|
BUSPIRONE 5 MG TABLET
|
Facility
|
IP
|
$65.80
|
|
|
Service Code
|
NDC 16729020001
|
| Hospital Charge Code |
9324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.80 |
| Max. Negotiated Rate |
$59.22 |
| Rate for Payer: Aetna Commercial |
$55.93
|
| Rate for Payer: BCBS Trust/PPO |
$54.34
|
| Rate for Payer: BCN Commercial |
$54.34
|
| Rate for Payer: Cash Price |
$52.64
|
| Rate for Payer: Cofinity Commercial |
$56.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.64
|
| Rate for Payer: Healthscope Commercial |
$59.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.93
|
| Rate for Payer: Nomi Health Commercial |
$53.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.35
|
| Rate for Payer: PHP Commercial |
$55.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$57.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.90
|
| Rate for Payer: UHC Core |
$54.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.35
|
|
|
BUSPIRONE 5 MG TABLET
|
Facility
|
OP
|
$65.80
|
|
|
Service Code
|
NDC 16729020001
|
| Hospital Charge Code |
9324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$59.22 |
| Rate for Payer: Aetna Commercial |
$55.93
|
| Rate for Payer: Aetna Medicare |
$17.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.56
|
| Rate for Payer: BCBS Complete |
$12.18
|
| Rate for Payer: BCBS MAPPO |
$16.45
|
| Rate for Payer: BCBS Trust/PPO |
$54.09
|
| Rate for Payer: BCN Commercial |
$54.09
|
| Rate for Payer: BCN Medicare Advantage |
$16.45
|
| Rate for Payer: Cash Price |
$52.64
|
| Rate for Payer: Cofinity Commercial |
$56.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.45
|
| Rate for Payer: Healthscope Commercial |
$59.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.35
|
| Rate for Payer: Mclaren Medicaid |
$11.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.27
|
| Rate for Payer: Meridian Medicaid |
$12.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.93
|
| Rate for Payer: Nomi Health Commercial |
$53.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.35
|
| Rate for Payer: PACE Senior Care Partners |
$15.63
|
| Rate for Payer: PACE SWMI |
$16.45
|
| Rate for Payer: PHP Commercial |
$55.93
|
| Rate for Payer: PHP Medicare Advantage |
$16.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$57.25
|
| Rate for Payer: Priority Health Medicare |
$16.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.80
|
| Rate for Payer: Railroad Medicare Medicare |
$16.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.90
|
| Rate for Payer: UHC Core |
$54.94
|
| Rate for Payer: UHC Exchange |
$16.45
|
| Rate for Payer: UHC Medicaid |
$11.60
|
| Rate for Payer: UHC Medicare Advantage |
$16.45
|
| Rate for Payer: UHCCP Medicaid |
$11.60
|
| Rate for Payer: VA VA |
$16.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.35
|
|
|
BUSPIRONE 7.5 MG TABLET
|
Facility
|
IP
|
$7.44
|
|
|
Service Code
|
NDC 60687080111
|
| Hospital Charge Code |
29967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$6.32
|
| Rate for Payer: BCBS Trust/PPO |
$6.14
|
| Rate for Payer: BCN Commercial |
$6.14
|
| Rate for Payer: Cash Price |
$5.95
|
| Rate for Payer: Cofinity Commercial |
$6.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.95
|
| Rate for Payer: Healthscope Commercial |
$6.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.32
|
| Rate for Payer: Nomi Health Commercial |
$6.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.58
|
| Rate for Payer: PHP Commercial |
$6.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.55
|
| Rate for Payer: UHC Core |
$6.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.58
|
|
|
BUSPIRONE 7.5 MG TABLET
|
Facility
|
OP
|
$225.15
|
|
|
Service Code
|
NDC 16729020101
|
| Hospital Charge Code |
29967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.69 |
| Max. Negotiated Rate |
$202.63 |
| Rate for Payer: Aetna Commercial |
$191.38
|
| Rate for Payer: Aetna Medicare |
$58.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70.36
|
| Rate for Payer: BCBS Complete |
$41.68
|
| Rate for Payer: BCBS MAPPO |
$56.29
|
| Rate for Payer: BCBS Trust/PPO |
$185.10
|
| Rate for Payer: BCN Commercial |
$185.10
|
| Rate for Payer: BCN Medicare Advantage |
$56.29
|
| Rate for Payer: Cash Price |
$180.12
|
| Rate for Payer: Cofinity Commercial |
$193.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.29
|
| Rate for Payer: Healthscope Commercial |
$202.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.86
|
| Rate for Payer: Mclaren Medicaid |
$39.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.10
|
| Rate for Payer: Meridian Medicaid |
$41.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$61.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.38
