|
PIPER.BUT-PYRETHRINS-PERMETHRN 4 %-0.33 %-0.5 % TOPICAL KIT
|
Facility
|
OP
|
$62.62
|
|
|
Service Code
|
NDC 16500050492
|
| Hospital Charge Code |
10920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.87 |
| Max. Negotiated Rate |
$56.36 |
| Rate for Payer: Aetna Commercial |
$53.23
|
| Rate for Payer: Aetna Medicare |
$16.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.57
|
| Rate for Payer: BCBS Complete |
$25.05
|
| Rate for Payer: BCBS MAPPO |
$15.66
|
| Rate for Payer: BCBS Trust/PPO |
$51.48
|
| Rate for Payer: BCN Commercial |
$48.69
|
| Rate for Payer: BCN Medicare Advantage |
$15.66
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cofinity Commercial |
$53.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.66
|
| Rate for Payer: Healthscope Commercial |
$56.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.23
|
| Rate for Payer: Nomi Health Commercial |
$51.35
|
| Rate for Payer: PACE Senior Care Partners |
$14.87
|
| Rate for Payer: PACE SWMI |
$15.66
|
| Rate for Payer: PHP Commercial |
$53.23
|
| Rate for Payer: PHP Medicare Advantage |
$15.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.70
|
| Rate for Payer: Priority Health HMO/PPO |
$54.48
|
| Rate for Payer: Priority Health Medicare |
$15.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.96
|
| Rate for Payer: Railroad Medicare Medicare |
$15.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.11
|
| Rate for Payer: UHC Core |
$52.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.66
|
| Rate for Payer: UHC Exchange |
$15.66
|
| Rate for Payer: UHC Medicare Advantage |
$15.66
|
| Rate for Payer: VA VA |
$15.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.96
|
|
|
PIPER.BUT-PYRETHRINS-PERMETHRN 4 %-0.33 %-0.5 % TOPICAL KIT
|
Facility
|
IP
|
$62.62
|
|
|
Service Code
|
NDC 16500050492
|
| Hospital Charge Code |
10920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.70 |
| Max. Negotiated Rate |
$56.36 |
| Rate for Payer: Aetna Commercial |
$53.23
|
| Rate for Payer: BCBS Trust/PPO |
$51.12
|
| Rate for Payer: BCN Commercial |
$48.39
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cofinity Commercial |
$53.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.10
|
| Rate for Payer: Healthscope Commercial |
$56.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.23
|
| Rate for Payer: Nomi Health Commercial |
$51.35
|
| Rate for Payer: PHP Commercial |
$53.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.70
|
| Rate for Payer: Priority Health HMO/PPO |
$54.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.11
|
| Rate for Payer: UHC Core |
$52.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.96
|
|
|
PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE
|
Facility
|
IP
|
$673.24
|
|
|
Service Code
|
HCPCS 90670
|
| Hospital Charge Code |
103895
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$437.61 |
| Max. Negotiated Rate |
$605.92 |
| Rate for Payer: Aetna Commercial |
$572.25
|
| Rate for Payer: BCBS Trust/PPO |
$549.57
|
| Rate for Payer: BCN Commercial |
$520.28
|
| Rate for Payer: Cash Price |
$538.59
|
| Rate for Payer: Cofinity Commercial |
$578.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.59
|
| Rate for Payer: Healthscope Commercial |
$605.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$504.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$572.25
|
| Rate for Payer: Nomi Health Commercial |
$552.06
|
| Rate for Payer: PHP Commercial |
$572.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.61
|
| Rate for Payer: Priority Health HMO/PPO |
$585.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$451.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$592.45
|
| Rate for Payer: UHC Core |
$562.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$504.93
|
|
|
PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE
|
Facility
|
OP
|
$673.24
|
|
|
Service Code
|
HCPCS 90670
|
| Hospital Charge Code |
103895
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$159.89 |
| Max. Negotiated Rate |
$605.92 |
| Rate for Payer: Aetna Commercial |
$572.25
|
| Rate for Payer: Aetna Medicare |
$175.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$210.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$210.39
|
| Rate for Payer: BCBS Complete |
$269.30
|
| Rate for Payer: BCBS MAPPO |
$168.31
|
| Rate for Payer: BCBS Trust/PPO |
$553.47
|
| Rate for Payer: BCN Commercial |
$523.44
|
| Rate for Payer: BCN Medicare Advantage |
$168.31
|
| Rate for Payer: Cash Price |
$538.59
|
