|
NOREPINEPHRINE BITARTRATE 8 MG/250 ML (32 MCG/ML) INFUSION
|
Facility
|
IP
|
$21.50
|
|
|
Service Code
|
NDC 44567064110
|
| Hospital Charge Code |
119763
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.96 |
| Max. Negotiated Rate |
$19.35 |
| Rate for Payer: Aetna Commercial |
$18.27
|
| Rate for Payer: BCBS Trust/PPO |
$17.76
|
| Rate for Payer: BCN Commercial |
$17.76
|
| Rate for Payer: Cash Price |
$17.20
|
| Rate for Payer: Cofinity Commercial |
$18.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.20
|
| Rate for Payer: Healthscope Commercial |
$19.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.27
|
| Rate for Payer: Nomi Health Commercial |
$17.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.12
|
| Rate for Payer: PHP Commercial |
$18.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.92
|
| Rate for Payer: UHC Core |
$17.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.12
|
|
|
NORTRIPTYLINE 25 MG CAPSULE
|
Facility
|
IP
|
$385.40
|
|
|
Service Code
|
NDC 00093081101
|
| Hospital Charge Code |
5675
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$268.24 |
| Max. Negotiated Rate |
$346.86 |
| Rate for Payer: Aetna Commercial |
$327.59
|
| Rate for Payer: BCBS Trust/PPO |
$318.30
|
| Rate for Payer: BCN Commercial |
$318.30
|
| Rate for Payer: Cash Price |
$308.32
|
| Rate for Payer: Cofinity Commercial |
$331.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.32
|
| Rate for Payer: Healthscope Commercial |
$346.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.59
|
| Rate for Payer: Nomi Health Commercial |
$316.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$289.05
|
| Rate for Payer: PHP Commercial |
$327.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$335.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$268.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$339.15
|
| Rate for Payer: UHC Core |
$321.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.05
|
|
|
NORTRIPTYLINE 25 MG CAPSULE
|
Facility
|
IP
|
$217.08
|
|
|
Service Code
|
NDC 50268060415
|
| Hospital Charge Code |
5675
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.09 |
| Max. Negotiated Rate |
$195.37 |
| Rate for Payer: Aetna Commercial |
$184.52
|
| Rate for Payer: BCBS Trust/PPO |
$179.29
|
| Rate for Payer: BCN Commercial |
$179.29
|
| Rate for Payer: Cash Price |
$173.66
|
| Rate for Payer: Cofinity Commercial |
$186.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.66
|
| Rate for Payer: Healthscope Commercial |
$195.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.52
|
| Rate for Payer: Nomi Health Commercial |
$178.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.81
|
| Rate for Payer: PHP Commercial |
$184.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$188.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.03
|
| Rate for Payer: UHC Core |
$181.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.81
|
|
|
NORTRIPTYLINE 25 MG CAPSULE
|
Facility
|
OP
|
$4.35
|
|
|
Service Code
|
NDC 50268060411
|
| Hospital Charge Code |
5675
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$3.92 |
| Rate for Payer: Aetna Commercial |
$3.70
|
| Rate for Payer: Aetna Medicare |
$1.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.36
|
| Rate for Payer: BCBS Complete |
$0.81
|
| Rate for Payer: BCBS MAPPO |
$1.09
|
| Rate for Payer: BCBS Trust/PPO |
$3.58
|
| Rate for Payer: BCN Commercial |
$3.58
|
| Rate for Payer: BCN Medicare Advantage |
$1.09
|
| Rate for Payer: Cash Price |
$3.48
|
| Rate for Payer: Cofinity Commercial |
$3.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.09
|
| Rate for Payer: Healthscope Commercial |
$3.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.26
|
| Rate for Payer: Mclaren Medicaid |
$0.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.14
|
| Rate for Payer: Meridian Medicaid |
$0.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.70
|
| Rate for Payer: Nomi Health Commercial |
$3.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.26
|
| Rate for Payer: PACE Senior Care Partners |
$1.03
|
| Rate for Payer: PACE SWMI |
$1.09
|
| Rate for Payer: PHP Commercial |
$3.70
