|
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 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
|
|
|
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
|
|
|
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 |
$885.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$885.23
|
| 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
|
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 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 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
|
|
|
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
|
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
|
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
|
|
|
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 |
$99.41 |
| 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 |
$99.41
|
| 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 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 |
$99.41 |
| 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 |
$99.41
|
| 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 20 MG TABLET
|
Facility
|
OP
|
$2.68
|
|
|
Service Code
|
NDC 60687033311
|
| Hospital Charge Code |
4526
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: Aetna Medicare |
$0.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.84
|
| Rate for Payer: BCBS Complete |
$1.07
|
| Rate for Payer: BCBS MAPPO |
$0.67
|
| Rate for Payer: BCBS Trust/PPO |
$2.20
|
| Rate for Payer: BCN Commercial |
$2.08
|
| Rate for Payer: BCN Medicare Advantage |
$0.67
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.67
|
| Rate for Payer: Healthscope Commercial |
$2.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.28
|
| Rate for Payer: Nomi Health Commercial |
$2.20
|
| Rate for Payer: PACE Senior Care Partners |
$0.64
|
| Rate for Payer: PACE SWMI |
$0.67
|
| Rate for Payer: PHP Commercial |
$2.28
|
| Rate for Payer: PHP Medicare Advantage |
$0.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.74
|
| Rate for Payer: Priority Health HMO/PPO |
$2.33
|
| Rate for Payer: Priority Health Medicare |
$0.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.80
|
| Rate for Payer: Railroad Medicare Medicare |
$0.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.36
|
| Rate for Payer: UHC Core |
$2.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.67
|
| Rate for Payer: UHC Exchange |
$0.67
|
| Rate for Payer: UHC Medicare Advantage |
$0.67
|
| Rate for Payer: VA VA |
$0.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.01
|
|
|
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 |
$133.25 |
| 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 |
$133.25
|
| 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: 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
|
|
|
LISINOPRIL 20 MG TABLET
|
Facility
|
IP
|
$267.90
|
|
|
Service Code
|
NDC 60687033301
|
| Hospital Charge Code |
4526
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.13 |
| Max. Negotiated Rate |
$241.11 |
| Rate for Payer: Aetna Commercial |
$227.72
|
| Rate for Payer: BCBS Trust/PPO |
$218.69
|
| Rate for Payer: BCN Commercial |
$207.03
|
| Rate for Payer: Cash Price |
$214.32
|
| Rate for Payer: Cofinity Commercial |
$230.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.32
|
| Rate for Payer: Healthscope Commercial |
$241.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.72
|
| Rate for Payer: Nomi Health Commercial |
$219.68
|
| Rate for Payer: PHP Commercial |
$227.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.13
|
| Rate for Payer: Priority Health HMO/PPO |
$233.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.75
|
| Rate for Payer: UHC Core |
$223.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.93
|
|
|
LISINOPRIL 20 MG TABLET
|
Facility
|
OP
|
$148.05
|
|
|
Service Code
|
NDC 00904679961
|
| Hospital Charge Code |
4526
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.16 |
| 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 |
$59.22
|
| Rate for Payer: BCBS MAPPO |
$37.01
|
| Rate for Payer: BCBS Trust/PPO |
$121.71
|
| Rate for Payer: BCN Commercial |
$115.11
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.84
