|
LIDOCAINE-TRANSPARENT DRESSING 4 % TOPICAL KIT
|
Facility
|
OP
|
$14.18
|
|
|
Service Code
|
NDC 00496088207
|
| Hospital Charge Code |
30183
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$12.76 |
| Rate for Payer: Aetna Commercial |
$12.05
|
| Rate for Payer: Aetna Medicare |
$3.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.43
|
| Rate for Payer: BCBS Complete |
$5.67
|
| Rate for Payer: BCBS MAPPO |
$3.54
|
| Rate for Payer: BCBS Trust/PPO |
$11.66
|
| Rate for Payer: BCN Commercial |
$11.02
|
| Rate for Payer: BCN Medicare Advantage |
$3.54
|
| Rate for Payer: Cash Price |
$11.34
|
| Rate for Payer: Cofinity Commercial |
$12.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.54
|
| Rate for Payer: Healthscope Commercial |
$12.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.05
|
| Rate for Payer: Nomi Health Commercial |
$11.63
|
| Rate for Payer: PACE Senior Care Partners |
$3.37
|
| Rate for Payer: PACE SWMI |
$3.54
|
| Rate for Payer: PHP Commercial |
$12.05
|
| Rate for Payer: PHP Medicare Advantage |
$3.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.22
|
| Rate for Payer: Priority Health HMO/PPO |
$12.34
|
| Rate for Payer: Priority Health Medicare |
$3.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.50
|
| Rate for Payer: Railroad Medicare Medicare |
$3.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.48
|
| Rate for Payer: UHC Core |
$11.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.54
|
| Rate for Payer: UHC Exchange |
$3.54
|
| Rate for Payer: UHC Medicare Advantage |
$3.54
|
| Rate for Payer: VA VA |
$3.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.64
|
|
|
LIDOCAINE-TRANSPARENT DRESSING 4 % TOPICAL KIT
|
Facility
|
IP
|
$14.18
|
|
|
Service Code
|
NDC 00496088207
|
| Hospital Charge Code |
30183
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.22 |
| Max. Negotiated Rate |
$12.76 |
| Rate for Payer: Aetna Commercial |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$11.58
|
| Rate for Payer: BCN Commercial |
$10.96
|
| Rate for Payer: Cash Price |
$11.34
|
| Rate for Payer: Cofinity Commercial |
$12.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.34
|
| Rate for Payer: Healthscope Commercial |
$12.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.05
|
| Rate for Payer: Nomi Health Commercial |
$11.63
|
| Rate for Payer: PHP Commercial |
$12.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.22
|
| Rate for Payer: Priority Health HMO/PPO |
$12.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.48
|
| Rate for Payer: UHC Core |
$11.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.64
|
|
|
LINAGLIPTIN 5 MG TABLET
|
Facility
|
IP
|
$4,697.89
|
|
|
Service Code
|
NDC 00597014061
|
| Hospital Charge Code |
152649
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,053.63 |
| Max. Negotiated Rate |
$4,228.10 |
| Rate for Payer: Aetna Commercial |
$3,993.21
|
| Rate for Payer: BCBS Trust/PPO |
$3,834.89
|
| Rate for Payer: BCN Commercial |
$3,630.53
|
| Rate for Payer: Cash Price |
$3,758.31
|
| Rate for Payer: Cofinity Commercial |
$4,040.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,758.31
|
| Rate for Payer: Healthscope Commercial |
$4,228.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,523.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,993.21
|
| Rate for Payer: Nomi Health Commercial |
$3,852.27
|
| Rate for Payer: PHP Commercial |
$3,993.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,053.63
|
| Rate for Payer: Priority Health HMO/PPO |
$4,087.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,147.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,134.14
|
| Rate for Payer: UHC Core |
$3,922.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,523.42
|
|
|
LINAGLIPTIN 5 MG TABLET
|
Facility
|
OP
|
$1,409.26
|
|
|
Service Code
|
NDC 00597014030
|
| Hospital Charge Code |
152649
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$334.70 |
| Max. Negotiated Rate |
$1,268.33 |
| Rate for Payer: Aetna Commercial |
$1,197.87
|
| Rate for Payer: Aetna Medicare |
$366.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$440.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$440.39
|
| Rate for Payer: BCBS Complete |