|
| Rate for Payer: PHP Medicare Advantage |
$1.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.78
|
| Rate for Payer: Priority Health Medicare |
$1.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.03
|
| Rate for Payer: Railroad Medicare Medicare |
$1.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.83
|
| Rate for Payer: UHC Core |
$3.63
|
| Rate for Payer: UHC Exchange |
$1.09
|
| Rate for Payer: UHC Medicaid |
$0.77
|
| Rate for Payer: UHC Medicare Advantage |
$1.09
|
| Rate for Payer: UHCCP Medicaid |
$0.77
|
| Rate for Payer: VA VA |
$1.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.26
|
|
|
NORTRIPTYLINE 25 MG CAPSULE
|
Facility
|
IP
|
$3.57
|
|
|
Service Code
|
NDC 60687029311
|
| Hospital Charge Code |
5675
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$3.21 |
| Rate for Payer: Aetna Commercial |
$3.03
|
| Rate for Payer: BCBS Trust/PPO |
$2.95
|
| Rate for Payer: BCN Commercial |
$2.95
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Cofinity Commercial |
$3.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.86
|
| Rate for Payer: Healthscope Commercial |
$3.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.03
|
| Rate for Payer: Nomi Health Commercial |
$2.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.68
|
| Rate for Payer: PHP Commercial |
$3.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.14
|
| Rate for Payer: UHC Core |
$2.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.68
|
|
|
NORTRIPTYLINE 25 MG CAPSULE
|
Facility
|
IP
|
$356.25
|
|
|
Service Code
|
NDC 60687029301
|
| Hospital Charge Code |
5675
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$247.95 |
| Max. Negotiated Rate |
$320.62 |
| Rate for Payer: Aetna Commercial |
$302.81
|
| Rate for Payer: BCBS Trust/PPO |
$294.23
|
| Rate for Payer: BCN Commercial |
$294.23
|
| Rate for Payer: Cash Price |
$285.00
|
| Rate for Payer: Cofinity Commercial |
$306.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.00
|
| Rate for Payer: Healthscope Commercial |
$320.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.81
|
| Rate for Payer: Nomi Health Commercial |
$292.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$267.19
|
| Rate for Payer: PHP Commercial |
$302.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$309.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$247.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$313.50
|
| Rate for Payer: UHC Core |
$297.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.19
|
|
|
NORTRIPTYLINE 25 MG CAPSULE
|
Facility
|
OP
|
$217.08
|
|
|
Service Code
|
NDC 50268060415
|
| Hospital Charge Code |
5675
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.27 |
| Max. Negotiated Rate |
$195.37 |
| Rate for Payer: Aetna Commercial |
$184.52
|
| Rate for Payer: Aetna Medicare |
$56.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.84
|
| Rate for Payer: BCBS Complete |
$40.18
|
| Rate for Payer: BCBS MAPPO |
$54.27
|
| Rate for Payer: BCBS Trust/PPO |
$178.46
|
| Rate for Payer: BCN Commercial |
$178.46
|
| Rate for Payer: BCN Medicare Advantage |
$54.27
|
| Rate for Payer: Cash Price |
$173.66
|
| Rate for Payer: Cofinity Commercial |
$186.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.27
|
| Rate for Payer: Healthscope Commercial |
$195.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.81
|
| Rate for Payer: Mclaren Medicaid |
$38.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.98
|
| Rate for Payer: Meridian Medicaid |
$40.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$59.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.52
|
| Rate for Payer: Nomi Health Commercial |
$178.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.81
|
| Rate for Payer: PACE Senior Care Partners |
$51.56
|
| Rate for Payer: PACE SWMI |
$54.27
|
| Rate for Payer: PHP Commercial |
$184.52
|
| Rate for Payer: PHP Medicare Advantage |
$54.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$188.86
|
| Rate for Payer: Priority Health Medicare |
$54.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.09
|
| Rate for Payer: Railroad Medicare Medicare |
$54.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.03
