|
LINAGLIPTIN 5 MG TABLET
|
Facility
|
IP
|
$1,626.15
|
|
|
Service Code
|
NDC 00597014030
|
| Hospital Charge Code |
152649
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,131.80 |
| Max. Negotiated Rate |
$1,463.54 |
| Rate for Payer: Aetna Commercial |
$1,382.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,343.04
|
| Rate for Payer: BCN Commercial |
$1,343.04
|
| Rate for Payer: Cash Price |
$1,300.92
|
| Rate for Payer: Cofinity Commercial |
$1,398.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,300.92
|
| Rate for Payer: Healthscope Commercial |
$1,463.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,219.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,382.23
|
| Rate for Payer: Nomi Health Commercial |
$1,333.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,219.61
|
| Rate for Payer: PHP Commercial |
$1,382.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,414.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,131.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,431.01
|
| Rate for Payer: UHC Core |
$1,357.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,219.61
|
|
|
LINAGLIPTIN 5 MG TABLET
|
Facility
|
OP
|
$1,626.15
|
|
|
Service Code
|
NDC 00597014030
|
| Hospital Charge Code |
152649
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$286.69 |
| Max. Negotiated Rate |
$1,463.54 |
| Rate for Payer: Aetna Commercial |
$1,382.23
|
| Rate for Payer: Aetna Medicare |
$422.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$508.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$508.17
|
| Rate for Payer: BCBS Complete |
$301.00
|
| Rate for Payer: BCBS MAPPO |
$406.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,336.86
|
| Rate for Payer: BCN Commercial |
$1,336.86
|
| Rate for Payer: BCN Medicare Advantage |
$406.54
|
| Rate for Payer: Cash Price |
$1,300.92
|
| Rate for Payer: Cofinity Commercial |
$1,398.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,300.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$406.54
|
| Rate for Payer: Healthscope Commercial |
$1,463.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,219.61
|
| Rate for Payer: Mclaren Medicaid |
$286.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$426.86
|
| Rate for Payer: Meridian Medicaid |
$301.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$467.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$447.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,382.23
|
| Rate for Payer: Nomi Health Commercial |
$1,333.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,219.61
|
| Rate for Payer: PACE Senior Care Partners |
$386.21
|
| Rate for Payer: PACE SWMI |
$406.54
|
| Rate for Payer: PHP Commercial |
$1,382.23
|
| Rate for Payer: PHP Medicare Advantage |
$406.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$286.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,414.75
|
| Rate for Payer: Priority Health Medicare |
$410.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,131.80
|
| Rate for Payer: Railroad Medicare Medicare |
$406.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,431.01
|
| Rate for Payer: UHC Core |
$1,357.84
|
| Rate for Payer: UHC Exchange |
$406.54
|
| Rate for Payer: UHC Medicaid |
$286.69
|
| Rate for Payer: UHC Medicare Advantage |
$406.54
|
| Rate for Payer: UHCCP Medicaid |
$286.69
|
| Rate for Payer: VA VA |
$406.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,219.61
|
|
|
LINAGLIPTIN 5 MG TABLET
|
Facility
|
OP
|
$5,420.50
|
|
|
Service Code
|
NDC 00597014061
|
| Hospital Charge Code |
152649
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$955.63 |
| Max. Negotiated Rate |
$4,878.45 |
| Rate for Payer: Aetna Commercial |
$4,607.43
|
| Rate for Payer: Aetna Medicare |
$1,409.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,693.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,693.91
|
| Rate for Payer: BCBS Complete |
$1,003.33
|
| Rate for Payer: BCBS MAPPO |
$1,355.12
|
| Rate for Payer: BCBS Trust/PPO |
$4,456.19
|
| Rate for Payer: BCN Commercial |
$4,456.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,355.12
|
| Rate for Payer: Cash Price |
$4,336.40
|
| Rate for Payer: Cofinity Commercial |
$4,661.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,336.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,355.12
|
| Rate for Payer: Healthscope Commercial |
$4,878.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,065.38
|
| Rate for Payer: Mclaren Medicaid |
$955.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,422.88
|
| Rate for Payer: Meridian Medicaid |
$1,003.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,558.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,490.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,607.43
|
| Rate for Payer: Nomi Health Commercial |
$4,444.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,065.38
|
| Rate for Payer: PACE Senior Care Partners |
$1,287.37
|
| Rate for Payer: PACE SWMI |
$1,355.12
|
| Rate for Payer: PHP Commercial |
$4,607.43
|
| Rate for Payer: PHP Medicare Advantage |
$1,355.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$955.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,715.84
|
| Rate for Payer: Priority Health Medicare |
$1,368.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,772.67
|
| Rate for Payer: Railroad Medicare Medicare |
$1,355.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,770.04
|
| Rate for Payer: UHC Core |
$4,526.12
|
| Rate for Payer: UHC Exchange |