|
| Rate for Payer: Nomi Health Commercial |
$184.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.86
|
| Rate for Payer: PACE Senior Care Partners |
$53.47
|
| Rate for Payer: PACE SWMI |
$56.29
|
| Rate for Payer: PHP Commercial |
$191.38
|
| Rate for Payer: PHP Medicare Advantage |
$56.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$195.88
|
| Rate for Payer: Priority Health Medicare |
$56.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$156.70
|
| Rate for Payer: Railroad Medicare Medicare |
$56.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.13
|
| Rate for Payer: UHC Core |
$188.00
|
| Rate for Payer: UHC Exchange |
$56.29
|
| Rate for Payer: UHC Medicaid |
$39.69
|
| Rate for Payer: UHC Medicare Advantage |
$56.29
|
| Rate for Payer: UHCCP Medicaid |
$39.69
|
| Rate for Payer: VA VA |
$56.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.86
|
|
|
BUSPIRONE 7.5 MG TABLET
|
Facility
|
OP
|
$298.45
|
|
|
Service Code
|
NDC 72888006301
|
| Hospital Charge Code |
29967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.62 |
| Max. Negotiated Rate |
$268.61 |
| Rate for Payer: Aetna Commercial |
$253.68
|
| Rate for Payer: Aetna Medicare |
$77.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.27
|
| Rate for Payer: BCBS Complete |
$55.24
|
| Rate for Payer: BCBS MAPPO |
$74.61
|
| Rate for Payer: BCBS Trust/PPO |
$245.36
|
| Rate for Payer: BCN Commercial |
$245.36
|
| Rate for Payer: BCN Medicare Advantage |
$74.61
|
| Rate for Payer: Cash Price |
$238.76
|
| Rate for Payer: Cofinity Commercial |
$256.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.61
|
| Rate for Payer: Healthscope Commercial |
$268.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.84
|
| Rate for Payer: Mclaren Medicaid |
$52.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.34
|
| Rate for Payer: Meridian Medicaid |
$55.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$82.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.68
|
| Rate for Payer: Nomi Health Commercial |
$244.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.84
|
| Rate for Payer: PACE Senior Care Partners |
$70.88
|
| Rate for Payer: PACE SWMI |
$74.61
|
| Rate for Payer: PHP Commercial |
$253.68
|
| Rate for Payer: PHP Medicare Advantage |
$74.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$259.65
|
| Rate for Payer: Priority Health Medicare |
$75.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$207.72
|
| Rate for Payer: Railroad Medicare Medicare |
$74.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.64
|
| Rate for Payer: UHC Core |
$249.21
|
| Rate for Payer: UHC Exchange |
$74.61
|
| Rate for Payer: UHC Medicaid |
$52.62
|
| Rate for Payer: UHC Medicare Advantage |
$74.61
|
| Rate for Payer: UHCCP Medicaid |
$52.62
|
| Rate for Payer: VA VA |
$74.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.84
|
|
|
BUSPIRONE 7.5 MG TABLET
|
Facility
|
OP
|
$7.44
|
|
|
Service Code
|
NDC 60687080111
|
| Hospital Charge Code |
29967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$6.32
|
| Rate for Payer: Aetna Medicare |
$1.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.33
|
| Rate for Payer: BCBS Complete |
$1.38
|
| Rate for Payer: BCBS MAPPO |
$1.86
|
| Rate for Payer: BCBS Trust/PPO |
$6.12
|
| Rate for Payer: BCN Commercial |
$6.12
|
| Rate for Payer: BCN Medicare Advantage |
$1.86
|
| Rate for Payer: Cash Price |
$5.95
|
| Rate for Payer: Cofinity Commercial |
$6.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.86
|
| Rate for Payer: Healthscope Commercial |
$6.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.58
|
| Rate for Payer: Mclaren Medicaid |
$1.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.95
|
| Rate for Payer: Meridian Medicaid |
$1.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.32
|
| Rate for Payer: Nomi Health Commercial |
$6.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.58
|
| Rate for Payer: PACE Senior Care Partners |
$1.77
|
| Rate for Payer: PACE SWMI |
$1.86
|
| Rate for Payer: PHP Commercial |
$6.32
|
| Rate for Payer: PHP Medicare Advantage |
$1.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.47
|
| Rate for Payer: Priority Health Medicare |
$1.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.55
|
| Rate for Payer: UHC Core |
$6.21
|
| Rate for Payer: UHC Exchange |
$1.86
|
| Rate for Payer: UHC Medicaid |
$1.31
|
| Rate for Payer: UHC Medicare Advantage |
$1.86
|
| Rate for Payer: UHCCP Medicaid |
$1.31
|
| Rate for Payer: VA VA |
$1.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.58
|
|
|
BUSPIRONE 7.5 MG TABLET
|
Facility
|
