|
BENZTROPINE 0.5 MG TABLET
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
NDC 00904678861
|
| Hospital Charge Code |
998
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.25 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Aetna Commercial |
$242.25
|
| Rate for Payer: Aetna Medicare |
$74.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.06
|
| Rate for Payer: BCBS Complete |
$52.75
|
| Rate for Payer: BCBS MAPPO |
$71.25
|
| Rate for Payer: BCBS Trust/PPO |
$234.30
|
| Rate for Payer: BCN Commercial |
$234.30
|
| Rate for Payer: BCN Medicare Advantage |
$71.25
|
| 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: Health Alliance Plan Medicare Advantage |
$71.25
|
| Rate for Payer: Healthscope Commercial |
$256.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.75
|
| Rate for Payer: Mclaren Medicaid |
$50.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.81
|
| Rate for Payer: Meridian Medicaid |
$52.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$78.38
|
| 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: PACE Senior Care Partners |
$67.69
|
| Rate for Payer: PACE SWMI |
$71.25
|
| Rate for Payer: PHP Commercial |
$242.25
|
| Rate for Payer: PHP Medicare Advantage |
$71.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$247.95
|
| Rate for Payer: Priority Health Medicare |
$71.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$198.36
|
| Rate for Payer: Railroad Medicare Medicare |
$71.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$250.80
|
| Rate for Payer: UHC Core |
$237.97
|
| Rate for Payer: UHC Exchange |
$71.25
|
| Rate for Payer: UHC Medicaid |
$50.25
|
| Rate for Payer: UHC Medicare Advantage |
$71.25
|
| Rate for Payer: UHCCP Medicaid |
$50.25
|
| Rate for Payer: VA VA |
$71.25
|
| 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
|
$284.35
|
|
|
Service Code
|
NDC 69097082607
|
| Hospital Charge Code |
998
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.13 |
| Max. Negotiated Rate |
$255.91 |
| Rate for Payer: Aetna Commercial |
$241.70
|
| Rate for Payer: Aetna Medicare |
$73.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$88.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$88.86
|
| Rate for Payer: BCBS Complete |
$52.63
|
| Rate for Payer: BCBS MAPPO |
$71.09
|
| Rate for Payer: BCBS Trust/PPO |
$233.76
|
| Rate for Payer: BCN Commercial |
$233.76
|
| Rate for Payer: BCN Medicare Advantage |
$71.09
|
| 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: Health Alliance Plan Medicare Advantage |
$71.09
|
| Rate for Payer: Healthscope Commercial |
$255.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.26
|
| Rate for Payer: Mclaren Medicaid |
$50.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.64
|
| Rate for Payer: Meridian Medicaid |
$52.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$78.20
|
| 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: PACE Senior Care Partners |
$67.53
|
| Rate for Payer: PACE SWMI |
$71.09
|
| Rate for Payer: PHP Commercial |
$241.70
|
| Rate for Payer: PHP Medicare Advantage |
$71.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$247.38
|
| Rate for Payer: Priority Health Medicare |
$71.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$197.91
|
| Rate for Payer: Railroad Medicare Medicare |
$71.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$250.23
|
| Rate for Payer: UHC Core |
$237.43
|
| Rate for Payer: UHC Exchange |
$71.09
|
| Rate for Payer: UHC Medicaid |
$50.13
|
| Rate for Payer: UHC Medicare Advantage |
$71.09
|
| Rate for Payer: UHCCP Medicaid |
$50.13
|
| Rate for Payer: VA VA |
$71.09
|
| 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 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$103.47
|
|
|
Service Code
|
HCPCS J0515
|
| Hospital Charge Code |
9259
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.24 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: Aetna Commercial |
$87.95
|
| Rate for Payer: Aetna Medicare |
$26.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.33
|
| Rate for Payer: BCBS Complete |
$19.15
|
| Rate for Payer: BCBS MAPPO |
$25.87
|
| Rate for Payer: BCBS Trust/PPO |
$85.06
|
| Rate for Payer: BCN Commercial |
$85.06
|
| Rate for Payer: BCN Medicare Advantage |
$25.87
|
| Rate for Payer: Cash Price |
$82.78
|
| Rate for Payer: Cofinity Commercial |
$88.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.87