$1,355.12
|
| Rate for Payer: UHC Medicaid |
$955.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,355.12
|
| Rate for Payer: UHCCP Medicaid |
$955.63
|
| Rate for Payer: VA VA |
$1,355.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,065.38
|
|
|
LINEZOLID 600 MG TABLET
|
Facility
|
IP
|
$174.15
|
|
|
Service Code
|
NDC 67877041920
|
| Hospital Charge Code |
28224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.21 |
| Max. Negotiated Rate |
$156.74 |
| Rate for Payer: Aetna Commercial |
$148.03
|
| Rate for Payer: BCBS Trust/PPO |
$143.83
|
| Rate for Payer: BCN Commercial |
$143.83
|
| Rate for Payer: Cash Price |
$139.32
|
| Rate for Payer: Cofinity Commercial |
$149.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.32
|
| Rate for Payer: Healthscope Commercial |
$156.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.03
|
| Rate for Payer: Nomi Health Commercial |
$142.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.61
|
| Rate for Payer: PHP Commercial |
$148.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$151.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.25
|
| Rate for Payer: UHC Core |
$145.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.61
|
|
|
LINEZOLID 600 MG TABLET
|
Facility
|
OP
|
$174.15
|
|
|
Service Code
|
NDC 67877041920
|
| Hospital Charge Code |
28224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.70 |
| Max. Negotiated Rate |
$156.74 |
| Rate for Payer: Aetna Commercial |
$148.03
|
| Rate for Payer: Aetna Medicare |
$45.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$54.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$54.42
|
| Rate for Payer: BCBS Complete |
$32.24
|
| Rate for Payer: BCBS MAPPO |
$43.54
|
| Rate for Payer: BCBS Trust/PPO |
$143.17
|
| Rate for Payer: BCN Commercial |
$143.17
|
| Rate for Payer: BCN Medicare Advantage |
$43.54
|
| Rate for Payer: Cash Price |
$139.32
|
| Rate for Payer: Cofinity Commercial |
$149.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.54
|
| Rate for Payer: Healthscope Commercial |
$156.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.61
|
| Rate for Payer: Mclaren Medicaid |
$30.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.71
|
| Rate for Payer: Meridian Medicaid |
$32.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$47.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.03
|
| Rate for Payer: Nomi Health Commercial |
$142.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.61
|
| Rate for Payer: PACE Senior Care Partners |
$41.36
|
| Rate for Payer: PACE SWMI |
$43.54
|
| Rate for Payer: PHP Commercial |
$148.03
|
| Rate for Payer: PHP Medicare Advantage |
$43.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$151.51
|
| Rate for Payer: Priority Health Medicare |
$43.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.21
|
| Rate for Payer: Railroad Medicare Medicare |
$43.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.25
|
| Rate for Payer: UHC Core |
$145.42
|
| Rate for Payer: UHC Exchange |
$43.54
|
| Rate for Payer: UHC Medicaid |
$30.70
|
| Rate for Payer: UHC Medicare Advantage |
$43.54
|
| Rate for Payer: UHCCP Medicaid |
$30.70
|
| Rate for Payer: VA VA |
$43.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.61
|
|
|
LINEZOLID 600 MG TABLET
|
Facility
|
IP
|
$339.55
|
|
|
Service Code
|
NDC 00904655304
|
| Hospital Charge Code |
28224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$236.33 |
| Max. Negotiated Rate |
$305.60 |
| Rate for Payer: Aetna Commercial |
$288.62
|
| Rate for Payer: BCBS Trust/PPO |
$280.43
|
| Rate for Payer: BCN Commercial |
$280.43
|
| Rate for Payer: Cash Price |
$271.64
|
| Rate for Payer: Cofinity Commercial |
$292.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.64
|
| Rate for Payer: Healthscope Commercial |
$305.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$254.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.62
|
| Rate for Payer: Nomi Health Commercial |
$278.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$254.66
|
| Rate for Payer: PHP Commercial |
$288.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$295.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$236.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$298.80
|
| Rate for Payer: UHC Core |
$283.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$254.66
|
|
|
LINEZOLID 600 MG TABLET
|
Facility
|
OP
|
$339.55
|
|
|
Service Code
|
NDC 00904655304
|
| Hospital Charge Code |
28224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.86 |
| Max. Negotiated Rate |
$305.60 |
| Rate for Payer: Aetna Commercial |
$288.62
|
| Rate for Payer: Aetna Medicare |
$88.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$106.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$106.11
|
| Rate for Payer: BCBS Complete |
$62.85
|
| Rate for Payer: BCBS MAPPO |
$84.89
|
| Rate for Payer: BCBS Trust/PPO |
$279.14
|
| Rate for Payer: BCN Commercial |
$279.14
|
| Rate for Payer: BCN Medicare Advantage |
$84.89
|
| Rate for Payer: Cash Price |
$271.64
|
| Rate for Payer: Cofinity Commercial |
$292.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.89
|
| Rate for Payer: Healthscope Commercial |
$305.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$254.66
|
| Rate for Payer: Mclaren Medicaid |
$59.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$89.13
|
| Rate for Payer: Meridian Medicaid |
$62.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$93.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.62