IP
|
$298.45
|
|
|
Service Code
|
NDC 72888006301
|
| Hospital Charge Code |
29967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$207.72 |
| Max. Negotiated Rate |
$268.61 |
| Rate for Payer: Aetna Commercial |
$253.68
|
| Rate for Payer: BCBS Trust/PPO |
$246.49
|
| Rate for Payer: BCN Commercial |
$246.49
|
| Rate for Payer: Cash Price |
$238.76
|
| Rate for Payer: Cofinity Commercial |
$256.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.76
|
| Rate for Payer: Healthscope Commercial |
$268.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.68
|
| Rate for Payer: Nomi Health Commercial |
$244.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.84
|
| Rate for Payer: PHP Commercial |
$253.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$259.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$207.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.64
|
| Rate for Payer: UHC Core |
$249.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.84
|
|
|
BUSPIRONE 7.5 MG TABLET
|
Facility
|
IP
|
$225.15
|
|
|
Service Code
|
NDC 16729020101
|
| Hospital Charge Code |
29967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.70 |
| Max. Negotiated Rate |
$202.63 |
| Rate for Payer: Aetna Commercial |
$191.38
|
| Rate for Payer: BCBS Trust/PPO |
$185.95
|
| Rate for Payer: BCN Commercial |
$185.95
|
| Rate for Payer: Cash Price |
$180.12
|
| Rate for Payer: Cofinity Commercial |
$193.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.12
|
| Rate for Payer: Healthscope Commercial |
$202.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.38
|
| Rate for Payer: Nomi Health Commercial |
$184.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.86
|
| Rate for Payer: PHP Commercial |
$191.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$195.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$156.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.13
|
| Rate for Payer: UHC Core |
$188.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.86
|
|
|
BUSPIRONE 7.5 MG TABLET
|
Facility
|
IP
|
$223.06
|
|
|
Service Code
|
NDC 60687080121
|
| Hospital Charge Code |
29967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.25 |
| Max. Negotiated Rate |
$200.75 |
| Rate for Payer: Aetna Commercial |
$189.60
|
| Rate for Payer: BCBS Trust/PPO |
$184.23
|
| Rate for Payer: BCN Commercial |
$184.23
|
| Rate for Payer: Cash Price |
$178.45
|
| Rate for Payer: Cofinity Commercial |
$191.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.45
|
| Rate for Payer: Healthscope Commercial |
$200.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.60
|
| Rate for Payer: Nomi Health Commercial |
$182.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$167.29
|
| Rate for Payer: PHP Commercial |
$189.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$194.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$155.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$196.29
|
| Rate for Payer: UHC Core |
$186.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.29
|
|
|
BUSPIRONE 7.5 MG TABLET
|
Facility
|
OP
|
$223.06
|
|
|
Service Code
|
NDC 60687080121
|
| Hospital Charge Code |
29967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.33 |
| Max. Negotiated Rate |
$200.75 |
| Rate for Payer: Aetna Commercial |
$189.60
|
| Rate for Payer: Aetna Medicare |
$58.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69.71
|
| Rate for Payer: BCBS Complete |
$41.29
|
| Rate for Payer: BCBS MAPPO |
$55.77
|
| Rate for Payer: BCBS Trust/PPO |
$183.38
|
| Rate for Payer: BCN Commercial |
$183.38
|
| Rate for Payer: BCN Medicare Advantage |
$55.77
|
| Rate for Payer: Cash Price |
$178.45
|
| Rate for Payer: Cofinity Commercial |
$191.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.77
|
| Rate for Payer: Healthscope Commercial |
$200.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.29
|
| Rate for Payer: Mclaren Medicaid |
$39.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.55
|
| Rate for Payer: Meridian Medicaid |
$41.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$61.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.60
|
| Rate for Payer: Nomi Health Commercial |
$182.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$167.29
|
| Rate for Payer: PACE Senior Care Partners |
$52.98
|
| Rate for Payer: PACE SWMI |
$55.77
|
| Rate for Payer: PHP Commercial |
$189.60
|
| Rate for Payer: PHP Medicare Advantage |
$55.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$194.06
|
| Rate for Payer: Priority Health Medicare |
$56.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$155.25
|
| Rate for Payer: Railroad Medicare Medicare |