$563.70
|
| Rate for Payer: BCBS MAPPO |
$352.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,158.55
|
| Rate for Payer: BCN Commercial |
$1,095.70
|
| Rate for Payer: BCN Medicare Advantage |
$352.32
|
| Rate for Payer: Cash Price |
$1,127.41
|
| Rate for Payer: Cofinity Commercial |
$1,211.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,127.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$352.32
|
| Rate for Payer: Healthscope Commercial |
$1,268.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,056.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$369.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$405.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,197.87
|
| Rate for Payer: Nomi Health Commercial |
$1,155.59
|
| Rate for Payer: PACE Senior Care Partners |
$334.70
|
| Rate for Payer: PACE SWMI |
$352.32
|
| Rate for Payer: PHP Commercial |
$1,197.87
|
| Rate for Payer: PHP Medicare Advantage |
$352.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$916.02
|
| Rate for Payer: Priority Health HMO/PPO |
$1,226.06
|
| Rate for Payer: Priority Health Medicare |
$355.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$944.20
|
| Rate for Payer: Railroad Medicare Medicare |
$352.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,240.15
|
| Rate for Payer: UHC Core |
$1,176.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$352.32
|
| Rate for Payer: UHC Exchange |
$352.32
|
| Rate for Payer: UHC Medicare Advantage |
$352.32
|
| Rate for Payer: VA VA |
$352.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,056.94
|
|
|
LINAGLIPTIN 5 MG TABLET
|
Facility
|
IP
|
$1,409.26
|
|
|
Service Code
|
NDC 00597014030
|
| Hospital Charge Code |
152649
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$916.02 |
| Max. Negotiated Rate |
$1,268.33 |
| Rate for Payer: Aetna Commercial |
$1,197.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,150.38
|
| Rate for Payer: BCN Commercial |
$1,089.08
|
| Rate for Payer: Cash Price |
$1,127.41
|
| Rate for Payer: Cofinity Commercial |
$1,211.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,127.41
|
| Rate for Payer: Healthscope Commercial |
$1,268.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,056.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,197.87
|
| Rate for Payer: Nomi Health Commercial |
$1,155.59
|
| Rate for Payer: PHP Commercial |
$1,197.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$916.02
|
| Rate for Payer: Priority Health HMO/PPO |
$1,226.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$944.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,240.15
|
| Rate for Payer: UHC Core |
$1,176.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,056.94
|
|
|
LINAGLIPTIN 5 MG TABLET
|
Facility
|
OP
|
$4,697.89
|
|
|
Service Code
|
NDC 00597014061
|
| Hospital Charge Code |
152649
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,115.75 |
| Max. Negotiated Rate |
$4,228.10 |
| Rate for Payer: Aetna Commercial |
$3,993.21
|
| Rate for Payer: Aetna Medicare |
$1,221.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,468.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,468.09
|
| Rate for Payer: BCBS Complete |
$1,879.16
|
| Rate for Payer: BCBS MAPPO |
$1,174.47
|
| Rate for Payer: BCBS Trust/PPO |
$3,862.14
|
| Rate for Payer: BCN Commercial |
$3,652.61
|
| Rate for Payer: BCN Medicare Advantage |
$1,174.47
|
| Rate for Payer: Cash Price |
$3,758.31
|
| Rate for Payer: Cofinity Commercial |
$4,040.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,758.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,174.47
|
| Rate for Payer: Healthscope Commercial |
$4,228.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,523.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,233.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,350.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,993.21
|
| Rate for Payer: Nomi Health Commercial |
$3,852.27
|
| Rate for Payer: PACE Senior Care Partners |
$1,115.75
|
| Rate for Payer: PACE SWMI |
$1,174.47
|
| Rate for Payer: PHP Commercial |
$3,993.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,174.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,053.63
