|
ADENOSINE 3 MG/ML IV (CODE)
|
Facility
|
IP
|
$18.05
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
163702
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.73 |
| Max. Negotiated Rate |
$16.24 |
| Rate for Payer: Aetna Commercial |
$15.34
|
| Rate for Payer: BCBS Trust/PPO |
$14.73
|
| Rate for Payer: BCN Commercial |
$13.95
|
| Rate for Payer: Cash Price |
$14.44
|
| Rate for Payer: Cofinity Commercial |
$15.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.44
|
| Rate for Payer: Healthscope Commercial |
$16.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.34
|
| Rate for Payer: Nomi Health Commercial |
$14.80
|
| Rate for Payer: PHP Commercial |
$15.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.73
|
| Rate for Payer: Priority Health HMO/PPO |
$15.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.88
|
| Rate for Payer: UHC Core |
$15.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.54
|
|
|
ADENOSINE 3 MG/ML IV (CODE)
|
Facility
|
OP
|
$18.05
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
163702
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$16.24 |
| Rate for Payer: Aetna Commercial |
$15.34
|
| Rate for Payer: Aetna Medicare |
$4.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.64
|
| Rate for Payer: BCBS Complete |
$7.22
|
| Rate for Payer: BCBS MAPPO |
$4.51
|
| Rate for Payer: BCBS Trust/PPO |
$14.84
|
| Rate for Payer: BCN Commercial |
$14.03
|
| Rate for Payer: BCN Medicare Advantage |
$4.51
|
| Rate for Payer: Cash Price |
$14.44
|
| Rate for Payer: Cofinity Commercial |
$15.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.51
|
| Rate for Payer: Healthscope Commercial |
$16.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.34
|
| Rate for Payer: Nomi Health Commercial |
$14.80
|
| Rate for Payer: PACE Senior Care Partners |
$4.29
|
| Rate for Payer: PACE SWMI |
$4.51
|
| Rate for Payer: PHP Commercial |
$15.34
|
| Rate for Payer: PHP Medicare Advantage |
$4.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.73
|
| Rate for Payer: Priority Health HMO/PPO |
$15.70
|
| Rate for Payer: Priority Health Medicare |
$4.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.09
|
| Rate for Payer: Railroad Medicare Medicare |
$4.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.88
|
| Rate for Payer: UHC Core |
$15.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.51
|
| Rate for Payer: UHC Exchange |
$4.51
|
| Rate for Payer: UHC Medicare Advantage |
$4.51
|
| Rate for Payer: VA VA |
$4.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.54
|
|
|
ALBENDAZOLE 200 MG TABLET
|
Facility
|
IP
|
$121.62
|
|
|
Service Code
|
NDC 00591271202
|
| Hospital Charge Code |
8979
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.05 |
| Max. Negotiated Rate |
$109.46 |
| Rate for Payer: Aetna Commercial |
$103.38
|
| Rate for Payer: BCBS Trust/PPO |
$99.28
|
| Rate for Payer: BCN Commercial |
$93.99
|
| Rate for Payer: Cash Price |
$97.30
|
| Rate for Payer: Cofinity Commercial |
$104.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.30
|
| Rate for Payer: Healthscope Commercial |
$109.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.38
|
| Rate for Payer: Nomi Health Commercial |
$99.73
|
| Rate for Payer: PHP Commercial |
$103.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.05
|
| Rate for Payer: Priority Health HMO/PPO |
$105.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.03
|
| Rate for Payer: UHC Core |
$101.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.22
|
|
|
ALBENDAZOLE 200 MG TABLET
|
Facility
|
OP
|
$121.62
|
|
|
Service Code
|
NDC 00591271202
|
| Hospital Charge Code |
8979
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.88 |
| Max. Negotiated Rate |
$109.46 |
| Rate for Payer: Aetna Commercial |
$103.38
|
| Rate for Payer: Aetna Medicare |
$31.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.01
|
| Rate for Payer: BCBS Complete |
$48.65
|
| Rate for Payer: BCBS MAPPO |
$30.40
|
| Rate for Payer: BCBS Trust/PPO |
$99.98
|
| Rate for Payer: BCN Commercial |
$94.56
|
| Rate for Payer: BCN Medicare Advantage |
$30.40
|
| Rate for Payer: Cash Price |
$97.30
|
| Rate for Payer: Cofinity Commercial |
$104.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.40
|
| Rate for Payer: Healthscope Commercial |
$109.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.38
|
| Rate for Payer: Nomi Health Commercial |
$99.73
|
| Rate for Payer: PACE Senior Care Partners |
$28.88
|
| Rate for Payer: PACE SWMI |
$30.40
|
| Rate for Payer: PHP Commercial |
$103.38
|
| Rate for Payer: PHP Medicare Advantage |
