|
ATROPINE 0.1 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$36.23
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
730
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.39 |
| Max. Negotiated Rate |
$32.61 |
| Rate for Payer: Aetna Commercial |
$30.80
|
| Rate for Payer: Aetna Commercial |
$36.66
|
| Rate for Payer: Aetna Commercial |
$64.30
|
| Rate for Payer: Aetna Commercial |
$36.54
|
| Rate for Payer: Aetna Medicare |
$11.18
|
| Rate for Payer: Aetna Medicare |
$9.42
|
| Rate for Payer: Aetna Medicare |
$11.21
|
| Rate for Payer: Aetna Medicare |
$19.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.32
|
| Rate for Payer: BCBS Complete |
$14.00
|
| Rate for Payer: BCBS Complete |
$7.96
|
| Rate for Payer: BCBS Complete |
$6.71
|
| Rate for Payer: BCBS Complete |
$7.98
|
| Rate for Payer: BCBS MAPPO |
$9.06
|
| Rate for Payer: BCBS MAPPO |
$10.75
|
| Rate for Payer: BCBS MAPPO |
$18.91
|
| Rate for Payer: BCBS MAPPO |
$10.78
|
| Rate for Payer: BCBS Trust/PPO |
$35.46
|
| Rate for Payer: BCBS Trust/PPO |
$29.78
|
| Rate for Payer: BCBS Trust/PPO |
$62.19
|
| Rate for Payer: BCBS Trust/PPO |
$35.34
|
| Rate for Payer: BCN Commercial |
$35.46
|
| Rate for Payer: BCN Commercial |
$62.19
|
| Rate for Payer: BCN Commercial |
$35.34
|
| Rate for Payer: BCN Commercial |
$29.78
|
| Rate for Payer: BCN Medicare Advantage |
$10.78
|
| Rate for Payer: BCN Medicare Advantage |
$10.75
|
| Rate for Payer: BCN Medicare Advantage |
$18.91
|
| Rate for Payer: BCN Medicare Advantage |
$9.06
|
| Rate for Payer: Cash Price |
$60.52
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$28.98
|
| Rate for Payer: Cash Price |
$34.39
|
| Rate for Payer: Cofinity Commercial |
$36.97
|
| Rate for Payer: Cofinity Commercial |
$31.16
|
| Rate for Payer: Cofinity Commercial |
$37.09
|
| Rate for Payer: Cofinity Commercial |
$65.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.78
|
| Rate for Payer: Healthscope Commercial |
$32.61
|
| Rate for Payer: Healthscope Commercial |
$68.08
|
| Rate for Payer: Healthscope Commercial |
$38.82
|
| Rate for Payer: Healthscope Commercial |
$38.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.17
|
| Rate for Payer: Mclaren Medicaid |
$7.60
|
| Rate for Payer: Mclaren Medicaid |
$7.58
|
| Rate for Payer: Mclaren Medicaid |
$6.39
|
| Rate for Payer: Mclaren Medicaid |
$13.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.51
|
| Rate for Payer: Meridian Medicaid |
$6.71
|
| Rate for Payer: Meridian Medicaid |
$7.98
|
| Rate for Payer: Meridian Medicaid |
$14.00
|
| Rate for Payer: Meridian Medicaid |
$7.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.30
|
| Rate for Payer: Nomi Health Commercial |
$35.37
|
| Rate for Payer: Nomi Health Commercial |
$29.71
|
| Rate for Payer: Nomi Health Commercial |
$35.25
|
| Rate for Payer: Nomi Health Commercial |
$62.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.17
|
| Rate for Payer: PACE Senior Care Partners |
$10.24
|
| Rate for Payer: PACE Senior Care Partners |
$17.97
|
| Rate for Payer: PACE Senior Care Partners |
$8.60
|
| Rate for Payer: PACE Senior Care Partners |
$10.21
|
| Rate for Payer: PACE SWMI |
$9.06
|
| Rate for Payer: PACE SWMI |
$18.91
|
| Rate for Payer: PACE SWMI |
$10.75
|
| Rate for Payer: PACE SWMI |
$10.78
|
| Rate for Payer: PHP Commercial |
$30.80
|
| Rate for Payer: PHP Commercial |
$36.54
|
| Rate for Payer: PHP Commercial |
$36.66
|
| Rate for Payer: PHP Commercial |
$64.30
|
| Rate for Payer: PHP Medicare Advantage |
$9.06
|
| Rate for Payer: PHP Medicare Advantage |
$18.91
|
| Rate for Payer: PHP Medicare Advantage |
$10.75
|
| Rate for Payer: PHP Medicare Advantage |
$10.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$37.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$65.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$37.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$31.52
|
| Rate for Payer: Priority Health Medicare |
$10.85
|
| Rate for Payer: Priority Health Medicare |
$9.15
|
| Rate for Payer: Priority Health Medicare |
$10.89
|
| Rate for Payer: Priority Health Medicare |
$19.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.22
|
| Rate for Payer: Railroad Medicare Medicare |
$10.78
|
| Rate for Payer: Railroad Medicare Medicare |
$9.06
|
| Rate for Payer: Railroad Medicare Medicare |
$18.91
|
| Rate for Payer: Railroad Medicare Medicare |
$10.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.57
|
| Rate for Payer: UHC Core |
$30.25
|
| Rate for Payer: UHC Core |
$36.01
|
| Rate for Payer: UHC Core |
$35.90
|
| Rate for Payer: UHC Core |
$63.17
|
| Rate for Payer: UHC Exchange |
$10.78
|
| Rate for Payer: UHC Exchange |
$10.75
|
| Rate for Payer: UHC Exchange |
$18.91
|
| Rate for Payer: UHC Exchange |
$9.06
|
| Rate for Payer: UHC Medicaid |
$6.39
|
| Rate for Payer: UHC Medicaid |
$7.58
|
| Rate for Payer: UHC Medicaid |
$7.60
|
| Rate for Payer: UHC Medicaid |
$13.34
|