|
| Rate for Payer: Priority Health HMO/PPO |
$4,087.16
|
| Rate for Payer: Priority Health Medicare |
$1,186.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,147.59
|
| Rate for Payer: Railroad Medicare Medicare |
$1,174.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,134.14
|
| Rate for Payer: UHC Core |
$3,922.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,174.47
|
| Rate for Payer: UHC Exchange |
$1,174.47
|
| Rate for Payer: UHC Medicare Advantage |
$1,174.47
|
| Rate for Payer: VA VA |
$1,174.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,523.42
|
|
|
LINEZOLID 600 MG TABLET
|
Facility
|
OP
|
$275.40
|
|
|
Service Code
|
NDC 00904655304
|
| Hospital Charge Code |
28224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.41 |
| Max. Negotiated Rate |
$247.86 |
| Rate for Payer: Aetna Commercial |
$234.09
|
| Rate for Payer: Aetna Medicare |
$71.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.06
|
| Rate for Payer: BCBS Complete |
$110.16
|
| Rate for Payer: BCBS MAPPO |
$68.85
|
| Rate for Payer: BCBS Trust/PPO |
$226.41
|
| Rate for Payer: BCN Commercial |
$214.12
|
| Rate for Payer: BCN Medicare Advantage |
$68.85
|
| Rate for Payer: Cash Price |
$220.32
|
| Rate for Payer: Cofinity Commercial |
$236.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.85
|
| Rate for Payer: Healthscope Commercial |
$247.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.09
|
| Rate for Payer: Nomi Health Commercial |
$225.83
|
| Rate for Payer: PACE Senior Care Partners |
$65.41
|
| Rate for Payer: PACE SWMI |
$68.85
|
| Rate for Payer: PHP Commercial |
$234.09
|
| Rate for Payer: PHP Medicare Advantage |
$68.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.01
|
| Rate for Payer: Priority Health HMO/PPO |
$239.60
|
| Rate for Payer: Priority Health Medicare |
$69.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.52
|
| Rate for Payer: Railroad Medicare Medicare |
$68.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.35
|
| Rate for Payer: UHC Core |
$229.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.85
|
| Rate for Payer: UHC Exchange |
$68.85
|
| Rate for Payer: UHC Medicare Advantage |
$68.85
|
| Rate for Payer: VA VA |
$68.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.55
|
|
|
LINEZOLID 600 MG TABLET
|
Facility
|
IP
|
$169.92
|
|
|
Service Code
|
NDC 67877041920
|
| Hospital Charge Code |
28224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.45 |
| Max. Negotiated Rate |
$152.93 |
| Rate for Payer: Aetna Commercial |
$144.43
|
| Rate for Payer: BCBS Trust/PPO |
$138.71
|
| Rate for Payer: BCN Commercial |
$131.31
|
| Rate for Payer: Cash Price |
$135.94
|
| Rate for Payer: Cofinity Commercial |
$146.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.94
|
| Rate for Payer: Healthscope Commercial |
$152.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.43
|
| Rate for Payer: Nomi Health Commercial |
$139.33
|
| Rate for Payer: PHP Commercial |
$144.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.45
|
| Rate for Payer: Priority Health HMO/PPO |
$147.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$113.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.53
|
| Rate for Payer: UHC Core |
$141.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.44
|
|
|
LINEZOLID 600 MG TABLET
|
Facility
|
OP
|
$169.92
|
|
|
Service Code
|
NDC 67877041920
|
| Hospital Charge Code |
28224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.36 |
| Max. Negotiated Rate |
$152.93 |
| Rate for Payer: Aetna Commercial |
$144.43
|
| Rate for Payer: Aetna Medicare |
$44.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.10
|
| Rate for Payer: BCBS Complete |
$67.97
|
| Rate for Payer: BCBS MAPPO |
$42.48
|
| Rate for Payer: BCBS Trust/PPO |
$139.69
|
| Rate for Payer: BCN Commercial |
$132.11
|
| Rate for Payer: BCN Medicare Advantage |
$42.48
|
| Rate for Payer: Cash Price |
$135.94
|
| Rate for Payer: Cofinity Commercial |
$146.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.48
|
| Rate for Payer: Healthscope Commercial |
$152.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.43
|
| Rate for Payer: Nomi Health Commercial |
$139.33
|