$30.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.05
|
| Rate for Payer: Priority Health HMO/PPO |
$105.81
|
| Rate for Payer: Priority Health Medicare |
$30.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.49
|
| Rate for Payer: Railroad Medicare Medicare |
$30.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.03
|
| Rate for Payer: UHC Core |
$101.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.40
|
| Rate for Payer: UHC Exchange |
$30.40
|
| Rate for Payer: UHC Medicare Advantage |
$30.40
|
| Rate for Payer: VA VA |
$30.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.22
|
|
|
ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$284.00
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
8981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.45 |
| Max. Negotiated Rate |
$255.60 |
| Rate for Payer: Aetna Commercial |
$241.40
|
| Rate for Payer: Aetna Commercial |
$151.30
|
| Rate for Payer: Aetna Medicare |
$73.84
|
| Rate for Payer: Aetna Medicare |
$46.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$88.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$88.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.62
|
| Rate for Payer: BCBS Complete |
$71.20
|
| Rate for Payer: BCBS Complete |
$113.60
|
| Rate for Payer: BCBS MAPPO |
$44.50
|
| Rate for Payer: BCBS MAPPO |
$71.00
|
| Rate for Payer: BCBS Trust/PPO |
$233.48
|
| Rate for Payer: BCBS Trust/PPO |
$146.33
|
| Rate for Payer: BCN Commercial |
$220.81
|
| Rate for Payer: BCN Commercial |
$138.40
|
| Rate for Payer: BCN Medicare Advantage |
$71.00
|
| Rate for Payer: BCN Medicare Advantage |
$44.50
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Cash Price |
$142.40
|
| Rate for Payer: Cofinity Commercial |
$153.08
|
| Rate for Payer: Cofinity Commercial |
$244.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.00
|
| Rate for Payer: Healthscope Commercial |
$160.20
|
| Rate for Payer: Healthscope Commercial |
$255.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.30
|
| Rate for Payer: Nomi Health Commercial |
$232.88
|
| Rate for Payer: Nomi Health Commercial |
$145.96
|
| Rate for Payer: PACE Senior Care Partners |
$67.45
|
| Rate for Payer: PACE Senior Care Partners |
$42.28
|
| Rate for Payer: PACE SWMI |
$71.00
|
| Rate for Payer: PACE SWMI |
$44.50
|
| Rate for Payer: PHP Commercial |
$241.40
|
| Rate for Payer: PHP Commercial |
$151.30
|
| Rate for Payer: PHP Medicare Advantage |
$44.50
|
| Rate for Payer: PHP Medicare Advantage |
$71.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.70
|
| Rate for Payer: Priority Health HMO/PPO |
$154.86
|
| Rate for Payer: Priority Health HMO/PPO |
$247.08
|
| Rate for Payer: Priority Health Medicare |
$71.71
|
| Rate for Payer: Priority Health Medicare |
$44.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$190.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$119.26
|
| Rate for Payer: Railroad Medicare Medicare |
$44.50
|
| Rate for Payer: Railroad Medicare Medicare |
$71.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$249.92
|
| Rate for Payer: UHC Core |
$237.14
|
| Rate for Payer: UHC Core |
$148.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.50
|
| Rate for Payer: UHC Exchange |
$44.50
|
| Rate for Payer: UHC Exchange |
$71.00
|
| Rate for Payer: UHC Medicare Advantage |
$44.50
|
| Rate for Payer: UHC Medicare Advantage |
$71.00
|
| Rate for Payer: VA VA |
$44.50
|
| Rate for Payer: VA VA |
$71.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.50
|
|
|
ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
8981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$115.70 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$151.30
|
| Rate for Payer: Aetna Commercial |
$241.40
|
| Rate for Payer: BCBS Trust/PPO |
$145.30
|
| Rate for Payer: BCBS Trust/PPO |
$231.83
|
| Rate for Payer: BCN Commercial |
$137.56
|
| Rate for Payer: BCN Commercial |
$219.48
|
| Rate for Payer: Cash Price |
$142.40
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Cofinity Commercial |
$244.24
|
| Rate for Payer: Cofinity Commercial |
$153.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.40
|
| Rate for Payer: Healthscope Commercial |
$160.20
|
| Rate for Payer: Healthscope Commercial |
$255.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.40
|
| Rate for Payer: Nomi Health Commercial |
$145.96
|
| Rate for Payer: Nomi Health Commercial |
$232.88
|
| Rate for Payer: PHP Commercial |
$151.30
|
| Rate for Payer: PHP Commercial |
$241.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.70
|
| Rate for Payer: Priority Health HMO/PPO |
$247.08
|