|
| Rate for Payer: Nomi Health Commercial |
$278.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$254.66
|
| Rate for Payer: PACE Senior Care Partners |
$80.64
|
| Rate for Payer: PACE SWMI |
$84.89
|
| Rate for Payer: PHP Commercial |
$288.62
|
| Rate for Payer: PHP Medicare Advantage |
$84.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$295.41
|
| Rate for Payer: Priority Health Medicare |
$85.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$236.33
|
| Rate for Payer: Railroad Medicare Medicare |
$84.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$298.80
|
| Rate for Payer: UHC Core |
$283.52
|
| Rate for Payer: UHC Exchange |
$84.89
|
| Rate for Payer: UHC Medicaid |
$59.86
|
| Rate for Payer: UHC Medicare Advantage |
$84.89
|
| Rate for Payer: UHCCP Medicaid |
$59.86
|
| Rate for Payer: VA VA |
$84.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$254.66
|
|
|
LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$139.20
|
|
|
Service Code
|
HCPCS J2020
|
| Hospital Charge Code |
112020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.54 |
| Max. Negotiated Rate |
$125.28 |
| Rate for Payer: Aetna Commercial |
$118.32
|
| Rate for Payer: Aetna Commercial |
$81.34
|
| Rate for Payer: Aetna Commercial |
$58.52
|
| Rate for Payer: Aetna Medicare |
$24.88
|
| Rate for Payer: Aetna Medicare |
$36.19
|
| Rate for Payer: Aetna Medicare |
$17.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.91
|
| Rate for Payer: BCBS Complete |
$12.74
|
| Rate for Payer: BCBS Complete |
$25.77
|
| Rate for Payer: BCBS Complete |
$17.71
|
| Rate for Payer: BCBS MAPPO |
$23.93
|
| Rate for Payer: BCBS MAPPO |
$34.80
|
| Rate for Payer: BCBS MAPPO |
$17.21
|
| Rate for Payer: BCBS Trust/PPO |
$114.44
|
| Rate for Payer: BCBS Trust/PPO |
$56.60
|
| Rate for Payer: BCBS Trust/PPO |
$78.67
|
| Rate for Payer: BCN Commercial |
$56.60
|
| Rate for Payer: BCN Commercial |
$78.67
|
| Rate for Payer: BCN Commercial |
$114.44
|
| Rate for Payer: BCN Medicare Advantage |
$23.93
|
| Rate for Payer: BCN Medicare Advantage |
$17.21
|
| Rate for Payer: BCN Medicare Advantage |
$34.80
|
| Rate for Payer: Cash Price |
$76.56
|
| Rate for Payer: Cash Price |
$55.08
|
| Rate for Payer: Cash Price |
$111.36
|
| Rate for Payer: Cofinity Commercial |
$119.71
|
| Rate for Payer: Cofinity Commercial |
$59.21
|
| Rate for Payer: Cofinity Commercial |
$82.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.80
|
| Rate for Payer: Healthscope Commercial |
$61.97
|
| Rate for Payer: Healthscope Commercial |
$125.28
|
| Rate for Payer: Healthscope Commercial |
$86.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.64
|
| Rate for Payer: Mclaren Medicaid |
$24.54
|
| Rate for Payer: Mclaren Medicaid |
$16.87
|
| Rate for Payer: Mclaren Medicaid |
$12.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.12
|
| Rate for Payer: Meridian Medicaid |
$17.71
|
| Rate for Payer: Meridian Medicaid |
$25.77
|
| Rate for Payer: Meridian Medicaid |
$12.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.52
|
| Rate for Payer: Nomi Health Commercial |
$78.47
|
| Rate for Payer: Nomi Health Commercial |
$56.46
|
| Rate for Payer: Nomi Health Commercial |
$114.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.40
|
| Rate for Payer: PACE Senior Care Partners |
$16.35
|
| Rate for Payer: PACE Senior Care Partners |
$33.06
|
| Rate for Payer: PACE Senior Care Partners |
$22.73
|
| Rate for Payer: PACE SWMI |
$23.93
|
| Rate for Payer: PACE SWMI |
$17.21
|
| Rate for Payer: PACE SWMI |
$34.80
|
| Rate for Payer: PHP Commercial |
$118.32
|
| Rate for Payer: PHP Commercial |
$81.34
|
| Rate for Payer: PHP Commercial |
$58.52
|
| Rate for Payer: PHP Medicare Advantage |
$17.21
|
| Rate for Payer: PHP Medicare Advantage |
$34.80
|
| Rate for Payer: PHP Medicare Advantage |
$23.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$59.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$121.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$83.26
|
| Rate for Payer: Priority Health Medicare |
$24.16
|
| Rate for Payer: Priority Health Medicare |
$17.38
|
| Rate for Payer: Priority Health Medicare |
$35.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.88
|
| Rate for Payer: Railroad Medicare Medicare |
$17.21
|
| Rate for Payer: Railroad Medicare Medicare |
$23.93
|
| Rate for Payer: Railroad Medicare Medicare |
$34.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.50
|
| Rate for Payer: UHC Core |
$116.23
|
| Rate for Payer: UHC Core |
$79.91
|
| Rate for Payer: UHC Core |
$57.49
|
| Rate for Payer: UHC Exchange |
$23.93
|
| Rate for Payer: UHC Exchange |
$17.21
|
| Rate for Payer: UHC Exchange |
$34.80
|
| Rate for Payer: UHC Medicaid |
$24.54
|
| Rate for Payer: UHC Medicaid |
$16.87
|
| Rate for Payer: UHC Medicaid |
$12.14
|
| Rate for Payer: UHC Medicare Advantage |
$17.21
|
| Rate for Payer: UHC Medicare Advantage |
$34.80
|
| Rate for Payer: UHC Medicare Advantage |
$23.93
|
| Rate for Payer: UHCCP Medicaid |
$12.14
|
| Rate for Payer: UHCCP Medicaid |
$24.54
|
| Rate for Payer: UHCCP Medicaid |
$16.87
|
| Rate for Payer: VA VA |
$34.80
|
| Rate for Payer: VA VA |
$23.93
|
| Rate for Payer: VA VA |
$17.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.78
|
|
|
LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$139.20
|
|
|
Service Code
|
HCPCS J2020
|
| Hospital Charge Code |
112020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$96.88 |
| Max. Negotiated Rate |
$125.28 |
