|
B-COMPLEX WITH VITAMIN C TABLET
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
NDC 80681015400
|
| Hospital Charge Code |
807
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.01 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna Commercial |
$125.80
|
| Rate for Payer: BCBS Trust/PPO |
$122.23
|
| Rate for Payer: BCN Commercial |
$122.23
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cofinity Commercial |
$127.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.40
|
| Rate for Payer: Healthscope Commercial |
$133.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.80
|
| Rate for Payer: Nomi Health Commercial |
$121.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.00
|
| Rate for Payer: PHP Commercial |
$125.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$128.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.24
|
| Rate for Payer: UHC Core |
$123.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.00
|
|
|
B-COMPLEX WITH VITAMIN C TABLET
|
Facility
|
IP
|
$196.56
|
|
|
Service Code
|
NDC 80681012600
|
| Hospital Charge Code |
807
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.81 |
| Max. Negotiated Rate |
$176.90 |
| Rate for Payer: Aetna Commercial |
$167.08
|
| Rate for Payer: BCBS Trust/PPO |
$162.34
|
| Rate for Payer: BCN Commercial |
$162.34
|
| Rate for Payer: Cash Price |
$157.25
|
| Rate for Payer: Cofinity Commercial |
$169.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.25
|
| Rate for Payer: Healthscope Commercial |
$176.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.08
|
| Rate for Payer: Nomi Health Commercial |
$161.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.42
|
| Rate for Payer: PHP Commercial |
$167.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$171.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$136.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.97
|
| Rate for Payer: UHC Core |
$164.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.42
|
|
|
B-COMPLEX WITH VITAMIN C TABLET
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
NDC 80681015400
|
| Hospital Charge Code |
807
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.09 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna Commercial |
$125.80
|
| Rate for Payer: Aetna Medicare |
$38.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.25
|
| Rate for Payer: BCBS Complete |
$27.39
|
| Rate for Payer: BCBS MAPPO |
$37.00
|
| Rate for Payer: BCBS Trust/PPO |
$121.67
|
| Rate for Payer: BCN Commercial |
$121.67
|
| Rate for Payer: BCN Medicare Advantage |
$37.00
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cofinity Commercial |
$127.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.00
|
| Rate for Payer: Healthscope Commercial |
$133.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.00
|
| Rate for Payer: Mclaren Medicaid |
$26.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.85
|
| Rate for Payer: Meridian Medicaid |
$27.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.80
|
| Rate for Payer: Nomi Health Commercial |
$121.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.00
|
| Rate for Payer: PACE Senior Care Partners |
$35.15
|
| Rate for Payer: PACE SWMI |
$37.00
|
| Rate for Payer: PHP Commercial |
$125.80
|
| Rate for Payer: PHP Medicare Advantage |
$37.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$128.76
|
| Rate for Payer: Priority Health Medicare |
$37.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.01
|
| Rate for Payer: Railroad Medicare Medicare |
$37.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.24
|
| Rate for Payer: UHC Core |
$123.58
|
| Rate for Payer: UHC Exchange |
$37.00
|
| Rate for Payer: UHC Medicaid |
$26.09
|
| Rate for Payer: UHC Medicare Advantage |
$37.00
|
| Rate for Payer: UHCCP Medicaid |
$26.09
|
| Rate for Payer: VA VA |
$37.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.00
|
|
|
BECLOMETHASONE DIPROP 40 MCG/ACTUATION HFA BREATH ACTIVATED AEROSOL
|
Facility
|
IP
|
$777.06
|
|
|
Service Code
|
NDC 59310030240
|
| Hospital Charge Code |
184684
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$540.83 |
| Max. Negotiated Rate |
$699.35 |
| Rate for Payer: Aetna Commercial |
$660.50
|
| Rate for Payer: BCBS Trust/PPO |
$641.77
|
| Rate for Payer: BCN Commercial |
$641.77
|
| Rate for Payer: Cash Price |
$621.65
|
| Rate for Payer: Cofinity Commercial |
$668.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$621.65
|
| Rate for Payer: Healthscope Commercial |
$699.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$582.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$660.50