| Rate for Payer: Priority Health HMO/PPO |
$154.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$119.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$190.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$249.92
|
| Rate for Payer: UHC Core |
$148.63
|
| Rate for Payer: UHC Core |
$237.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.00
|
|
|
ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$2.57
|
|
|
Service Code
|
HCPCS J7613
|
| Hospital Charge Code |
250
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$2.31 |
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: Aetna Commercial |
$2.86
|
| Rate for Payer: Aetna Commercial |
$3.72
|
| Rate for Payer: BCBS Trust/PPO |
$2.75
|
| Rate for Payer: BCBS Trust/PPO |
$2.10
|
| Rate for Payer: BCBS Trust/PPO |
$3.58
|
| Rate for Payer: BCN Commercial |
$2.60
|
| Rate for Payer: BCN Commercial |
$1.99
|
| Rate for Payer: BCN Commercial |
$3.38
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cofinity Commercial |
$3.77
|
| Rate for Payer: Cofinity Commercial |
$2.90
|
| Rate for Payer: Cofinity Commercial |
$2.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.50
|
| Rate for Payer: Healthscope Commercial |
$3.03
|
| Rate for Payer: Healthscope Commercial |
$2.31
|
| Rate for Payer: Healthscope Commercial |
$3.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.72
|
| Rate for Payer: Nomi Health Commercial |
$2.11
|
| Rate for Payer: Nomi Health Commercial |
$2.76
|
| Rate for Payer: Nomi Health Commercial |
$3.59
|
| Rate for Payer: PHP Commercial |
$2.86
|
| Rate for Payer: PHP Commercial |
$2.18
|
| Rate for Payer: PHP Commercial |
$3.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.19
|
| Rate for Payer: Priority Health HMO/PPO |
$3.81
|
| Rate for Payer: Priority Health HMO/PPO |
$2.93
|
| Rate for Payer: Priority Health HMO/PPO |
$2.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.26
|
| Rate for Payer: UHC Core |
$2.15
|
| Rate for Payer: UHC Core |
$3.66
|
| Rate for Payer: UHC Core |
$2.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.53
|
|
|
ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION
|
Facility
|
OP
|
$2.57
|
|
|
Service Code
|
HCPCS J7613
|
| Hospital Charge Code |
250
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$2.31 |
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: Aetna Commercial |
$3.72
|
| Rate for Payer: Aetna Commercial |
$2.86
|
| Rate for Payer: Aetna Medicare |
$1.14
|
| Rate for Payer: Aetna Medicare |
$0.67
|
| Rate for Payer: Aetna Medicare |
$0.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.37
|
| Rate for Payer: BCBS Complete |
$1.35
|
| Rate for Payer: BCBS Complete |
$1.03
|
| Rate for Payer: BCBS Complete |
$1.75
|
| Rate for Payer: BCBS MAPPO |
$1.10
|
| Rate for Payer: BCBS MAPPO |
$0.64
|
| Rate for Payer: BCBS MAPPO |
$0.84
|
| Rate for Payer: BCBS Trust/PPO |
$2.77
|
| Rate for Payer: BCBS Trust/PPO |
$2.11
|
| Rate for Payer: BCBS Trust/PPO |
$3.60
|
| Rate for Payer: BCN Commercial |
$2.62
|
| Rate for Payer: BCN Commercial |
$3.41
|
| Rate for Payer: BCN Commercial |
$2.00
|
| Rate for Payer: BCN Medicare Advantage |
$0.64
|
| Rate for Payer: BCN Medicare Advantage |
$0.84
|
| Rate for Payer: BCN Medicare Advantage |
$1.10
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cofinity Commercial |
$3.77
|
| Rate for Payer: Cofinity Commercial |
$2.21
|
| Rate for Payer: Cofinity Commercial |
$2.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.64
|
| Rate for Payer: Healthscope Commercial |
$3.03
|
| Rate for Payer: Healthscope Commercial |
$2.31
|
| Rate for Payer: Healthscope Commercial |
$3.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.18
|
| Rate for Payer: Nomi Health Commercial |
$3.59
|
| Rate for Payer: Nomi Health Commercial |
$2.11
|
| Rate for Payer: Nomi Health Commercial |
$2.76
|
| Rate for Payer: PACE Senior Care Partners |
$1.04
|
| Rate for Payer: PACE Senior Care Partners |
$0.61
|
| Rate for Payer: PACE Senior Care Partners |
$0.80
|
| Rate for Payer: PACE SWMI |
$0.84
|
| Rate for Payer: PACE SWMI |
$0.64
|
| Rate for Payer: PACE SWMI |
$1.10
|
| Rate for Payer: PHP Commercial |
$3.72
|
| Rate for Payer: PHP Commercial |
$2.86
|
| Rate for Payer: PHP Commercial |
$2.18
|
| Rate for Payer: PHP Medicare Advantage |
$0.84
|
| Rate for Payer: PHP Medicare Advantage |
$1.10
|
| Rate for Payer: PHP Medicare Advantage |
$0.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.19
|
| Rate for Payer: Priority Health HMO/PPO |
$3.81
|
| Rate for Payer: Priority Health HMO/PPO |
$2.24
|
| Rate for Payer: Priority Health HMO/PPO |
$2.93
|