| Rate for Payer: PACE Senior Care Partners |
$40.36
|
| Rate for Payer: PACE SWMI |
$42.48
|
| Rate for Payer: PHP Commercial |
$144.43
|
| Rate for Payer: PHP Medicare Advantage |
$42.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.45
|
| Rate for Payer: Priority Health HMO/PPO |
$147.83
|
| Rate for Payer: Priority Health Medicare |
$42.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$113.85
|
| Rate for Payer: Railroad Medicare Medicare |
$42.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.53
|
| Rate for Payer: UHC Core |
$141.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.48
|
| Rate for Payer: UHC Exchange |
$42.48
|
| Rate for Payer: UHC Medicare Advantage |
$42.48
|
| Rate for Payer: VA VA |
$42.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.44
|
|
|
LINEZOLID 600 MG TABLET
|
Facility
|
IP
|
$275.40
|
|
|
Service Code
|
NDC 00904655304
|
| Hospital Charge Code |
28224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.01 |
| Max. Negotiated Rate |
$247.86 |
| Rate for Payer: Aetna Commercial |
$234.09
|
| Rate for Payer: BCBS Trust/PPO |
$224.81
|
| Rate for Payer: BCN Commercial |
$212.83
|
| Rate for Payer: Cash Price |
$220.32
|
| Rate for Payer: Cofinity Commercial |
$236.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.32
|
| Rate for Payer: Healthscope Commercial |
$247.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.09
|
| Rate for Payer: Nomi Health Commercial |
$225.83
|
| Rate for Payer: PHP Commercial |
$234.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.01
|
| Rate for Payer: Priority Health HMO/PPO |
$239.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.35
|
| Rate for Payer: UHC Core |
$229.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.55
|
|
|
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 |
$33.06 |
| Max. Negotiated Rate |
$125.28 |
| Rate for Payer: Aetna Commercial |
$118.32
|
| Rate for Payer: Aetna Medicare |
$36.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.50
|
| Rate for Payer: BCBS Complete |
$55.68
|
| Rate for Payer: BCBS MAPPO |
$34.80
|
| Rate for Payer: BCBS Trust/PPO |
$114.44
|
| Rate for Payer: BCN Commercial |
$108.23
|
| Rate for Payer: BCN Medicare Advantage |
$34.80
|
| Rate for Payer: Cash Price |
$111.36
|
| Rate for Payer: Cofinity Commercial |
$119.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.80
|
| Rate for Payer: Healthscope Commercial |
$125.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.32
|
| Rate for Payer: Nomi Health Commercial |
$114.14
|
| Rate for Payer: PACE Senior Care Partners |
$33.06
|
| Rate for Payer: PACE SWMI |
$34.80
|
| Rate for Payer: PHP Commercial |
$118.32
|
| Rate for Payer: PHP Medicare Advantage |
$34.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.48
|
| Rate for Payer: Priority Health HMO/PPO |
$121.10
|
| Rate for Payer: Priority Health Medicare |
$35.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.26
|
| Rate for Payer: Railroad Medicare Medicare |
$34.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.50
|
| Rate for Payer: UHC Core |
$116.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.80
|
| Rate for Payer: UHC Exchange |
$34.80
|
| Rate for Payer: UHC Medicare Advantage |
$34.80
|
| Rate for Payer: VA VA |
$34.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.40
|
|
|
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 |
$90.48 |
| Max. Negotiated Rate |
$125.28 |
| Rate for Payer: Aetna Commercial |
$118.32
|
| Rate for Payer: BCBS Trust/PPO |
$113.63
|
| Rate for Payer: BCN Commercial |
$107.57
|
| Rate for Payer: Cash Price |
$111.36
|
| Rate for Payer: Cofinity Commercial |
$119.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.36
|
| Rate for Payer: Healthscope Commercial |
$125.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.32
|
| Rate for Payer: Nomi Health Commercial |
$114.14
|
| Rate for Payer: PHP Commercial |
$118.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.48
|
| Rate for Payer: Priority Health HMO/PPO |
$121.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.50
|
| Rate for Payer: UHC Core |
$116.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.40
|
|
|
LIPASE-PROTEASE-AMYLASE 24,000-76,000-120,000 UNIT CAPSULE,DELAYED REL