| Rate for Payer: Cofinity Commercial |
$578.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.31
|
| Rate for Payer: Healthscope Commercial |
$605.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$504.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$572.25
|
| Rate for Payer: Nomi Health Commercial |
$552.06
|
| Rate for Payer: PACE Senior Care Partners |
$159.89
|
| Rate for Payer: PACE SWMI |
$168.31
|
| Rate for Payer: PHP Commercial |
$572.25
|
| Rate for Payer: PHP Medicare Advantage |
$168.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.61
|
| Rate for Payer: Priority Health HMO/PPO |
$585.72
|
| Rate for Payer: Priority Health Medicare |
$169.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$451.07
|
| Rate for Payer: Railroad Medicare Medicare |
$168.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$592.45
|
| Rate for Payer: UHC Core |
$562.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$168.31
|
| Rate for Payer: UHC Exchange |
$168.31
|
| Rate for Payer: UHC Medicare Advantage |
$168.31
|
| Rate for Payer: VA VA |
$168.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$504.93
|
|
|
PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE
|
Facility
|
OP
|
$801.99
|
|
|
Service Code
|
HCPCS 90677
|
| Hospital Charge Code |
197781
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$190.47 |
| Max. Negotiated Rate |
$721.79 |
| Rate for Payer: Aetna Commercial |
$681.69
|
| Rate for Payer: Aetna Commercial |
$660.99
|
| Rate for Payer: Aetna Medicare |
$208.52
|
| Rate for Payer: Aetna Medicare |
$202.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$250.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$250.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.01
|
| Rate for Payer: BCBS Complete |
$311.05
|
| Rate for Payer: BCBS Complete |
$320.80
|
| Rate for Payer: BCBS MAPPO |
$194.41
|
| Rate for Payer: BCBS MAPPO |
$200.50
|
| Rate for Payer: BCBS Trust/PPO |
$659.32
|
| Rate for Payer: BCBS Trust/PPO |
$639.29
|
| Rate for Payer: BCN Commercial |
$623.55
|
| Rate for Payer: BCN Commercial |
$604.61
|
| Rate for Payer: BCN Medicare Advantage |
$200.50
|
| Rate for Payer: BCN Medicare Advantage |
$194.41
|
| Rate for Payer: Cash Price |
$641.59
|
| Rate for Payer: Cash Price |
$622.10
|
| Rate for Payer: Cofinity Commercial |
$668.76
|
| Rate for Payer: Cofinity Commercial |
$689.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$641.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$200.50
|
| Rate for Payer: Healthscope Commercial |
$699.87
|
| Rate for Payer: Healthscope Commercial |
$721.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$601.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$583.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$210.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$230.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$681.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$660.99
|
| Rate for Payer: Nomi Health Commercial |
$657.63
|
| Rate for Payer: Nomi Health Commercial |
$637.66
|
| Rate for Payer: PACE Senior Care Partners |
$190.47
|
| Rate for Payer: PACE Senior Care Partners |
$184.69
|
| Rate for Payer: PACE SWMI |
$200.50
|
| Rate for Payer: PACE SWMI |
$194.41
|
| Rate for Payer: PHP Commercial |
$681.69
|
| Rate for Payer: PHP Commercial |
$660.99
|
| Rate for Payer: PHP Medicare Advantage |
$194.41
|
| Rate for Payer: PHP Medicare Advantage |
$200.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$521.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.46
|
| Rate for Payer: Priority Health HMO/PPO |
$676.54
|
| Rate for Payer: Priority Health HMO/PPO |
$697.73
|
| Rate for Payer: Priority Health Medicare |
$202.50
|
| Rate for Payer: Priority Health Medicare |
$196.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$537.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$521.01
|
| Rate for Payer: Railroad Medicare Medicare |
$194.41
|
| Rate for Payer: Railroad Medicare Medicare |
$200.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$684.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$705.75
|
| Rate for Payer: UHC Core |
$669.66
|
| Rate for Payer: UHC Core |
$649.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$200.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.41
|
| Rate for Payer: UHC Exchange |
$194.41
|
| Rate for Payer: UHC Exchange |
$200.50
|
| Rate for Payer: UHC Medicare Advantage |
$194.41
|
| Rate for Payer: UHC Medicare Advantage |
$200.50
|
| Rate for Payer: VA VA |