|
| Rate for Payer: Nomi Health Commercial |
$637.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$582.79
|
| Rate for Payer: PHP Commercial |
$660.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$676.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$540.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$683.81
|
| Rate for Payer: UHC Core |
$648.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$582.79
|
|
|
BECLOMETHASONE DIPROP 40 MCG/ACTUATION HFA BREATH ACTIVATED AEROSOL
|
Facility
|
OP
|
$777.06
|
|
|
Service Code
|
NDC 59310030240
|
| Hospital Charge Code |
184684
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.00 |
| Max. Negotiated Rate |
$699.35 |
| Rate for Payer: Aetna Commercial |
$660.50
|
| Rate for Payer: Aetna Medicare |
$202.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.83
|
| Rate for Payer: BCBS Complete |
$143.83
|
| Rate for Payer: BCBS MAPPO |
$194.26
|
| Rate for Payer: BCBS Trust/PPO |
$638.82
|
| Rate for Payer: BCN Commercial |
$638.82
|
| Rate for Payer: BCN Medicare Advantage |
$194.26
|
| Rate for Payer: Cash Price |
$621.65
|
| Rate for Payer: Cofinity Commercial |
$668.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$621.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.26
|
| Rate for Payer: Healthscope Commercial |
$699.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$582.79
|
| Rate for Payer: Mclaren Medicaid |
$137.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.98
|
| Rate for Payer: Meridian Medicaid |
$143.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$213.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$660.50
|
| Rate for Payer: Nomi Health Commercial |
$637.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$582.79
|
| Rate for Payer: PACE Senior Care Partners |
$184.55
|
| Rate for Payer: PACE SWMI |
$194.26
|
| Rate for Payer: PHP Commercial |
$660.50
|
| Rate for Payer: PHP Medicare Advantage |
$194.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$676.04
|
| Rate for Payer: Priority Health Medicare |
$196.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$540.83
|
| Rate for Payer: Railroad Medicare Medicare |
$194.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$683.81
|
| Rate for Payer: UHC Core |
$648.85
|
| Rate for Payer: UHC Exchange |
$194.26
|
| Rate for Payer: UHC Medicaid |
$137.00
|
| Rate for Payer: UHC Medicare Advantage |
$194.26
|
| Rate for Payer: UHCCP Medicaid |
$137.00
|
| Rate for Payer: VA VA |
$194.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$582.79
|
|
|
BENZOCAINE 20 % MUCOSAL SPRAY
|
Facility
|
OP
|
$38.65
|
|
|
Service Code
|
NDC 00283061043
|
| Hospital Charge Code |
27666
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$34.78 |
| Rate for Payer: Aetna Commercial |
$32.85
|
| Rate for Payer: Aetna Medicare |
$10.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.08
|
| Rate for Payer: BCBS Complete |
$7.15
|
| Rate for Payer: BCBS MAPPO |
$9.66
|
| Rate for Payer: BCBS Trust/PPO |
$31.77
|
| Rate for Payer: BCN Commercial |
$31.77
|
| Rate for Payer: BCN Medicare Advantage |
$9.66
|
| Rate for Payer: Cash Price |
$30.92
|
| Rate for Payer: Cofinity Commercial |
$33.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.66
|
| Rate for Payer: Healthscope Commercial |
$34.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.99
|
| Rate for Payer: Mclaren Medicaid |
$6.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.15
|
| Rate for Payer: Meridian Medicaid |
$7.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.85
|
| Rate for Payer: Nomi Health Commercial |
$31.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.99
|
| Rate for Payer: PACE Senior Care Partners |
$9.18
|
| Rate for Payer: PACE SWMI |
$9.66
|
| Rate for Payer: PHP Commercial |
$32.85
|
| Rate for Payer: PHP Medicare Advantage |
$9.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$33.63
|
| Rate for Payer: Priority Health Medicare |
$9.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.90
|
| Rate for Payer: Railroad Medicare Medicare |
$9.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.01
|
| Rate for Payer: UHC Core |
$32.27
|
| Rate for Payer: UHC Exchange |
$9.66
|
| Rate for Payer: UHC Medicaid |
$6.81
|
| Rate for Payer: UHC Medicare Advantage |
$9.66
|
| Rate for Payer: UHCCP Medicaid |
$6.81
|
| Rate for Payer: VA VA |
$9.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.99
|
|
|
BENZOCAINE 20 % MUCOSAL SPRAY
|
Facility
|
IP
|
$36.29
|
|
|
Service Code
|
NDC 00283061026
|
| Hospital Charge Code |