|
Facility
|
IP
|
$2,832.72
|
|
|
Service Code
|
NDC 00032122401
|
| Hospital Charge Code |
98036
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,841.27 |
| Max. Negotiated Rate |
$2,549.45 |
| Rate for Payer: Aetna Commercial |
$2,407.81
|
| Rate for Payer: BCBS Trust/PPO |
$2,312.35
|
| Rate for Payer: BCN Commercial |
$2,189.13
|
| 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: PHP Commercial |
$2,407.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,841.27
|
| Rate for Payer: Priority Health HMO/PPO |
$2,464.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,897.92
|
| 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
|
|
|
LIPASE-PROTEASE-AMYLASE 24,000-76,000-120,000 UNIT CAPSULE,DELAYED REL
|
Facility
|
OP
|
$2,832.72
|
|
|
Service Code
|
NDC 00032122401
|
| Hospital Charge Code |
98036
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$672.77 |
| 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 |
$885.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$885.22
|
| Rate for Payer: BCBS Complete |
$1,133.09
|
| Rate for Payer: BCBS MAPPO |
$708.18
|
| Rate for Payer: BCBS Trust/PPO |
$2,328.78
|
| Rate for Payer: BCN Commercial |
$2,202.44
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$743.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$814.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,407.81
|
| Rate for Payer: Nomi Health Commercial |
$2,322.83
|
| 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 Cigna Priority Health |
$1,841.27
|
| Rate for Payer: Priority Health HMO/PPO |
$2,464.47
|
| Rate for Payer: Priority Health Medicare |
$715.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,897.92
|
| 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 Dual Complete DSNP |
$708.18
|
| Rate for Payer: UHC Exchange |
$708.18
|
| Rate for Payer: UHC Medicare Advantage |
$708.18
|
| Rate for Payer: VA VA |
$708.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,124.54
|
|
|
LIPASE-PROTEASE-AMYLASE 24,000-76,000-120,000 UNIT CAPSULE,DELAYED REL
|
Facility
|
OP
|
$2,926.33
|
|
|
Service Code
|
NDC 00032263601
|
| Hospital Charge Code |
98036
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$695.00 |
| Max. Negotiated Rate |
$2,633.70 |
| Rate for Payer: Aetna Commercial |
$2,487.38
|
| Rate for Payer: Aetna Medicare |
$760.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$914.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$914.48
|
| Rate for Payer: BCBS Complete |
$1,170.53
|
| Rate for Payer: BCBS MAPPO |
$731.58
|
| Rate for Payer: BCBS Trust/PPO |
$2,405.74
|
| Rate for Payer: BCN Commercial |
$2,275.22
|
| Rate for Payer: BCN Medicare Advantage |
$731.58
|
| Rate for Payer: Cash Price |
$2,341.06
|
| Rate for Payer: Cofinity Commercial |
$2,516.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,341.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$731.58
|
| Rate for Payer: Healthscope Commercial |
$2,633.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,194.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$768.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$841.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,487.38
|
| Rate for Payer: Nomi Health Commercial |
$2,399.59
|
| Rate for Payer: PACE Senior Care Partners |
$695.00
|
| Rate for Payer: PACE SWMI |
$731.58
|
| Rate for Payer: PHP Commercial |
$2,487.38
|
| Rate for Payer: PHP Medicare Advantage |
$731.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,902.11
|
| Rate for Payer: Priority Health HMO/PPO |
$2,545.91
|
| Rate for Payer: Priority Health Medicare |
$738.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,960.64
|
| Rate for Payer: Railroad Medicare Medicare |
$731.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,575.17
|
| Rate for Payer: UHC Core |
$2,443.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$731.58
|
| Rate for Payer: UHC Exchange |
$731.58
|
| Rate for Payer: UHC Medicare Advantage |
$731.58
|
| Rate for Payer: VA VA |
$731.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,194.75
|
|
|
LIPASE-PROTEASE-AMYLASE 24,000-76,000-120,000 UNIT CAPSULE,DELAYED REL
|
Facility
|
IP
|
$2,926.33
|
|
|
Service Code
|