|
| Rate for Payer: UHC Core |
$181.26
|
| Rate for Payer: UHC Exchange |
$54.27
|
| Rate for Payer: UHC Medicaid |
$38.27
|
| Rate for Payer: UHC Medicare Advantage |
$54.27
|
| Rate for Payer: UHCCP Medicaid |
$38.27
|
| Rate for Payer: VA VA |
$54.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.81
|
|
|
NORTRIPTYLINE 25 MG CAPSULE
|
Facility
|
OP
|
$356.25
|
|
|
Service Code
|
NDC 60687029301
|
| Hospital Charge Code |
5675
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.81 |
| Max. Negotiated Rate |
$320.62 |
| Rate for Payer: Aetna Commercial |
$302.81
|
| Rate for Payer: Aetna Medicare |
$92.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$111.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$111.33
|
| Rate for Payer: BCBS Complete |
$65.94
|
| Rate for Payer: BCBS MAPPO |
$89.06
|
| Rate for Payer: BCBS Trust/PPO |
$292.87
|
| Rate for Payer: BCN Commercial |
$292.87
|
| Rate for Payer: BCN Medicare Advantage |
$89.06
|
| Rate for Payer: Cash Price |
$285.00
|
| Rate for Payer: Cofinity Commercial |
$306.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.06
|
| Rate for Payer: Healthscope Commercial |
$320.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.19
|
| Rate for Payer: Mclaren Medicaid |
$62.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.52
|
| Rate for Payer: Meridian Medicaid |
$65.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$102.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$97.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.81
|
| Rate for Payer: Nomi Health Commercial |
$292.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$267.19
|
| Rate for Payer: PACE Senior Care Partners |
$84.61
|
| Rate for Payer: PACE SWMI |
$89.06
|
| Rate for Payer: PHP Commercial |
$302.81
|
| Rate for Payer: PHP Medicare Advantage |
$89.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$309.94
|
| Rate for Payer: Priority Health Medicare |
$89.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$247.95
|
| Rate for Payer: Railroad Medicare Medicare |
$89.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$313.50
|
| Rate for Payer: UHC Core |
$297.47
|
| Rate for Payer: UHC Exchange |
$89.06
|
| Rate for Payer: UHC Medicaid |
$62.81
|
| Rate for Payer: UHC Medicare Advantage |
$89.06
|
| Rate for Payer: UHCCP Medicaid |
$62.81
|
| Rate for Payer: VA VA |
$89.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.19
|
|
|
NORTRIPTYLINE 25 MG CAPSULE
|
Facility
|
OP
|
$206.80
|
|
|
Service Code
|
NDC 51672400201
|
| Hospital Charge Code |
5675
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.46 |
| Max. Negotiated Rate |
$186.12 |
| Rate for Payer: Aetna Commercial |
$175.78
|
| Rate for Payer: Aetna Medicare |
$53.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.62
|
| Rate for Payer: BCBS Complete |
$38.28
|
| Rate for Payer: BCBS MAPPO |
$51.70
|
| Rate for Payer: BCBS Trust/PPO |
$170.01
|
| Rate for Payer: BCN Commercial |
$170.01
|
| Rate for Payer: BCN Medicare Advantage |
$51.70
|
| Rate for Payer: Cash Price |
$165.44
|
| Rate for Payer: Cofinity Commercial |
$177.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.70
|
| Rate for Payer: Healthscope Commercial |
$186.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.10
|
| Rate for Payer: Mclaren Medicaid |
$36.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.28
|
| Rate for Payer: Meridian Medicaid |
$38.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$56.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.78
|
| Rate for Payer: Nomi Health Commercial |
$169.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.10
|
| Rate for Payer: PACE Senior Care Partners |
$49.12
|
| Rate for Payer: PACE SWMI |
$51.70
|
| Rate for Payer: PHP Commercial |
$175.78
|
| Rate for Payer: PHP Medicare Advantage |
$51.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$179.92
|
| Rate for Payer: Priority Health Medicare |
$52.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$143.93
|
| Rate for Payer: Railroad Medicare Medicare |
$51.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.98
|
| Rate for Payer: UHC Core |
$172.68