| Rate for Payer: UHC Medicare Advantage |
$10.75
|
| Rate for Payer: UHC Medicare Advantage |
$9.06
|
| Rate for Payer: UHC Medicare Advantage |
$18.91
|
| Rate for Payer: UHC Medicare Advantage |
$10.78
|
| Rate for Payer: UHCCP Medicaid |
$7.60
|
| Rate for Payer: UHCCP Medicaid |
$13.34
|
| Rate for Payer: UHCCP Medicaid |
$7.58
|
| Rate for Payer: UHCCP Medicaid |
$6.39
|
| Rate for Payer: VA VA |
$9.06
|
| Rate for Payer: VA VA |
$18.91
|
| Rate for Payer: VA VA |
$10.78
|
| Rate for Payer: VA VA |
$10.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.74
|
|
|
ATROPINE 0.1 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$43.13
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
730
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.02 |
| Max. Negotiated Rate |
$38.82 |
| Rate for Payer: Aetna Commercial |
$36.66
|
| Rate for Payer: Aetna Commercial |
$36.54
|
| Rate for Payer: Aetna Commercial |
$30.80
|
| Rate for Payer: Aetna Commercial |
$64.30
|
| Rate for Payer: BCBS Trust/PPO |
$35.62
|
| Rate for Payer: BCBS Trust/PPO |
$62.48
|
| Rate for Payer: BCBS Trust/PPO |
$35.51
|
| Rate for Payer: BCBS Trust/PPO |
$29.92
|
| Rate for Payer: BCN Commercial |
$35.62
|
| Rate for Payer: BCN Commercial |
$29.92
|
| Rate for Payer: BCN Commercial |
$62.48
|
| Rate for Payer: BCN Commercial |
$35.51
|
| Rate for Payer: Cash Price |
$34.39
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$60.52
|
| Rate for Payer: Cash Price |
$28.98
|
| Rate for Payer: Cofinity Commercial |
$31.16
|
| Rate for Payer: Cofinity Commercial |
$65.06
|
| Rate for Payer: Cofinity Commercial |
$37.09
|
| Rate for Payer: Cofinity Commercial |
$36.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.52
|
| Rate for Payer: Healthscope Commercial |
$68.08
|
| Rate for Payer: Healthscope Commercial |
$38.69
|
| Rate for Payer: Healthscope Commercial |
$38.82
|
| Rate for Payer: Healthscope Commercial |
$32.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.30
|
| Rate for Payer: Nomi Health Commercial |
$29.71
|
| Rate for Payer: Nomi Health Commercial |
$35.25
|
| Rate for Payer: Nomi Health Commercial |
$62.03
|
| Rate for Payer: Nomi Health Commercial |
$35.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.74
|
| Rate for Payer: PHP Commercial |
$64.30
|
| Rate for Payer: PHP Commercial |
$30.80
|
| Rate for Payer: PHP Commercial |
$36.54
|
| Rate for Payer: PHP Commercial |
$36.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$37.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$65.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$31.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$37.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.95
|
| Rate for Payer: UHC Core |
$36.01
|
| Rate for Payer: UHC Core |
$63.17
|
| Rate for Payer: UHC Core |
$35.90
|
| Rate for Payer: UHC Core |
$30.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.35
|
|
|
ATROPINE 0.1 MG/ML SYRINGE (CODE)
|
Facility
|
OP
|
$75.65
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
163701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.34 |
| Max. Negotiated Rate |
$68.08 |
| Rate for Payer: Aetna Commercial |
$64.30
|
| Rate for Payer: Aetna Medicare |
$19.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.64
|
| Rate for Payer: BCBS Complete |
$14.00
|
| Rate for Payer: BCBS MAPPO |
$18.91
|
| Rate for Payer: BCBS Trust/PPO |
$62.19
|
| Rate for Payer: BCN Commercial |
$62.19
|
| Rate for Payer: BCN Medicare Advantage |
$18.91
|
| Rate for Payer: Cash Price |
$60.52
|
| Rate for Payer: Cofinity Commercial |
$65.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.91
|
| Rate for Payer: Healthscope Commercial |
$68.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.74
|
| Rate for Payer: Mclaren Medicaid |
$13.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.86
|
| Rate for Payer: Meridian Medicaid |
$14.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.30
|
| Rate for Payer: Nomi Health Commercial |
$62.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.74
|
| Rate for Payer: PACE Senior Care Partners |
$17.97
|
| Rate for Payer: PACE SWMI |
$18.91
|
| Rate for Payer: PHP Commercial |
$64.30
|
| Rate for Payer: PHP Medicare Advantage |
$18.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$65.82
|
| Rate for Payer: Priority Health Medicare |
$19.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.65
|
| Rate for Payer: Railroad Medicare Medicare |
$18.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.57
|
| Rate for Payer: UHC Core |
$63.17
|
| Rate for Payer: UHC Exchange |
$18.91
|
| Rate for Payer: UHC Medicaid |
$13.34
|
| Rate for Payer: UHC Medicare Advantage |
$18.91
|
| Rate for Payer: UHCCP Medicaid |
$13.34
|
| Rate for Payer: VA VA |
$18.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.74
|
|
|
ATROPINE 0.1 MG/ML SYRINGE (CODE)
|
Facility
|
IP
|
$75.65
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