| Rate for Payer: Priority Health Medicare |
$0.65
|
| Rate for Payer: Priority Health Medicare |
$1.11
|
| Rate for Payer: Priority Health Medicare |
$0.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.72
|
| Rate for Payer: Railroad Medicare Medicare |
$0.84
|
| Rate for Payer: Railroad Medicare Medicare |
$1.10
|
| Rate for Payer: Railroad Medicare Medicare |
$0.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.26
|
| Rate for Payer: UHC Core |
$3.66
|
| Rate for Payer: UHC Core |
$2.81
|
| Rate for Payer: UHC Core |
$2.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.84
|
| Rate for Payer: UHC Exchange |
$0.84
|
| Rate for Payer: UHC Exchange |
$0.64
|
| Rate for Payer: UHC Exchange |
$1.10
|
| Rate for Payer: UHC Medicare Advantage |
$0.64
|
| Rate for Payer: UHC Medicare Advantage |
$0.84
|
| Rate for Payer: UHC Medicare Advantage |
$1.10
|
| Rate for Payer: VA VA |
$0.84
|
| Rate for Payer: VA VA |
$1.10
|
| Rate for Payer: VA VA |
$0.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.53
|
|
|
ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION
|
Facility
|
OP
|
$3.36
|
|
|
Service Code
|
HCPCS J7611
|
| Hospital Charge Code |
115221
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Aetna Commercial |
$2.86
|
| Rate for Payer: Aetna Medicare |
$0.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.05
|
| Rate for Payer: BCBS Complete |
$1.34
|
| Rate for Payer: BCBS MAPPO |
$0.84
|
| Rate for Payer: BCBS Trust/PPO |
$2.76
|
| Rate for Payer: BCN Commercial |
$2.61
|
| Rate for Payer: BCN Medicare Advantage |
$0.84
|
| Rate for Payer: Cash Price |
$2.69
|
| Rate for Payer: Cofinity Commercial |
$2.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.84
|
| Rate for Payer: Healthscope Commercial |
$3.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.86
|
| Rate for Payer: Nomi Health Commercial |
$2.76
|
| Rate for Payer: PACE Senior Care Partners |
$0.80
|
| Rate for Payer: PACE SWMI |
$0.84
|
| Rate for Payer: PHP Commercial |
$2.86
|
| Rate for Payer: PHP Medicare Advantage |
$0.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.18
|
| Rate for Payer: Priority Health HMO/PPO |
$2.92
|
| Rate for Payer: Priority Health Medicare |
$0.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.25
|
| Rate for Payer: Railroad Medicare Medicare |
$0.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.96
|
| Rate for Payer: UHC Core |
$2.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.84
|
| Rate for Payer: UHC Exchange |
$0.84
|
| Rate for Payer: UHC Medicare Advantage |
$0.84
|
| Rate for Payer: VA VA |
$0.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.52
|
|
|
ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$3.36
|
|
|
Service Code
|
HCPCS J7611
|
| Hospital Charge Code |
115221
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Aetna Commercial |
$2.86
|
| Rate for Payer: BCBS Trust/PPO |
$2.74
|
| Rate for Payer: BCN Commercial |
$2.60
|
| Rate for Payer: Cash Price |
$2.69
|
| Rate for Payer: Cofinity Commercial |
$2.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.69
|
| Rate for Payer: Healthscope Commercial |
$3.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.86
|
| Rate for Payer: Nomi Health Commercial |
$2.76
|
| Rate for Payer: PHP Commercial |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.18
|
| Rate for Payer: Priority Health HMO/PPO |
$2.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.96
|
| Rate for Payer: UHC Core |
$2.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.52
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
|
IP
|
$109.20
|
|
|
Service Code
|
NDC 09900001169
|
| Hospital Charge Code |
300450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.98 |
| Max. Negotiated Rate |
$98.28 |
| Rate for Payer: Aetna Commercial |
$92.82
|
| Rate for Payer: BCBS Trust/PPO |
$89.14
|
| Rate for Payer: BCN Commercial |
$84.39
|
| Rate for Payer: Cash Price |
$87.36
|
| Rate for Payer: Cofinity Commercial |
$93.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.36
|
| Rate for Payer: Healthscope Commercial |
$98.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.82
|
| Rate for Payer: Nomi Health Commercial |
$89.54
|
| Rate for Payer: PHP Commercial |
$92.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.98
|
| Rate for Payer: Priority Health HMO/PPO |
$95.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.10
|
| Rate for Payer: UHC Core |
$91.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.90
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
|
IP
|
$163.10
|
|
|
Service Code
|
NDC 68180096301
|
| Hospital Charge Code |