|
| Rate for Payer: UHC Exchange |
$51.70
|
| Rate for Payer: UHC Medicaid |
$36.46
|
| Rate for Payer: UHC Medicare Advantage |
$51.70
|
| Rate for Payer: UHCCP Medicaid |
$36.46
|
| Rate for Payer: VA VA |
$51.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.10
|
|
|
NORTRIPTYLINE 25 MG CAPSULE
|
Facility
|
IP
|
$4.35
|
|
|
Service Code
|
NDC 50268060411
|
| Hospital Charge Code |
5675
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$3.92 |
| Rate for Payer: Aetna Commercial |
$3.70
|
| Rate for Payer: BCBS Trust/PPO |
$3.59
|
| Rate for Payer: BCN Commercial |
$3.59
|
| Rate for Payer: Cash Price |
$3.48
|
| Rate for Payer: Cofinity Commercial |
$3.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.48
|
| Rate for Payer: Healthscope Commercial |
$3.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.70
|
| Rate for Payer: Nomi Health Commercial |
$3.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.26
|
| Rate for Payer: PHP Commercial |
$3.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.83
|
| Rate for Payer: UHC Core |
$3.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.26
|
|
|
NORTRIPTYLINE 25 MG CAPSULE
|
Facility
|
OP
|
$3.57
|
|
|
Service Code
|
NDC 60687029311
|
| Hospital Charge Code |
5675
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$3.21 |
| Rate for Payer: Aetna Commercial |
$3.03
|
| Rate for Payer: Aetna Medicare |
$0.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.12
|
| Rate for Payer: BCBS Complete |
$0.66
|
| Rate for Payer: BCBS MAPPO |
$0.89
|
| Rate for Payer: BCBS Trust/PPO |
$2.93
|
| Rate for Payer: BCN Commercial |
$2.93
|
| Rate for Payer: BCN Medicare Advantage |
$0.89
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Cofinity Commercial |
$3.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.89
|
| Rate for Payer: Healthscope Commercial |
$3.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.68
|
| Rate for Payer: Mclaren Medicaid |
$0.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.94
|
| Rate for Payer: Meridian Medicaid |
$0.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.03
|
| Rate for Payer: Nomi Health Commercial |
$2.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.68
|
| Rate for Payer: PACE Senior Care Partners |
$0.85
|
| Rate for Payer: PACE SWMI |
$0.89
|
| Rate for Payer: PHP Commercial |
$3.03
|
| Rate for Payer: PHP Medicare Advantage |
$0.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.11
|
| Rate for Payer: Priority Health Medicare |
$0.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.48
|
| Rate for Payer: Railroad Medicare Medicare |
$0.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.14
|
| Rate for Payer: UHC Core |
$2.98
|
| Rate for Payer: UHC Exchange |
$0.89
|
| Rate for Payer: UHC Medicaid |
$0.63
|
| Rate for Payer: UHC Medicare Advantage |
$0.89
|
| Rate for Payer: UHCCP Medicaid |
$0.63
|
| Rate for Payer: VA VA |
$0.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.68
|
|
|
NORTRIPTYLINE 25 MG CAPSULE
|
Facility
|
OP
|
$385.40
|
|
|
Service Code
|
NDC 00093081101
|
| Hospital Charge Code |
5675
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.95 |
| Max. Negotiated Rate |
$346.86 |
| Rate for Payer: Aetna Commercial |
$327.59
|
| Rate for Payer: Aetna Medicare |
$100.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$120.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$120.44
|
| Rate for Payer: BCBS Complete |
$71.34
|
| Rate for Payer: BCBS MAPPO |
$96.35
|
| Rate for Payer: BCBS Trust/PPO |
$316.84
|
| Rate for Payer: BCN Commercial |
$316.84
|
| Rate for Payer: BCN Medicare Advantage |
$96.35
|
| Rate for Payer: Cash Price |
$308.32
|
| Rate for Payer: Cofinity Commercial |
$331.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.35
|
| Rate for Payer: Healthscope Commercial |
$346.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.05
|
| Rate for Payer: Mclaren Medicaid |
$67.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.17
|
| Rate for Payer: Meridian Medicaid |
$71.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$105.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.59
|