NDC 00032263601
|
| Hospital Charge Code |
98036
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,902.11 |
| Max. Negotiated Rate |
$2,633.70 |
| Rate for Payer: Aetna Commercial |
$2,487.38
|
| Rate for Payer: BCBS Trust/PPO |
$2,388.76
|
| Rate for Payer: BCN Commercial |
$2,261.47
|
| Rate for Payer: Cash Price |
$2,341.06
|
| Rate for Payer: Cofinity Commercial |
$2,516.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,341.06
|
| Rate for Payer: Healthscope Commercial |
$2,633.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,194.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,487.38
|
| Rate for Payer: Nomi Health Commercial |
$2,399.59
|
| Rate for Payer: PHP Commercial |
$2,487.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,902.11
|
| Rate for Payer: Priority Health HMO/PPO |
$2,545.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,960.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,575.17
|
| Rate for Payer: UHC Core |
$2,443.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,194.75
|
|
|
LIPASE-PROTEASE-AMYLASE 3,000-9,500-15,000 UNIT CAPSULE, DELAYED REL
|
Facility
|
OP
|
$549.36
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
153195
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$130.47 |
| Max. Negotiated Rate |
$494.42 |
| Rate for Payer: Aetna Commercial |
$466.96
|
| Rate for Payer: Aetna Medicare |
$142.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$171.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$171.68
|
| Rate for Payer: BCBS Complete |
$219.74
|
| Rate for Payer: BCBS MAPPO |
$137.34
|
| Rate for Payer: BCBS Trust/PPO |
$451.63
|
| Rate for Payer: BCN Commercial |
$427.13
|
| Rate for Payer: BCN Medicare Advantage |
$137.34
|
| Rate for Payer: Cash Price |
$439.49
|
| Rate for Payer: Cofinity Commercial |
$472.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$439.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.34
|
| Rate for Payer: Healthscope Commercial |
$494.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$412.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$157.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$466.96
|
| Rate for Payer: Nomi Health Commercial |
$450.48
|
| Rate for Payer: PACE Senior Care Partners |
$130.47
|
| Rate for Payer: PACE SWMI |
$137.34
|
| Rate for Payer: PHP Commercial |
$466.96
|
| Rate for Payer: PHP Medicare Advantage |
$137.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.08
|
| Rate for Payer: Priority Health HMO/PPO |
$477.94
|
| Rate for Payer: Priority Health Medicare |
$138.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$368.07
|
| Rate for Payer: Railroad Medicare Medicare |
$137.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$483.44
|
| Rate for Payer: UHC Core |
$458.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.34
|
| Rate for Payer: UHC Exchange |
$137.34
|
| Rate for Payer: UHC Medicare Advantage |
$137.34
|
| Rate for Payer: VA VA |
$137.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$412.02
|
|
|
LIPASE-PROTEASE-AMYLASE 3,000-9,500-15,000 UNIT CAPSULE, DELAYED REL
|
Facility
|
IP
|
$549.36
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
153195
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$357.08 |
| Max. Negotiated Rate |
$494.42 |
| Rate for Payer: Aetna Commercial |
$466.96
|
| Rate for Payer: BCBS Trust/PPO |
$448.44
|
| Rate for Payer: BCN Commercial |
$424.55
|
| Rate for Payer: Cash Price |
$439.49
|
| Rate for Payer: Cofinity Commercial |
$472.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$439.49
|
| Rate for Payer: Healthscope Commercial |
$494.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$412.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$466.96
|
| Rate for Payer: Nomi Health Commercial |
$450.48
|
| Rate for Payer: PHP Commercial |
$466.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.08
|
| Rate for Payer: Priority Health HMO/PPO |
$477.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$368.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$483.44
|
| Rate for Payer: UHC Core |
$458.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$412.02
|
|
|
LIPASE-PROTEASE-AMYLASE 6,000-19,000-30,000 UNIT CAPSULE,DELAYED REL