|
| Rate for Payer: Nomi Health Commercial |
$121.40
|
| 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 Cigna Priority Health |
$96.23
|
| Rate for Payer: Priority Health HMO/PPO |
$128.80
|
| Rate for Payer: Priority Health Medicare |
$37.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.19
|
| 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 Dual Complete DSNP |
$37.01
|
| Rate for Payer: UHC Exchange |
$37.01
|
| Rate for Payer: UHC Medicare Advantage |
$37.01
|
| Rate for Payer: VA VA |
$37.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.04
|
|
|
LISINOPRIL 20 MG TABLET
|
Facility
|
IP
|
$2.68
|
|
|
Service Code
|
NDC 60687033311
|
| Hospital Charge Code |
4526
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: BCBS Trust/PPO |
$2.19
|
| Rate for Payer: BCN Commercial |
$2.07
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Healthscope Commercial |
$2.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.28
|
| Rate for Payer: Nomi Health Commercial |
$2.20
|
| Rate for Payer: PHP Commercial |
$2.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.74
|
| Rate for Payer: Priority Health HMO/PPO |
$2.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.36
|
| Rate for Payer: UHC Core |
$2.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.01
|
|
|
LISINOPRIL 20 MG TABLET
|
Facility
|
OP
|
$267.90
|
|
|
Service Code
|
NDC 60687033301
|
| Hospital Charge Code |
4526
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.63 |
| Max. Negotiated Rate |
$241.11 |
| Rate for Payer: Aetna Commercial |
$227.72
|
| Rate for Payer: Aetna Medicare |
$69.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$83.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$83.72
|
| Rate for Payer: BCBS Complete |
$107.16
|
| Rate for Payer: BCBS MAPPO |
$66.97
|
| Rate for Payer: BCBS Trust/PPO |
$220.24
|
| Rate for Payer: BCN Commercial |
$208.29
|
| Rate for Payer: BCN Medicare Advantage |
$66.97
|
| Rate for Payer: Cash Price |
$214.32
|
| Rate for Payer: Cofinity Commercial |
$230.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.97
|
| Rate for Payer: Healthscope Commercial |
$241.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.72
|
| Rate for Payer: Nomi Health Commercial |
$219.68
|
| Rate for Payer: PACE Senior Care Partners |
$63.63
|
| Rate for Payer: PACE SWMI |
$66.97
|
| Rate for Payer: PHP Commercial |
$227.72
|
| Rate for Payer: PHP Medicare Advantage |
$66.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.13
|
| Rate for Payer: Priority Health HMO/PPO |
$233.07
|
| Rate for Payer: Priority Health Medicare |
$67.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.49
|
| Rate for Payer: Railroad Medicare Medicare |
$66.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.75
|
| Rate for Payer: UHC Core |
$223.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.97
|
| Rate for Payer: UHC Exchange |
$66.97
|
| Rate for Payer: UHC Medicare Advantage |
$66.97
|
| Rate for Payer: VA VA |
$66.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.93
|
|
|
LISINOPRIL 2.5 MG TABLET
|
Facility
|
OP
|
$30.55
|
|
|
Service Code
|
NDC 68180051201
|
| Hospital Charge Code |
13089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.26 |
| Max. Negotiated Rate |
$27.50 |
| Rate for Payer: Aetna Commercial |
$25.97
|
| Rate for Payer: Aetna Medicare |
$7.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.55
|
| Rate for Payer: BCBS Complete |
$12.22
|
| Rate for Payer: BCBS MAPPO |
$7.64
|
| Rate for Payer: BCBS Trust/PPO |
$25.12
|
| Rate for Payer: BCN Commercial |
$23.75
|
| Rate for Payer: BCN Medicare Advantage |
$7.64
|
| Rate for Payer: Cash Price |
$24.44
|
| Rate for Payer: Cofinity Commercial |
$26.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.64
|
| Rate for Payer: Healthscope Commercial |
$27.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.97
|
| Rate for Payer: Nomi Health Commercial |
$25.05
|
| Rate for Payer: PACE Senior Care Partners |
$7.26
|
| Rate for Payer: PACE SWMI |
$7.64
|
| Rate for Payer: PHP Commercial |
$25.97
|
| Rate for Payer: PHP Medicare Advantage |
$7.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.86
