|
LOSARTAN 25 MG TABLET
|
Facility
|
OP
|
$3.40
|
|
|
Service Code
|
NDC 68084034611
|
| Hospital Charge Code |
14823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Aetna Commercial |
$2.89
|
| Rate for Payer: Aetna Medicare |
$0.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.06
|
| Rate for Payer: BCBS Complete |
$1.36
|
| Rate for Payer: BCBS MAPPO |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$2.80
|
| Rate for Payer: BCN Commercial |
$2.64
|
| Rate for Payer: BCN Medicare Advantage |
$0.85
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.85
|
| Rate for Payer: Healthscope Commercial |
$3.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.89
|
| Rate for Payer: Nomi Health Commercial |
$2.79
|
| Rate for Payer: PACE Senior Care Partners |
$0.81
|
| Rate for Payer: PACE SWMI |
$0.85
|
| Rate for Payer: PHP Commercial |
$2.89
|
| Rate for Payer: PHP Medicare Advantage |
$0.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.21
|
| Rate for Payer: Priority Health HMO/PPO |
$2.96
|
| Rate for Payer: Priority Health Medicare |
$0.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.28
|
| Rate for Payer: Railroad Medicare Medicare |
$0.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.99
|
| Rate for Payer: UHC Core |
$2.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.85
|
| Rate for Payer: UHC Exchange |
$0.85
|
| Rate for Payer: UHC Medicare Advantage |
$0.85
|
| Rate for Payer: VA VA |
$0.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.55
|
|
|
LOSARTAN 25 MG TABLET
|
Facility
|
IP
|
$3.40
|
|
|
Service Code
|
NDC 68084034611
|
| Hospital Charge Code |
14823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Aetna Commercial |
$2.89
|
| Rate for Payer: BCBS Trust/PPO |
$2.78
|
| Rate for Payer: BCN Commercial |
$2.63
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.72
|
| Rate for Payer: Healthscope Commercial |
$3.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.89
|
| Rate for Payer: Nomi Health Commercial |
$2.79
|
| Rate for Payer: PHP Commercial |
$2.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.21
|
| Rate for Payer: Priority Health HMO/PPO |
$2.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.99
|
| Rate for Payer: UHC Core |
$2.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.55
|
|
|
LOSARTAN 25 MG TABLET
|
Facility
|
IP
|
$308.75
|
|
|
Service Code
|
NDC 00904704761
|
| Hospital Charge Code |
14823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$200.69 |
| Max. Negotiated Rate |
$277.88 |
| Rate for Payer: Aetna Commercial |
$262.44
|
| Rate for Payer: BCBS Trust/PPO |
$252.03
|
| Rate for Payer: BCN Commercial |
$238.60
|
| Rate for Payer: Cash Price |
$247.00
|
| Rate for Payer: Cofinity Commercial |
$265.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.00
|
| Rate for Payer: Healthscope Commercial |
$277.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.44
|
| Rate for Payer: Nomi Health Commercial |
$253.18
|
| Rate for Payer: PHP Commercial |
$262.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.69
|
| Rate for Payer: Priority Health HMO/PPO |
$268.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$206.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.70
|
| Rate for Payer: UHC Core |
$257.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.56
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
IP
|
$253.65
|
|
|
Service Code
|
NDC 68084034711
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.87 |
| Max. Negotiated Rate |
$228.28 |
| Rate for Payer: Aetna Commercial |
$215.60
|
| Rate for Payer: BCBS Trust/PPO |
$207.05
|
| Rate for Payer: BCN Commercial |
$196.02
|
| Rate for Payer: Cash Price |
$202.92
|
| Rate for Payer: Cofinity Commercial |
$218.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.92
|
| Rate for Payer: Healthscope Commercial |
$228.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.60
|
| Rate for Payer: Nomi Health Commercial |
$207.99
|
| Rate for Payer: PHP Commercial |
$215.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.87