|
| Rate for Payer: Healthscope Commercial |
$93.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.60
|
| Rate for Payer: Mclaren Medicaid |
$18.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.16
|
| Rate for Payer: Meridian Medicaid |
$19.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.95
|
| Rate for Payer: Nomi Health Commercial |
$84.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.60
|
| Rate for Payer: PACE Senior Care Partners |
$24.57
|
| Rate for Payer: PACE SWMI |
$25.87
|
| Rate for Payer: PHP Commercial |
$87.95
|
| Rate for Payer: PHP Medicare Advantage |
$25.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$90.02
|
| Rate for Payer: Priority Health Medicare |
$26.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.02
|
| Rate for Payer: Railroad Medicare Medicare |
$25.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.05
|
| Rate for Payer: UHC Core |
$86.40
|
| Rate for Payer: UHC Exchange |
$25.87
|
| Rate for Payer: UHC Medicaid |
$18.24
|
| Rate for Payer: UHC Medicare Advantage |
$25.87
|
| Rate for Payer: UHCCP Medicaid |
$18.24
|
| Rate for Payer: VA VA |
$25.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.60
|
|
|
BENZTROPINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$103.47
|
|
|
Service Code
|
HCPCS J0515
|
| Hospital Charge Code |
9259
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$72.02 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: Aetna Commercial |
$87.95
|
| Rate for Payer: BCBS Trust/PPO |
$85.46
|
| Rate for Payer: BCN Commercial |
$85.46
|
| Rate for Payer: Cash Price |
$82.78
|
| Rate for Payer: Cofinity Commercial |
$88.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.78
|
| Rate for Payer: Healthscope Commercial |
$93.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.95
|
| Rate for Payer: Nomi Health Commercial |
$84.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.60
|
| Rate for Payer: PHP Commercial |
$87.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$90.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.05
|
| Rate for Payer: UHC Core |
$86.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.60
|
|
|
BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
OP
|
$158.16
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
9266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.88 |
| Max. Negotiated Rate |
$142.34 |
| Rate for Payer: Aetna Commercial |
$134.44
|
| Rate for Payer: Aetna Medicare |
$41.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.42
|
| Rate for Payer: BCBS Complete |
$29.28
|
| Rate for Payer: BCBS MAPPO |
$39.54
|
| Rate for Payer: BCBS Trust/PPO |
$130.02
|
| Rate for Payer: BCN Commercial |
$130.02
|
| Rate for Payer: BCN Medicare Advantage |
$39.54
|
| Rate for Payer: Cash Price |
$126.53
|
| Rate for Payer: Cofinity Commercial |
$136.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.54
|
| Rate for Payer: Healthscope Commercial |
$142.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.62
|
| Rate for Payer: Mclaren Medicaid |
$27.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.52
|
| Rate for Payer: Meridian Medicaid |
$29.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$43.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.44
|
| Rate for Payer: Nomi Health Commercial |
$129.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.62
|
| Rate for Payer: PACE Senior Care Partners |
$37.56
|
| Rate for Payer: PACE SWMI |
$39.54
|
| Rate for Payer: PHP Commercial |
$134.44
|
| Rate for Payer: PHP Medicare Advantage |
$39.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$137.60
|
| Rate for Payer: Priority Health Medicare |
$39.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.08
|
| Rate for Payer: Railroad Medicare Medicare |
$39.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.18
|
| Rate for Payer: UHC Core |
$132.06
|
| Rate for Payer: UHC Exchange |
$39.54
|
| Rate for Payer: UHC Medicaid |
$27.88
|
| Rate for Payer: UHC Medicare Advantage |
$39.54
|
| Rate for Payer: UHCCP Medicaid |
$27.88
|
| Rate for Payer: VA VA |
$39.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.62
|
|
|
BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
IP
|
$158.16
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
9266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$110.08 |
| Max. Negotiated Rate |
$142.34 |
| Rate for Payer: Aetna Commercial |
