
$36.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.22
|
| Rate for Payer: Healthscope Commercial |
$38.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.36
|
| Rate for Payer: Nomi Health Commercial |
$35.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.09
|
| Rate for Payer: PHP Commercial |
$36.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$37.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.65
|
| Rate for Payer: UHC Core |
$35.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.09
|
|
|
ASPIRIN 325 MG TABLET
|
Facility
|
OP
|
$94.50
|
|
|
Service Code
|
NDC 00536105429
|
| Hospital Charge Code |
681
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.66 |
| Max. Negotiated Rate |
$85.05 |
| Rate for Payer: Aetna Commercial |
$80.33
|
| Rate for Payer: Aetna Medicare |
$24.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.53
|
| Rate for Payer: BCBS Complete |
$17.49
|
| Rate for Payer: BCBS MAPPO |
$23.62
|
| Rate for Payer: BCBS Trust/PPO |
$77.69
|
| Rate for Payer: BCN Commercial |
$77.69
|
| Rate for Payer: BCN Medicare Advantage |
$23.62
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cofinity Commercial |
$81.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.62
|
| Rate for Payer: Healthscope Commercial |
$85.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.88
|
| Rate for Payer: Mclaren Medicaid |
$16.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.81
|
| Rate for Payer: Meridian Medicaid |
$17.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.33
|
| Rate for Payer: Nomi Health Commercial |
$77.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.88
|
| Rate for Payer: PACE Senior Care Partners |
$22.44
|
| Rate for Payer: PACE SWMI |
$23.62
|
| Rate for Payer: PHP Commercial |
$80.33
|
| Rate for Payer: PHP Medicare Advantage |
$23.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$82.22
|
| Rate for Payer: Priority Health Medicare |
$23.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.77
|
| Rate for Payer: Railroad Medicare Medicare |
$23.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.16
|
| Rate for Payer: UHC Core |
$78.91
|
| Rate for Payer: UHC Exchange |
$23.62
|
| Rate for Payer: UHC Medicaid |
$16.66
|
| Rate for Payer: UHC Medicare Advantage |
$23.62
|
| Rate for Payer: UHCCP Medicaid |
$16.66
|
| Rate for Payer: VA VA |
$23.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.88
|
|
|
ASPIRIN 325 MG TABLET
|
Facility
|
IP
|
$654.50
|
|
|
Service Code
|
NDC 66553000101
|
| Hospital Charge Code |
681
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$455.53 |
| Max. Negotiated Rate |
$589.05 |
| Rate for Payer: Aetna Commercial |
$556.33
|
| Rate for Payer: BCBS Trust/PPO |
$540.55
|
| Rate for Payer: BCN Commercial |
$540.55
|
| Rate for Payer: Cash Price |
$523.60
|
| Rate for Payer: Cofinity Commercial |
$562.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$523.60
|
| Rate for Payer: Healthscope Commercial |
$589.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$490.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$556.33
|
| Rate for Payer: Nomi Health Commercial |
$536.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$490.88
|
| Rate for Payer: PHP Commercial |
$556.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$569.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$455.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$575.96
|
| Rate for Payer: UHC Core |
$546.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$490.88
|
|
|
ASPIRIN 325 MG TABLET
|
Facility
|
OP
|
$654.50
|
|
|
Service Code
|
NDC 66553000101
|
| Hospital Charge Code |
681
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.39 |
| Max. Negotiated Rate |
$589.05 |
| Rate for Payer: Aetna Commercial |
$556.33
|
| Rate for Payer: Aetna Medicare |
$170.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.53
|
| Rate for Payer: BCBS Complete |
$121.15
|
| Rate for Payer: BCBS MAPPO |
$163.62
|
| Rate for Payer: BCBS Trust/PPO |
$538.06
|
| Rate for Payer: BCN Commercial |
$538.06
|
| Rate for Payer: BCN Medicare Advantage |
$163.62
|
| Rate for Payer: Cash Price |
$523.60
|
| Rate for Payer: Cofinity Commercial |
$562.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$523.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.62
|
| Rate for Payer: Healthscope Commercial |
$589.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$490.88
|
| Rate for Payer: Mclaren Medicaid |
$115.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$171.81
|
| Rate for Payer: Meridian Medicaid |
$121.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$179.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$556.33
|
| Rate for Payer: Nomi Health Commercial |
$536.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$490.88
|
| Rate for Payer: PACE Senior Care Partners |
$155.44
|
| Rate for Payer: PACE SWMI |
$163.62
|
| Rate for Payer: PHP Commercial |
$556.33
|
| Rate for Payer: PHP Medicare Advantage |
$163.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$115.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$569.41
|