| Rate for Payer: Aetna Commercial |
$118.32
|
| Rate for Payer: Aetna Commercial |
$58.52
|
| Rate for Payer: Aetna Commercial |
$81.34
|
| Rate for Payer: BCBS Trust/PPO |
$56.86
|
| Rate for Payer: BCBS Trust/PPO |
$114.97
|
| Rate for Payer: BCBS Trust/PPO |
$79.04
|
| Rate for Payer: BCN Commercial |
$56.86
|
| Rate for Payer: BCN Commercial |
$114.97
|
| Rate for Payer: BCN Commercial |
$79.04
|
| Rate for Payer: Cash Price |
$111.36
|
| Rate for Payer: Cash Price |
$76.56
|
| Rate for Payer: Cash Price |
$55.08
|
| Rate for Payer: Cofinity Commercial |
$82.30
|
| Rate for Payer: Cofinity Commercial |
$59.21
|
| Rate for Payer: Cofinity Commercial |
$119.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.56
|
| Rate for Payer: Healthscope Commercial |
$61.97
|
| Rate for Payer: Healthscope Commercial |
$125.28
|
| Rate for Payer: Healthscope Commercial |
$86.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.34
|
| Rate for Payer: Nomi Health Commercial |
$114.14
|
| Rate for Payer: Nomi Health Commercial |
$56.46
|
| Rate for Payer: Nomi Health Commercial |
$78.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.78
|
| Rate for Payer: PHP Commercial |
$118.32
|
| Rate for Payer: PHP Commercial |
$81.34
|
| Rate for Payer: PHP Commercial |
$58.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$83.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$59.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$121.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.50
|
| Rate for Payer: UHC Core |
$116.23
|
| Rate for Payer: UHC Core |
$79.91
|
| Rate for Payer: UHC Core |
$57.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.64
|
|
|
LIOTHYRONINE 25 MCG TABLET
|
Facility
|
IP
|
$268.32
|
|
|
Service Code
|
NDC 70377011512
|
| Hospital Charge Code |
4504
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$186.75 |
| Max. Negotiated Rate |
$241.49 |
| Rate for Payer: Aetna Commercial |
$228.07
|
| Rate for Payer: BCBS Trust/PPO |
$221.61
|
| Rate for Payer: BCN Commercial |
$221.61
|
| Rate for Payer: Cash Price |
$214.66
|
| Rate for Payer: Cofinity Commercial |
$230.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.66
|
| Rate for Payer: Healthscope Commercial |
$241.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.07
|
| Rate for Payer: Nomi Health Commercial |
$220.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$201.24
|
| Rate for Payer: PHP Commercial |
$228.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$233.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$186.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$236.12
|
| Rate for Payer: UHC Core |
$224.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.24
|
|
|
LIOTHYRONINE 25 MCG TABLET
|
Facility
|
OP
|
$268.32
|
|
|
Service Code
|
NDC 70377011512
|
| Hospital Charge Code |
4504
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.30 |
| Max. Negotiated Rate |
$241.49 |
| Rate for Payer: Aetna Commercial |
$228.07
|
| Rate for Payer: Aetna Medicare |
$69.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$83.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$83.85
|
| Rate for Payer: BCBS Complete |
$49.67
|
| Rate for Payer: BCBS MAPPO |
$67.08
|
| Rate for Payer: BCBS Trust/PPO |
$220.59
|
| Rate for Payer: BCN Commercial |
$220.59
|
| Rate for Payer: BCN Medicare Advantage |
$67.08
|
| Rate for Payer: Cash Price |
$214.66
|
| Rate for Payer: Cofinity Commercial |
$230.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.08
|
| Rate for Payer: Healthscope Commercial |
$241.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.24
|
| Rate for Payer: Mclaren Medicaid |
$47.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.43
|
| Rate for Payer: Meridian Medicaid |
$49.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$73.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.07
|
| Rate for Payer: Nomi Health Commercial |
$220.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$201.24
|
| Rate for Payer: PACE Senior Care Partners |
$63.73
|
| Rate for Payer: PACE SWMI |
$67.08
|
| Rate for Payer: PHP Commercial |
$228.07
|
| Rate for Payer: PHP Medicare Advantage |
$67.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$233.44
|
| Rate for Payer: Priority Health Medicare |
$67.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$186.75
|
| Rate for Payer: Railroad Medicare Medicare |
$67.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$236.12
|
| Rate for Payer: UHC Core |
$224.05
|
| Rate for Payer: UHC Exchange |
$67.08
|
| Rate for Payer: UHC Medicaid |
$47.30
|
| Rate for Payer: UHC Medicare Advantage |
$67.08
|
| Rate for Payer: UHCCP Medicaid |
$47.30
|
| Rate for Payer: VA VA |
$67.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.24
|
|
|
LIOTHYRONINE 5 MCG TABLET
|
Facility
|
OP
|
$270.75
|
|
|
Service Code
|
NDC 70377011412
|
| Hospital Charge Code |
10443
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.73 |
| Max. Negotiated Rate |
$243.68 |
| Rate for Payer: Aetna Commercial |
$230.14
|
| Rate for Payer: Aetna Medicare |
$70.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$84.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$84.61
|
| Rate for Payer: BCBS Complete |
$50.12
|
| Rate for Payer: BCBS MAPPO |
$67.69
|
| Rate for Payer: BCBS Trust/PPO |
$222.58
|
| Rate for Payer: BCN Commercial |
$222.58
|
| Rate for Payer: BCN Medicare Advantage |
$67.69
|
| Rate for Payer: Cash Price |
$216.60
|
| Rate for Payer: Cofinity Commercial |