| Rate for Payer: Nomi Health Commercial |
$316.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$289.05
|
| Rate for Payer: PACE Senior Care Partners |
$91.53
|
| Rate for Payer: PACE SWMI |
$96.35
|
| Rate for Payer: PHP Commercial |
$327.59
|
| Rate for Payer: PHP Medicare Advantage |
$96.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$335.30
|
| Rate for Payer: Priority Health Medicare |
$97.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$268.24
|
| Rate for Payer: Railroad Medicare Medicare |
$96.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$339.15
|
| Rate for Payer: UHC Core |
$321.81
|
| Rate for Payer: UHC Exchange |
$96.35
|
| Rate for Payer: UHC Medicaid |
$67.95
|
| Rate for Payer: UHC Medicare Advantage |
$96.35
|
| Rate for Payer: UHCCP Medicaid |
$67.95
|
| Rate for Payer: VA VA |
$96.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.05
|
|
|
NORTRIPTYLINE 25 MG CAPSULE
|
Facility
|
IP
|
$206.80
|
|
|
Service Code
|
NDC 51672400201
|
| Hospital Charge Code |
5675
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.93 |
| Max. Negotiated Rate |
$186.12 |
| Rate for Payer: Aetna Commercial |
$175.78
|
| Rate for Payer: BCBS Trust/PPO |
$170.80
|
| Rate for Payer: BCN Commercial |
$170.80
|
| Rate for Payer: Cash Price |
$165.44
|
| Rate for Payer: Cofinity Commercial |
$177.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.44
|
| Rate for Payer: Healthscope Commercial |
$186.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.78
|
| Rate for Payer: Nomi Health Commercial |
$169.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.10
|
| Rate for Payer: PHP Commercial |
$175.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$179.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$143.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.98
|
| Rate for Payer: UHC Core |
$172.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.10
|
|
|
NOVASOURCE RENAL CONTINUOUS FEED
|
Facility
|
OP
|
$6.83
|
|
|
Service Code
|
NDC 43900035111
|
| Hospital Charge Code |
168945
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$6.15 |
| Rate for Payer: Aetna Commercial |
$5.81
|
| Rate for Payer: Aetna Medicare |
$1.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.13
|
| Rate for Payer: BCBS Complete |
$1.26
|
| Rate for Payer: BCBS MAPPO |
$1.71
|
| Rate for Payer: BCBS Trust/PPO |
$5.61
|
| Rate for Payer: BCN Commercial |
$5.61
|
| Rate for Payer: BCN Medicare Advantage |
$1.71
|
| Rate for Payer: Cash Price |
$5.46
|
| Rate for Payer: Cofinity Commercial |
$5.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.71
|
| Rate for Payer: Healthscope Commercial |
$6.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.12
|
| Rate for Payer: Mclaren Medicaid |
$1.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.79
|
| Rate for Payer: Meridian Medicaid |
$1.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.81
|
| Rate for Payer: Nomi Health Commercial |
$5.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.12
|
| Rate for Payer: PACE Senior Care Partners |
$1.62
|
| Rate for Payer: PACE SWMI |
$1.71
|
| Rate for Payer: PHP Commercial |
$5.81
|
| Rate for Payer: PHP Medicare Advantage |
$1.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.94
|
| Rate for Payer: Priority Health Medicare |
$1.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.75
|
| Rate for Payer: Railroad Medicare Medicare |
$1.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.01
|
| Rate for Payer: UHC Core |
$5.70
|
| Rate for Payer: UHC Exchange |
$1.71
|
| Rate for Payer: UHC Medicaid |
$1.20
|
| Rate for Payer: UHC Medicare Advantage |
$1.71
|
| Rate for Payer: UHCCP Medicaid |
$1.20
|
| Rate for Payer: VA VA |
$1.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.12
|
|
|
NOVASOURCE RENAL CONTINUOUS FEED
|
Facility
|
IP
|
$6.83
|
|
|
Service Code
|
NDC 43900035111
|
| Hospital Charge Code |
168945
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$6.15 |
| Rate for Payer: Aetna Commercial |
$5.81
|
| Rate for Payer: BCBS Trust/PPO |
$5.64
|
| Rate for Payer: BCN Commercial |
$5.64
|
| Rate for Payer: Cash Price |
$5.46
|
| Rate for Payer: Cofinity Commercial |