| Rate for Payer: Priority Health Medicare |
$165.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$455.53
|
| Rate for Payer: Railroad Medicare Medicare |
$163.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$575.96
|
| Rate for Payer: UHC Core |
$546.51
|
| Rate for Payer: UHC Exchange |
$163.62
|
| Rate for Payer: UHC Medicaid |
$115.39
|
| Rate for Payer: UHC Medicare Advantage |
$163.62
|
| Rate for Payer: UHCCP Medicaid |
$115.39
|
| Rate for Payer: VA VA |
$163.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$490.88
|
|
|
ASPIRIN 325 MG TABLET
|
Facility
|
OP
|
$3.68
|
|
|
Service Code
|
NDC 47682080533
|
| Hospital Charge Code |
681
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$3.31 |
| Rate for Payer: Aetna Commercial |
$3.13
|
| Rate for Payer: Aetna Medicare |
$0.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.15
|
| Rate for Payer: BCBS Complete |
$0.68
|
| Rate for Payer: BCBS MAPPO |
$0.92
|
| Rate for Payer: BCBS Trust/PPO |
$3.03
|
| Rate for Payer: BCN Commercial |
$3.03
|
| Rate for Payer: BCN Medicare Advantage |
$0.92
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cofinity Commercial |
$3.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.92
|
| Rate for Payer: Healthscope Commercial |
$3.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.76
|
| Rate for Payer: Mclaren Medicaid |
$0.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.97
|
| Rate for Payer: Meridian Medicaid |
$0.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.13
|
| Rate for Payer: Nomi Health Commercial |
$3.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.76
|
| Rate for Payer: PACE Senior Care Partners |
$0.87
|
| Rate for Payer: PACE SWMI |
$0.92
|
| Rate for Payer: PHP Commercial |
$3.13
|
| Rate for Payer: PHP Medicare Advantage |
$0.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.20
|
| Rate for Payer: Priority Health Medicare |
$0.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.56
|
| Rate for Payer: Railroad Medicare Medicare |
$0.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.24
|
| Rate for Payer: UHC Core |
$3.07
|
| Rate for Payer: UHC Exchange |
$0.92
|
| Rate for Payer: UHC Medicaid |
$0.65
|
| Rate for Payer: UHC Medicare Advantage |
$0.92
|
| Rate for Payer: UHCCP Medicaid |
$0.65
|
| Rate for Payer: VA VA |
$0.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.76
|
|
|
ASPIRIN 325 MG TABLET
|
Facility
|
IP
|
$3.68
|
|
|
Service Code
|
NDC 47682080533
|
| Hospital Charge Code |
681
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$3.31 |
| Rate for Payer: Aetna Commercial |
$3.13
|
| Rate for Payer: BCBS Trust/PPO |
$3.04
|
| Rate for Payer: BCN Commercial |
$3.04
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cofinity Commercial |
$3.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.94
|
| Rate for Payer: Healthscope Commercial |
$3.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.13
|
| Rate for Payer: Nomi Health Commercial |
$3.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.76
|
| Rate for Payer: PHP Commercial |
$3.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.24
|
| Rate for Payer: UHC Core |
$3.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.76
|
|
|
ASPIRIN 325 MG TABLET
|
Facility
|
IP
|
$94.50
|
|
|
Service Code
|
NDC 00536105429
|
| Hospital Charge Code |
681
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.77 |
| Max. Negotiated Rate |
$85.05 |
| Rate for Payer: Aetna Commercial |
$80.33
|
| Rate for Payer: BCBS Trust/PPO |
$78.05
|
| Rate for Payer: BCN Commercial |
$78.05
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cofinity Commercial |
$81.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.60
|
| Rate for Payer: Healthscope Commercial |
$85.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.33
|
| Rate for Payer: Nomi Health Commercial |
$77.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.88
|
| Rate for Payer: PHP Commercial |
$80.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$82.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.16
|
| Rate for Payer: UHC Core |
$78.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.88
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
IP
|
$90.72
|
|
|
Service Code
|
NDC 00904679489
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.14 |
| Max. Negotiated Rate |
$81.65 |
| Rate for Payer: Aetna Commercial |
$77.11
|
| Rate for Payer: BCBS Trust/PPO |
$74.93
|
| Rate for Payer: BCN Commercial |
$74.93
|
| Rate for Payer: Cash Price |
$72.58
|
| Rate for Payer: Cofinity Commercial |
$78.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.58
|
| Rate for Payer: Healthscope Commercial |
$81.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.11
|
| Rate for Payer: Nomi Health Commercial |
$74.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.04
|
| Rate for Payer: PHP Commercial |
$77.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$78.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.83
|
| Rate for Payer: UHC Core |
$75.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.04
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