$232.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.69
|
| Rate for Payer: Healthscope Commercial |
$243.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.06
|
| Rate for Payer: Mclaren Medicaid |
$47.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.07
|
| Rate for Payer: Meridian Medicaid |
$50.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$74.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.14
|
| Rate for Payer: Nomi Health Commercial |
$222.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.06
|
| Rate for Payer: PACE Senior Care Partners |
$64.30
|
| Rate for Payer: PACE SWMI |
$67.69
|
| Rate for Payer: PHP Commercial |
$230.14
|
| Rate for Payer: PHP Medicare Advantage |
$67.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$235.55
|
| Rate for Payer: Priority Health Medicare |
$68.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$188.44
|
| Rate for Payer: Railroad Medicare Medicare |
$67.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.26
|
| Rate for Payer: UHC Core |
$226.08
|
| Rate for Payer: UHC Exchange |
$67.69
|
| Rate for Payer: UHC Medicaid |
$47.73
|
| Rate for Payer: UHC Medicare Advantage |
$67.69
|
| Rate for Payer: UHCCP Medicaid |
$47.73
|
| Rate for Payer: VA VA |
$67.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.06
|
|
|
LIOTHYRONINE 5 MCG TABLET
|
Facility
|
IP
|
$270.75
|
|
|
Service Code
|
NDC 70377011412
|
| Hospital Charge Code |
10443
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.44 |
| Max. Negotiated Rate |
$243.68 |
| Rate for Payer: Aetna Commercial |
$230.14
|
| Rate for Payer: BCBS Trust/PPO |
$223.61
|
| Rate for Payer: BCN Commercial |
$223.61
|
| Rate for Payer: Cash Price |
$216.60
|
| Rate for Payer: Cofinity Commercial |
$232.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.60
|
| Rate for Payer: Healthscope Commercial |
$243.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.14
|
| Rate for Payer: Nomi Health Commercial |
$222.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.06
|
| Rate for Payer: PHP Commercial |
$230.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$235.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$188.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.26
|
| Rate for Payer: UHC Core |
$226.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.06
|
|
|
LIPASE-PROTEASE-AMYLASE (PORK)6,000-19,000-30,000 UNIT CAPSULE,DEL REL
|
Facility
|
OP
|
$933.12
|
|
|
Service Code
|
NDC 00032120601
|
| Hospital Charge Code |
98034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.51 |
| Max. Negotiated Rate |
$839.81 |
| Rate for Payer: Aetna Commercial |
$793.15
|
| Rate for Payer: Aetna Medicare |
$242.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$291.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$291.60
|
| Rate for Payer: BCBS Complete |
$172.72
|
| Rate for Payer: BCBS MAPPO |
$233.28
|
| Rate for Payer: BCBS Trust/PPO |
$767.12
|
| Rate for Payer: BCN Commercial |
$767.12
|
| Rate for Payer: BCN Medicare Advantage |
$233.28
|
| Rate for Payer: Cash Price |
$746.50
|
| Rate for Payer: Cofinity Commercial |
$802.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$746.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.28
|
| Rate for Payer: Healthscope Commercial |
$839.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$699.84
|
| Rate for Payer: Mclaren Medicaid |
$164.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$244.94
|
| Rate for Payer: Meridian Medicaid |
$172.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$268.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$256.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$793.15
|
| Rate for Payer: Nomi Health Commercial |
$765.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$699.84
|
| Rate for Payer: PACE Senior Care Partners |
$221.62
|
| Rate for Payer: PACE SWMI |
$233.28
|
| Rate for Payer: PHP Commercial |
$793.15
|
| Rate for Payer: PHP Medicare Advantage |
$233.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$811.81
|
| Rate for Payer: Priority Health Medicare |
$235.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$649.45
|
| Rate for Payer: Railroad Medicare Medicare |
$233.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$821.15
|
| Rate for Payer: UHC Core |
$779.16
|
| Rate for Payer: UHC Exchange |
$233.28
|
| Rate for Payer: UHC Medicaid |
$164.51
|
| Rate for Payer: UHC Medicare Advantage |
$233.28
|
| Rate for Payer: UHCCP Medicaid |
$164.51
|
| Rate for Payer: VA VA |
$233.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$699.84
|
|
|
LIPASE-PROTEASE-AMYLASE (PORK)6,000-19,000-30,000 UNIT CAPSULE,DEL REL
|
Facility
|
IP
|
$757.76
|
|
|
Service Code
|
NDC 00032004670
|
| Hospital Charge Code |
98034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$527.40 |
| Max. Negotiated Rate |
$681.98 |
| Rate for Payer: Aetna Commercial |
$644.10
|
| Rate for Payer: BCBS Trust/PPO |
$625.83
|
| Rate for Payer: BCN Commercial |
$625.83
|
| Rate for Payer: Cash Price |
$606.21
|
| Rate for Payer: Cofinity Commercial |
$651.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$606.21
|
| Rate for Payer: Healthscope Commercial |
$681.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$568.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$644.10
|
| Rate for Payer: Nomi Health Commercial |
$621.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$568.32
|
| Rate for Payer: PHP Commercial |