27666
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.26 |
| Max. Negotiated Rate |
$32.66 |
| Rate for Payer: Aetna Commercial |
$30.85
|
| Rate for Payer: BCBS Trust/PPO |
$29.97
|
| Rate for Payer: BCN Commercial |
$29.97
|
| Rate for Payer: Cash Price |
$29.03
|
| Rate for Payer: Cofinity Commercial |
$31.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.03
|
| Rate for Payer: Healthscope Commercial |
$32.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.85
|
| Rate for Payer: Nomi Health Commercial |
$29.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.22
|
| Rate for Payer: PHP Commercial |
$30.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$31.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.94
|
| Rate for Payer: UHC Core |
$30.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.22
|
|
|
BENZOCAINE 20 % MUCOSAL SPRAY
|
Facility
|
OP
|
$36.29
|
|
|
Service Code
|
NDC 00283061026
|
| Hospital Charge Code |
27666
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$32.66 |
| Rate for Payer: Aetna Commercial |
$30.85
|
| Rate for Payer: Aetna Medicare |
$9.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.34
|
| Rate for Payer: BCBS Complete |
$6.72
|
| Rate for Payer: BCBS MAPPO |
$9.07
|
| Rate for Payer: BCBS Trust/PPO |
$29.83
|
| Rate for Payer: BCN Commercial |
$29.83
|
| Rate for Payer: BCN Medicare Advantage |
$9.07
|
| Rate for Payer: Cash Price |
$29.03
|
| Rate for Payer: Cofinity Commercial |
$31.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.07
|
| Rate for Payer: Healthscope Commercial |
$32.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.22
|
| Rate for Payer: Mclaren Medicaid |
$6.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.53
|
| Rate for Payer: Meridian Medicaid |
$6.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.85
|
| Rate for Payer: Nomi Health Commercial |
$29.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.22
|
| Rate for Payer: PACE Senior Care Partners |
$8.62
|
| Rate for Payer: PACE SWMI |
$9.07
|
| Rate for Payer: PHP Commercial |
$30.85
|
| Rate for Payer: PHP Medicare Advantage |
$9.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$31.57
|
| Rate for Payer: Priority Health Medicare |
$9.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.26
|
| Rate for Payer: Railroad Medicare Medicare |
$9.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.94
|
| Rate for Payer: UHC Core |
$30.30
|
| Rate for Payer: UHC Exchange |
$9.07
|
| Rate for Payer: UHC Medicaid |
$6.40
|
| Rate for Payer: UHC Medicare Advantage |
$9.07
|
| Rate for Payer: UHCCP Medicaid |
$6.40
|
| Rate for Payer: VA VA |
$9.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.22
|
|
|
BENZOCAINE 20 % MUCOSAL SPRAY
|
Facility
|
IP
|
$38.65
|
|
|
Service Code
|
NDC 00283061043
|
| Hospital Charge Code |
27666
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.90 |
| Max. Negotiated Rate |
$34.78 |
| Rate for Payer: Aetna Commercial |
$32.85
|
| Rate for Payer: BCBS Trust/PPO |
$31.92
|
| Rate for Payer: BCN Commercial |
$31.92
|
| Rate for Payer: Cash Price |
$30.92
|
| Rate for Payer: Cofinity Commercial |
$33.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.92
|
| Rate for Payer: Healthscope Commercial |
$34.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.85
|
| Rate for Payer: Nomi Health Commercial |
$31.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.99
|
| Rate for Payer: PHP Commercial |
$32.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$33.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.01
|
| Rate for Payer: UHC Core |
$32.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.99
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
IP
|
$369.55
|
|
|
Service Code
|
NDC 68084021401
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$257.21 |
| Max. Negotiated Rate |
$332.60 |
| Rate for Payer: Aetna Commercial |
$314.12
|
| Rate for Payer: BCBS Trust/PPO |
$305.21
|
| Rate for Payer: BCN Commercial |
$305.21
|
| Rate for Payer: Cash Price |
$295.64
|
| Rate for Payer: Cofinity Commercial |
$317.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.64
|
| Rate for Payer: Healthscope Commercial |
$332.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$277.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.12
|
| Rate for Payer: Nomi Health Commercial |
$303.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$277.16
|
| Rate for Payer: PHP Commercial |
$314.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$321.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$257.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$325.20