163701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.65 |
| Max. Negotiated Rate |
$68.08 |
| Rate for Payer: Aetna Commercial |
$64.30
|
| Rate for Payer: BCBS Trust/PPO |
$62.48
|
| Rate for Payer: BCN Commercial |
$62.48
|
| Rate for Payer: Cash Price |
$60.52
|
| Rate for Payer: Cofinity Commercial |
$65.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.52
|
| Rate for Payer: Healthscope Commercial |
$68.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.30
|
| Rate for Payer: Nomi Health Commercial |
$62.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.74
|
| Rate for Payer: PHP Commercial |
$64.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$65.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.57
|
| Rate for Payer: UHC Core |
$63.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.74
|
|
|
ATROPINE 1 % EYE DROPS
|
Facility
|
IP
|
$161.25
|
|
|
Service Code
|
NDC 00065030355
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.23 |
| Max. Negotiated Rate |
$145.12 |
| Rate for Payer: Aetna Commercial |
$137.06
|
| Rate for Payer: BCBS Trust/PPO |
$133.18
|
| Rate for Payer: BCN Commercial |
$133.18
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cofinity Commercial |
$138.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.00
|
| Rate for Payer: Healthscope Commercial |
$145.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.06
|
| Rate for Payer: Nomi Health Commercial |
$132.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.94
|
| Rate for Payer: PHP Commercial |
$137.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$140.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$112.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.90
|
| Rate for Payer: UHC Core |
$134.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.94
|
|
|
ATROPINE 1 % EYE DROPS
|
Facility
|
IP
|
$122.08
|
|
|
Service Code
|
NDC 17478021505
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.97 |
| Max. Negotiated Rate |
$109.87 |
| Rate for Payer: Aetna Commercial |
$103.77
|
| Rate for Payer: BCBS Trust/PPO |
$100.83
|
| Rate for Payer: BCN Commercial |
$100.83
|
| Rate for Payer: Cash Price |
$97.66
|
| Rate for Payer: Cofinity Commercial |
$104.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.66
|
| Rate for Payer: Healthscope Commercial |
$109.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.77
|
| Rate for Payer: Nomi Health Commercial |
$100.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.56
|
| Rate for Payer: PHP Commercial |
$103.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$106.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$84.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.43
|
| Rate for Payer: UHC Core |
$101.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.56
|
|
|
ATROPINE 1 % EYE DROPS
|
Facility
|
OP
|
$161.25
|
|
|
Service Code
|
NDC 00065030355
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.43 |
| Max. Negotiated Rate |
$145.12 |
| Rate for Payer: Aetna Commercial |
$137.06
|
| Rate for Payer: Aetna Medicare |
$41.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.39
|
| Rate for Payer: BCBS Complete |
$29.85
|
| Rate for Payer: BCBS MAPPO |
$40.31
|
| Rate for Payer: BCBS Trust/PPO |
$132.56
|
| Rate for Payer: BCN Commercial |
$132.56
|
| Rate for Payer: BCN Medicare Advantage |
$40.31
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cofinity Commercial |
$138.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.31
|
| Rate for Payer: Healthscope Commercial |
$145.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.94
|
| Rate for Payer: Mclaren Medicaid |
$28.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.33
|
| Rate for Payer: Meridian Medicaid |
$29.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$44.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.06
|
| Rate for Payer: Nomi Health Commercial |
$132.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.94
|
| Rate for Payer: PACE Senior Care Partners |
$38.30
|
| Rate for Payer: PACE SWMI |
$40.31
|
| Rate for Payer: PHP Commercial |
$137.06
|
| Rate for Payer: PHP Medicare Advantage |
$40.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$140.29
|
| Rate for Payer: Priority Health Medicare |
$40.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$112.23
|
| Rate for Payer: Railroad Medicare Medicare |
$40.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.90
|
| Rate for Payer: UHC Core |
$134.64
|
| Rate for Payer: UHC Exchange |
$40.31
|
| Rate for Payer: UHC Medicaid |
$28.43
|
| Rate for Payer: UHC Medicare Advantage |
$40.31
|
| Rate for Payer: UHCCP Medicaid |
$28.43
|
| Rate for Payer: VA VA |
$40.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.94
|
|
|
ATROPINE 1 % EYE DROPS
|
Facility
|
OP
|
$122.08
|
|
|
Service Code
|
NDC 17478021505
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.52 |
| Max. Negotiated Rate |
$109.87 |
| Rate for Payer: Aetna Commercial |
$103.77
|