|
| Rate for Payer: Priority Health HMO/PPO |
$220.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$169.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.21
|
| Rate for Payer: UHC Core |
$211.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.24
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
OP
|
$230.85
|
|
|
Service Code
|
NDC 00904704861
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.83 |
| Max. Negotiated Rate |
$207.76 |
| Rate for Payer: Aetna Commercial |
$196.22
|
| Rate for Payer: Aetna Medicare |
$60.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.14
|
| Rate for Payer: BCBS Complete |
$92.34
|
| Rate for Payer: BCBS MAPPO |
$57.71
|
| Rate for Payer: BCBS Trust/PPO |
$189.78
|
| Rate for Payer: BCN Commercial |
$179.49
|
| Rate for Payer: BCN Medicare Advantage |
$57.71
|
| Rate for Payer: Cash Price |
$184.68
|
| Rate for Payer: Cofinity Commercial |
$198.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.71
|
| Rate for Payer: Healthscope Commercial |
$207.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.22
|
| Rate for Payer: Nomi Health Commercial |
$189.30
|
| Rate for Payer: PACE Senior Care Partners |
$54.83
|
| Rate for Payer: PACE SWMI |
$57.71
|
| Rate for Payer: PHP Commercial |
$196.22
|
| Rate for Payer: PHP Medicare Advantage |
$57.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.05
|
| Rate for Payer: Priority Health HMO/PPO |
$200.84
|
| Rate for Payer: Priority Health Medicare |
$58.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.67
|
| Rate for Payer: Railroad Medicare Medicare |
$57.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.15
|
| Rate for Payer: UHC Core |
$192.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.71
|
| Rate for Payer: UHC Exchange |
$57.71
|
| Rate for Payer: UHC Medicare Advantage |
$57.71
|
| Rate for Payer: VA VA |
$57.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.14
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
OP
|
$253.65
|
|
|
Service Code
|
NDC 68084034711
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.24 |
| Max. Negotiated Rate |
$228.28 |
| Rate for Payer: Aetna Commercial |
$215.60
|
| Rate for Payer: Aetna Medicare |
$65.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.27
|
| Rate for Payer: BCBS Complete |
$101.46
|
| Rate for Payer: BCBS MAPPO |
$63.41
|
| Rate for Payer: BCBS Trust/PPO |
$208.53
|
| Rate for Payer: BCN Commercial |
$197.21
|
| Rate for Payer: BCN Medicare Advantage |
$63.41
|
| Rate for Payer: Cash Price |
$202.92
|
| Rate for Payer: Cofinity Commercial |
$218.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.41
|
| Rate for Payer: Healthscope Commercial |
$228.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.60
|
| Rate for Payer: Nomi Health Commercial |
$207.99
|
| Rate for Payer: PACE Senior Care Partners |
$60.24
|
| Rate for Payer: PACE SWMI |
$63.41
|
| Rate for Payer: PHP Commercial |
$215.60
|
| Rate for Payer: PHP Medicare Advantage |
$63.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.87
|
| Rate for Payer: Priority Health HMO/PPO |
$220.68
|
| Rate for Payer: Priority Health Medicare |
$64.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$169.95
|
| Rate for Payer: Railroad Medicare Medicare |
$63.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.21
|
| Rate for Payer: UHC Core |
$211.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.41
|
| Rate for Payer: UHC Exchange |
$63.41
|
| Rate for Payer: UHC Medicare Advantage |
$63.41
|
| Rate for Payer: VA VA |
$63.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.24
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
IP
|
$230.85
|
|
|
Service Code
|
NDC 00904704861
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.05 |
| Max. Negotiated Rate |
$207.76 |
| Rate for Payer: Aetna Commercial |
$196.22
|
| Rate for Payer: BCBS Trust/PPO |
$188.44
|
| Rate for Payer: BCN Commercial |
$178.40
|
| Rate for Payer: Cash Price |
$184.68
|
| Rate for Payer: Cofinity Commercial |