$5.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.46
|
| Rate for Payer: Healthscope Commercial |
$6.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.81
|
| Rate for Payer: Nomi Health Commercial |
$5.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.12
|
| Rate for Payer: PHP Commercial |
$5.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.01
|
| Rate for Payer: UHC Core |
$5.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.12
|
|
|
NOVASOURCE RENAL INTERMITTENT FEED
|
Facility
|
OP
|
$6.83
|
|
|
Service Code
|
NDC 43900035111
|
| Hospital Charge Code |
200086
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$6.15 |
| Rate for Payer: Aetna Commercial |
$5.81
|
| Rate for Payer: Aetna Medicare |
$1.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.13
|
| Rate for Payer: BCBS Complete |
$1.26
|
| Rate for Payer: BCBS MAPPO |
$1.71
|
| Rate for Payer: BCBS Trust/PPO |
$5.61
|
| Rate for Payer: BCN Commercial |
$5.61
|
| Rate for Payer: BCN Medicare Advantage |
$1.71
|
| Rate for Payer: Cash Price |
$5.46
|
| Rate for Payer: Cofinity Commercial |
$5.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.71
|
| Rate for Payer: Healthscope Commercial |
$6.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.12
|
| Rate for Payer: Mclaren Medicaid |
$1.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.79
|
| Rate for Payer: Meridian Medicaid |
$1.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.81
|
| Rate for Payer: Nomi Health Commercial |
$5.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.12
|
| Rate for Payer: PACE Senior Care Partners |
$1.62
|
| Rate for Payer: PACE SWMI |
$1.71
|
| Rate for Payer: PHP Commercial |
$5.81
|
| Rate for Payer: PHP Medicare Advantage |
$1.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.94
|
| Rate for Payer: Priority Health Medicare |
$1.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.75
|
| Rate for Payer: Railroad Medicare Medicare |
$1.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.01
|
| Rate for Payer: UHC Core |
$5.70
|
| Rate for Payer: UHC Exchange |
$1.71
|
| Rate for Payer: UHC Medicaid |
$1.20
|
| Rate for Payer: UHC Medicare Advantage |
$1.71
|
| Rate for Payer: UHCCP Medicaid |
$1.20
|
| Rate for Payer: VA VA |
$1.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.12
|
|
|
NOVASOURCE RENAL INTERMITTENT FEED
|
Facility
|
IP
|
$6.83
|
|
|
Service Code
|
NDC 43900035111
|
| Hospital Charge Code |
200086
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$6.15 |
| Rate for Payer: Aetna Commercial |
$5.81
|
| Rate for Payer: BCBS Trust/PPO |
$5.64
|
| Rate for Payer: BCN Commercial |
$5.64
|
| Rate for Payer: Cash Price |
$5.46
|
| Rate for Payer: Cofinity Commercial |
$5.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.46
|
| Rate for Payer: Healthscope Commercial |
$6.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.81
|
| Rate for Payer: Nomi Health Commercial |
$5.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.12
|
| Rate for Payer: PHP Commercial |
$5.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.01
|
| Rate for Payer: UHC Core |
$5.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.12
|
|
|
NURSING CASE MANAGEMENT
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS RN001
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$20.25 |
| Rate for Payer: Aetna Medicare |
$13.50
|
| Rate for Payer: BCBS Complete |
$10.80
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.25
|
|
|
NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM
|
Facility
|
OP
|
$25.52
|
|
|
Service Code
|
NDC 45802005911
|
| Hospital Charge Code |
5749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$22.97 |
| Rate for Payer: Aetna Commercial |
$21.69
|
| Rate for Payer: Aetna Medicare |
$6.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.97
|
| Rate for Payer: BCBS Complete |
$4.72
|
| Rate for Payer: BCBS MAPPO |
$6.38
|
| Rate for Payer: BCBS Trust/PPO |
$20.98
|
| Rate for Payer: BCN Commercial |
$20.98
|
| Rate for Payer: BCN Medicare Advantage |
$6.38
|
| Rate for Payer: Cash Price |
$20.42
|
| Rate for Payer: Cofinity Commercial |