| Rate for Payer: Aetna Medicare |
$31.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.15
|
| Rate for Payer: BCBS Complete |
$22.60
|
| Rate for Payer: BCBS MAPPO |
$30.52
|
| Rate for Payer: BCBS Trust/PPO |
$100.36
|
| Rate for Payer: BCN Commercial |
$100.36
|
| Rate for Payer: BCN Medicare Advantage |
$30.52
|
| Rate for Payer: Cash Price |
$97.66
|
| Rate for Payer: Cofinity Commercial |
$104.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.52
|
| Rate for Payer: Healthscope Commercial |
$109.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.56
|
| Rate for Payer: Mclaren Medicaid |
$21.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.05
|
| Rate for Payer: Meridian Medicaid |
$22.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$33.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.77
|
| Rate for Payer: Nomi Health Commercial |
$100.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.56
|
| Rate for Payer: PACE Senior Care Partners |
$28.99
|
| Rate for Payer: PACE SWMI |
$30.52
|
| Rate for Payer: PHP Commercial |
$103.77
|
| Rate for Payer: PHP Medicare Advantage |
$30.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$106.21
|
| Rate for Payer: Priority Health Medicare |
$30.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$84.97
|
| Rate for Payer: Railroad Medicare Medicare |
$30.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.43
|
| Rate for Payer: UHC Core |
$101.94
|
| Rate for Payer: UHC Exchange |
$30.52
|
| Rate for Payer: UHC Medicaid |
$21.52
|
| Rate for Payer: UHC Medicare Advantage |
$30.52
|
| Rate for Payer: UHCCP Medicaid |
$21.52
|
| Rate for Payer: VA VA |
$30.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.56
|
|
|
ATROPINE 1 MG/ML INJECTION SOLUTION WRAPPER
|
Facility
|
IP
|
$29.39
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
301597
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$26.45 |
| Rate for Payer: Aetna Commercial |
$24.98
|
| Rate for Payer: Aetna Commercial |
$25.75
|
| Rate for Payer: Aetna Commercial |
$25.80
|
| Rate for Payer: BCBS Trust/PPO |
$25.02
|
| Rate for Payer: BCBS Trust/PPO |
$24.27
|
| Rate for Payer: BCBS Trust/PPO |
$25.07
|
| Rate for Payer: BCN Commercial |
$25.02
|
| Rate for Payer: BCN Commercial |
$24.27
|
| Rate for Payer: BCN Commercial |
$25.07
|
| Rate for Payer: Cash Price |
$23.51
|
| Rate for Payer: Cash Price |
$24.28
|
| Rate for Payer: Cash Price |
$24.23
|
| Rate for Payer: Cofinity Commercial |
$26.10
|
| Rate for Payer: Cofinity Commercial |
$26.05
|
| Rate for Payer: Cofinity Commercial |
$25.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.28
|
| Rate for Payer: Healthscope Commercial |
$27.26
|
| Rate for Payer: Healthscope Commercial |
$26.45
|
| Rate for Payer: Healthscope Commercial |
$27.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.80
|
| Rate for Payer: Nomi Health Commercial |
$24.10
|
| Rate for Payer: Nomi Health Commercial |
$24.84
|
| Rate for Payer: Nomi Health Commercial |
$24.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.76
|
| Rate for Payer: PHP Commercial |
$24.98
|
| Rate for Payer: PHP Commercial |
$25.80
|
| Rate for Payer: PHP Commercial |
$25.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$26.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$26.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$25.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.86
|
| Rate for Payer: UHC Core |
$24.54
|
| Rate for Payer: UHC Core |
$25.34
|
| Rate for Payer: UHC Core |
$25.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.72
|
|
|
ATROPINE 1 MG/ML INJECTION SOLUTION WRAPPER
|
Facility
|
OP
|
$29.39
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
301597
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$26.45 |
| Rate for Payer: Aetna Commercial |
$24.98
|
| Rate for Payer: Aetna Commercial |
$25.80
|
| Rate for Payer: Aetna Commercial |
$25.75
|
| Rate for Payer: Aetna Medicare |
$7.89
|
| Rate for Payer: Aetna Medicare |
$7.64
|
| Rate for Payer: Aetna Medicare |
$7.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.48
|
| Rate for Payer: BCBS Complete |
$5.61
|
| Rate for Payer: BCBS Complete |
$5.44
|
| Rate for Payer: BCBS Complete |
$5.62
|
| Rate for Payer: BCBS MAPPO |
$7.59
|
| Rate for Payer: BCBS MAPPO |
$7.35
|
| Rate for Payer: BCBS MAPPO |
$7.57
|
| Rate for Payer: BCBS Trust/PPO |
$24.16
|
| Rate for Payer: BCBS Trust/PPO |
$24.90
|
| Rate for Payer: BCBS Trust/PPO |
$24.95
|
| Rate for Payer: BCN Commercial |
$24.90
|
| Rate for Payer: BCN Commercial |
$24.95
|
| Rate for Payer: BCN Commercial |
$24.16
|
| Rate for Payer: BCN Medicare Advantage |
$7.59
|
| Rate for Payer: BCN Medicare Advantage |
$7.57
|
| Rate for Payer: BCN Medicare Advantage |
$7.35
|
| Rate for Payer: Cash Price |
$24.28
|
| Rate for Payer: Cash Price |
$24.23
|
| Rate for Payer: Cash Price |
$23.51
|
| Rate for Payer: Cofinity Commercial |
$25.28
|
| Rate for Payer: Cofinity Commercial |