$198.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.68
|
| Rate for Payer: Healthscope Commercial |
$207.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.22
|
| Rate for Payer: Nomi Health Commercial |
$189.30
|
| Rate for Payer: PHP Commercial |
$196.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.05
|
| Rate for Payer: Priority Health HMO/PPO |
$200.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.15
|
| Rate for Payer: UHC Core |
$192.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.14
|
|
|
LOVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$70.50
|
|
|
Service Code
|
NDC 68180046707
|
| Hospital Charge Code |
10469
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.74 |
| Max. Negotiated Rate |
$63.45 |
| Rate for Payer: Aetna Commercial |
$59.92
|
| Rate for Payer: Aetna Medicare |
$18.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.03
|
| Rate for Payer: BCBS Complete |
$28.20
|
| Rate for Payer: BCBS MAPPO |
$17.62
|
| Rate for Payer: BCBS Trust/PPO |
$57.96
|
| Rate for Payer: BCN Commercial |
$54.81
|
| Rate for Payer: BCN Medicare Advantage |
$17.62
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cofinity Commercial |
$60.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.62
|
| Rate for Payer: Healthscope Commercial |
$63.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.92
|
| Rate for Payer: Nomi Health Commercial |
$57.81
|
| Rate for Payer: PACE Senior Care Partners |
$16.74
|
| Rate for Payer: PACE SWMI |
$17.62
|
| Rate for Payer: PHP Commercial |
$59.92
|
| Rate for Payer: PHP Medicare Advantage |
$17.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.83
|
| Rate for Payer: Priority Health HMO/PPO |
$61.34
|
| Rate for Payer: Priority Health Medicare |
$17.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.23
|
| Rate for Payer: Railroad Medicare Medicare |
$17.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.04
|
| Rate for Payer: UHC Core |
$58.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.62
|
| Rate for Payer: UHC Exchange |
$17.62
|
| Rate for Payer: UHC Medicare Advantage |
$17.62
|
| Rate for Payer: VA VA |
$17.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.88
|
|
|
LOVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$70.50
|
|
|
Service Code
|
NDC 68180046707
|
| Hospital Charge Code |
10469
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.83 |
| Max. Negotiated Rate |
$63.45 |
| Rate for Payer: Aetna Commercial |
$59.92
|
| Rate for Payer: BCBS Trust/PPO |
$57.55
|
| Rate for Payer: BCN Commercial |
$54.48
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cofinity Commercial |
$60.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.40
|
| Rate for Payer: Healthscope Commercial |
$63.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.92
|
| Rate for Payer: Nomi Health Commercial |
$57.81
|
| Rate for Payer: PHP Commercial |
$59.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.83
|
| Rate for Payer: Priority Health HMO/PPO |
$61.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.04
|
| Rate for Payer: UHC Core |
$58.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.88
|
|
|
LOXAPINE SUCCINATE 25 MG CAPSULE
|
Facility
|
IP
|
$486.24
|
|
|
Service Code
|
NDC 00378702501
|
| Hospital Charge Code |
4600
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$316.06 |
| Max. Negotiated Rate |
$437.62 |
| Rate for Payer: Aetna Commercial |
$413.30
|
| Rate for Payer: BCBS Trust/PPO |
$396.92
|
| Rate for Payer: BCN Commercial |
$375.77
|
| Rate for Payer: Cash Price |
$388.99
|
| Rate for Payer: Cofinity Commercial |
$418.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.99
|
| Rate for Payer: Healthscope Commercial |
$437.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$364.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$413.30
|
| Rate for Payer: Nomi Health Commercial |
$398.72
|
| Rate for Payer: PHP Commercial |
$413.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$316.06
|
| Rate for Payer: Priority Health HMO/PPO |