$194.41
|
| Rate for Payer: VA VA |
$200.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$601.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$583.22
|
|
|
PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE
|
Facility
|
IP
|
$777.63
|
|
|
Service Code
|
HCPCS 90677
|
| Hospital Charge Code |
197781
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$505.46 |
| Max. Negotiated Rate |
$699.87 |
| Rate for Payer: Aetna Commercial |
$660.99
|
| Rate for Payer: Aetna Commercial |
$681.69
|
| Rate for Payer: BCBS Trust/PPO |
$634.78
|
| Rate for Payer: BCBS Trust/PPO |
$654.66
|
| Rate for Payer: BCN Commercial |
$600.95
|
| Rate for Payer: BCN Commercial |
$619.78
|
| Rate for Payer: Cash Price |
$622.10
|
| Rate for Payer: Cash Price |
$641.59
|
| Rate for Payer: Cofinity Commercial |
$689.71
|
| Rate for Payer: Cofinity Commercial |
$668.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$641.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.10
|
| Rate for Payer: Healthscope Commercial |
$699.87
|
| Rate for Payer: Healthscope Commercial |
$721.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$583.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$601.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$660.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$681.69
|
| Rate for Payer: Nomi Health Commercial |
$637.66
|
| Rate for Payer: Nomi Health Commercial |
$657.63
|
| Rate for Payer: PHP Commercial |
$660.99
|
| Rate for Payer: PHP Commercial |
$681.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$521.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.46
|
| Rate for Payer: Priority Health HMO/PPO |
$697.73
|
| Rate for Payer: Priority Health HMO/PPO |
$676.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$521.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$537.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$684.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$705.75
|
| Rate for Payer: UHC Core |
$649.32
|
| Rate for Payer: UHC Core |
$669.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$583.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$601.49
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWDER
|
Facility
|
IP
|
$18.75
|
|
|
Service Code
|
NDC 45802086801
|
| Hospital Charge Code |
24984
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.19 |
| Max. Negotiated Rate |
$16.88 |
| Rate for Payer: Aetna Commercial |
$15.94
|
| Rate for Payer: BCBS Trust/PPO |
$15.31
|
| Rate for Payer: BCN Commercial |
$14.49
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cofinity Commercial |
$16.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.00
|
| Rate for Payer: Healthscope Commercial |
$16.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.94
|
| Rate for Payer: Nomi Health Commercial |
$15.38
|
| Rate for Payer: PHP Commercial |
$15.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.19
|
| Rate for Payer: Priority Health HMO/PPO |
$16.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.50
|
| Rate for Payer: UHC Core |
$15.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.06
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWDER
|
Facility
|
OP
|
$18.75
|
|
|
Service Code
|
NDC 45802086801
|
| Hospital Charge Code |
24984
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.45 |
| Max. Negotiated Rate |
$16.88 |
| Rate for Payer: Aetna Commercial |
$15.94
|
| Rate for Payer: Aetna Medicare |
$4.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.86
|
| Rate for Payer: BCBS Complete |
$7.50
|
| Rate for Payer: BCBS MAPPO |
$4.69
|
| Rate for Payer: BCBS Trust/PPO |
$15.41
|
| Rate for Payer: BCN Commercial |
$14.58
|
| Rate for Payer: BCN Medicare Advantage |
$4.69
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cofinity Commercial |
$16.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.69
|
| Rate for Payer: Healthscope Commercial |
$16.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.94
|
| Rate for Payer: Nomi Health Commercial |
$15.38
|
| Rate for Payer: PACE Senior Care Partners |
$4.45
|
| Rate for Payer: PACE SWMI |
$4.69
|
| Rate for Payer: PHP Commercial |
$15.94
|
| Rate for Payer: PHP Medicare Advantage |
$4.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.19
|
| Rate for Payer: Priority Health HMO/PPO |
$16.31
|
| Rate for Payer: Priority Health Medicare |
$4.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.56
|
| Rate for Payer: Railroad Medicare Medicare |
$4.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.50