|
| Rate for Payer: UHC Core |
$308.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$277.16
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
OP
|
$162.15
|
|
|
Service Code
|
NDC 42806071401
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.59 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna Commercial |
$137.83
|
| Rate for Payer: Aetna Medicare |
$42.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.67
|
| Rate for Payer: BCBS Complete |
$30.01
|
| Rate for Payer: BCBS MAPPO |
$40.54
|
| Rate for Payer: BCBS Trust/PPO |
$133.30
|
| Rate for Payer: BCN Commercial |
$133.30
|
| Rate for Payer: BCN Medicare Advantage |
$40.54
|
| Rate for Payer: Cash Price |
$129.72
|
| Rate for Payer: Cofinity Commercial |
$139.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.54
|
| Rate for Payer: Healthscope Commercial |
$145.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.61
|
| Rate for Payer: Mclaren Medicaid |
$28.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.56
|
| Rate for Payer: Meridian Medicaid |
$30.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$44.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.83
|
| Rate for Payer: Nomi Health Commercial |
$132.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.61
|
| Rate for Payer: PACE Senior Care Partners |
$38.51
|
| Rate for Payer: PACE SWMI |
$40.54
|
| Rate for Payer: PHP Commercial |
$137.83
|
| Rate for Payer: PHP Medicare Advantage |
$40.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$141.07
|
| Rate for Payer: Priority Health Medicare |
$40.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$112.86
|
| Rate for Payer: Railroad Medicare Medicare |
$40.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.69
|
| Rate for Payer: UHC Core |
$135.40
|
| Rate for Payer: UHC Exchange |
$40.54
|
| Rate for Payer: UHC Medicaid |
$28.59
|
| Rate for Payer: UHC Medicare Advantage |
$40.54
|
| Rate for Payer: UHCCP Medicaid |
$28.59
|
| Rate for Payer: VA VA |
$40.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.61
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
OP
|
$369.55
|
|
|
Service Code
|
NDC 68084021401
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.15 |
| Max. Negotiated Rate |
$332.60 |
| Rate for Payer: Aetna Commercial |
$314.12
|
| Rate for Payer: Aetna Medicare |
$96.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$115.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$115.48
|
| Rate for Payer: BCBS Complete |
$68.40
|
| Rate for Payer: BCBS MAPPO |
$92.39
|
| Rate for Payer: BCBS Trust/PPO |
$303.81
|
| Rate for Payer: BCN Commercial |
$303.81
|
| Rate for Payer: BCN Medicare Advantage |
$92.39
|
| Rate for Payer: Cash Price |
$295.64
|
| Rate for Payer: Cofinity Commercial |
$317.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.39
|
| Rate for Payer: Healthscope Commercial |
$332.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$277.16
|
| Rate for Payer: Mclaren Medicaid |
$65.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$97.01
|
| Rate for Payer: Meridian Medicaid |
$68.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$106.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$101.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.12
|
| Rate for Payer: Nomi Health Commercial |
$303.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$277.16
|
| Rate for Payer: PACE Senior Care Partners |
$87.77
|
| Rate for Payer: PACE SWMI |
$92.39
|
| Rate for Payer: PHP Commercial |
$314.12
|
| Rate for Payer: PHP Medicare Advantage |
$92.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$321.51
|
| Rate for Payer: Priority Health Medicare |
$93.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$257.21
|
| Rate for Payer: Railroad Medicare Medicare |
$92.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$325.20
|
| Rate for Payer: UHC Core |
$308.57
|
| Rate for Payer: UHC Exchange |
$92.39
|
| Rate for Payer: UHC Medicaid |
$65.15
|
| Rate for Payer: UHC Medicare Advantage |
$92.39
|
| Rate for Payer: UHCCP Medicaid |
$65.15
|
| Rate for Payer: VA VA |
$92.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$277.16
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
IP
|
$335.35
|
|
|
Service Code
|
NDC 00904715361
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$233.40 |
| Max. Negotiated Rate |
$301.81 |
| Rate for Payer: Aetna Commercial |
$285.05
|
| Rate for Payer: BCBS Trust/PPO |
$276.97
|
| Rate for Payer: BCN Commercial |
$276.97
|
| Rate for Payer: Cash Price |