$26.05
|
| Rate for Payer: Cofinity Commercial |
$26.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.35
|
| Rate for Payer: Healthscope Commercial |
$27.26
|
| Rate for Payer: Healthscope Commercial |
$26.45
|
| Rate for Payer: Healthscope Commercial |
$27.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.72
|
| Rate for Payer: Mclaren Medicaid |
$5.18
|
| Rate for Payer: Mclaren Medicaid |
$5.35
|
| Rate for Payer: Mclaren Medicaid |
$5.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.97
|
| Rate for Payer: Meridian Medicaid |
$5.62
|
| Rate for Payer: Meridian Medicaid |
$5.44
|
| Rate for Payer: Meridian Medicaid |
$5.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.75
|
| Rate for Payer: Nomi Health Commercial |
$24.89
|
| Rate for Payer: Nomi Health Commercial |
$24.84
|
| Rate for Payer: Nomi Health Commercial |
$24.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.04
|
| Rate for Payer: PACE Senior Care Partners |
$7.19
|
| Rate for Payer: PACE Senior Care Partners |
$6.98
|
| Rate for Payer: PACE Senior Care Partners |
$7.21
|
| Rate for Payer: PACE SWMI |
$7.59
|
| Rate for Payer: PACE SWMI |
$7.57
|
| Rate for Payer: PACE SWMI |
$7.35
|
| Rate for Payer: PHP Commercial |
$24.98
|
| Rate for Payer: PHP Commercial |
$25.80
|
| Rate for Payer: PHP Commercial |
$25.75
|
| Rate for Payer: PHP Medicare Advantage |
$7.57
|
| Rate for Payer: PHP Medicare Advantage |
$7.35
|
| Rate for Payer: PHP Medicare Advantage |
$7.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$26.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$25.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$26.40
|
| Rate for Payer: Priority Health Medicare |
$7.66
|
| Rate for Payer: Priority Health Medicare |
$7.65
|
| Rate for Payer: Priority Health Medicare |
$7.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.46
|
| Rate for Payer: Railroad Medicare Medicare |
$7.57
|
| Rate for Payer: Railroad Medicare Medicare |
$7.59
|
| Rate for Payer: Railroad Medicare Medicare |
$7.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.86
|
| Rate for Payer: UHC Core |
$24.54
|
| Rate for Payer: UHC Core |
$25.34
|
| Rate for Payer: UHC Core |
$25.29
|
| Rate for Payer: UHC Exchange |
$7.59
|
| Rate for Payer: UHC Exchange |
$7.57
|
| Rate for Payer: UHC Exchange |
$7.35
|
| Rate for Payer: UHC Medicaid |
$5.18
|
| Rate for Payer: UHC Medicaid |
$5.35
|
| Rate for Payer: UHC Medicaid |
$5.34
|
| Rate for Payer: UHC Medicare Advantage |
$7.57
|
| Rate for Payer: UHC Medicare Advantage |
$7.35
|
| Rate for Payer: UHC Medicare Advantage |
$7.59
|
| Rate for Payer: UHCCP Medicaid |
$5.34
|
| Rate for Payer: UHCCP Medicaid |
$5.18
|
| Rate for Payer: UHCCP Medicaid |
$5.35
|
| Rate for Payer: VA VA |
$7.35
|
| Rate for Payer: VA VA |
$7.59
|
| Rate for Payer: VA VA |
$7.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.76
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$22,693.15
|
|
|
Service Code
|
APR-DRG 0082
|
| Min. Negotiated Rate |
$21,612.52 |
| Max. Negotiated Rate |
$22,693.15 |
| Rate for Payer: BCBS Complete |
$22,693.15
|
| Rate for Payer: Mclaren Medicaid |
$21,612.52
|
| Rate for Payer: Meridian Medicaid |
$22,693.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$21,612.52
|
| Rate for Payer: UHC Medicaid |
$21,612.52
|
| Rate for Payer: UHCCP Medicaid |
$21,612.52
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$33,589.61
|
|
|
Service Code
|
APR-DRG 0083
|
| Min. Negotiated Rate |
$31,990.10 |
| Max. Negotiated Rate |
$33,589.61 |
| Rate for Payer: BCBS Complete |
$33,589.61
|
| Rate for Payer: Mclaren Medicaid |
$31,990.10
|
| Rate for Payer: Meridian Medicaid |
$33,589.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$31,990.10
|
| Rate for Payer: UHC Medicaid |
$31,990.10
|
| Rate for Payer: UHCCP Medicaid |
$31,990.10
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$18,781.43
|
|
|
Service Code
|
APR-DRG 0081
|
| Min. Negotiated Rate |
$17,887.07 |
| Max. Negotiated Rate |
$18,781.43 |
| Rate for Payer: BCBS Complete |
$18,781.43
|
| Rate for Payer: Mclaren Medicaid |
$17,887.07
|
| Rate for Payer: Meridian Medicaid |
$18,781.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$17,887.07
|
| Rate for Payer: UHC Medicaid |
$17,887.07
|
| Rate for Payer: UHCCP Medicaid |
$17,887.07
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$55,457.19
|
|
|
Service Code
|
APR-DRG 0084
|
| Min. Negotiated Rate |
$52,816.37 |
| Max. Negotiated Rate |
$55,457.19 |
| Rate for Payer: BCBS Complete |
$55,457.19
|
| Rate for Payer: Mclaren Medicaid |
$52,816.37
|
| Rate for Payer: Meridian Medicaid |
$55,457.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$52,816.37
|
| Rate for Payer: UHC Medicaid |
$52,816.37
|
| Rate for Payer: UHCCP Medicaid |
$52,816.37
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$116.79
|
|
|
Service Code
|
NDC 00093202631
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.59 |