|
| Rate for Payer: UHC Core |
$15.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.69
|
| Rate for Payer: UHC Exchange |
$4.69
|
| Rate for Payer: UHC Medicare Advantage |
$4.69
|
| Rate for Payer: VA VA |
$4.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.06
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$69.89
|
|
|
Service Code
|
NDC 68084043098
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.60 |
| Max. Negotiated Rate |
$62.90 |
| Rate for Payer: Aetna Commercial |
$59.41
|
| Rate for Payer: Aetna Medicare |
$18.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.84
|
| Rate for Payer: BCBS Complete |
$27.96
|
| Rate for Payer: BCBS MAPPO |
$17.47
|
| Rate for Payer: BCBS Trust/PPO |
$57.46
|
| Rate for Payer: BCN Commercial |
$54.34
|
| Rate for Payer: BCN Medicare Advantage |
$17.47
|
| Rate for Payer: Cash Price |
$55.91
|
| Rate for Payer: Cofinity Commercial |
$60.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.47
|
| Rate for Payer: Healthscope Commercial |
$62.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.41
|
| Rate for Payer: Nomi Health Commercial |
$57.31
|
| Rate for Payer: PACE Senior Care Partners |
$16.60
|
| Rate for Payer: PACE SWMI |
$17.47
|
| Rate for Payer: PHP Commercial |
$59.41
|
| Rate for Payer: PHP Medicare Advantage |
$17.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.43
|
| Rate for Payer: Priority Health HMO/PPO |
$60.80
|
| Rate for Payer: Priority Health Medicare |
$17.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.83
|
| Rate for Payer: Railroad Medicare Medicare |
$17.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.50
|
| Rate for Payer: UHC Core |
$58.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.47
|
| Rate for Payer: UHC Exchange |
$17.47
|
| Rate for Payer: UHC Medicare Advantage |
$17.47
|
| Rate for Payer: VA VA |
$17.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.42
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$69.89
|
|
|
Service Code
|
NDC 68084043098
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.43 |
| Max. Negotiated Rate |
$62.90 |
| Rate for Payer: Aetna Commercial |
$59.41
|
| Rate for Payer: BCBS Trust/PPO |
$57.05
|
| Rate for Payer: BCN Commercial |
$54.01
|
| Rate for Payer: Cash Price |
$55.91
|
| Rate for Payer: Cofinity Commercial |
$60.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.91
|
| Rate for Payer: Healthscope Commercial |
$62.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.41
|
| Rate for Payer: Nomi Health Commercial |
$57.31
|
| Rate for Payer: PHP Commercial |
$59.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.43
|
| Rate for Payer: Priority Health HMO/PPO |
$60.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.50
|
| Rate for Payer: UHC Core |
$58.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.42
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$71.48
|
|
|
Service Code
|
NDC 11523726803
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.98 |
| Max. Negotiated Rate |
$64.33 |
| Rate for Payer: Aetna Commercial |
$60.76
|
| Rate for Payer: Aetna Medicare |
$18.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.34
|
| Rate for Payer: BCBS Complete |
$28.59
|
| Rate for Payer: BCBS MAPPO |
$17.87
|
| Rate for Payer: BCBS Trust/PPO |
$58.76
|
| Rate for Payer: BCN Commercial |
$55.58
|
| Rate for Payer: BCN Medicare Advantage |
$17.87
|
| Rate for Payer: Cash Price |
$57.18
|
| Rate for Payer: Cofinity Commercial |
$61.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.87
|
| Rate for Payer: Healthscope Commercial |
$64.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.76
|
| Rate for Payer: Nomi Health Commercial |
$58.61
|
| Rate for Payer: PACE Senior Care Partners |
$16.98
|
| Rate for Payer: PACE SWMI |
$17.87
|
| Rate for Payer: PHP Commercial |
$60.76
|
| Rate for Payer: PHP Medicare Advantage |
$17.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.46
|
| Rate for Payer: Priority Health HMO/PPO |
$62.19
|
| Rate for Payer: Priority Health Medicare |
$18.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.89
|
| Rate for Payer: Railroad Medicare Medicare |
$17.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.90
|
| Rate for Payer: UHC Core |
$59.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.87
|
| Rate for Payer: UHC Exchange |
$17.87
|
| Rate for Payer: UHC Medicare Advantage |
$17.87
|
| Rate for Payer: VA VA |
$17.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.61