$21.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.38
|
| Rate for Payer: Healthscope Commercial |
$22.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.14
|
| Rate for Payer: Mclaren Medicaid |
$4.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.70
|
| Rate for Payer: Meridian Medicaid |
$4.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.69
|
| Rate for Payer: Nomi Health Commercial |
$20.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.14
|
| Rate for Payer: PACE Senior Care Partners |
$6.06
|
| Rate for Payer: PACE SWMI |
$6.38
|
| Rate for Payer: PHP Commercial |
$21.69
|
| Rate for Payer: PHP Medicare Advantage |
$6.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.20
|
| Rate for Payer: Priority Health Medicare |
$6.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.76
|
| Rate for Payer: Railroad Medicare Medicare |
$6.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.46
|
| Rate for Payer: UHC Core |
$21.31
|
| Rate for Payer: UHC Exchange |
$6.38
|
| Rate for Payer: UHC Medicaid |
$4.50
|
| Rate for Payer: UHC Medicare Advantage |
$6.38
|
| Rate for Payer: UHCCP Medicaid |
$4.50
|
| Rate for Payer: VA VA |
$6.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.14
|
|
|
NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM
|
Facility
|
IP
|
$25.52
|
|
|
Service Code
|
NDC 45802005911
|
| Hospital Charge Code |
5749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.76 |
| Max. Negotiated Rate |
$22.97 |
| Rate for Payer: Aetna Commercial |
$21.69
|
| Rate for Payer: BCBS Trust/PPO |
$21.08
|
| Rate for Payer: BCN Commercial |
$21.08
|
| Rate for Payer: Cash Price |
$20.42
|
| Rate for Payer: Cofinity Commercial |
$21.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.42
|
| Rate for Payer: Healthscope Commercial |
$22.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.69
|
| Rate for Payer: Nomi Health Commercial |
$20.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.14
|
| Rate for Payer: PHP Commercial |
$21.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.46
|
| Rate for Payer: UHC Core |
$21.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.14
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$8.70
|
|
|
Service Code
|
NDC 00121086800
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$7.83 |
| Rate for Payer: Aetna Commercial |
$7.39
|
| Rate for Payer: Aetna Medicare |
$2.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.72
|
| Rate for Payer: BCBS Complete |
$1.61
|
| Rate for Payer: BCBS MAPPO |
$2.17
|
| Rate for Payer: BCBS Trust/PPO |
$7.15
|
| Rate for Payer: BCN Commercial |
$7.15
|
| Rate for Payer: BCN Medicare Advantage |
$2.17
|
| Rate for Payer: Cash Price |
$6.96
|
| Rate for Payer: Cofinity Commercial |
$7.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.17
|
| Rate for Payer: Healthscope Commercial |
$7.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.53
|
| Rate for Payer: Mclaren Medicaid |
$1.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.28
|
| Rate for Payer: Meridian Medicaid |
$1.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.39
|
| Rate for Payer: Nomi Health Commercial |
$7.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.53
|
| Rate for Payer: PACE Senior Care Partners |
$2.07
|
| Rate for Payer: PACE SWMI |
$2.17
|
| Rate for Payer: PHP Commercial |
$7.39
|
| Rate for Payer: PHP Medicare Advantage |
$2.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7.57
|
| Rate for Payer: Priority Health Medicare |
$2.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.06
|
| Rate for Payer: Railroad Medicare Medicare |
$2.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.66
|
| Rate for Payer: UHC Core |
$7.26
|
| Rate for Payer: UHC Exchange |
$2.17
|
| Rate for Payer: UHC Medicaid |
$1.53
|
| Rate for Payer: UHC Medicare Advantage |
$2.17
|
| Rate for Payer: UHCCP Medicaid |
$1.53
|
| Rate for Payer: VA VA |
$2.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.53
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$7.17
|
|
|
Service Code
|
NDC 00904727641
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.99 |
| Max. Negotiated Rate |
$6.45 |