$423.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$325.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$427.89
|
| Rate for Payer: UHC Core |
$406.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$364.68
|
|
|
LOXAPINE SUCCINATE 25 MG CAPSULE
|
Facility
|
OP
|
$486.24
|
|
|
Service Code
|
NDC 00378702501
|
| Hospital Charge Code |
4600
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.48 |
| Max. Negotiated Rate |
$437.62 |
| Rate for Payer: Aetna Commercial |
$413.30
|
| Rate for Payer: Aetna Medicare |
$126.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$151.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$151.95
|
| Rate for Payer: BCBS Complete |
$194.50
|
| Rate for Payer: BCBS MAPPO |
$121.56
|
| Rate for Payer: BCBS Trust/PPO |
$399.74
|
| Rate for Payer: BCN Commercial |
$378.05
|
| Rate for Payer: BCN Medicare Advantage |
$121.56
|
| Rate for Payer: Cash Price |
$388.99
|
| Rate for Payer: Cofinity Commercial |
$418.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$121.56
|
| Rate for Payer: Healthscope Commercial |
$437.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$364.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$127.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$139.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$413.30
|
| Rate for Payer: Nomi Health Commercial |
$398.72
|
| Rate for Payer: PACE Senior Care Partners |
$115.48
|
| Rate for Payer: PACE SWMI |
$121.56
|
| Rate for Payer: PHP Commercial |
$413.30
|
| Rate for Payer: PHP Medicare Advantage |
$121.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$316.06
|
| Rate for Payer: Priority Health HMO/PPO |
$423.03
|
| Rate for Payer: Priority Health Medicare |
$122.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$325.78
|
| Rate for Payer: Railroad Medicare Medicare |
$121.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$427.89
|
| Rate for Payer: UHC Core |
$406.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$121.56
|
| Rate for Payer: UHC Exchange |
$121.56
|
| Rate for Payer: UHC Medicare Advantage |
$121.56
|
| Rate for Payer: VA VA |
$121.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$364.68
|
|
|
LUBIPROSTONE 8 MCG CAPSULE
|
Facility
|
IP
|
$1,276.95
|
|
|
Service Code
|
NDC 64764008060
|
| Hospital Charge Code |
91534
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$830.02 |
| Max. Negotiated Rate |
$1,149.26 |
| Rate for Payer: Aetna Commercial |
$1,085.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,042.37
|
| Rate for Payer: BCN Commercial |
$986.83
|
| Rate for Payer: Cash Price |
$1,021.56
|
| Rate for Payer: Cofinity Commercial |
$1,098.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,021.56
|
| Rate for Payer: Healthscope Commercial |
$1,149.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$957.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,085.41
|
| Rate for Payer: Nomi Health Commercial |
$1,047.10
|
| Rate for Payer: PHP Commercial |
$1,085.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$830.02
|
| Rate for Payer: Priority Health HMO/PPO |
$1,110.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$855.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,123.72
|
| Rate for Payer: UHC Core |
$1,066.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$957.71
|
|
|
LUBIPROSTONE 8 MCG CAPSULE
|
Facility
|
OP
|
$1,276.95
|
|
|
Service Code
|
NDC 64764008060
|
| Hospital Charge Code |
91534
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$303.28 |
| Max. Negotiated Rate |
$1,149.26 |
| Rate for Payer: Aetna Commercial |
$1,085.41
|
| Rate for Payer: Aetna Medicare |
$332.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$399.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$399.05
|
| Rate for Payer: BCBS Complete |
$510.78
|
| Rate for Payer: BCBS MAPPO |
$319.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,049.78
|
| Rate for Payer: BCN Commercial |
$992.83
|
| Rate for Payer: BCN Medicare Advantage |
$319.24
|
| Rate for Payer: Cash Price |
$1,021.56
|
| Rate for Payer: Cofinity Commercial |