|
Facility
|
OP
|
$933.12
|
|
|
Service Code
|
NDC 00032120601
|
| Hospital Charge Code |
98034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$221.62 |
| 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 |
$373.25
|
| Rate for Payer: BCBS MAPPO |
$233.28
|
| Rate for Payer: BCBS Trust/PPO |
$767.12
|
| Rate for Payer: BCN Commercial |
$725.50
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$244.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$268.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$793.15
|
| Rate for Payer: Nomi Health Commercial |
$765.16
|
| 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 Cigna Priority Health |
$606.53
|
| Rate for Payer: Priority Health HMO/PPO |
$811.81
|
| Rate for Payer: Priority Health Medicare |
$235.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$625.19
|
| 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 Dual Complete DSNP |
$233.28
|
| Rate for Payer: UHC Exchange |
$233.28
|
| Rate for Payer: UHC Medicare Advantage |
$233.28
|
| Rate for Payer: VA VA |
$233.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$699.84
|
|
|
LIPASE-PROTEASE-AMYLASE 6,000-19,000-30,000 UNIT CAPSULE,DELAYED REL
|
Facility
|
OP
|
$958.08
|
|
|
Service Code
|
NDC 00032004670
|
| Hospital Charge Code |
98034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$227.54 |
| Max. Negotiated Rate |
$862.27 |
| Rate for Payer: Aetna Commercial |
$814.37
|
| Rate for Payer: Aetna Medicare |
$249.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$299.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$299.40
|
| Rate for Payer: BCBS Complete |
$383.23
|
| Rate for Payer: BCBS MAPPO |
$239.52
|
| Rate for Payer: BCBS Trust/PPO |
$787.64
|
| Rate for Payer: BCN Commercial |
$744.91
|
| Rate for Payer: BCN Medicare Advantage |
$239.52
|
| Rate for Payer: Cash Price |
$766.46
|
| Rate for Payer: Cofinity Commercial |
$823.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$766.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$239.52
|
| Rate for Payer: Healthscope Commercial |
$862.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$718.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$251.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$275.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$814.37
|
| Rate for Payer: Nomi Health Commercial |
$785.63
|
| Rate for Payer: PACE Senior Care Partners |
$227.54
|
| Rate for Payer: PACE SWMI |
$239.52
|
| Rate for Payer: PHP Commercial |
$814.37
|
| Rate for Payer: PHP Medicare Advantage |
$239.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$622.75
|
| Rate for Payer: Priority Health HMO/PPO |
$833.53
|
| Rate for Payer: Priority Health Medicare |
$241.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$641.91
|
| Rate for Payer: Railroad Medicare Medicare |
$239.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$843.11
|
| Rate for Payer: UHC Core |
$800.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$239.52
|
| Rate for Payer: UHC Exchange |
$239.52
|
| Rate for Payer: UHC Medicare Advantage |
$239.52
|
| Rate for Payer: VA VA |
$239.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$718.56
|
|
|
LIPASE-PROTEASE-AMYLASE 6,000-19,000-30,000 UNIT CAPSULE,DELAYED REL
|
Facility
|
IP
|
$958.08
|
|
|
Service Code
|
NDC 00032004670
|
| Hospital Charge Code |
98034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$622.75 |
| Max. Negotiated Rate |
$862.27 |
| Rate for Payer: Aetna Commercial |
$814.37
|
| Rate for Payer: BCBS Trust/PPO |
$782.08
|
| Rate for Payer: BCN Commercial |
$740.40
|
| Rate for Payer: Cash Price |
$766.46
|
| Rate for Payer: Cofinity Commercial |
$823.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$766.46
|
| Rate for Payer: Healthscope Commercial |
$862.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$718.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$814.37
|
| Rate for Payer: Nomi Health Commercial |
$785.63
|
| Rate for Payer: PHP Commercial |
$814.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$622.75
|
| Rate for Payer: Priority Health HMO/PPO |
$833.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$641.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$843.11