| Max. Negotiated Rate |
$105.11 |
| Rate for Payer: Aetna Commercial |
$99.27
|
| Rate for Payer: Aetna Medicare |
$30.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.50
|
| Rate for Payer: BCBS Complete |
$21.62
|
| Rate for Payer: BCBS MAPPO |
$29.20
|
| Rate for Payer: BCBS Trust/PPO |
$96.01
|
| Rate for Payer: BCN Commercial |
$96.01
|
| Rate for Payer: BCN Medicare Advantage |
$29.20
|
| Rate for Payer: Cash Price |
$93.43
|
| Rate for Payer: Cofinity Commercial |
$100.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.20
|
| Rate for Payer: Healthscope Commercial |
$105.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.59
|
| Rate for Payer: Mclaren Medicaid |
$20.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.66
|
| Rate for Payer: Meridian Medicaid |
$21.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$32.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.27
|
| Rate for Payer: Nomi Health Commercial |
$95.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.59
|
| Rate for Payer: PACE Senior Care Partners |
$27.74
|
| Rate for Payer: PACE SWMI |
$29.20
|
| Rate for Payer: PHP Commercial |
$99.27
|
| Rate for Payer: PHP Medicare Advantage |
$29.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$101.61
|
| Rate for Payer: Priority Health Medicare |
$29.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.29
|
| Rate for Payer: Railroad Medicare Medicare |
$29.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.78
|
| Rate for Payer: UHC Core |
$97.52
|
| Rate for Payer: UHC Exchange |
$29.20
|
| Rate for Payer: UHC Medicaid |
$20.59
|
| Rate for Payer: UHC Medicare Advantage |
$29.20
|
| Rate for Payer: UHCCP Medicaid |
$20.59
|
| Rate for Payer: VA VA |
$29.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.59
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$82.37
|
|
|
Service Code
|
NDC 42806015134
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.33 |
| Max. Negotiated Rate |
$74.13 |
| Rate for Payer: Aetna Commercial |
$70.01
|
| Rate for Payer: BCBS Trust/PPO |
$68.03
|
| Rate for Payer: BCN Commercial |
$68.03
|
| Rate for Payer: Cash Price |
$65.90
|
| Rate for Payer: Cofinity Commercial |
$70.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.90
|
| Rate for Payer: Healthscope Commercial |
$74.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.01
|
| Rate for Payer: Nomi Health Commercial |
$67.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.78
|
| Rate for Payer: PHP Commercial |
$70.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$71.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.49
|
| Rate for Payer: UHC Core |
$68.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.78
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$19.08
|
|
|
Service Code
|
NDC 09900000333
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$17.17 |
| Rate for Payer: Aetna Commercial |
$16.22
|
| Rate for Payer: Aetna Medicare |
$4.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.96
|
| Rate for Payer: BCBS Complete |
$3.53
|
| Rate for Payer: BCBS MAPPO |
$4.77
|
| Rate for Payer: BCBS Trust/PPO |
$15.69
|
| Rate for Payer: BCN Commercial |
$15.69
|
| Rate for Payer: BCN Medicare Advantage |
$4.77
|
| Rate for Payer: Cash Price |
$15.26
|
| Rate for Payer: Cofinity Commercial |
$16.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.77
|
| Rate for Payer: Healthscope Commercial |
$17.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.31
|
| Rate for Payer: Mclaren Medicaid |
$3.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.01
|
| Rate for Payer: Meridian Medicaid |
$3.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.22
|
| Rate for Payer: Nomi Health Commercial |
$15.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.31
|
| Rate for Payer: PACE Senior Care Partners |
$4.53
|
| Rate for Payer: PACE SWMI |
$4.77
|
| Rate for Payer: PHP Commercial |
$16.22
|
| Rate for Payer: PHP Medicare Advantage |
$4.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.60
|
| Rate for Payer: Priority Health Medicare |
$4.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.28
|
| Rate for Payer: Railroad Medicare Medicare |
$4.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.79
|
| Rate for Payer: UHC Core |
$15.93
|
| Rate for Payer: UHC Exchange |
$4.77
|
| Rate for Payer: UHC Medicaid |
$3.36
|
| Rate for Payer: UHC Medicare Advantage |
$4.77
|
| Rate for Payer: UHCCP Medicaid |
$3.36
|
| Rate for Payer: VA VA |
$4.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.31
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$116.79
|
|
|
Service Code
|
NDC 00093202631
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.29 |
| Max. Negotiated Rate |
$105.11 |
| Rate for Payer: Aetna Commercial |
$99.27
|
| Rate for Payer: BCBS Trust/PPO |
$96.46
|
| Rate for Payer: BCN Commercial |
$96.46
|
| Rate for Payer: Cash Price |
$93.43
|
| Rate for Payer: Cofinity Commercial |