300450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.02 |
| Max. Negotiated Rate |
$146.79 |
| Rate for Payer: Aetna Commercial |
$138.64
|
| Rate for Payer: BCBS Trust/PPO |
$133.14
|
| Rate for Payer: BCN Commercial |
$126.04
|
| Rate for Payer: Cash Price |
$130.48
|
| Rate for Payer: Cofinity Commercial |
$140.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.48
|
| Rate for Payer: Healthscope Commercial |
$146.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.64
|
| Rate for Payer: Nomi Health Commercial |
$133.74
|
| Rate for Payer: PHP Commercial |
$138.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.02
|
| Rate for Payer: Priority Health HMO/PPO |
$141.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$109.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.53
|
| Rate for Payer: UHC Core |
$136.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.32
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
|
OP
|
$163.10
|
|
|
Service Code
|
NDC 68180096301
|
| Hospital Charge Code |
300450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.74 |
| Max. Negotiated Rate |
$146.79 |
| Rate for Payer: Aetna Commercial |
$138.64
|
| Rate for Payer: Aetna Medicare |
$42.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.97
|
| Rate for Payer: BCBS Complete |
$65.24
|
| Rate for Payer: BCBS MAPPO |
$40.78
|
| Rate for Payer: BCBS Trust/PPO |
$134.08
|
| Rate for Payer: BCN Commercial |
$126.81
|
| Rate for Payer: BCN Medicare Advantage |
$40.78
|
| Rate for Payer: Cash Price |
$130.48
|
| Rate for Payer: Cofinity Commercial |
$140.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.78
|
| Rate for Payer: Healthscope Commercial |
$146.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.64
|
| Rate for Payer: Nomi Health Commercial |
$133.74
|
| Rate for Payer: PACE Senior Care Partners |
$38.74
|
| Rate for Payer: PACE SWMI |
$40.78
|
| Rate for Payer: PHP Commercial |
$138.64
|
| Rate for Payer: PHP Medicare Advantage |
$40.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.02
|
| Rate for Payer: Priority Health HMO/PPO |
$141.90
|
| Rate for Payer: Priority Health Medicare |
$41.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$109.28
|
| Rate for Payer: Railroad Medicare Medicare |
$40.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.53
|
| Rate for Payer: UHC Core |
$136.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.78
|
| Rate for Payer: UHC Exchange |
$40.78
|
| Rate for Payer: UHC Medicare Advantage |
$40.78
|
| Rate for Payer: VA VA |
$40.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.32
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
|
OP
|
$109.20
|
|
|
Service Code
|
NDC 09900001169
|
| Hospital Charge Code |
300450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.94 |
| Max. Negotiated Rate |
$98.28 |
| Rate for Payer: Aetna Commercial |
$92.82
|
| Rate for Payer: Aetna Medicare |
$28.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.12
|
| Rate for Payer: BCBS Complete |
$43.68
|
| Rate for Payer: BCBS MAPPO |
$27.30
|
| Rate for Payer: BCBS Trust/PPO |
$89.77
|
| Rate for Payer: BCN Commercial |
$84.90
|
| Rate for Payer: BCN Medicare Advantage |
$27.30
|
| Rate for Payer: Cash Price |
$87.36
|
| Rate for Payer: Cofinity Commercial |
$93.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.30
|
| Rate for Payer: Healthscope Commercial |
$98.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.82
|
| Rate for Payer: Nomi Health Commercial |
$89.54
|
| Rate for Payer: PACE Senior Care Partners |
$25.94
|
| Rate for Payer: PACE SWMI |
$27.30
|
| Rate for Payer: PHP Commercial |
$92.82
|
| Rate for Payer: PHP Medicare Advantage |
$27.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.98
|
| Rate for Payer: Priority Health HMO/PPO |
$95.00
|
| Rate for Payer: Priority Health Medicare |
$27.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.16
|
| Rate for Payer: Railroad Medicare Medicare |
$27.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.10
|
| Rate for Payer: UHC Core |
$91.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.30
|
| Rate for Payer: UHC Exchange |
$27.30
|
| Rate for Payer: UHC Medicare Advantage |
$27.30
|
| Rate for Payer: VA VA |
$27.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.90
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
OP
|
$163.10
|
|
|
Service Code
|
NDC 68180096301
|
| Hospital Charge Code |
17837
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.74 |
| Max. Negotiated Rate |
$146.79 |
| Rate for Payer: Aetna Commercial |
$138.64
|
| Rate for Payer: Aetna Medicare |