$55.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$196.29
|
| Rate for Payer: UHC Core |
$186.26
|
| Rate for Payer: UHC Exchange |
$55.77
|
| Rate for Payer: UHC Medicaid |
$39.33
|
| Rate for Payer: UHC Medicare Advantage |
$55.77
|
| Rate for Payer: UHCCP Medicaid |
$39.33
|
| Rate for Payer: VA VA |
$55.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.29
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
OP
|
$735.70
|
|
|
Service Code
|
NDC 00603254421
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.70 |
| Max. Negotiated Rate |
$662.13 |
| Rate for Payer: Aetna Commercial |
$625.35
|
| Rate for Payer: Aetna Medicare |
$191.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$229.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$229.91
|
| Rate for Payer: BCBS Complete |
$136.18
|
| Rate for Payer: BCBS MAPPO |
$183.93
|
| Rate for Payer: BCBS Trust/PPO |
$604.82
|
| Rate for Payer: BCN Commercial |
$604.82
|
| Rate for Payer: BCN Medicare Advantage |
$183.93
|
| Rate for Payer: Cash Price |
$588.56
|
| Rate for Payer: Cofinity Commercial |
$632.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$588.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$183.93
|
| Rate for Payer: Healthscope Commercial |
$662.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$551.77
|
| Rate for Payer: Mclaren Medicaid |
$129.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$193.12
|
| Rate for Payer: Meridian Medicaid |
$136.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$211.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$202.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$625.35
|
| Rate for Payer: Nomi Health Commercial |
$603.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$551.77
|
| Rate for Payer: PACE Senior Care Partners |
$174.73
|
| Rate for Payer: PACE SWMI |
$183.93
|
| Rate for Payer: PHP Commercial |
$625.35
|
| Rate for Payer: PHP Medicare Advantage |
$183.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$129.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$640.06
|
| Rate for Payer: Priority Health Medicare |
$185.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$512.05
|
| Rate for Payer: Railroad Medicare Medicare |
$183.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$647.42
|
| Rate for Payer: UHC Core |
$614.31
|
| Rate for Payer: UHC Exchange |
$183.93
|
| Rate for Payer: UHC Medicaid |
$129.70
|
| Rate for Payer: UHC Medicare Advantage |
$183.93
|
| Rate for Payer: UHCCP Medicaid |
$129.70
|
| Rate for Payer: VA VA |
$183.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$551.77
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
OP
|
$302.75
|
|
|
Service Code
|
NDC 00527169501
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.37 |
| Max. Negotiated Rate |
$272.48 |
| Rate for Payer: Aetna Commercial |
$257.34
|
| Rate for Payer: Aetna Medicare |
$78.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$94.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$94.61
|
| Rate for Payer: BCBS Complete |
$56.04
|
| Rate for Payer: BCBS MAPPO |
$75.69
|
| Rate for Payer: BCBS Trust/PPO |
$248.89
|
| Rate for Payer: BCN Commercial |
$248.89
|
| Rate for Payer: BCN Medicare Advantage |
$75.69
|
| Rate for Payer: Cash Price |
$242.20
|
| Rate for Payer: Cofinity Commercial |
$260.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.69
|
| Rate for Payer: Healthscope Commercial |
$272.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.06
|
| Rate for Payer: Mclaren Medicaid |
$53.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.47
|
| Rate for Payer: Meridian Medicaid |
$56.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$83.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.34
|
| Rate for Payer: Nomi Health Commercial |
$248.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$227.06
|
| Rate for Payer: PACE Senior Care Partners |
$71.90
|
| Rate for Payer: PACE SWMI |
$75.69
|
| Rate for Payer: PHP Commercial |
$257.34
|
| Rate for Payer: PHP Medicare Advantage |
$75.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$263.39
|
| Rate for Payer: Priority Health Medicare |
$76.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$210.71
|
| Rate for Payer: Railroad Medicare Medicare |
$75.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.42
|
| Rate for Payer: UHC Core |
$252.80
|
| Rate for Payer: UHC Exchange |
$75.69
|
| Rate for Payer: UHC Medicaid |
$53.37
|
| Rate for Payer: UHC Medicare Advantage |
$75.69
|
| Rate for Payer: UHCCP Medicaid |
$53.37
|
| Rate for Payer: VA VA |
$75.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.06
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