$268.28
|
| Rate for Payer: Cofinity Commercial |
$288.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.28
|
| Rate for Payer: Healthscope Commercial |
$301.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$251.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.05
|
| Rate for Payer: Nomi Health Commercial |
$274.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$251.51
|
| Rate for Payer: PHP Commercial |
$285.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$291.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$233.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$295.11
|
| Rate for Payer: UHC Core |
$280.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$251.51
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
IP
|
$371.30
|
|
|
Service Code
|
NDC 67877057301
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$258.42 |
| Max. Negotiated Rate |
$334.17 |
| Rate for Payer: Aetna Commercial |
$315.61
|
| Rate for Payer: BCBS Trust/PPO |
$306.66
|
| Rate for Payer: BCN Commercial |
$306.66
|
| Rate for Payer: Cash Price |
$297.04
|
| Rate for Payer: Cofinity Commercial |
$319.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.04
|
| Rate for Payer: Healthscope Commercial |
$334.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.61
|
| Rate for Payer: Nomi Health Commercial |
$304.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$278.48
|
| Rate for Payer: PHP Commercial |
$315.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$323.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$258.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.74
|
| Rate for Payer: UHC Core |
$310.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.48
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
IP
|
$3.70
|
|
|
Service Code
|
NDC 68084021411
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$3.33 |
| Rate for Payer: Aetna Commercial |
$3.15
|
| Rate for Payer: BCBS Trust/PPO |
$3.06
|
| Rate for Payer: BCN Commercial |
$3.06
|
| Rate for Payer: Cash Price |
$2.96
|
| Rate for Payer: Cofinity Commercial |
$3.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.96
|
| Rate for Payer: Healthscope Commercial |
$3.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.15
|
| Rate for Payer: Nomi Health Commercial |
$3.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.77
|
| Rate for Payer: PHP Commercial |
$3.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.26
|
| Rate for Payer: UHC Core |
$3.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.77
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
OP
|
$3.70
|
|
|
Service Code
|
NDC 68084021411
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$3.33 |
| Rate for Payer: Aetna Commercial |
$3.15
|
| Rate for Payer: Aetna Medicare |
$0.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.16
|
| Rate for Payer: BCBS Complete |
$0.68
|
| Rate for Payer: BCBS MAPPO |
$0.93
|
| Rate for Payer: BCBS Trust/PPO |
$3.04
|
| Rate for Payer: BCN Commercial |
$3.04
|
| Rate for Payer: BCN Medicare Advantage |
$0.93
|
| Rate for Payer: Cash Price |
$2.96
|
| Rate for Payer: Cofinity Commercial |
$3.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.93
|
| Rate for Payer: Healthscope Commercial |
$3.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.77
|
| 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 |
$1.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.15
|
| Rate for Payer: Nomi Health Commercial |
$3.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.77
|
| Rate for Payer: PACE Senior Care Partners |
$0.88
|
| Rate for Payer: PACE SWMI |
$0.93
|
| Rate for Payer: PHP Commercial |
$3.15
|
| Rate for Payer: PHP Medicare Advantage |
$0.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.22
|
| Rate for Payer: Priority Health Medicare |
$0.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.58
|
| Rate for Payer: Railroad Medicare Medicare |
$0.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.26
|
| Rate for Payer: UHC Core |
$3.09
|
| Rate for Payer: UHC Exchange |
$0.93
|
| Rate for Payer: UHC Medicaid |
$0.65
|
| Rate for Payer: UHC Medicare Advantage |
$0.93
|
| Rate for Payer: UHCCP Medicaid |
$0.65
|
| Rate for Payer: VA VA |
$0.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.77
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
OP
|
$335.35
|
|
|
Service Code
|
NDC 00904715361
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.12 |
| Max. Negotiated Rate |
$301.81 |
| Rate for Payer: Aetna Commercial |
$285.05
|
| Rate for Payer: Aetna Medicare |