NDC 16103036611
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.43 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Aetna Commercial |
$214.20
|
| Rate for Payer: Aetna Medicare |
$65.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.75
|
| Rate for Payer: BCBS Complete |
$46.65
|
| Rate for Payer: BCBS MAPPO |
$63.00
|
| Rate for Payer: BCBS Trust/PPO |
$207.17
|
| Rate for Payer: BCN Commercial |
$207.17
|
| Rate for Payer: BCN Medicare Advantage |
$63.00
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cofinity Commercial |
$216.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.00
|
| Rate for Payer: Healthscope Commercial |
$226.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.00
|
| Rate for Payer: Mclaren Medicaid |
$44.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.15
|
| Rate for Payer: Meridian Medicaid |
$46.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$69.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.20
|
| Rate for Payer: Nomi Health Commercial |
$206.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$189.00
|
| Rate for Payer: PACE Senior Care Partners |
$59.85
|
| Rate for Payer: PACE SWMI |
$63.00
|
| Rate for Payer: PHP Commercial |
$214.20
|
| Rate for Payer: PHP Medicare Advantage |
$63.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$219.24
|
| Rate for Payer: Priority Health Medicare |
$63.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$175.39
|
| Rate for Payer: Railroad Medicare Medicare |
$63.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.76
|
| Rate for Payer: UHC Core |
$210.42
|
| Rate for Payer: UHC Exchange |
$63.00
|
| Rate for Payer: UHC Medicaid |
$44.43
|
| Rate for Payer: UHC Medicare Advantage |
$63.00
|
| Rate for Payer: UHCCP Medicaid |
$44.43
|
| Rate for Payer: VA VA |
$63.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.00
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
IP
|
$504.00
|
|
|
Service Code
|
NDC 00904679480
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$350.78 |
| Max. Negotiated Rate |
$453.60 |
| Rate for Payer: Aetna Commercial |
$428.40
|
| Rate for Payer: BCBS Trust/PPO |
$416.25
|
| Rate for Payer: BCN Commercial |
$416.25
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cofinity Commercial |
$433.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$403.20
|
| Rate for Payer: Healthscope Commercial |
$453.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$378.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$428.40
|
| Rate for Payer: Nomi Health Commercial |
$413.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$378.00
|
| Rate for Payer: PHP Commercial |
$428.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$438.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$350.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$443.52
|
| Rate for Payer: UHC Core |
$420.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$378.00
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
IP
|
$174.90
|
|
|
Service Code
|
NDC 77333004920
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.73 |
| Max. Negotiated Rate |
$157.41 |
| Rate for Payer: Aetna Commercial |
$148.66
|
| Rate for Payer: BCBS Trust/PPO |
$144.45
|
| Rate for Payer: BCN Commercial |
$144.45
|
| Rate for Payer: Cash Price |
$139.92
|
| Rate for Payer: Cofinity Commercial |
$150.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.92
|
| Rate for Payer: Healthscope Commercial |
$157.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.66
|
| Rate for Payer: Nomi Health Commercial |
$143.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$131.18
|
| Rate for Payer: PHP Commercial |
$148.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$152.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.91
|
| Rate for Payer: UHC Core |
$146.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.18
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
OP
|
$174.90
|
|
|
Service Code
|
NDC 77333004920
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.83 |
| Max. Negotiated Rate |
$157.41 |
| Rate for Payer: Aetna Commercial |
$148.66
|
| Rate for Payer: Aetna Medicare |
$45.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$54.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$54.66
|
| Rate for Payer: BCBS Complete |
$32.37
|
| Rate for Payer: BCBS MAPPO |
$43.73
|
| Rate for Payer: BCBS Trust/PPO |
$143.79
|
| Rate for Payer: BCN Commercial |
$143.79
|
| Rate for Payer: BCN Medicare Advantage |
$43.73
|
| Rate for Payer: Cash Price |
$139.92
|
| Rate for Payer: Cofinity Commercial |
$150.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.73
|
| Rate for Payer: Healthscope Commercial |
$157.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.18
|
| Rate for Payer: Mclaren Medicaid |
$30.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.91
|
| Rate for Payer: Meridian Medicaid |
$32.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$48.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.66
|
| Rate for Payer: Nomi Health Commercial |
$143.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$131.18
|