|
| Rate for Payer: UHC Core |
$800.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$718.56
|
|
|
LIPASE-PROTEASE-AMYLASE 6,000-19,000-30,000 UNIT CAPSULE,DELAYED REL
|
Facility
|
IP
|
$933.12
|
|
|
Service Code
|
NDC 00032120601
|
| Hospital Charge Code |
98034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$606.53 |
| Max. Negotiated Rate |
$839.81 |
| Rate for Payer: Aetna Commercial |
$793.15
|
| Rate for Payer: BCBS Trust/PPO |
$761.71
|
| Rate for Payer: BCN Commercial |
$721.12
|
| 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: PHP Commercial |
$793.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$606.53
|
| Rate for Payer: Priority Health HMO/PPO |
$811.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$625.19
|
| 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
|
|
|
LISINOPRIL 10 MG TABLET
|
Facility
|
IP
|
$110.45
|
|
|
Service Code
|
NDC 00904679861
|
| Hospital Charge Code |
10449
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.79 |
| Max. Negotiated Rate |
$99.40 |
| Rate for Payer: Aetna Commercial |
$93.88
|
| Rate for Payer: BCBS Trust/PPO |
$90.16
|
| Rate for Payer: BCN Commercial |
$85.36
|
| Rate for Payer: Cash Price |
$88.36
|
| Rate for Payer: Cofinity Commercial |
$94.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.36
|
| Rate for Payer: Healthscope Commercial |
$99.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.88
|
| Rate for Payer: Nomi Health Commercial |
$90.57
|
| Rate for Payer: PHP Commercial |
$93.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.79
|
| Rate for Payer: Priority Health HMO/PPO |
$96.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.20
|
| Rate for Payer: UHC Core |
$92.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.84
|
|
|
LISINOPRIL 10 MG TABLET
|
Facility
|
OP
|
$110.45
|
|
|
Service Code
|
NDC 00904679861
|
| Hospital Charge Code |
10449
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.23 |
| Max. Negotiated Rate |
$99.40 |
| Rate for Payer: Aetna Commercial |
$93.88
|
| Rate for Payer: Aetna Medicare |
$28.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.52
|
| Rate for Payer: BCBS Complete |
$44.18
|
| Rate for Payer: BCBS MAPPO |
$27.61
|
| Rate for Payer: BCBS Trust/PPO |
$90.80
|
| Rate for Payer: BCN Commercial |
$85.87
|
| Rate for Payer: BCN Medicare Advantage |
$27.61
|
| Rate for Payer: Cash Price |
$88.36
|
| Rate for Payer: Cofinity Commercial |
$94.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.61
|
| Rate for Payer: Healthscope Commercial |
$99.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.88
|
| Rate for Payer: Nomi Health Commercial |
$90.57
|
| Rate for Payer: PACE Senior Care Partners |
$26.23
|
| Rate for Payer: PACE SWMI |
$27.61
|
| Rate for Payer: PHP Commercial |
$93.88
|
| Rate for Payer: PHP Medicare Advantage |
$27.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.79
|
| Rate for Payer: Priority Health HMO/PPO |
$96.09
|
| Rate for Payer: Priority Health Medicare |
$27.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.00
|
| Rate for Payer: Railroad Medicare Medicare |
$27.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.20
|
| Rate for Payer: UHC Core |
$92.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.61
|
| Rate for Payer: UHC Exchange |
$27.61
|
| Rate for Payer: UHC Medicare Advantage |
$27.61
|
| Rate for Payer: VA VA |
$27.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.84
|
|
|
LISINOPRIL 20 MG TABLET
|
Facility
|
IP
|
$148.05
|
|
|
Service Code
|
NDC 00904679961
|
| Hospital Charge Code |
4526
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.23 |
| Max. Negotiated Rate |
$133.24 |
| Rate for Payer: Aetna Commercial |
$125.84
|
| Rate for Payer: BCBS Trust/PPO |
$120.85
|
| Rate for Payer: BCN Commercial |
$114.41
|
| 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 |
$133.24
|
| 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: PHP Commercial |
$125.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.23
|
| Rate for Payer: Priority Health HMO/PPO |
$128.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.19
|
| 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
|
|