$87.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104.80
|
| Rate for Payer: BCBS Complete |
$62.07
|
| Rate for Payer: BCBS MAPPO |
$83.84
|
| Rate for Payer: BCBS Trust/PPO |
$275.69
|
| Rate for Payer: BCN Commercial |
$275.69
|
| Rate for Payer: BCN Medicare Advantage |
$83.84
|
| Rate for Payer: Cash Price |
$268.28
|
| Rate for Payer: Cofinity Commercial |
$288.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.84
|
| Rate for Payer: Healthscope Commercial |
$301.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$251.51
|
| Rate for Payer: Mclaren Medicaid |
$59.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.03
|
| Rate for Payer: Meridian Medicaid |
$62.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$92.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.05
|
| Rate for Payer: Nomi Health Commercial |
$274.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$251.51
|
| Rate for Payer: PACE Senior Care Partners |
$79.65
|
| Rate for Payer: PACE SWMI |
$83.84
|
| Rate for Payer: PHP Commercial |
$285.05
|
| Rate for Payer: PHP Medicare Advantage |
$83.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$291.75
|
| Rate for Payer: Priority Health Medicare |
$84.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$233.40
|
| Rate for Payer: Railroad Medicare Medicare |
$83.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$295.11
|
| Rate for Payer: UHC Core |
$280.02
|
| Rate for Payer: UHC Exchange |
$83.84
|
| Rate for Payer: UHC Medicaid |
$59.12
|
| Rate for Payer: UHC Medicare Advantage |
$83.84
|
| Rate for Payer: UHCCP Medicaid |
$59.12
|
| Rate for Payer: VA VA |
$83.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$251.51
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
IP
|
$162.15
|
|
|
Service Code
|
NDC 42806071401
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.86 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna Commercial |
$137.83
|
| Rate for Payer: BCBS Trust/PPO |
$133.92
|
| Rate for Payer: BCN Commercial |
$133.92
|
| Rate for Payer: Cash Price |
$129.72
|
| Rate for Payer: Cofinity Commercial |
$139.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.72
|
| Rate for Payer: Healthscope Commercial |
$145.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.83
|
| Rate for Payer: Nomi Health Commercial |
$132.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.61
|
| Rate for Payer: PHP Commercial |
$137.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$141.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$112.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.69
|
| Rate for Payer: UHC Core |
$135.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.61
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
OP
|
$371.30
|
|
|
Service Code
|
NDC 67877057301
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.46 |
| Max. Negotiated Rate |
$334.17 |
| Rate for Payer: Aetna Commercial |
$315.61
|
| Rate for Payer: Aetna Medicare |
$96.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$116.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$116.03
|
| Rate for Payer: BCBS Complete |
$68.73
|
| Rate for Payer: BCBS MAPPO |
$92.83
|
| Rate for Payer: BCBS Trust/PPO |
$305.25
|
| Rate for Payer: BCN Commercial |
$305.25
|
| Rate for Payer: BCN Medicare Advantage |
$92.83
|
| Rate for Payer: Cash Price |
$297.04
|
| Rate for Payer: Cofinity Commercial |
$319.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.83
|
| Rate for Payer: Healthscope Commercial |
$334.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.48
|
| Rate for Payer: Mclaren Medicaid |
$65.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$97.47
|
| Rate for Payer: Meridian Medicaid |
$68.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$106.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$102.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.61
|
| Rate for Payer: Nomi Health Commercial |
$304.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$278.48
|
| Rate for Payer: PACE Senior Care Partners |
$88.18
|
| Rate for Payer: PACE SWMI |
$92.83
|
| Rate for Payer: PHP Commercial |
$315.61
|
| Rate for Payer: PHP Medicare Advantage |
$92.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$323.03
|
| Rate for Payer: Priority Health Medicare |
$93.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$258.42
|
| Rate for Payer: Railroad Medicare Medicare |
$92.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.74
|
| Rate for Payer: UHC Core |
$310.04
|
| Rate for Payer: UHC Exchange |
$92.83
|
| Rate for Payer: UHC Medicaid |