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$6.77
|
|
|
Service Code
|
NDC 11523723401
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$6.09 |
| Rate for Payer: Aetna Commercial |
$5.75
|
| Rate for Payer: BCBS Trust/PPO |
$5.53
|
| Rate for Payer: BCN Commercial |
$5.23
|
| Rate for Payer: Cash Price |
$5.42
|
| Rate for Payer: Cofinity Commercial |
$5.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.42
|
| Rate for Payer: Healthscope Commercial |
$6.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.75
|
| Rate for Payer: Nomi Health Commercial |
$5.55
|
| Rate for Payer: PHP Commercial |
$5.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.40
|
| Rate for Payer: Priority Health HMO/PPO |
$5.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.96
|
| Rate for Payer: UHC Core |
$5.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.08
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$554.88
|
|
|
Service Code
|
NDC 60687043192
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$360.67 |
| Max. Negotiated Rate |
$499.39 |
| Rate for Payer: Aetna Commercial |
$471.65
|
| Rate for Payer: BCBS Trust/PPO |
$452.95
|
| Rate for Payer: BCN Commercial |
$428.81
|
| Rate for Payer: Cash Price |
$443.90
|
| Rate for Payer: Cofinity Commercial |
$477.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$443.90
|
| Rate for Payer: Healthscope Commercial |
$499.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$416.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$471.65
|
| Rate for Payer: Nomi Health Commercial |
$455.00
|
| Rate for Payer: PHP Commercial |
$471.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$360.67
|
| Rate for Payer: Priority Health HMO/PPO |
$482.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$371.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$488.29
|
| Rate for Payer: UHC Core |
$463.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$416.16
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$6.84
|
|
|
Service Code
|
NDC 51079030601
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$6.16 |
| Rate for Payer: Aetna Commercial |
$5.81
|
| Rate for Payer: Aetna Medicare |
$1.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.14
|
| Rate for Payer: BCBS Complete |
$2.74
|
| Rate for Payer: BCBS MAPPO |
$1.71
|
| Rate for Payer: BCBS Trust/PPO |
$5.62
|
| Rate for Payer: BCN Commercial |
$5.32
|
| Rate for Payer: BCN Medicare Advantage |
$1.71
|
| Rate for Payer: Cash Price |
$5.47
|
| Rate for Payer: Cofinity Commercial |
$5.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.71
|
| Rate for Payer: Healthscope Commercial |
$6.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.81
|
| Rate for Payer: Nomi Health Commercial |
$5.61
|
| 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 Cigna Priority Health |
$4.45
|
| Rate for Payer: Priority Health HMO/PPO |
$5.95
|
| Rate for Payer: Priority Health Medicare |
$1.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.58
|
| Rate for Payer: Railroad Medicare Medicare |
$1.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.02
|
| Rate for Payer: UHC Core |
$5.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.71
|
| Rate for Payer: UHC Exchange |
$1.71
|
| Rate for Payer: UHC Medicare Advantage |
$1.71
|
| Rate for Payer: VA VA |
$1.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.13
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$5.76
|
|
|
Service Code
|
NDC 60687043199
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$5.18 |
| Rate for Payer: Aetna Commercial |
$4.90
|
| Rate for Payer: Aetna Medicare |
$1.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.80
|
| Rate for Payer: BCBS Complete |
$2.30
|
| Rate for Payer: BCBS MAPPO |
$1.44
|
| Rate for Payer: BCBS Trust/PPO |
$4.74
|
| Rate for Payer: BCN Commercial |
$4.48
|
| Rate for Payer: BCN Medicare Advantage |
$1.44
|
| Rate for Payer: Cash Price |
$4.61
|
| Rate for Payer: Cofinity Commercial |
$4.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.44
|
| Rate for Payer: Healthscope Commercial |
$5.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.90
|
| Rate for Payer: Nomi Health Commercial |
$4.72
|
| Rate for Payer: PACE Senior Care Partners |
$1.37
|
| Rate for Payer: PACE SWMI |
$1.44
|
| Rate for Payer: PHP Commercial |
$4.90
|
| Rate for Payer: PHP Medicare Advantage |
$1.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.74
|
| Rate for Payer: Priority Health HMO/PPO |
$5.01
|
| Rate for Payer: Priority Health Medicare |