$42.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.97
|
| Rate for Payer: BCBS Complete |
$65.24
|
| Rate for Payer: BCBS MAPPO |
$40.78
|
| Rate for Payer: BCBS Trust/PPO |
$134.08
|
| Rate for Payer: BCN Commercial |
$126.81
|
| Rate for Payer: BCN Medicare Advantage |
$40.78
|
| Rate for Payer: Cash Price |
$130.48
|
| Rate for Payer: Cofinity Commercial |
$140.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.78
|
| Rate for Payer: Healthscope Commercial |
$146.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.64
|
| Rate for Payer: Nomi Health Commercial |
$133.74
|
| Rate for Payer: PACE Senior Care Partners |
$38.74
|
| Rate for Payer: PACE SWMI |
$40.78
|
| Rate for Payer: PHP Commercial |
$138.64
|
| Rate for Payer: PHP Medicare Advantage |
$40.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.02
|
| Rate for Payer: Priority Health HMO/PPO |
$141.90
|
| Rate for Payer: Priority Health Medicare |
$41.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$109.28
|
| Rate for Payer: Railroad Medicare Medicare |
$40.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.53
|
| Rate for Payer: UHC Core |
$136.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.78
|
| Rate for Payer: UHC Exchange |
$40.78
|
| Rate for Payer: UHC Medicare Advantage |
$40.78
|
| Rate for Payer: VA VA |
$40.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.32
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
IP
|
$163.10
|
|
|
Service Code
|
NDC 68180096301
|
| Hospital Charge Code |
17837
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.02 |
| Max. Negotiated Rate |
$146.79 |
| Rate for Payer: Aetna Commercial |
$138.64
|
| Rate for Payer: BCBS Trust/PPO |
$133.14
|
| Rate for Payer: BCN Commercial |
$126.04
|
| Rate for Payer: Cash Price |
$130.48
|
| Rate for Payer: Cofinity Commercial |
$140.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.48
|
| Rate for Payer: Healthscope Commercial |
$146.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.64
|
| Rate for Payer: Nomi Health Commercial |
$133.74
|
| Rate for Payer: PHP Commercial |
$138.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.02
|
| Rate for Payer: Priority Health HMO/PPO |
$141.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$109.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.53
|
| Rate for Payer: UHC Core |
$136.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.32
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
IP
|
$2.73
|
|
|
Service Code
|
NDC 51079020501
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Aetna Commercial |
$2.32
|
| Rate for Payer: BCBS Trust/PPO |
$2.23
|
| Rate for Payer: BCN Commercial |
$2.11
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$2.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Healthscope Commercial |
$2.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.32
|
| Rate for Payer: Nomi Health Commercial |
$2.24
|
| Rate for Payer: PHP Commercial |
$2.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.77
|
| Rate for Payer: Priority Health HMO/PPO |
$2.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.40
|
| Rate for Payer: UHC Core |
$2.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.05
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
OP
|
$451.20
|
|
|
Service Code
|
NDC 00904704161
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.16 |
| Max. Negotiated Rate |
$406.08 |
| Rate for Payer: Aetna Commercial |
$383.52
|
| Rate for Payer: Aetna Medicare |
$117.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$141.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$141.00
|
| Rate for Payer: BCBS Complete |
$180.48
|
| Rate for Payer: BCBS MAPPO |
$112.80
|
| Rate for Payer: BCBS Trust/PPO |
$370.93
|
| Rate for Payer: BCN Commercial |
$350.81
|
| Rate for Payer: BCN Medicare Advantage |
$112.80
|
| Rate for Payer: Cash Price |
$360.96
|
| Rate for Payer: Cofinity Commercial |
$388.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.80
|
| Rate for Payer: Healthscope Commercial |
$406.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$338.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$118.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$383.52
|
| Rate for Payer: Nomi Health Commercial |
$369.98
|
| Rate for Payer: PACE Senior Care Partners |
$107.16
|
| Rate for Payer: PACE SWMI |
$112.80
|
| Rate for Payer: PHP Commercial |
$383.52
|
| Rate for Payer: PHP Medicare Advantage |
$112.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.28
|
| Rate for Payer: Priority Health HMO/PPO |
$392.54
|
| Rate for Payer: Priority Health Medicare |