$65.46
|
| Rate for Payer: UHC Medicare Advantage |
$92.83
|
| Rate for Payer: UHCCP Medicaid |
$65.46
|
| Rate for Payer: VA VA |
$92.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.48
|
|
|
BENZOYL PEROXIDE 5 % TOPICAL CLEANSER
|
Facility
|
OP
|
$36.50
|
|
|
Service Code
|
NDC 35573045308
|
| Hospital Charge Code |
993
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.43 |
| Max. Negotiated Rate |
$32.85 |
| Rate for Payer: Aetna Commercial |
$31.02
|
| Rate for Payer: Aetna Medicare |
$9.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.41
|
| Rate for Payer: BCBS Complete |
$6.76
|
| Rate for Payer: BCBS MAPPO |
$9.12
|
| Rate for Payer: BCBS Trust/PPO |
$30.01
|
| Rate for Payer: BCN Commercial |
$30.01
|
| Rate for Payer: BCN Medicare Advantage |
$9.12
|
| Rate for Payer: Cash Price |
$29.20
|
| Rate for Payer: Cofinity Commercial |
$31.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.12
|
| Rate for Payer: Healthscope Commercial |
$32.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.38
|
| Rate for Payer: Mclaren Medicaid |
$6.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.58
|
| Rate for Payer: Meridian Medicaid |
$6.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.02
|
| Rate for Payer: Nomi Health Commercial |
$29.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.38
|
| Rate for Payer: PACE Senior Care Partners |
$8.67
|
| Rate for Payer: PACE SWMI |
$9.12
|
| Rate for Payer: PHP Commercial |
$31.02
|
| Rate for Payer: PHP Medicare Advantage |
$9.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$31.75
|
| Rate for Payer: Priority Health Medicare |
$9.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.40
|
| Rate for Payer: Railroad Medicare Medicare |
$9.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.12
|
| Rate for Payer: UHC Core |
$30.48
|
| Rate for Payer: UHC Exchange |
$9.12
|
| Rate for Payer: UHC Medicaid |
$6.43
|
| Rate for Payer: UHC Medicare Advantage |
$9.12
|
| Rate for Payer: UHCCP Medicaid |
$6.43
|
| Rate for Payer: VA VA |
$9.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.38
|
|
|
BENZOYL PEROXIDE 5 % TOPICAL CLEANSER
|
Facility
|
IP
|
$36.50
|
|
|
Service Code
|
NDC 35573045308
|
| Hospital Charge Code |
993
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.40 |
| Max. Negotiated Rate |
$32.85 |
| Rate for Payer: Aetna Commercial |
$31.02
|
| Rate for Payer: BCBS Trust/PPO |
$30.15
|
| Rate for Payer: BCN Commercial |
$30.15
|
| Rate for Payer: Cash Price |
$29.20
|
| Rate for Payer: Cofinity Commercial |
$31.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.20
|
| Rate for Payer: Healthscope Commercial |
$32.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.02
|
| Rate for Payer: Nomi Health Commercial |
$29.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.38
|
| Rate for Payer: PHP Commercial |
$31.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$31.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.12
|
| Rate for Payer: UHC Core |
$30.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.38
|
|
|
BENZTROPINE 0.5 MG TABLET
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
NDC 00904678861
|
| Hospital Charge Code |
998
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$198.36 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Aetna Commercial |
$242.25
|
| Rate for Payer: BCBS Trust/PPO |
$235.38
|
| Rate for Payer: BCN Commercial |
$235.38
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cofinity Commercial |
$245.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.00
|
| Rate for Payer: Healthscope Commercial |
$256.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.25
|
| Rate for Payer: Nomi Health Commercial |
$233.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.75
|
| Rate for Payer: PHP Commercial |
$242.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$247.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$198.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$250.80
|
| Rate for Payer: UHC Core |
$237.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.75
|
|
|
BENZTROPINE 0.5 MG TABLET
|
Facility
|
IP
|
$284.35
|
|
|
Service Code
|
NDC 69097082607
|
| Hospital Charge Code |
998
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$197.91 |
| Max. Negotiated Rate |
$255.91 |
| Rate for Payer: Aetna Commercial |
$241.70
|
| Rate for Payer: BCBS Trust/PPO |
$234.84
|
| Rate for Payer: BCN Commercial |
$234.84
|
| Rate for Payer: Cash Price |
$227.48
|
| Rate for Payer: Cofinity Commercial |
$244.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.48