IP
|
$302.75
|
|
|
Service Code
|
NDC 00527169501
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$210.71 |
| Max. Negotiated Rate |
$272.48 |
| Rate for Payer: Aetna Commercial |
$257.34
|
| Rate for Payer: BCBS Trust/PPO |
$250.04
|
| Rate for Payer: BCN Commercial |
$250.04
|
| Rate for Payer: Cash Price |
$242.20
|
| Rate for Payer: Cofinity Commercial |
$260.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.20
|
| Rate for Payer: Healthscope Commercial |
$272.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.34
|
| Rate for Payer: Nomi Health Commercial |
$248.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$227.06
|
| Rate for Payer: PHP Commercial |
$257.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$263.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$210.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.42
|
| Rate for Payer: UHC Core |
$252.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.06
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
IP
|
$325.50
|
|
|
Service Code
|
NDC 70010014901
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$226.55 |
| Max. Negotiated Rate |
$292.95 |
| Rate for Payer: Aetna Commercial |
$276.68
|
| Rate for Payer: BCBS Trust/PPO |
$268.83
|
| Rate for Payer: BCN Commercial |
$268.83
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cofinity Commercial |
$279.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.40
|
| Rate for Payer: Healthscope Commercial |
$292.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.68
|
| Rate for Payer: Nomi Health Commercial |
$266.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$244.12
|
| Rate for Payer: PHP Commercial |
$276.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$283.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$226.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$286.44
|
| Rate for Payer: UHC Core |
$271.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.12
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
OP
|
$325.50
|
|
|
Service Code
|
NDC 70010014901
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.39 |
| Max. Negotiated Rate |
$292.95 |
| Rate for Payer: Aetna Commercial |
$276.68
|
| Rate for Payer: Aetna Medicare |
$84.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$101.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$101.72
|
| Rate for Payer: BCBS Complete |
$60.25
|
| Rate for Payer: BCBS MAPPO |
$81.38
|
| Rate for Payer: BCBS Trust/PPO |
$267.59
|
| Rate for Payer: BCN Commercial |
$267.59
|
| Rate for Payer: BCN Medicare Advantage |
$81.38
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cofinity Commercial |
$279.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.38
|
| Rate for Payer: Healthscope Commercial |
$292.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.12
|
| Rate for Payer: Mclaren Medicaid |
$57.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.44
|
| Rate for Payer: Meridian Medicaid |
$60.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$89.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.68
|
| Rate for Payer: Nomi Health Commercial |
$266.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$244.12
|
| Rate for Payer: PACE Senior Care Partners |
$77.31
|
| Rate for Payer: PACE SWMI |
$81.38
|
| Rate for Payer: PHP Commercial |
$276.68
|
| Rate for Payer: PHP Medicare Advantage |
$81.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$57.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$283.19
|
| Rate for Payer: Priority Health Medicare |
$82.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$226.55
|
| Rate for Payer: Railroad Medicare Medicare |
$81.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$286.44
|
| Rate for Payer: UHC Core |
$271.79
|
| Rate for Payer: UHC Exchange |
$81.38
|
| Rate for Payer: UHC Medicaid |
$57.39
|
| Rate for Payer: UHC Medicare Advantage |
$81.38
|
| Rate for Payer: UHCCP Medicaid |
$57.39
|
| Rate for Payer: VA VA |
$81.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.12
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
IP
|
$735.70
|
|
|
Service Code
|
NDC 00603254421
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$512.05 |
| Max. Negotiated Rate |
$662.13 |
| Rate for Payer: Aetna Commercial |
$625.35
|
| Rate for Payer: BCBS Trust/PPO |
$607.61
|
| Rate for Payer: BCN Commercial |
$607.61
|
| Rate for Payer: Cash Price |
$588.56
|
| Rate for Payer: Cofinity Commercial |
$632.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$588.56
|
| Rate for Payer: Healthscope Commercial |
$662.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$551.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$625.35