$1,098.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,021.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$319.24
|
| Rate for Payer: Healthscope Commercial |
$1,149.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$957.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$335.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$367.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,085.41
|
| Rate for Payer: Nomi Health Commercial |
$1,047.10
|
| Rate for Payer: PACE Senior Care Partners |
$303.28
|
| Rate for Payer: PACE SWMI |
$319.24
|
| Rate for Payer: PHP Commercial |
$1,085.41
|
| Rate for Payer: PHP Medicare Advantage |
$319.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$830.02
|
| Rate for Payer: Priority Health HMO/PPO |
$1,110.95
|
| Rate for Payer: Priority Health Medicare |
$322.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$855.56
|
| Rate for Payer: Railroad Medicare Medicare |
$319.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,123.72
|
| Rate for Payer: UHC Core |
$1,066.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$319.24
|
| Rate for Payer: UHC Exchange |
$319.24
|
| Rate for Payer: UHC Medicare Advantage |
$319.24
|
| Rate for Payer: VA VA |
$319.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$957.71
|
|
|
LURASIDONE 20 MG TABLET
|
Facility
|
IP
|
$117.74
|
|
|
Service Code
|
NDC 67877063830
|
| Hospital Charge Code |
158952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.53 |
| Max. Negotiated Rate |
$105.97 |
| Rate for Payer: Aetna Commercial |
$100.08
|
| Rate for Payer: BCBS Trust/PPO |
$96.11
|
| Rate for Payer: BCN Commercial |
$90.99
|
| Rate for Payer: Cash Price |
$94.19
|
| Rate for Payer: Cofinity Commercial |
$101.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.19
|
| Rate for Payer: Healthscope Commercial |
$105.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.08
|
| Rate for Payer: Nomi Health Commercial |
$96.55
|
| Rate for Payer: PHP Commercial |
$100.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.53
|
| Rate for Payer: Priority Health HMO/PPO |
$102.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.61
|
| Rate for Payer: UHC Core |
$98.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.31
|
|
|
LURASIDONE 20 MG TABLET
|
Facility
|
OP
|
$117.74
|
|
|
Service Code
|
NDC 67877063830
|
| Hospital Charge Code |
158952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.96 |
| Max. Negotiated Rate |
$105.97 |
| Rate for Payer: Aetna Commercial |
$100.08
|
| Rate for Payer: Aetna Medicare |
$30.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.79
|
| Rate for Payer: BCBS Complete |
$47.10
|
| Rate for Payer: BCBS MAPPO |
$29.43
|
| Rate for Payer: BCBS Trust/PPO |
$96.79
|
| Rate for Payer: BCN Commercial |
$91.54
|
| Rate for Payer: BCN Medicare Advantage |
$29.43
|
| Rate for Payer: Cash Price |
$94.19
|
| Rate for Payer: Cofinity Commercial |
$101.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.43
|
| Rate for Payer: Healthscope Commercial |
$105.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.08
|
| Rate for Payer: Nomi Health Commercial |
$96.55
|
| Rate for Payer: PACE Senior Care Partners |
$27.96
|
| Rate for Payer: PACE SWMI |
$29.43
|
| Rate for Payer: PHP Commercial |
$100.08
|
| Rate for Payer: PHP Medicare Advantage |
$29.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.53
|
| Rate for Payer: Priority Health HMO/PPO |
$102.43
|
| Rate for Payer: Priority Health Medicare |
$29.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.89
|
| Rate for Payer: Railroad Medicare Medicare |
$29.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.61
|
| Rate for Payer: UHC Core |
$98.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.43
|
| Rate for Payer: UHC Exchange |
$29.43
|
| Rate for Payer: UHC Medicare Advantage |
$29.43
|
| Rate for Payer: VA VA |
$29.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.31
|
|
|
MAGNESIUM CITRATE ORAL SOLUTION
|
Facility
|
OP
|
$17.32
|
|
|
Service Code
|
NDC 71399005101