$134.44
|
| Rate for Payer: BCBS Trust/PPO |
$130.62
|
| Rate for Payer: BCN Commercial |
$130.62
|
| Rate for Payer: Cash Price |
$126.53
|
| Rate for Payer: Cofinity Commercial |
$136.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.53
|
| Rate for Payer: Healthscope Commercial |
$142.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.44
|
| Rate for Payer: Nomi Health Commercial |
$129.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.62
|
| Rate for Payer: PHP Commercial |
$134.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$137.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.18
|
| Rate for Payer: UHC Core |
$132.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.62
|
|
|
BICTEGRAVIR 50 MG-EMTRICITABINE 200 MG-TENOFOVIR ALAFENAM 25 MG TABLET
|
Facility
|
IP
|
$15,209.56
|
|
|
Service Code
|
NDC 61958250103
|
| Hospital Charge Code |
185933
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10,585.85 |
| Max. Negotiated Rate |
$13,688.60 |
| Rate for Payer: Aetna Commercial |
$12,928.13
|
| Rate for Payer: BCBS Trust/PPO |
$12,561.58
|
| Rate for Payer: BCN Commercial |
$12,561.58
|
| Rate for Payer: Cash Price |
$12,167.65
|
| Rate for Payer: Cofinity Commercial |
$13,080.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,167.65
|
| Rate for Payer: Healthscope Commercial |
$13,688.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,407.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,928.13
|
| Rate for Payer: Nomi Health Commercial |
$12,471.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11,407.17
|
| Rate for Payer: PHP Commercial |
$12,928.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13,232.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10,585.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,384.41
|
| Rate for Payer: UHC Core |
$12,699.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,407.17
|
|
|
BICTEGRAVIR 50 MG-EMTRICITABINE 200 MG-TENOFOVIR ALAFENAM 25 MG TABLET
|
Facility
|
OP
|
$15,209.56
|
|
|
Service Code
|
NDC 61958250103
|
| Hospital Charge Code |
185933
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,681.45 |
| Max. Negotiated Rate |
$13,688.60 |
| Rate for Payer: Aetna Commercial |
$12,928.13
|
| Rate for Payer: Aetna Medicare |
$3,954.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,752.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,752.99
|
| Rate for Payer: BCBS Complete |
$2,815.29
|
| Rate for Payer: BCBS MAPPO |
$3,802.39
|
| Rate for Payer: BCBS Trust/PPO |
$12,503.78
|
| Rate for Payer: BCN Commercial |
$12,503.78
|
| Rate for Payer: BCN Medicare Advantage |
$3,802.39
|
| Rate for Payer: Cash Price |
$12,167.65
|
| Rate for Payer: Cofinity Commercial |
$13,080.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,167.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,802.39
|
| Rate for Payer: Healthscope Commercial |
$13,688.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,407.17
|
| Rate for Payer: Mclaren Medicaid |
$2,681.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,992.51
|
| Rate for Payer: Meridian Medicaid |
$2,815.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,372.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,182.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,928.13
|
| Rate for Payer: Nomi Health Commercial |
$12,471.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11,407.17
|
| Rate for Payer: PACE Senior Care Partners |
$3,612.27
|
| Rate for Payer: PACE SWMI |
$3,802.39
|
| Rate for Payer: PHP Commercial |
$12,928.13
|
| Rate for Payer: PHP Medicare Advantage |
$3,802.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,681.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13,232.32
|
| Rate for Payer: Priority Health Medicare |
$3,840.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10,585.85
|
| Rate for Payer: Railroad Medicare Medicare |
$3,802.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,384.41
|
| Rate for Payer: UHC Core |
$12,699.98
|
| Rate for Payer: UHC Exchange |
$3,802.39
|
| Rate for Payer: UHC Medicaid |
$2,681.45
|
| Rate for Payer: UHC Medicare Advantage |
$3,802.39
|
| Rate for Payer: UHCCP Medicaid |
$2,681.45
|
| Rate for Payer: VA VA |
$3,802.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,407.17
|
|
|
BIPOLAR DISORDERS
|
Facility
|
IP
|
$6,078.71
|
|
|
Service Code
|
APR-DRG 7533
|
| Min. Negotiated Rate |