$644.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$659.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$527.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$666.83
|
| Rate for Payer: UHC Core |
$632.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$568.32
|
|
|
LIPASE-PROTEASE-AMYLASE (PORK)6,000-19,000-30,000 UNIT CAPSULE,DEL REL
|
Facility
|
OP
|
$757.76
|
|
|
Service Code
|
NDC 00032004670
|
| Hospital Charge Code |
98034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.59 |
| Max. Negotiated Rate |
$681.98 |
| Rate for Payer: Aetna Commercial |
$644.10
|
| Rate for Payer: Aetna Medicare |
$197.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$236.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$236.80
|
| Rate for Payer: BCBS Complete |
$140.26
|
| Rate for Payer: BCBS MAPPO |
$189.44
|
| Rate for Payer: BCBS Trust/PPO |
$622.95
|
| Rate for Payer: BCN Commercial |
$622.95
|
| Rate for Payer: BCN Medicare Advantage |
$189.44
|
| Rate for Payer: Cash Price |
$606.21
|
| Rate for Payer: Cofinity Commercial |
$651.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$606.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.44
|
| Rate for Payer: Healthscope Commercial |
$681.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$568.32
|
| Rate for Payer: Mclaren Medicaid |
$133.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.91
|
| Rate for Payer: Meridian Medicaid |
$140.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$217.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$208.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$644.10
|
| Rate for Payer: Nomi Health Commercial |
$621.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$568.32
|
| Rate for Payer: PACE Senior Care Partners |
$179.97
|
| Rate for Payer: PACE SWMI |
$189.44
|
| Rate for Payer: PHP Commercial |
$644.10
|
| Rate for Payer: PHP Medicare Advantage |
$189.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$133.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$659.25
|
| Rate for Payer: Priority Health Medicare |
$191.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$527.40
|
| Rate for Payer: Railroad Medicare Medicare |
$189.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$666.83
|
| Rate for Payer: UHC Core |
$632.73
|
| Rate for Payer: UHC Exchange |
$189.44
|
| Rate for Payer: UHC Medicaid |
$133.59
|
| Rate for Payer: UHC Medicare Advantage |
$189.44
|
| Rate for Payer: UHCCP Medicaid |
$133.59
|
| Rate for Payer: VA VA |
$189.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$568.32
|
|
|
LIPASE-PROTEASE-AMYLASE (PORK)6,000-19,000-30,000 UNIT CAPSULE,DEL REL
|
Facility
|
IP
|
$933.12
|
|
|
Service Code
|
NDC 00032120601
|
| Hospital Charge Code |
98034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$649.45 |
| Max. Negotiated Rate |
$839.81 |
| Rate for Payer: Aetna Commercial |
$793.15
|
| Rate for Payer: BCBS Trust/PPO |
$770.66
|
| Rate for Payer: BCN Commercial |
$770.66
|
| Rate for Payer: Cash Price |
$746.50
|
| Rate for Payer: Cofinity Commercial |
$802.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$746.50
|
| Rate for Payer: Healthscope Commercial |
$839.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$699.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$793.15
|
| Rate for Payer: Nomi Health Commercial |
$765.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$699.84
|
| Rate for Payer: PHP Commercial |
$793.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$811.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$649.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$821.15
|
| Rate for Payer: UHC Core |
$779.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$699.84
|
|
|
LIPASE-PROTEASE-AMYLAS(PORK)24,000-76,000-120,000 UNIT CAPSULE,DEL REL
|
Facility
|
OP
|
$2,832.72
|
|
|
Service Code
|
NDC 00032122401
|
| Hospital Charge Code |
98036
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$499.41 |
| Max. Negotiated Rate |
$2,549.45 |
| Rate for Payer: Aetna Commercial |
$2,407.81
|
| Rate for Payer: Aetna Medicare |
$736.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$885.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$885.23
|
| Rate for Payer: BCBS Complete |
$524.34
|
| Rate for Payer: BCBS MAPPO |
$708.18
|
| Rate for Payer: BCBS Trust/PPO |
$2,328.78
|
| Rate for Payer: BCN Commercial |
$2,328.78
|
| Rate for Payer: BCN Medicare Advantage |
$708.18
|
| Rate for Payer: Cash Price |
$2,266.18
|
| Rate for Payer: Cofinity Commercial |
$2,436.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,266.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$708.18
|
| Rate for Payer: Healthscope Commercial |
$2,549.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,124.54
|
| Rate for Payer: Mclaren Medicaid |
$499.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$743.59
|
| Rate for Payer: Meridian Medicaid |
$524.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$814.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$779.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,407.81
|
| Rate for Payer: Nomi Health Commercial |
$2,322.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,124.54
|
| Rate for Payer: PACE Senior Care Partners |
$672.77
|
| Rate for Payer: PACE SWMI |
$708.18
|
| Rate for Payer: PHP Commercial |
$2,407.81
|
| Rate for Payer: PHP Medicare Advantage |
$708.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$499.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,464.47
|
| Rate for Payer: Priority Health Medicare |