|
| Rate for Payer: Nomi Health Commercial |
$603.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$551.77
|
| Rate for Payer: PHP Commercial |
$625.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$640.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$512.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$647.42
|
| Rate for Payer: UHC Core |
$614.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$551.77
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
OP
|
$373.45
|
|
|
Service Code
|
NDC 00904693806
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.84 |
| Max. Negotiated Rate |
$336.11 |
| Rate for Payer: Aetna Commercial |
$317.43
|
| Rate for Payer: Aetna Medicare |
$97.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$116.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$116.70
|
| Rate for Payer: BCBS Complete |
$69.13
|
| Rate for Payer: BCBS MAPPO |
$93.36
|
| Rate for Payer: BCBS Trust/PPO |
$307.01
|
| Rate for Payer: BCN Commercial |
$307.01
|
| Rate for Payer: BCN Medicare Advantage |
$93.36
|
| Rate for Payer: Cash Price |
$298.76
|
| Rate for Payer: Cofinity Commercial |
$321.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.36
|
| Rate for Payer: Healthscope Commercial |
$336.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.09
|
| Rate for Payer: Mclaren Medicaid |
$65.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.03
|
| Rate for Payer: Meridian Medicaid |
$69.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$102.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.43
|
| Rate for Payer: Nomi Health Commercial |
$306.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.09
|
| Rate for Payer: PACE Senior Care Partners |
$88.69
|
| Rate for Payer: PACE SWMI |
$93.36
|
| Rate for Payer: PHP Commercial |
$317.43
|
| Rate for Payer: PHP Medicare Advantage |
$93.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$324.90
|
| Rate for Payer: Priority Health Medicare |
$94.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$259.92
|
| Rate for Payer: Railroad Medicare Medicare |
$93.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$328.64
|
| Rate for Payer: UHC Core |
$311.83
|
| Rate for Payer: UHC Exchange |
$93.36
|
| Rate for Payer: UHC Medicaid |
$65.84
|
| Rate for Payer: UHC Medicare Advantage |
$93.36
|
| Rate for Payer: UHCCP Medicaid |
$65.84
|
| Rate for Payer: VA VA |
$93.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.09
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
IP
|
$373.45
|
|
|
Service Code
|
NDC 00904693806
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$259.92 |
| Max. Negotiated Rate |
$336.11 |
| Rate for Payer: Aetna Commercial |
$317.43
|
| Rate for Payer: BCBS Trust/PPO |
$308.43
|
| Rate for Payer: BCN Commercial |
$308.43
|
| Rate for Payer: Cash Price |
$298.76
|
| Rate for Payer: Cofinity Commercial |
$321.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.76
|
| Rate for Payer: Healthscope Commercial |
$336.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.43
|
| Rate for Payer: Nomi Health Commercial |
$306.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.09
|
| Rate for Payer: PHP Commercial |
$317.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$324.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$259.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$328.64
|
| Rate for Payer: UHC Core |
$311.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.09
|
|
|
CALAMINE 8 %-ZINC OXIDE 8 % LOTION
|
Facility
|
IP
|
$17.53
|
|
|
Service Code
|
NDC 00395041396
|
| Hospital Charge Code |
78879
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$15.78 |
| Rate for Payer: Aetna Commercial |
$14.90
|
| Rate for Payer: BCBS Trust/PPO |
$14.48
|
| Rate for Payer: BCN Commercial |
$14.48
|
| Rate for Payer: Cash Price |
$14.02
|
| Rate for Payer: Cofinity Commercial |
$15.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.02
|
| Rate for Payer: Healthscope Commercial |
$15.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.90
|
| Rate for Payer: Nomi Health Commercial |
$14.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.15
|
| Rate for Payer: PHP Commercial |
$14.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.43
|
| Rate for Payer: UHC Core |
$14.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.15
|
|
|
CALAMINE 8 %-ZINC OXIDE 8 % LOTION
|
Facility
|
IP
|
$8.50
|
|
|
Service Code
|
NDC 00904253321
|
| Hospital Charge Code |
78879
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.92 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna Commercial |
$7.22
|
| Rate for Payer: BCBS Trust/PPO |