$5,789.25 |
| Max. Negotiated Rate |
$6,078.71 |
| Rate for Payer: BCBS Complete |
$6,078.71
|
| Rate for Payer: Mclaren Medicaid |
$5,789.25
|
| Rate for Payer: Meridian Medicaid |
$6,078.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,789.25
|
| Rate for Payer: UHC Medicaid |
$5,789.25
|
| Rate for Payer: UHCCP Medicaid |
$5,789.25
|
|
|
BIPOLAR DISORDERS
|
Facility
|
IP
|
$11,524.31
|
|
|
Service Code
|
APR-DRG 7534
|
| Min. Negotiated Rate |
$10,975.53 |
| Max. Negotiated Rate |
$11,524.31 |
| Rate for Payer: BCBS Complete |
$11,524.31
|
| Rate for Payer: Mclaren Medicaid |
$10,975.53
|
| Rate for Payer: Meridian Medicaid |
$11,524.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,975.53
|
| Rate for Payer: UHC Medicaid |
$10,975.53
|
| Rate for Payer: UHCCP Medicaid |
$10,975.53
|
|
|
BIPOLAR DISORDERS
|
Facility
|
IP
|
$2,492.48
|
|
|
Service Code
|
APR-DRG 7531
|
| Min. Negotiated Rate |
$2,373.79 |
| Max. Negotiated Rate |
$2,492.48 |
| Rate for Payer: BCBS Complete |
$2,492.48
|
| Rate for Payer: Mclaren Medicaid |
$2,373.79
|
| Rate for Payer: Meridian Medicaid |
$2,492.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,373.79
|
| Rate for Payer: UHC Medicaid |
$2,373.79
|
| Rate for Payer: UHCCP Medicaid |
$2,373.79
|
|
|
BIPOLAR DISORDERS
|
Facility
|
IP
|
$3,131.90
|
|
|
Service Code
|
APR-DRG 7532
|
| Min. Negotiated Rate |
$2,982.76 |
| Max. Negotiated Rate |
$3,131.90 |
| Rate for Payer: BCBS Complete |
$3,131.90
|
| Rate for Payer: Mclaren Medicaid |
$2,982.76
|
| Rate for Payer: Meridian Medicaid |
$3,131.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,982.76
|
| Rate for Payer: UHC Medicaid |
$2,982.76
|
| Rate for Payer: UHCCP Medicaid |
$2,982.76
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$26.22
|
|
|
Service Code
|
NDC 00574705012
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$23.60 |
| Rate for Payer: Aetna Commercial |
$22.29
|
| Rate for Payer: Aetna Medicare |
$6.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.19
|
| Rate for Payer: BCBS Complete |
$4.85
|
| Rate for Payer: BCBS MAPPO |
$6.55
|
| Rate for Payer: BCBS Trust/PPO |
$21.56
|
| Rate for Payer: BCN Commercial |
$21.56
|
| Rate for Payer: BCN Medicare Advantage |
$6.55
|
| Rate for Payer: Cash Price |
$20.98
|
| Rate for Payer: Cofinity Commercial |
$22.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.55
|
| Rate for Payer: Healthscope Commercial |
$23.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.66
|
| Rate for Payer: Mclaren Medicaid |
$4.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.88
|
| Rate for Payer: Meridian Medicaid |
$4.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.29
|
| Rate for Payer: Nomi Health Commercial |
$21.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.66
|
| Rate for Payer: PACE Senior Care Partners |
$6.23
|
| Rate for Payer: PACE SWMI |
$6.55
|
| Rate for Payer: PHP Commercial |
$22.29
|
| Rate for Payer: PHP Medicare Advantage |
$6.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.81
|
| Rate for Payer: Priority Health Medicare |
$6.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.25
|
| Rate for Payer: Railroad Medicare Medicare |
$6.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.07
|
| Rate for Payer: UHC Core |
$21.89
|
| Rate for Payer: UHC Exchange |
$6.55
|
| Rate for Payer: UHC Medicaid |
$4.62
|
| Rate for Payer: UHC Medicare Advantage |
$6.55
|
| Rate for Payer: UHCCP Medicaid |
$4.62
|
| Rate for Payer: VA VA |
$6.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.66
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$26.22
|
|
|
Service Code
|
NDC 00574705012
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.25 |
| Max. Negotiated Rate |
$23.60 |
| Rate for Payer: Aetna Commercial |
$22.29
|
| Rate for Payer: BCBS Trust/PPO |
$21.66
|
| Rate for Payer: BCN Commercial |
$21.66
|
| Rate for Payer: Cash Price |
$20.98
|
| Rate for Payer: Cofinity Commercial |
$22.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.98
|
| Rate for Payer: Healthscope Commercial |
$23.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.29
|
| Rate for Payer: Nomi Health Commercial |
$21.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.66
|
| Rate for Payer: PHP Commercial |
$22.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.07
|
| Rate for Payer: UHC Core |
$21.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.66