|
| Hospital Charge Code |
4712
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.11 |
| Max. Negotiated Rate |
$15.59 |
| Rate for Payer: Aetna Commercial |
$14.72
|
| Rate for Payer: Aetna Medicare |
$4.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.41
|
| Rate for Payer: BCBS Complete |
$6.93
|
| Rate for Payer: BCBS MAPPO |
$4.33
|
| Rate for Payer: BCBS Trust/PPO |
$14.24
|
| Rate for Payer: BCN Commercial |
$13.47
|
| Rate for Payer: BCN Medicare Advantage |
$4.33
|
| Rate for Payer: Cash Price |
$13.86
|
| Rate for Payer: Cofinity Commercial |
$14.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.33
|
| Rate for Payer: Healthscope Commercial |
$15.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.72
|
| Rate for Payer: Nomi Health Commercial |
$14.20
|
| Rate for Payer: PACE Senior Care Partners |
$4.11
|
| Rate for Payer: PACE SWMI |
$4.33
|
| Rate for Payer: PHP Commercial |
$14.72
|
| Rate for Payer: PHP Medicare Advantage |
$4.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.26
|
| Rate for Payer: Priority Health HMO/PPO |
$15.07
|
| Rate for Payer: Priority Health Medicare |
$4.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.60
|
| Rate for Payer: Railroad Medicare Medicare |
$4.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.24
|
| Rate for Payer: UHC Core |
$14.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.33
|
| Rate for Payer: UHC Exchange |
$4.33
|
| Rate for Payer: UHC Medicare Advantage |
$4.33
|
| Rate for Payer: VA VA |
$4.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.99
|
|
|
MAGNESIUM CITRATE ORAL SOLUTION
|
Facility
|
IP
|
$17.32
|
|
|
Service Code
|
NDC 71399005101
|
| Hospital Charge Code |
4712
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.26 |
| Max. Negotiated Rate |
$15.59 |
| Rate for Payer: Aetna Commercial |
$14.72
|
| Rate for Payer: BCBS Trust/PPO |
$14.14
|
| Rate for Payer: BCN Commercial |
$13.38
|
| Rate for Payer: Cash Price |
$13.86
|
| Rate for Payer: Cofinity Commercial |
$14.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.86
|
| Rate for Payer: Healthscope Commercial |
$15.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.72
|
| Rate for Payer: Nomi Health Commercial |
$14.20
|
| Rate for Payer: PHP Commercial |
$14.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.26
|
| Rate for Payer: Priority Health HMO/PPO |
$15.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.24
|
| Rate for Payer: UHC Core |
$14.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.99
|
|
|
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$8.64
|
|
|
Service Code
|
NDC 00121043130
|
| Hospital Charge Code |
108978
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.05 |
| Max. Negotiated Rate |
$7.78 |
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: Aetna Medicare |
$2.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.70
|
| Rate for Payer: BCBS Complete |
$3.46
|
| Rate for Payer: BCBS MAPPO |
$2.16
|
| Rate for Payer: BCBS Trust/PPO |
$7.10
|
| Rate for Payer: BCN Commercial |
$6.72
|
| Rate for Payer: BCN Medicare Advantage |
$2.16
|
| Rate for Payer: Cash Price |
$6.91
|
| Rate for Payer: Cofinity Commercial |
$7.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.16
|
| Rate for Payer: Healthscope Commercial |
$7.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.34
|
| Rate for Payer: Nomi Health Commercial |
$7.08
|
| Rate for Payer: PACE Senior Care Partners |
$2.05
|
| Rate for Payer: PACE SWMI |
$2.16
|
| Rate for Payer: PHP Commercial |
$7.34
|
| Rate for Payer: PHP Medicare Advantage |
$2.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.62
|
| Rate for Payer: Priority Health HMO/PPO |
$7.52
|
| Rate for Payer: Priority Health Medicare |
$2.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.79
|
| Rate for Payer: Railroad Medicare Medicare |
$2.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.60
|
| Rate for Payer: UHC Core |
$7.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.16
|
| Rate for Payer: UHC Exchange |
$2.16
|