$7.02
|
| Rate for Payer: BCN Commercial |
$7.02
|
| Rate for Payer: Cash Price |
$6.80
|
| Rate for Payer: Cofinity Commercial |
$7.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.80
|
| Rate for Payer: Healthscope Commercial |
$7.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.22
|
| Rate for Payer: Nomi Health Commercial |
$6.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.38
|
| Rate for Payer: PHP Commercial |
$7.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.48
|
| Rate for Payer: UHC Core |
$7.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.38
|
|
|
CALAMINE 8 %-ZINC OXIDE 8 % LOTION
|
Facility
|
OP
|
$17.53
|
|
|
Service Code
|
NDC 00395041396
|
| Hospital Charge Code |
78879
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$15.78 |
| Rate for Payer: Aetna Commercial |
$14.90
|
| Rate for Payer: Aetna Medicare |
$4.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.48
|
| Rate for Payer: BCBS Complete |
$3.24
|
| Rate for Payer: BCBS MAPPO |
$4.38
|
| Rate for Payer: BCBS Trust/PPO |
$14.41
|
| Rate for Payer: BCN Commercial |
$14.41
|
| Rate for Payer: BCN Medicare Advantage |
$4.38
|
| Rate for Payer: Cash Price |
$14.02
|
| Rate for Payer: Cofinity Commercial |
$15.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.38
|
| Rate for Payer: Healthscope Commercial |
$15.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.15
|
| Rate for Payer: Mclaren Medicaid |
$3.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.60
|
| Rate for Payer: Meridian Medicaid |
$3.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.90
|
| Rate for Payer: Nomi Health Commercial |
$14.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.15
|
| Rate for Payer: PACE Senior Care Partners |
$4.16
|
| Rate for Payer: PACE SWMI |
$4.38
|
| Rate for Payer: PHP Commercial |
$14.90
|
| Rate for Payer: PHP Medicare Advantage |
$4.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.25
|
| Rate for Payer: Priority Health Medicare |
$4.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.20
|
| Rate for Payer: Railroad Medicare Medicare |
$4.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.43
|
| Rate for Payer: UHC Core |
$14.64
|
| Rate for Payer: UHC Exchange |
$4.38
|
| Rate for Payer: UHC Medicaid |
$3.09
|
| Rate for Payer: UHC Medicare Advantage |
$4.38
|
| Rate for Payer: UHCCP Medicaid |
$3.09
|
| Rate for Payer: VA VA |
$4.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.15
|
|
|
CALAMINE 8 %-ZINC OXIDE 8 % LOTION
|
Facility
|
OP
|
$8.50
|
|
|
Service Code
|
NDC 00904253321
|
| Hospital Charge Code |
78879
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna Commercial |
$7.22
|
| Rate for Payer: Aetna Medicare |
$2.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.66
|
| Rate for Payer: BCBS Complete |
$1.57
|
| Rate for Payer: BCBS MAPPO |
$2.12
|
| Rate for Payer: BCBS Trust/PPO |
$6.99
|
| Rate for Payer: BCN Commercial |
$6.99
|
| Rate for Payer: BCN Medicare Advantage |
$2.12
|
| Rate for Payer: Cash Price |
$6.80
|
| Rate for Payer: Cofinity Commercial |
$7.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.12
|
| Rate for Payer: Healthscope Commercial |
$7.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.38
|
| Rate for Payer: Mclaren Medicaid |
$1.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.23
|
| Rate for Payer: Meridian Medicaid |
$1.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.22
|
| Rate for Payer: Nomi Health Commercial |
$6.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.38
|
| Rate for Payer: PACE Senior Care Partners |
$2.02
|
| Rate for Payer: PACE SWMI |
$2.12
|
| Rate for Payer: PHP Commercial |
$7.22
|
| Rate for Payer: PHP Medicare Advantage |
$2.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7.39
|
| Rate for Payer: Priority Health Medicare |
$2.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.92
|
| Rate for Payer: Railroad Medicare Medicare |
$2.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.48
|
| Rate for Payer: UHC Core |
$7.10
|
| Rate for Payer: UHC Exchange |
$2.12
|
| Rate for Payer: UHC Medicaid |
$1.50
|
| Rate for Payer: UHC Medicare Advantage |
$2.12
|
| Rate for Payer: UHCCP Medicaid |
$1.50
|
| Rate for Payer: VA VA |
$2.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.38
|
|
|
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY
|
Facility
|
OP
|
$243.71
|
|
|
Service Code
|
NDC 60505082306
|
| Hospital Charge Code |
15738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.97 |
| Max. Negotiated Rate |
$219.34 |
| Rate for Payer: Aetna Commercial |
$207.15
|
| Rate for Payer: Aetna Medicare |