$715.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,971.57
|
| Rate for Payer: Railroad Medicare Medicare |
$708.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,492.79
|
| Rate for Payer: UHC Core |
$2,365.32
|
| Rate for Payer: UHC Exchange |
$708.18
|
| Rate for Payer: UHC Medicaid |
$499.41
|
| Rate for Payer: UHC Medicare Advantage |
$708.18
|
| Rate for Payer: UHCCP Medicaid |
$499.41
|
| Rate for Payer: VA VA |
$708.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,124.54
|
|
|
LIPASE-PROTEASE-AMYLAS(PORK)24,000-76,000-120,000 UNIT CAPSULE,DEL REL
|
Facility
|
IP
|
$3,002.55
|
|
|
Service Code
|
NDC 00032263601
|
| Hospital Charge Code |
98036
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,089.77 |
| Max. Negotiated Rate |
$2,702.30 |
| Rate for Payer: Aetna Commercial |
$2,552.17
|
| Rate for Payer: BCBS Trust/PPO |
$2,479.81
|
| Rate for Payer: BCN Commercial |
$2,479.81
|
| Rate for Payer: Cash Price |
$2,402.04
|
| Rate for Payer: Cofinity Commercial |
$2,582.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,402.04
|
| Rate for Payer: Healthscope Commercial |
$2,702.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,251.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,552.17
|
| Rate for Payer: Nomi Health Commercial |
$2,462.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,251.91
|
| Rate for Payer: PHP Commercial |
$2,552.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,612.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,089.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,642.24
|
| Rate for Payer: UHC Core |
$2,507.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,251.91
|
|
|
LIPASE-PROTEASE-AMYLAS(PORK)24,000-76,000-120,000 UNIT CAPSULE,DEL REL
|
Facility
|
OP
|
$3,002.55
|
|
|
Service Code
|
NDC 00032263601
|
| Hospital Charge Code |
98036
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$529.35 |
| Max. Negotiated Rate |
$2,702.30 |
| Rate for Payer: Aetna Commercial |
$2,552.17
|
| Rate for Payer: Aetna Medicare |
$780.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$938.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$938.30
|
| Rate for Payer: BCBS Complete |
$555.77
|
| Rate for Payer: BCBS MAPPO |
$750.64
|
| Rate for Payer: BCBS Trust/PPO |
$2,468.40
|
| Rate for Payer: BCN Commercial |
$2,468.40
|
| Rate for Payer: BCN Medicare Advantage |
$750.64
|
| Rate for Payer: Cash Price |
$2,402.04
|
| Rate for Payer: Cofinity Commercial |
$2,582.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,402.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$750.64
|
| Rate for Payer: Healthscope Commercial |
$2,702.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,251.91
|
| Rate for Payer: Mclaren Medicaid |
$529.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$788.17
|
| Rate for Payer: Meridian Medicaid |
$555.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$863.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$825.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,552.17
|
| Rate for Payer: Nomi Health Commercial |
$2,462.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,251.91
|
| Rate for Payer: PACE Senior Care Partners |
$713.11
|
| Rate for Payer: PACE SWMI |
$750.64
|
| Rate for Payer: PHP Commercial |
$2,552.17
|
| Rate for Payer: PHP Medicare Advantage |
$750.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$529.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,612.22
|
| Rate for Payer: Priority Health Medicare |
$758.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,089.77
|
| Rate for Payer: Railroad Medicare Medicare |
$750.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,642.24
|
| Rate for Payer: UHC Core |
$2,507.13
|
| Rate for Payer: UHC Exchange |
$750.64
|
| Rate for Payer: UHC Medicaid |
$529.35
|
| Rate for Payer: UHC Medicare Advantage |
$750.64
|
| Rate for Payer: UHCCP Medicaid |
$529.35
|
| Rate for Payer: VA VA |
$750.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,251.91
|
|
|
LIPASE-PROTEASE-AMYLAS(PORK)24,000-76,000-120,000 UNIT CAPSULE,DEL REL
|
Facility
|
IP
|
$2,832.72
|
|
|
Service Code
|
NDC 00032122401
|
| Hospital Charge Code |
98036
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,971.57 |
| Max. Negotiated Rate |
$2,549.45 |
| Rate for Payer: Aetna Commercial |
$2,407.81
|
| Rate for Payer: BCBS Trust/PPO |
$2,339.54
|
| Rate for Payer: BCN Commercial |
$2,339.54
|
| Rate for Payer: Cash Price |
$2,266.18
|
| Rate for Payer: Cofinity Commercial |
$2,436.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,266.18
|
| Rate for Payer: Healthscope Commercial |
$2,549.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,124.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,407.81
|
| Rate for Payer: Nomi Health Commercial |
$2,322.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,124.54
|
| Rate for Payer: PHP Commercial |
$2,407.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,464.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,971.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,492.79
|
| Rate for Payer: UHC Core |
$2,365.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,124.54
|
|
|
LISINOPRIL 10 MG TABLET
|
Facility
|
OP
|
$112.80
|
|
|
Service Code
|
NDC 00904679861
|
| Hospital Charge Code |
10449
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.89 |
| Max. Negotiated Rate |
$101.52 |
| Rate for Payer: Aetna Commercial |
$95.88
|
| Rate for Payer: Aetna Medicare |