$100.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.43
|
| Rate for Payer: Healthscope Commercial |
$105.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.27
|
| Rate for Payer: Nomi Health Commercial |
$95.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.59
|
| Rate for Payer: PHP Commercial |
$99.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$101.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.78
|
| Rate for Payer: UHC Core |
$97.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.59
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$19.08
|
|
|
Service Code
|
NDC 09900000333
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$17.17 |
| Rate for Payer: Aetna Commercial |
$16.22
|
| Rate for Payer: BCBS Trust/PPO |
$15.76
|
| Rate for Payer: BCN Commercial |
$15.76
|
| Rate for Payer: Cash Price |
$15.26
|
| Rate for Payer: Cofinity Commercial |
$16.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.26
|
| Rate for Payer: Healthscope Commercial |
$17.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.22
|
| Rate for Payer: Nomi Health Commercial |
$15.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.31
|
| Rate for Payer: PHP Commercial |
$16.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.79
|
| Rate for Payer: UHC Core |
$15.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.31
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$82.37
|
|
|
Service Code
|
NDC 42806015134
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.52 |
| Max. Negotiated Rate |
$74.13 |
| Rate for Payer: Aetna Commercial |
$70.01
|
| Rate for Payer: Aetna Medicare |
$21.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.74
|
| Rate for Payer: BCBS Complete |
$15.25
|
| Rate for Payer: BCBS MAPPO |
$20.59
|
| Rate for Payer: BCBS Trust/PPO |
$67.72
|
| Rate for Payer: BCN Commercial |
$67.72
|
| Rate for Payer: BCN Medicare Advantage |
$20.59
|
| Rate for Payer: Cash Price |
$65.90
|
| Rate for Payer: Cofinity Commercial |
$70.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.59
|
| Rate for Payer: Healthscope Commercial |
$74.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.78
|
| Rate for Payer: Mclaren Medicaid |
$14.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.62
|
| Rate for Payer: Meridian Medicaid |
$15.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.01
|
| Rate for Payer: Nomi Health Commercial |
$67.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.78
|
| Rate for Payer: PACE Senior Care Partners |
$19.56
|
| Rate for Payer: PACE SWMI |
$20.59
|
| Rate for Payer: PHP Commercial |
$70.01
|
| Rate for Payer: PHP Medicare Advantage |
$20.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$71.66
|
| Rate for Payer: Priority Health Medicare |
$20.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.33
|
| Rate for Payer: Railroad Medicare Medicare |
$20.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.49
|
| Rate for Payer: UHC Core |
$68.78
|
| Rate for Payer: UHC Exchange |
$20.59
|
| Rate for Payer: UHC Medicaid |
$14.52
|
| Rate for Payer: UHC Medicare Advantage |
$20.59
|
| Rate for Payer: UHCCP Medicaid |
$14.52
|
| Rate for Payer: VA VA |
$20.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.78
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$37.68
|
|
|
Service Code
|
NDC 50111078766
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.23 |
| Max. Negotiated Rate |
$33.91 |
| Rate for Payer: Aetna Commercial |
$32.03
|
| Rate for Payer: BCBS Trust/PPO |
$31.12
|
| Rate for Payer: BCN Commercial |
$31.12
|
| Rate for Payer: Cash Price |
$30.14
|
| Rate for Payer: Cofinity Commercial |
$32.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.14
|
| Rate for Payer: Healthscope Commercial |
$33.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.03
|
| Rate for Payer: Nomi Health Commercial |
$30.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.26
|
| Rate for Payer: PHP Commercial |
$32.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$32.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.16
|
| Rate for Payer: UHC Core |
$31.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.26
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$51.62
|
|
|
Service Code
|
NDC 50111078751
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.93 |
| Max. Negotiated Rate |
$46.46 |
| Rate for Payer: Aetna Commercial |
$43.88
|
| Rate for Payer: BCBS Trust/PPO |
$42.63
|
| Rate for Payer: BCN Commercial |
$42.63
|
| Rate for Payer: Cash Price |
$41.30
|
| Rate for Payer: Cofinity Commercial |
$44.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.30
|
| Rate for Payer: Healthscope Commercial |
$46.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.88
|
| Rate for Payer: Nomi Health Commercial |
$42.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.72
|
| Rate for Payer: PHP Commercial |
$43.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$44.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.43