$63.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.16
|
| Rate for Payer: BCBS Complete |
$45.11
|
| Rate for Payer: BCBS MAPPO |
$60.93
|
| Rate for Payer: BCBS Trust/PPO |
$200.35
|
| Rate for Payer: BCN Commercial |
$200.35
|
| Rate for Payer: BCN Medicare Advantage |
$60.93
|
| Rate for Payer: Cash Price |
$194.97
|
| Rate for Payer: Cofinity Commercial |
$209.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.93
|
| Rate for Payer: Healthscope Commercial |
$219.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.78
|
| Rate for Payer: Mclaren Medicaid |
$42.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.97
|
| Rate for Payer: Meridian Medicaid |
$45.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$67.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.15
|
| Rate for Payer: Nomi Health Commercial |
$199.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$182.78
|
| Rate for Payer: PACE Senior Care Partners |
$57.88
|
| Rate for Payer: PACE SWMI |
$60.93
|
| Rate for Payer: PHP Commercial |
$207.15
|
| Rate for Payer: PHP Medicare Advantage |
$60.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$212.03
|
| Rate for Payer: Priority Health Medicare |
$61.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$169.62
|
| Rate for Payer: Railroad Medicare Medicare |
$60.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.46
|
| Rate for Payer: UHC Core |
$203.50
|
| Rate for Payer: UHC Exchange |
$60.93
|
| Rate for Payer: UHC Medicaid |
$42.97
|
| Rate for Payer: UHC Medicare Advantage |
$60.93
|
| Rate for Payer: UHCCP Medicaid |
$42.97
|
| Rate for Payer: VA VA |
$60.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.78
|
|
|
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY
|
Facility
|
OP
|
$159.92
|
|
|
Service Code
|
NDC 49884016111
|
| Hospital Charge Code |
15738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.19 |
| Max. Negotiated Rate |
$143.93 |
| Rate for Payer: Aetna Commercial |
$135.93
|
| Rate for Payer: Aetna Medicare |
$41.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.98
|
| Rate for Payer: BCBS Complete |
$29.60
|
| Rate for Payer: BCBS MAPPO |
$39.98
|
| Rate for Payer: BCBS Trust/PPO |
$131.47
|
| Rate for Payer: BCN Commercial |
$131.47
|
| Rate for Payer: BCN Medicare Advantage |
$39.98
|
| Rate for Payer: Cash Price |
$127.94
|
| Rate for Payer: Cofinity Commercial |
$137.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.98
|
| Rate for Payer: Healthscope Commercial |
$143.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.94
|
| Rate for Payer: Mclaren Medicaid |
$28.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.98
|
| Rate for Payer: Meridian Medicaid |
$29.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$43.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.93
|
| Rate for Payer: Nomi Health Commercial |
$131.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.94
|
| Rate for Payer: PACE Senior Care Partners |
$37.98
|
| Rate for Payer: PACE SWMI |
$39.98
|
| Rate for Payer: PHP Commercial |
$135.93
|
| Rate for Payer: PHP Medicare Advantage |
$39.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$139.13
|
| Rate for Payer: Priority Health Medicare |
$40.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.30
|
| Rate for Payer: Railroad Medicare Medicare |
$39.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.73
|
| Rate for Payer: UHC Core |
$133.53
|
| Rate for Payer: UHC Exchange |
$39.98
|
| Rate for Payer: UHC Medicaid |
$28.19
|
| Rate for Payer: UHC Medicare Advantage |
$39.98
|
| Rate for Payer: UHCCP Medicaid |
$28.19
|
| Rate for Payer: VA VA |
$39.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.94
|
|
|
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY
|
Facility
|
IP
|
$159.92
|
|
|
Service Code
|
NDC 49884016111
|
| Hospital Charge Code |
15738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.30 |
| Max. Negotiated Rate |
$143.93 |
| Rate for Payer: Aetna Commercial |
$135.93
|
| Rate for Payer: BCBS Trust/PPO |
$132.08
|
| Rate for Payer: BCN Commercial |
$132.08
|
| Rate for Payer: Cash Price |
$127.94
|
| Rate for Payer: Cofinity Commercial |
$137.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.94
|
| Rate for Payer: Healthscope Commercial |
$143.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.93
|
| Rate for Payer: Nomi Health Commercial |
$131.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.94
|
| Rate for Payer: PHP Commercial |
$135.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$139.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.73
|
| Rate for Payer: UHC Core |
$133.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.94
|
|