| Rate for Payer: UHC Medicare Advantage |
$2.16
|
| Rate for Payer: VA VA |
$2.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.48
|
|
|
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$8.64
|
|
|
Service Code
|
NDC 09900000148
|
| Hospital Charge Code |
108978
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.62 |
| Max. Negotiated Rate |
$7.78 |
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: BCBS Trust/PPO |
$7.05
|
| Rate for Payer: BCN Commercial |
$6.68
|
| Rate for Payer: Cash Price |
$6.91
|
| Rate for Payer: Cofinity Commercial |
$7.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.91
|
| Rate for Payer: Healthscope Commercial |
$7.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.34
|
| Rate for Payer: Nomi Health Commercial |
$7.08
|
| Rate for Payer: PHP Commercial |
$7.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.62
|
| Rate for Payer: Priority Health HMO/PPO |
$7.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.60
|
| Rate for Payer: UHC Core |
$7.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.48
|
|
|
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$8.79
|
|
|
Service Code
|
NDC 60687042945
|
| Hospital Charge Code |
108978
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.71 |
| Max. Negotiated Rate |
$7.91 |
| Rate for Payer: Aetna Commercial |
$7.47
|
| Rate for Payer: BCBS Trust/PPO |
$7.18
|
| Rate for Payer: BCN Commercial |
$6.79
|
| Rate for Payer: Cash Price |
$7.03
|
| Rate for Payer: Cofinity Commercial |
$7.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.03
|
| Rate for Payer: Healthscope Commercial |
$7.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.47
|
| Rate for Payer: Nomi Health Commercial |
$7.21
|
| Rate for Payer: PHP Commercial |
$7.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.71
|
| Rate for Payer: Priority Health HMO/PPO |
$7.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.74
|
| Rate for Payer: UHC Core |
$7.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.59
|
|
|
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$8.79
|
|
|
Service Code
|
NDC 60687042976
|
| Hospital Charge Code |
108978
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.71 |
| Max. Negotiated Rate |
$7.91 |
| Rate for Payer: Aetna Commercial |
$7.47
|
| Rate for Payer: BCBS Trust/PPO |
$7.18
|
| Rate for Payer: BCN Commercial |
$6.79
|
| Rate for Payer: Cash Price |
$7.03
|
| Rate for Payer: Cofinity Commercial |
$7.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.03
|
| Rate for Payer: Healthscope Commercial |
$7.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.47
|
| Rate for Payer: Nomi Health Commercial |
$7.21
|
| Rate for Payer: PHP Commercial |
$7.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.71
|
| Rate for Payer: Priority Health HMO/PPO |
$7.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.74
|
| Rate for Payer: UHC Core |
$7.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.59
|
|
|
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$8.79
|
|
|
Service Code
|
NDC 60687042945
|
| Hospital Charge Code |
108978
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$7.91 |
| Rate for Payer: Aetna Commercial |
$7.47
|
| Rate for Payer: Aetna Medicare |
$2.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.75
|
| Rate for Payer: BCBS Complete |
$3.52
|
| Rate for Payer: BCBS MAPPO |
$2.20
|
| Rate for Payer: BCBS Trust/PPO |
$7.23
|
| Rate for Payer: BCN Commercial |
$6.83
|
| Rate for Payer: BCN Medicare Advantage |
$2.20
|
| Rate for Payer: Cash Price |
$7.03
|
| Rate for Payer: Cofinity Commercial |
$7.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.20
|
| Rate for Payer: Healthscope Commercial |
$7.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.47
|
| Rate for Payer: Nomi Health Commercial |
$7.21
|
| Rate for Payer: PACE Senior Care Partners |
$2.09
|
| Rate for Payer: PACE SWMI |
$2.20
|
| Rate for Payer: PHP Commercial |
$7.47
|
| Rate for Payer: PHP Medicare Advantage |
$2.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.71