|
| Rate for Payer: Priority Health HMO/PPO |
$26.58
|
| Rate for Payer: Priority Health Medicare |
$7.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.47
|
| Rate for Payer: Railroad Medicare Medicare |
$7.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.88
|
| Rate for Payer: UHC Core |
$25.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.64
|
| Rate for Payer: UHC Exchange |
$7.64
|
| Rate for Payer: UHC Medicare Advantage |
$7.64
|
| Rate for Payer: VA VA |
$7.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.91
|
|
|
LISINOPRIL 2.5 MG TABLET
|
Facility
|
IP
|
$30.55
|
|
|
Service Code
|
NDC 68180051201
|
| Hospital Charge Code |
13089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.86 |
| Max. Negotiated Rate |
$27.50 |
| Rate for Payer: Aetna Commercial |
$25.97
|
| Rate for Payer: BCBS Trust/PPO |
$24.94
|
| Rate for Payer: BCN Commercial |
$23.61
|
| Rate for Payer: Cash Price |
$24.44
|
| Rate for Payer: Cofinity Commercial |
$26.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.44
|
| Rate for Payer: Healthscope Commercial |
$27.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.97
|
| Rate for Payer: Nomi Health Commercial |
$25.05
|
| Rate for Payer: PHP Commercial |
$25.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.86
|
| Rate for Payer: Priority Health HMO/PPO |
$26.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.88
|
| Rate for Payer: UHC Core |
$25.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.91
|
|
|
LISINOPRIL 2.5 MG TABLET
|
Facility
|
OP
|
$127.68
|
|
|
Service Code
|
NDC 68084076521
|
| Hospital Charge Code |
13089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.32 |
| Max. Negotiated Rate |
$114.91 |
| Rate for Payer: Aetna Commercial |
$108.53
|
| Rate for Payer: Aetna Medicare |
$33.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.90
|
| Rate for Payer: BCBS Complete |
$51.07
|
| Rate for Payer: BCBS MAPPO |
$31.92
|
| Rate for Payer: BCBS Trust/PPO |
$104.97
|
| Rate for Payer: BCN Commercial |
$99.27
|
| Rate for Payer: BCN Medicare Advantage |
$31.92
|
| Rate for Payer: Cash Price |
$102.14
|
| Rate for Payer: Cofinity Commercial |
$109.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.92
|
| Rate for Payer: Healthscope Commercial |
$114.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.53
|
| Rate for Payer: Nomi Health Commercial |
$104.70
|
| Rate for Payer: PACE Senior Care Partners |
$30.32
|
| Rate for Payer: PACE SWMI |
$31.92
|
| Rate for Payer: PHP Commercial |
$108.53
|
| Rate for Payer: PHP Medicare Advantage |
$31.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.99
|
| Rate for Payer: Priority Health HMO/PPO |
$111.08
|
| Rate for Payer: Priority Health Medicare |
$32.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.55
|
| Rate for Payer: Railroad Medicare Medicare |
$31.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.36
|
| Rate for Payer: UHC Core |
$106.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.92
|
| Rate for Payer: UHC Exchange |
$31.92
|
| Rate for Payer: UHC Medicare Advantage |
$31.92
|
| Rate for Payer: VA VA |
$31.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.76
|
|
|
LISINOPRIL 2.5 MG TABLET
|
Facility
|
IP
|
$127.68
|
|
|
Service Code
|
NDC 68084076521
|
| Hospital Charge Code |
13089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.99 |
| Max. Negotiated Rate |
$114.91 |
| Rate for Payer: Aetna Commercial |
$108.53
|
| Rate for Payer: BCBS Trust/PPO |
$104.23
|
| Rate for Payer: BCN Commercial |
$98.67
|
| Rate for Payer: Cash Price |
$102.14
|
| Rate for Payer: Cofinity Commercial |
$109.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.14
|
| Rate for Payer: Healthscope Commercial |
$114.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.53
|
| Rate for Payer: Nomi Health Commercial |
$104.70
|
| Rate for Payer: PHP Commercial |
$108.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.99
|
| Rate for Payer: Priority Health HMO/PPO |
$111.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.36
|
| Rate for Payer: UHC Core |
$106.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.76
|
|