| Rate for Payer: Aetna Commercial |
$6.09
|
| Rate for Payer: BCBS Trust/PPO |
$5.92
|
| Rate for Payer: BCN Commercial |
$5.92
|
| Rate for Payer: Cash Price |
$5.74
|
| Rate for Payer: Cofinity Commercial |
$6.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.74
|
| Rate for Payer: Healthscope Commercial |
$6.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.09
|
| Rate for Payer: Nomi Health Commercial |
$5.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.38
|
| Rate for Payer: PHP Commercial |
$6.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.31
|
| Rate for Payer: UHC Core |
$5.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.38
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$7.17
|
|
|
Service Code
|
NDC 00904727670
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.99 |
| Max. Negotiated Rate |
$6.45 |
| Rate for Payer: Aetna Commercial |
$6.09
|
| Rate for Payer: BCBS Trust/PPO |
$5.92
|
| Rate for Payer: BCN Commercial |
$5.92
|
| Rate for Payer: Cash Price |
$5.74
|
| Rate for Payer: Cofinity Commercial |
$6.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.74
|
| Rate for Payer: Healthscope Commercial |
$6.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.09
|
| Rate for Payer: Nomi Health Commercial |
$5.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.38
|
| Rate for Payer: PHP Commercial |
$6.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.31
|
| Rate for Payer: UHC Core |
$5.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.38
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$7.17
|
|
|
Service Code
|
NDC 00904727641
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$6.45 |
| Rate for Payer: Aetna Commercial |
$6.09
|
| Rate for Payer: Aetna Medicare |
$1.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.24
|
| Rate for Payer: BCBS Complete |
$1.33
|
| Rate for Payer: BCBS MAPPO |
$1.79
|
| Rate for Payer: BCBS Trust/PPO |
$5.89
|
| Rate for Payer: BCN Commercial |
$5.89
|
| Rate for Payer: BCN Medicare Advantage |
$1.79
|
| Rate for Payer: Cash Price |
$5.74
|
| Rate for Payer: Cofinity Commercial |
$6.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.79
|
| Rate for Payer: Healthscope Commercial |
$6.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.38
|
| Rate for Payer: Mclaren Medicaid |
$1.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.88
|
| Rate for Payer: Meridian Medicaid |
$1.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.09
|
| Rate for Payer: Nomi Health Commercial |
$5.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.38
|
| Rate for Payer: PACE Senior Care Partners |
$1.70
|
| Rate for Payer: PACE SWMI |
$1.79
|
| Rate for Payer: PHP Commercial |
$6.09
|
| Rate for Payer: PHP Medicare Advantage |
$1.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.24
|
| Rate for Payer: Priority Health Medicare |
$1.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.99
|
| Rate for Payer: Railroad Medicare Medicare |
$1.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.31
|
| Rate for Payer: UHC Core |
$5.99
|
| Rate for Payer: UHC Exchange |
$1.79
|
| Rate for Payer: UHC Medicaid |
$1.26
|
| Rate for Payer: UHC Medicare Advantage |
$1.79
|
| Rate for Payer: UHCCP Medicaid |
$1.26
|
| Rate for Payer: VA VA |
$1.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.38
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$8.70
|
|
|
Service Code
|
NDC 00121086800
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$7.83 |
| Rate for Payer: Aetna Commercial |
$7.39
|
| Rate for Payer: BCBS Trust/PPO |
$7.19
|
| Rate for Payer: BCN Commercial |
$7.19
|
| Rate for Payer: Cash Price |
$6.96
|
| Rate for Payer: Cofinity Commercial |
$7.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.96
|
| Rate for Payer: Healthscope Commercial |
$7.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.39
|
| Rate for Payer: Nomi Health Commercial |
$7.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.53
|
| Rate for Payer: PHP Commercial |
$7.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.66
|
| Rate for Payer: UHC Core |
$7.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.53
|
|