|
| Rate for Payer: Priority Health HMO/PPO |
$7.65
|
| Rate for Payer: Priority Health Medicare |
$2.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.89
|
| Rate for Payer: Railroad Medicare Medicare |
$2.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.74
|
| Rate for Payer: UHC Core |
$7.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.20
|
| Rate for Payer: UHC Exchange |
$2.20
|
| Rate for Payer: UHC Medicare Advantage |
$2.20
|
| Rate for Payer: VA VA |
$2.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.59
|
|
|
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$10.51
|
|
|
Service Code
|
NDC 00904078816
|
| Hospital Charge Code |
108978
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$9.46 |
| Rate for Payer: Aetna Commercial |
$8.93
|
| Rate for Payer: Aetna Medicare |
$2.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.28
|
| Rate for Payer: BCBS Complete |
$4.20
|
| Rate for Payer: BCBS MAPPO |
$2.63
|
| Rate for Payer: BCBS Trust/PPO |
$8.64
|
| Rate for Payer: BCN Commercial |
$8.17
|
| Rate for Payer: BCN Medicare Advantage |
$2.63
|
| Rate for Payer: Cash Price |
$8.41
|
| Rate for Payer: Cofinity Commercial |
$9.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.63
|
| Rate for Payer: Healthscope Commercial |
$9.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.93
|
| Rate for Payer: Nomi Health Commercial |
$8.62
|
| Rate for Payer: PACE Senior Care Partners |
$2.50
|
| Rate for Payer: PACE SWMI |
$2.63
|
| Rate for Payer: PHP Commercial |
$8.93
|
| Rate for Payer: PHP Medicare Advantage |
$2.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.83
|
| Rate for Payer: Priority Health HMO/PPO |
$9.14
|
| Rate for Payer: Priority Health Medicare |
$2.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.04
|
| Rate for Payer: Railroad Medicare Medicare |
$2.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.25
|
| Rate for Payer: UHC Core |
$8.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.63
|
| Rate for Payer: UHC Exchange |
$2.63
|
| Rate for Payer: UHC Medicare Advantage |
$2.63
|
| Rate for Payer: VA VA |
$2.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.88
|
|
|
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$8.64
|
|
|
Service Code
|
NDC 00121043130
|
| Hospital Charge Code |
108978
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.62 |
| Max. Negotiated Rate |
$7.78 |
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: BCBS Trust/PPO |
$7.05
|
| Rate for Payer: BCN Commercial |
$6.68
|
| Rate for Payer: Cash Price |
$6.91
|
| Rate for Payer: Cofinity Commercial |
$7.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.91
|
| Rate for Payer: Healthscope Commercial |
$7.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.34
|
| Rate for Payer: Nomi Health Commercial |
$7.08
|
| Rate for Payer: PHP Commercial |
$7.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.62
|
| Rate for Payer: Priority Health HMO/PPO |
$7.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.60
|
| Rate for Payer: UHC Core |
$7.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.48
|
|
|
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$10.51
|
|
|
Service Code
|
NDC 00904078816
|
| Hospital Charge Code |
108978
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$9.46 |
| Rate for Payer: Aetna Commercial |
$8.93
|
| Rate for Payer: BCBS Trust/PPO |
$8.58
|
| Rate for Payer: BCN Commercial |
$8.12
|
| Rate for Payer: Cash Price |
$8.41
|
| Rate for Payer: Cofinity Commercial |
$9.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.41
|
| Rate for Payer: Healthscope Commercial |
$9.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.93
|
| Rate for Payer: Nomi Health Commercial |
$8.62
|
| Rate for Payer: PHP Commercial |
$8.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.83
|
| Rate for Payer: Priority Health HMO/PPO |
$9.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.25
|
| Rate for Payer: UHC Core |
$8.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.88
|
|