$113.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$302.30
|
| Rate for Payer: Railroad Medicare Medicare |
$112.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$397.06
|
| Rate for Payer: UHC Core |
$376.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$112.80
|
| Rate for Payer: UHC Exchange |
$112.80
|
| Rate for Payer: UHC Medicare Advantage |
$112.80
|
| Rate for Payer: VA VA |
$112.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$338.40
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
OP
|
$253.80
|
|
|
Service Code
|
NDC 53489015601
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.28 |
| Max. Negotiated Rate |
$228.42 |
| Rate for Payer: Aetna Commercial |
$215.73
|
| Rate for Payer: Aetna Medicare |
$65.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.31
|
| Rate for Payer: BCBS Complete |
$101.52
|
| Rate for Payer: BCBS MAPPO |
$63.45
|
| Rate for Payer: BCBS Trust/PPO |
$208.65
|
| Rate for Payer: BCN Commercial |
$197.33
|
| Rate for Payer: BCN Medicare Advantage |
$63.45
|
| Rate for Payer: Cash Price |
$203.04
|
| Rate for Payer: Cofinity Commercial |
$218.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.45
|
| Rate for Payer: Healthscope Commercial |
$228.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.73
|
| Rate for Payer: Nomi Health Commercial |
$208.12
|
| Rate for Payer: PACE Senior Care Partners |
$60.28
|
| Rate for Payer: PACE SWMI |
$63.45
|
| Rate for Payer: PHP Commercial |
$215.73
|
| Rate for Payer: PHP Medicare Advantage |
$63.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.97
|
| Rate for Payer: Priority Health HMO/PPO |
$220.81
|
| Rate for Payer: Priority Health Medicare |
$64.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.05
|
| Rate for Payer: Railroad Medicare Medicare |
$63.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.34
|
| Rate for Payer: UHC Core |
$211.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.45
|
| Rate for Payer: UHC Exchange |
$63.45
|
| Rate for Payer: UHC Medicare Advantage |
$63.45
|
| Rate for Payer: VA VA |
$63.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.35
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
IP
|
$253.80
|
|
|
Service Code
|
NDC 53489015601
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.97 |
| Max. Negotiated Rate |
$228.42 |
| Rate for Payer: Aetna Commercial |
$215.73
|
| Rate for Payer: BCBS Trust/PPO |
$207.18
|
| Rate for Payer: BCN Commercial |
$196.14
|
| Rate for Payer: Cash Price |
$203.04
|
| Rate for Payer: Cofinity Commercial |
$218.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.04
|
| Rate for Payer: Healthscope Commercial |
$228.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.73
|
| Rate for Payer: Nomi Health Commercial |
$208.12
|
| Rate for Payer: PHP Commercial |
$215.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.97
|
| Rate for Payer: Priority Health HMO/PPO |
$220.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.34
|
| Rate for Payer: UHC Core |
$211.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.35
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
OP
|
$2.73
|
|
|
Service Code
|
NDC 51079020501
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Aetna Commercial |
$2.32
|
| Rate for Payer: Aetna Medicare |
$0.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.85
|
| Rate for Payer: BCBS Complete |
$1.09
|
| Rate for Payer: BCBS MAPPO |
$0.68
|
| Rate for Payer: BCBS Trust/PPO |
$2.24
|
| Rate for Payer: BCN Commercial |
$2.12
|
| Rate for Payer: BCN Medicare Advantage |
$0.68
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$2.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.68
|
| Rate for Payer: Healthscope Commercial |
$2.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.32
|
| Rate for Payer: Nomi Health Commercial |
$2.24
|
| Rate for Payer: PACE Senior Care Partners |
$0.65
|
| Rate for Payer: PACE SWMI |
$0.68
|
| Rate for Payer: PHP Commercial |
$2.32
|
| Rate for Payer: PHP Medicare Advantage |
$0.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.77
|
| Rate for Payer: Priority Health HMO/PPO |
$2.38
|
| Rate for Payer: Priority Health Medicare |
$0.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.83
|
| Rate for Payer: Railroad Medicare Medicare |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.40
|
| Rate for Payer: UHC Core |
$2.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UHC Medicare Advantage |
$0.68
|
| Rate for Payer: VA VA |
$0.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.05
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
IP
|
$451.20