|
| Rate for Payer: Healthscope Commercial |
$255.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.70
|
| Rate for Payer: Nomi Health Commercial |
$233.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.26
|
| Rate for Payer: PHP Commercial |
$241.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$247.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$197.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$250.23
|
| Rate for Payer: UHC Core |
$237.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.26
|
|
|
BENZTROPINE 0.5 MG TABLET
|
Facility
|
OP
|
$338.20
|
|
|
Service Code
|
NDC 00904728861
|
| Hospital Charge Code |
998
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.62 |
| Max. Negotiated Rate |
$304.38 |
| Rate for Payer: Aetna Commercial |
$287.47
|
| Rate for Payer: Aetna Medicare |
$87.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$105.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$105.69
|
| Rate for Payer: BCBS Complete |
$62.60
|
| Rate for Payer: BCBS MAPPO |
$84.55
|
| Rate for Payer: BCBS Trust/PPO |
$278.03
|
| Rate for Payer: BCN Commercial |
$278.03
|
| Rate for Payer: BCN Medicare Advantage |
$84.55
|
| Rate for Payer: Cash Price |
$270.56
|
| Rate for Payer: Cofinity Commercial |
$290.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.55
|
| Rate for Payer: Healthscope Commercial |
$304.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.65
|
| Rate for Payer: Mclaren Medicaid |
$59.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.78
|
| Rate for Payer: Meridian Medicaid |
$62.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$93.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.47
|
| Rate for Payer: Nomi Health Commercial |
$277.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.65
|
| Rate for Payer: PACE Senior Care Partners |
$80.32
|
| Rate for Payer: PACE SWMI |
$84.55
|
| Rate for Payer: PHP Commercial |
$287.47
|
| Rate for Payer: PHP Medicare Advantage |
$84.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$294.23
|
| Rate for Payer: Priority Health Medicare |
$85.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$235.39
|
| Rate for Payer: Railroad Medicare Medicare |
$84.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$297.62
|
| Rate for Payer: UHC Core |
$282.40
|
| Rate for Payer: UHC Exchange |
$84.55
|
| Rate for Payer: UHC Medicaid |
$59.62
|
| Rate for Payer: UHC Medicare Advantage |
$84.55
|
| Rate for Payer: UHCCP Medicaid |
$59.62
|
| Rate for Payer: VA VA |
$84.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.65
|
|
|
BENZTROPINE 0.5 MG TABLET
|
Facility
|
OP
|
$183.30
|
|
|
Service Code
|
NDC 69315013601
|
| Hospital Charge Code |
998
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.32 |
| Max. Negotiated Rate |
$164.97 |
| Rate for Payer: Aetna Commercial |
$155.81
|
| Rate for Payer: Aetna Medicare |
$47.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57.28
|
| Rate for Payer: BCBS Complete |
$33.93
|
| Rate for Payer: BCBS MAPPO |
$45.83
|
| Rate for Payer: BCBS Trust/PPO |
$150.69
|
| Rate for Payer: BCN Commercial |
$150.69
|
| Rate for Payer: BCN Medicare Advantage |
$45.83
|
| Rate for Payer: Cash Price |
$146.64
|
| Rate for Payer: Cofinity Commercial |
$157.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.83
|
| Rate for Payer: Healthscope Commercial |
$164.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.47
|
| Rate for Payer: Mclaren Medicaid |
$32.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.12
|
| Rate for Payer: Meridian Medicaid |
$33.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$50.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.81
|
| Rate for Payer: Nomi Health Commercial |
$150.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$137.47
|
| Rate for Payer: PACE Senior Care Partners |
$43.53
|
| Rate for Payer: PACE SWMI |
$45.83
|
| Rate for Payer: PHP Commercial |
$155.81
|
| Rate for Payer: PHP Medicare Advantage |
$45.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$159.47
|
| Rate for Payer: Priority Health Medicare |
$46.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$127.58
|
| Rate for Payer: Railroad Medicare Medicare |
$45.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.30
|
| Rate for Payer: UHC Core |
$153.06
|
| Rate for Payer: UHC Exchange |
$45.83
|
| Rate for Payer: UHC Medicaid |
$32.32
|
| Rate for Payer: UHC Medicare Advantage |
$45.83
|
| Rate for Payer: UHCCP Medicaid |
$32.32
|
| Rate for Payer: VA VA |
$45.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.47
|
|