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$37.85
|
|
|
Service Code
|
NDC 00904714212
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.67 |
| Max. Negotiated Rate |
$34.06 |
| Rate for Payer: Aetna Commercial |
$32.17
|
| Rate for Payer: Aetna Medicare |
$9.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.83
|
| Rate for Payer: BCBS Complete |
$7.01
|
| Rate for Payer: BCBS MAPPO |
$9.46
|
| Rate for Payer: BCBS Trust/PPO |
$31.12
|
| Rate for Payer: BCN Commercial |
$31.12
|
| Rate for Payer: BCN Medicare Advantage |
$9.46
|
| Rate for Payer: Cash Price |
$30.28
|
| Rate for Payer: Cofinity Commercial |
$32.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.46
|
| Rate for Payer: Healthscope Commercial |
$34.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.39
|
| Rate for Payer: Mclaren Medicaid |
$6.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.94
|
| Rate for Payer: Meridian Medicaid |
$7.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.17
|
| Rate for Payer: Nomi Health Commercial |
$31.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.39
|
| Rate for Payer: PACE Senior Care Partners |
$8.99
|
| Rate for Payer: PACE SWMI |
$9.46
|
| Rate for Payer: PHP Commercial |
$32.17
|
| Rate for Payer: PHP Medicare Advantage |
$9.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$32.93
|
| Rate for Payer: Priority Health Medicare |
$9.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.34
|
| Rate for Payer: Railroad Medicare Medicare |
$9.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.31
|
| Rate for Payer: UHC Core |
$31.60
|
| Rate for Payer: UHC Exchange |
$9.46
|
| Rate for Payer: UHC Medicaid |
$6.67
|
| Rate for Payer: UHC Medicare Advantage |
$9.46
|
| Rate for Payer: UHCCP Medicaid |
$6.67
|
| Rate for Payer: VA VA |
$9.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.39
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$37.85
|
|
|
Service Code
|
NDC 00904714212
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.34 |
| Max. Negotiated Rate |
$34.06 |
| Rate for Payer: Aetna Commercial |
$32.17
|
| Rate for Payer: BCBS Trust/PPO |
$31.26
|
| Rate for Payer: BCN Commercial |
$31.26
|
| Rate for Payer: Cash Price |
$30.28
|
| Rate for Payer: Cofinity Commercial |
$32.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.28
|
| Rate for Payer: Healthscope Commercial |
$34.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.17
|
| Rate for Payer: Nomi Health Commercial |
$31.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.39
|
| Rate for Payer: PHP Commercial |
$32.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$32.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.31
|
| Rate for Payer: UHC Core |
$31.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.39
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$124.06
|
|
|
Service Code
|
NDC 81421002105
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.35 |
| Max. Negotiated Rate |
$111.65 |
| Rate for Payer: Aetna Commercial |
$105.45
|
| Rate for Payer: BCBS Trust/PPO |
$102.46
|
| Rate for Payer: BCN Commercial |
$102.46
|
| Rate for Payer: Cash Price |
$99.25
|
| Rate for Payer: Cofinity Commercial |
$106.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.25
|
| Rate for Payer: Healthscope Commercial |
$111.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.45
|
| Rate for Payer: Nomi Health Commercial |
$101.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.05
|
| Rate for Payer: PHP Commercial |
$105.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$107.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.17
|
| Rate for Payer: UHC Core |
$103.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.05
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$124.06
|
|
|
Service Code
|
NDC 81421002105
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$111.65 |
| Rate for Payer: Aetna Commercial |
$105.45
|
| Rate for Payer: Aetna Medicare |
$32.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.77
|
| Rate for Payer: BCBS Complete |
$22.96
|
| Rate for Payer: BCBS MAPPO |
$31.02
|
| Rate for Payer: BCBS Trust/PPO |
$101.99
|
| Rate for Payer: BCN Commercial |
$101.99
|
| Rate for Payer: BCN Medicare Advantage |
$31.02
|
| Rate for Payer: Cash Price |
$99.25
|
| Rate for Payer: Cofinity Commercial |
$106.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.02