|
|
|
Service Code
|
NDC 00904704161
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$293.28 |
| Max. Negotiated Rate |
$406.08 |
| Rate for Payer: Aetna Commercial |
$383.52
|
| Rate for Payer: BCBS Trust/PPO |
$368.31
|
| Rate for Payer: BCN Commercial |
$348.69
|
| Rate for Payer: Cash Price |
$360.96
|
| Rate for Payer: Cofinity Commercial |
$388.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.96
|
| Rate for Payer: Healthscope Commercial |
$406.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$338.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$383.52
|
| Rate for Payer: Nomi Health Commercial |
$369.98
|
| Rate for Payer: PHP Commercial |
$383.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.28
|
| Rate for Payer: Priority Health HMO/PPO |
$392.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$302.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$397.06
|
| Rate for Payer: UHC Core |
$376.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$338.40
|
|
|
ALLOPURINOL 300 MG TABLET
|
Facility
|
OP
|
$254.40
|
|
|
Service Code
|
NDC 00378018101
|
| Hospital Charge Code |
311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.42 |
| Max. Negotiated Rate |
$228.96 |
| Rate for Payer: Aetna Commercial |
$216.24
|
| Rate for Payer: Aetna Medicare |
$66.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.50
|
| Rate for Payer: BCBS Complete |
$101.76
|
| Rate for Payer: BCBS MAPPO |
$63.60
|
| Rate for Payer: BCBS Trust/PPO |
$209.14
|
| Rate for Payer: BCN Commercial |
$197.80
|
| Rate for Payer: BCN Medicare Advantage |
$63.60
|
| Rate for Payer: Cash Price |
$203.52
|
| Rate for Payer: Cofinity Commercial |
$218.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.60
|
| Rate for Payer: Healthscope Commercial |
$228.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.24
|
| Rate for Payer: Nomi Health Commercial |
$208.61
|
| Rate for Payer: PACE Senior Care Partners |
$60.42
|
| Rate for Payer: PACE SWMI |
$63.60
|
| Rate for Payer: PHP Commercial |
$216.24
|
| Rate for Payer: PHP Medicare Advantage |
$63.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.36
|
| Rate for Payer: Priority Health HMO/PPO |
$221.33
|
| Rate for Payer: Priority Health Medicare |
$64.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.45
|
| Rate for Payer: Railroad Medicare Medicare |
$63.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.87
|
| Rate for Payer: UHC Core |
$212.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.60
|
| Rate for Payer: UHC Exchange |
$63.60
|
| Rate for Payer: UHC Medicare Advantage |
$63.60
|
| Rate for Payer: VA VA |
$63.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.80
|
|
|
ALLOPURINOL 300 MG TABLET
|
Facility
|
IP
|
$254.40
|
|
|
Service Code
|
NDC 00378018101
|
| Hospital Charge Code |
311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.36 |
| Max. Negotiated Rate |
$228.96 |
| Rate for Payer: Aetna Commercial |
$216.24
|
| Rate for Payer: BCBS Trust/PPO |
$207.67
|
| Rate for Payer: BCN Commercial |
$196.60
|
| Rate for Payer: Cash Price |
$203.52
|
| Rate for Payer: Cofinity Commercial |
$218.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.52
|
| Rate for Payer: Healthscope Commercial |
$228.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.24
|
| Rate for Payer: Nomi Health Commercial |
$208.61
|
| Rate for Payer: PHP Commercial |
$216.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.36
|
| Rate for Payer: Priority Health HMO/PPO |
$221.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.87
|
| Rate for Payer: UHC Core |
$212.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.80
|
|
|
ALLOPURINOL 300 MG TABLET
|
Facility
|
IP
|
$267.84
|
|
|
Service Code
|
NDC 00591554401
|
| Hospital Charge Code |
311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.10 |
| Max. Negotiated Rate |
$241.06 |
| Rate for Payer: Aetna Commercial |
$227.66
|
| Rate for Payer: BCBS Trust/PPO |
$218.64
|
| Rate for Payer: BCN Commercial |
$206.99
|
| Rate for Payer: Cash Price |
$214.27
|
| Rate for Payer: Cofinity Commercial |
$230.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.27
|
| Rate for Payer: Healthscope Commercial |
$241.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.66
|
| Rate for Payer: Nomi Health Commercial |
$219.63
|
| Rate for Payer: PHP Commercial |
$227.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.10
|
| Rate for Payer: Priority Health HMO/PPO |
$233.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.70
|
| Rate for Payer: UHC Core |
$223.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.88
|
|