| Rate for Payer: PACE Senior Care Partners |
$41.54
|
| Rate for Payer: PACE SWMI |
$43.73
|
| Rate for Payer: PHP Commercial |
$148.66
|
| Rate for Payer: PHP Medicare Advantage |
$43.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$152.16
|
| Rate for Payer: Priority Health Medicare |
$44.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.73
|
| Rate for Payer: Railroad Medicare Medicare |
$43.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.91
|
| Rate for Payer: UHC Core |
$146.04
|
| Rate for Payer: UHC Exchange |
$43.73
|
| Rate for Payer: UHC Medicaid |
$30.83
|
| Rate for Payer: UHC Medicare Advantage |
$43.73
|
| Rate for Payer: UHCCP Medicaid |
$30.83
|
| Rate for Payer: VA VA |
$43.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.18
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
OP
|
$684.00
|
|
|
Service Code
|
NDC 00904750930
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.59 |
| Max. Negotiated Rate |
$615.60 |
| Rate for Payer: Aetna Commercial |
$581.40
|
| Rate for Payer: Aetna Medicare |
$177.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$213.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$213.75
|
| Rate for Payer: BCBS Complete |
$126.61
|
| Rate for Payer: BCBS MAPPO |
$171.00
|
| Rate for Payer: BCBS Trust/PPO |
$562.32
|
| Rate for Payer: BCN Commercial |
$562.32
|
| Rate for Payer: BCN Medicare Advantage |
$171.00
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cofinity Commercial |
$588.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$547.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$171.00
|
| Rate for Payer: Healthscope Commercial |
$615.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$513.00
|
| Rate for Payer: Mclaren Medicaid |
$120.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$179.55
|
| Rate for Payer: Meridian Medicaid |
$126.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$196.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$188.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$581.40
|
| Rate for Payer: Nomi Health Commercial |
$560.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$513.00
|
| Rate for Payer: PACE Senior Care Partners |
$162.45
|
| Rate for Payer: PACE SWMI |
$171.00
|
| Rate for Payer: PHP Commercial |
$581.40
|
| Rate for Payer: PHP Medicare Advantage |
$171.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$595.08
|
| Rate for Payer: Priority Health Medicare |
$172.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$476.06
|
| Rate for Payer: Railroad Medicare Medicare |
$171.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$601.92
|
| Rate for Payer: UHC Core |
$571.14
|
| Rate for Payer: UHC Exchange |
$171.00
|
| Rate for Payer: UHC Medicaid |
$120.59
|
| Rate for Payer: UHC Medicare Advantage |
$171.00
|
| Rate for Payer: UHCCP Medicaid |
$120.59
|
| Rate for Payer: VA VA |
$171.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$513.00
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
IP
|
$676.50
|
|
|
Service Code
|
NDC 66553000201
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$470.84 |
| Max. Negotiated Rate |
$608.85 |
| Rate for Payer: Aetna Commercial |
$575.02
|
| Rate for Payer: BCBS Trust/PPO |
$558.72
|
| Rate for Payer: BCN Commercial |
$558.72
|
| Rate for Payer: Cash Price |
$541.20
|
| Rate for Payer: Cofinity Commercial |
$581.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$541.20
|
| Rate for Payer: Healthscope Commercial |
$608.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$507.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$575.02
|
| Rate for Payer: Nomi Health Commercial |
$554.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$507.38
|
| Rate for Payer: PHP Commercial |
$575.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$588.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$470.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$595.32
|
| Rate for Payer: UHC Core |
$564.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$507.38
|
|
|
ASPIRIN 81 MG CHEWABLE TABLET
|
Facility
|
IP
|
$756.00
|
|
|
Service Code
|
NDC 63739043402
|
| Hospital Charge Code |
679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$526.18 |
| Max. Negotiated Rate |
$680.40 |
| Rate for Payer: Aetna Commercial |
$642.60
|
| Rate for Payer: BCBS Trust/PPO |
$624.38
|
| Rate for Payer: BCN Commercial |
$624.38
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cofinity Commercial |
$650.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$604.80
|
| Rate for Payer: Healthscope Commercial |
$680.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$567.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$642.60
|
| Rate for Payer: Nomi Health Commercial |
$619.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$567.00
|
| Rate for Payer: PHP Commercial |
$642.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$657.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$526.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$665.28
|
| Rate for Payer: UHC Core |
$631.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$567.00
|
|