|
| Rate for Payer: Healthscope Commercial |
$111.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.05
|
| Rate for Payer: Mclaren Medicaid |
$21.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.57
|
| Rate for Payer: Meridian Medicaid |
$22.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$34.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.45
|
| Rate for Payer: Nomi Health Commercial |
$101.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.05
|
| Rate for Payer: PACE Senior Care Partners |
$29.46
|
| Rate for Payer: PACE SWMI |
$31.02
|
| Rate for Payer: PHP Commercial |
$105.45
|
| Rate for Payer: PHP Medicare Advantage |
$31.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$107.93
|
| Rate for Payer: Priority Health Medicare |
$31.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.35
|
| Rate for Payer: Railroad Medicare Medicare |
$31.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.17
|
| Rate for Payer: UHC Core |
$103.59
|
| Rate for Payer: UHC Exchange |
$31.02
|
| Rate for Payer: UHC Medicaid |
$21.87
|
| Rate for Payer: UHC Medicare Advantage |
$31.02
|
| Rate for Payer: UHCCP Medicaid |
$21.87
|
| Rate for Payer: VA VA |
$31.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.05
|
|
|
BISACODYL 5 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$6.35
|
|
|
Service Code
|
NDC 00904640761
|
| Hospital Charge Code |
1079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$5.71 |
| Rate for Payer: Aetna Commercial |
$5.40
|
| Rate for Payer: BCBS Trust/PPO |
$5.24
|
| Rate for Payer: BCN Commercial |
$5.24
|
| Rate for Payer: Cash Price |
$5.08
|
| Rate for Payer: Cofinity Commercial |
$5.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.08
|
| Rate for Payer: Healthscope Commercial |
$5.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.40
|
| Rate for Payer: Nomi Health Commercial |
$5.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.76
|
| Rate for Payer: PHP Commercial |
$5.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.59
|
| Rate for Payer: UHC Core |
$5.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.76
|
|
|
BISACODYL 5 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$6.35
|
|
|
Service Code
|
NDC 00904640761
|
| Hospital Charge Code |
1079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$5.71 |
| Rate for Payer: Aetna Commercial |
$5.40
|
| Rate for Payer: Aetna Medicare |
$1.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.98
|
| Rate for Payer: BCBS Complete |
$1.18
|
| Rate for Payer: BCBS MAPPO |
$1.59
|
| Rate for Payer: BCBS Trust/PPO |
$5.22
|
| Rate for Payer: BCN Commercial |
$5.22
|
| Rate for Payer: BCN Medicare Advantage |
$1.59
|
| Rate for Payer: Cash Price |
$5.08
|
| Rate for Payer: Cofinity Commercial |
$5.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.59
|
| Rate for Payer: Healthscope Commercial |
$5.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.76
|
| Rate for Payer: Mclaren Medicaid |
$1.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.67
|
| Rate for Payer: Meridian Medicaid |
$1.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.40
|
| Rate for Payer: Nomi Health Commercial |
$5.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.76
|
| Rate for Payer: PACE Senior Care Partners |
$1.51
|
| Rate for Payer: PACE SWMI |
$1.59
|
| Rate for Payer: PHP Commercial |
$5.40
|
| Rate for Payer: PHP Medicare Advantage |
$1.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.52
|
| Rate for Payer: Priority Health Medicare |
$1.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.42
|
| Rate for Payer: Railroad Medicare Medicare |
$1.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.59
|
| Rate for Payer: UHC Core |
$5.30
|
| Rate for Payer: UHC Exchange |
$1.59
|
| Rate for Payer: UHC Medicaid |
$1.12
|
| Rate for Payer: UHC Medicare Advantage |
$1.59
|
| Rate for Payer: UHCCP Medicaid |
$1.12
|
| Rate for Payer: VA VA |
$1.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.76
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
OP
|
$5.81
|
|
|
Service Code
|
NDC 60687067911
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$5.23 |
| Rate for Payer: Aetna Commercial |
$4.94
|
| Rate for Payer: Aetna Medicare |
$1.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.82
|
| Rate for Payer: BCBS Complete |
$1.08
|
| Rate for Payer: BCBS MAPPO |
$1.45
|