|
| Rate for Payer: UHC Core |
$43.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.72
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$7.76
|
|
|
Service Code
|
NDC 60687028211
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$6.98 |
| Rate for Payer: Aetna Commercial |
$6.60
|
| Rate for Payer: BCBS Trust/PPO |
$6.41
|
| Rate for Payer: BCN Commercial |
$6.41
|
| Rate for Payer: Cash Price |
$6.21
|
| Rate for Payer: Cofinity Commercial |
$6.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.21
|
| Rate for Payer: Healthscope Commercial |
$6.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.60
|
| Rate for Payer: Nomi Health Commercial |
$6.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.82
|
| Rate for Payer: PHP Commercial |
$6.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.83
|
| Rate for Payer: UHC Core |
$6.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.82
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$37.68
|
|
|
Service Code
|
NDC 50111078766
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.64 |
| Max. Negotiated Rate |
$33.91 |
| Rate for Payer: Aetna Commercial |
$32.03
|
| Rate for Payer: Aetna Medicare |
$9.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.78
|
| Rate for Payer: BCBS Complete |
$6.97
|
| Rate for Payer: BCBS MAPPO |
$9.42
|
| Rate for Payer: BCBS Trust/PPO |
$30.98
|
| Rate for Payer: BCN Commercial |
$30.98
|
| Rate for Payer: BCN Medicare Advantage |
$9.42
|
| Rate for Payer: Cash Price |
$30.14
|
| Rate for Payer: Cofinity Commercial |
$32.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.42
|
| Rate for Payer: Healthscope Commercial |
$33.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.26
|
| Rate for Payer: Mclaren Medicaid |
$6.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.89
|
| Rate for Payer: Meridian Medicaid |
$6.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.03
|
| Rate for Payer: Nomi Health Commercial |
$30.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.26
|
| Rate for Payer: PACE Senior Care Partners |
$8.95
|
| Rate for Payer: PACE SWMI |
$9.42
|
| Rate for Payer: PHP Commercial |
$32.03
|
| Rate for Payer: PHP Medicare Advantage |
$9.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$32.78
|
| Rate for Payer: Priority Health Medicare |
$9.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.23
|
| Rate for Payer: Railroad Medicare Medicare |
$9.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.16
|
| Rate for Payer: UHC Core |
$31.46
|
| Rate for Payer: UHC Exchange |
$9.42
|
| Rate for Payer: UHC Medicaid |
$6.64
|
| Rate for Payer: UHC Medicare Advantage |
$9.42
|
| Rate for Payer: UHCCP Medicaid |
$6.64
|
| Rate for Payer: VA VA |
$9.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.26
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$419.04
|
|
|
Service Code
|
NDC 00904735061
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.88 |
| Max. Negotiated Rate |
$377.14 |
| Rate for Payer: Aetna Commercial |
$356.18
|
| Rate for Payer: Aetna Medicare |
$108.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.95
|
| Rate for Payer: BCBS Complete |
$77.56
|
| Rate for Payer: BCBS MAPPO |
$104.76
|
| Rate for Payer: BCBS Trust/PPO |
$344.49
|
| Rate for Payer: BCN Commercial |
$344.49
|
| Rate for Payer: BCN Medicare Advantage |
$104.76
|
| Rate for Payer: Cash Price |
$335.23
|
| Rate for Payer: Cofinity Commercial |
$360.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$335.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.76
|
| Rate for Payer: Healthscope Commercial |
$377.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$314.28
|
| Rate for Payer: Mclaren Medicaid |
$73.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.00
|
| Rate for Payer: Meridian Medicaid |
$77.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$115.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$356.18
|
| Rate for Payer: Nomi Health Commercial |
$343.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$314.28
|
| Rate for Payer: PACE Senior Care Partners |
$99.52
|
| Rate for Payer: PACE SWMI |
$104.76
|
| Rate for Payer: PHP Commercial |
$356.18
|
| Rate for Payer: PHP Medicare Advantage |
$104.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$73.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$364.56
|
| Rate for Payer: Priority Health Medicare |
$105.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$291.65
|
| Rate for Payer: Railroad Medicare Medicare |
$104.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$368.76
|
| Rate for Payer: UHC Core |
$349.90
|
| Rate for Payer: UHC Exchange |
$104.76
|
| Rate for Payer: UHC Medicaid |
$73.88
|
| Rate for Payer: UHC Medicare Advantage |
$104.76
|
| Rate for Payer: UHCCP Medicaid |
$73.88
|
| Rate for Payer: VA VA |
$104.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$314.28
|
|