$29.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.25
|
| Rate for Payer: BCBS Complete |
$20.88
|
| Rate for Payer: BCBS MAPPO |
$28.20
|
| Rate for Payer: BCBS Trust/PPO |
$92.73
|
| Rate for Payer: BCN Commercial |
$92.73
|
| Rate for Payer: BCN Medicare Advantage |
$28.20
|
| Rate for Payer: Cash Price |
$90.24
|
| Rate for Payer: Cofinity Commercial |
$97.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.20
|
| Rate for Payer: Healthscope Commercial |
$101.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.60
|
| Rate for Payer: Mclaren Medicaid |
$19.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.61
|
| Rate for Payer: Meridian Medicaid |
$20.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$31.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.88
|
| Rate for Payer: Nomi Health Commercial |
$92.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.60
|
| Rate for Payer: PACE Senior Care Partners |
$26.79
|
| Rate for Payer: PACE SWMI |
$28.20
|
| Rate for Payer: PHP Commercial |
$95.88
|
| Rate for Payer: PHP Medicare Advantage |
$28.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$98.14
|
| Rate for Payer: Priority Health Medicare |
$28.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.51
|
| Rate for Payer: Railroad Medicare Medicare |
$28.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.26
|
| Rate for Payer: UHC Core |
$94.19
|
| Rate for Payer: UHC Exchange |
$28.20
|
| Rate for Payer: UHC Medicaid |
$19.89
|
| Rate for Payer: UHC Medicare Advantage |
$28.20
|
| Rate for Payer: UHCCP Medicaid |
$19.89
|
| Rate for Payer: VA VA |
$28.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.60
|
|
|
LISINOPRIL 10 MG TABLET
|
Facility
|
IP
|
$112.80
|
|
|
Service Code
|
NDC 00904679861
|
| Hospital Charge Code |
10449
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.51 |
| Max. Negotiated Rate |
$101.52 |
| Rate for Payer: Aetna Commercial |
$95.88
|
| Rate for Payer: BCBS Trust/PPO |
$93.16
|
| Rate for Payer: BCN Commercial |
$93.16
|
| Rate for Payer: Cash Price |
$90.24
|
| Rate for Payer: Cofinity Commercial |
$97.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.24
|
| Rate for Payer: Healthscope Commercial |
$101.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.88
|
| Rate for Payer: Nomi Health Commercial |
$92.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.60
|
| Rate for Payer: PHP Commercial |
$95.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$98.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.26
|
| Rate for Payer: UHC Core |
$94.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.60
|
|
|
LISINOPRIL 20 MG TABLET
|
Facility
|
OP
|
$148.05
|
|
|
Service Code
|
NDC 00904679961
|
| Hospital Charge Code |
4526
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.10 |
| Max. Negotiated Rate |
$133.25 |
| Rate for Payer: Aetna Commercial |
$125.84
|
| Rate for Payer: Aetna Medicare |
$38.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.27
|
| Rate for Payer: BCBS Complete |
$27.40
|
| Rate for Payer: BCBS MAPPO |
$37.01
|
| Rate for Payer: BCBS Trust/PPO |
$121.71
|
| Rate for Payer: BCN Commercial |
$121.71
|
| Rate for Payer: BCN Medicare Advantage |
$37.01
|
| Rate for Payer: Cash Price |
$118.44
|
| Rate for Payer: Cofinity Commercial |
$127.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.01
|
| Rate for Payer: Healthscope Commercial |
$133.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.04
|
| Rate for Payer: Mclaren Medicaid |
$26.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.86
|
| Rate for Payer: Meridian Medicaid |
$27.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.84
|
| Rate for Payer: Nomi Health Commercial |
$121.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.04
|
| Rate for Payer: PACE Senior Care Partners |
$35.16
|
| Rate for Payer: PACE SWMI |
$37.01
|
| Rate for Payer: PHP Commercial |
$125.84
|
| Rate for Payer: PHP Medicare Advantage |
$37.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$128.80
|
| Rate for Payer: Priority Health Medicare |
$37.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.04
|
| Rate for Payer: Railroad Medicare Medicare |
$37.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.28
|
| Rate for Payer: UHC Core |
$123.62
|
| Rate for Payer: UHC Exchange |
$37.01
|
| Rate for Payer: UHC Medicaid |
$26.10
|
| Rate for Payer: UHC Medicare Advantage |
$37.01
|
| Rate for Payer: UHCCP Medicaid |
$26.10
|
| Rate for Payer: VA VA |
$37.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.04
|
|
|
LISINOPRIL 20 MG TABLET
|
Facility
|
IP
|
$148.05
|
|
|
Service Code
|
NDC 00904679961
|
| Hospital Charge Code |
4526
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.04 |
| Max. Negotiated Rate |
$133.25 |
| Rate for Payer: Aetna Commercial |
$125.84
|
| Rate for Payer: BCBS Trust/PPO |
$122.27
|
| Rate for Payer: BCN Commercial |
$122.27
|
| Rate for Payer: Cash Price |
$118.44
|
| Rate for Payer: Cofinity Commercial |
$127.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.44
|
| Rate for Payer: Healthscope Commercial |
$133.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.84
|
| Rate for Payer: Nomi Health Commercial |
$121.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.04
|
| Rate for Payer: PHP Commercial |
$125.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$128.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.28
|
| Rate for Payer: UHC Core |
$123.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.04
|
|