| Rate for Payer: BCBS Trust/PPO |
$4.78
|
| Rate for Payer: BCN Commercial |
$4.78
|
| Rate for Payer: BCN Medicare Advantage |
$1.45
|
| Rate for Payer: Cash Price |
$4.65
|
| Rate for Payer: Cofinity Commercial |
$5.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.45
|
| Rate for Payer: Healthscope Commercial |
$5.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.36
|
| Rate for Payer: Mclaren Medicaid |
$1.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.53
|
| Rate for Payer: Meridian Medicaid |
$1.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.94
|
| Rate for Payer: Nomi Health Commercial |
$4.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.36
|
| Rate for Payer: PACE Senior Care Partners |
$1.38
|
| Rate for Payer: PACE SWMI |
$1.45
|
| Rate for Payer: PHP Commercial |
$4.94
|
| Rate for Payer: PHP Medicare Advantage |
$1.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.05
|
| Rate for Payer: Priority Health Medicare |
$1.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.04
|
| Rate for Payer: Railroad Medicare Medicare |
$1.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.11
|
| Rate for Payer: UHC Core |
$4.85
|
| Rate for Payer: UHC Exchange |
$1.45
|
| Rate for Payer: UHC Medicaid |
$1.02
|
| Rate for Payer: UHC Medicare Advantage |
$1.45
|
| Rate for Payer: UHCCP Medicaid |
$1.02
|
| Rate for Payer: VA VA |
$1.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.36
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
IP
|
$124.79
|
|
|
Service Code
|
NDC 52817027030
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.85 |
| Max. Negotiated Rate |
$112.31 |
| Rate for Payer: Aetna Commercial |
$106.07
|
| Rate for Payer: BCBS Trust/PPO |
$103.06
|
| Rate for Payer: BCN Commercial |
$103.06
|
| Rate for Payer: Cash Price |
$99.83
|
| Rate for Payer: Cofinity Commercial |
$107.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.83
|
| Rate for Payer: Healthscope Commercial |
$112.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.07
|
| Rate for Payer: Nomi Health Commercial |
$102.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.59
|
| Rate for Payer: PHP Commercial |
$106.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$108.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.82
|
| Rate for Payer: UHC Core |
$104.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.59
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
OP
|
$174.10
|
|
|
Service Code
|
NDC 60687067921
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.69 |
| Max. Negotiated Rate |
$156.69 |
| Rate for Payer: Aetna Commercial |
$147.99
|
| Rate for Payer: Aetna Medicare |
$45.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$54.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$54.41
|
| Rate for Payer: BCBS Complete |
$32.23
|
| Rate for Payer: BCBS MAPPO |
$43.52
|
| Rate for Payer: BCBS Trust/PPO |
$143.13
|
| Rate for Payer: BCN Commercial |
$143.13
|
| Rate for Payer: BCN Medicare Advantage |
$43.52
|
| Rate for Payer: Cash Price |
$139.28
|
| Rate for Payer: Cofinity Commercial |
$149.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.52
|
| Rate for Payer: Healthscope Commercial |
$156.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.57
|
| Rate for Payer: Mclaren Medicaid |
$30.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.70
|
| Rate for Payer: Meridian Medicaid |
$32.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$47.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.99
|
| Rate for Payer: Nomi Health Commercial |
$142.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.57
|
| Rate for Payer: PACE Senior Care Partners |
$41.35
|
| Rate for Payer: PACE SWMI |
$43.52
|
| Rate for Payer: PHP Commercial |
$147.99
|
| Rate for Payer: PHP Medicare Advantage |
$43.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$151.47
|
| Rate for Payer: Priority Health Medicare |
$43.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.17
|
| Rate for Payer: Railroad Medicare Medicare |
$43.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.21
|
| Rate for Payer: UHC Core |
$145.37
|
| Rate for Payer: UHC Exchange |
$43.52
|
| Rate for Payer: UHC Medicaid |
$30.69
|
| Rate for Payer: UHC Medicare Advantage |
$43.52
|
| Rate for Payer: UHCCP Medicaid |
$30.69
|
| Rate for Payer: VA VA |
$43.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.57
|
|