$1.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.86
|
| Rate for Payer: Railroad Medicare Medicare |
$1.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.07
|
| Rate for Payer: UHC Core |
$4.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.44
|
| Rate for Payer: UHC Exchange |
$1.44
|
| Rate for Payer: UHC Medicare Advantage |
$1.44
|
| Rate for Payer: VA VA |
$1.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.32
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$69.89
|
|
|
Service Code
|
NDC 68084043099
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.43 |
| Max. Negotiated Rate |
$62.90 |
| Rate for Payer: Aetna Commercial |
$59.41
|
| Rate for Payer: BCBS Trust/PPO |
$57.05
|
| Rate for Payer: BCN Commercial |
$54.01
|
| Rate for Payer: Cash Price |
$55.91
|
| Rate for Payer: Cofinity Commercial |
$60.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.91
|
| Rate for Payer: Healthscope Commercial |
$62.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.41
|
| Rate for Payer: Nomi Health Commercial |
$57.31
|
| Rate for Payer: PHP Commercial |
$59.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.43
|
| Rate for Payer: Priority Health HMO/PPO |
$60.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.50
|
| Rate for Payer: UHC Core |
$58.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.42
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$6.84
|
|
|
Service Code
|
NDC 51079030601
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.45 |
| Max. Negotiated Rate |
$6.16 |
| Rate for Payer: Aetna Commercial |
$5.81
|
| Rate for Payer: BCBS Trust/PPO |
$5.58
|
| Rate for Payer: BCN Commercial |
$5.29
|
| Rate for Payer: Cash Price |
$5.47
|
| Rate for Payer: Cofinity Commercial |
$5.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.47
|
| Rate for Payer: Healthscope Commercial |
$6.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.81
|
| Rate for Payer: Nomi Health Commercial |
$5.61
|
| Rate for Payer: PHP Commercial |
$5.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.45
|
| Rate for Payer: Priority Health HMO/PPO |
$5.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.02
|
| Rate for Payer: UHC Core |
$5.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.13
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$6.71
|
|
|
Service Code
|
NDC 00904693186
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.36 |
| Max. Negotiated Rate |
$6.04 |
| Rate for Payer: Aetna Commercial |
$5.70
|
| Rate for Payer: BCBS Trust/PPO |
$5.48
|
| Rate for Payer: BCN Commercial |
$5.19
|
| Rate for Payer: Cash Price |
$5.37
|
| Rate for Payer: Cofinity Commercial |
$5.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.37
|
| Rate for Payer: Healthscope Commercial |
$6.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.70
|
| Rate for Payer: Nomi Health Commercial |
$5.50
|
| Rate for Payer: PHP Commercial |
$5.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.36
|
| Rate for Payer: Priority Health HMO/PPO |
$5.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.90
|
| Rate for Payer: UHC Core |
$5.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.03
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$205.20
|
|
|
Service Code
|
NDC 51079030630
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.38 |
| Max. Negotiated Rate |
$184.68 |
| Rate for Payer: Aetna Commercial |
$174.42
|
| Rate for Payer: BCBS Trust/PPO |
$167.50
|
| Rate for Payer: BCN Commercial |
$158.58
|
| Rate for Payer: Cash Price |
$164.16
|
| Rate for Payer: Cofinity Commercial |
$176.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.16
|
| Rate for Payer: Healthscope Commercial |
$184.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.42
|
| Rate for Payer: Nomi Health Commercial |
$168.26
|
| Rate for Payer: PHP Commercial |
$174.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.38
|
| Rate for Payer: Priority Health HMO/PPO |
$178.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.58
|
| Rate for Payer: UHC Core |
$171.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.90
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$6.77
|
|
|
Service Code
|
NDC 11523723401
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$6.09 |
| Rate for Payer: Aetna Commercial |
$5.75
|
| Rate for Payer: Aetna Medicare |
$1.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.12
|
| Rate for Payer: BCBS Complete |
$2.71
|
| Rate for Payer: BCBS MAPPO |
$1.69
|
| Rate for Payer: BCBS Trust/PPO |
$5.57
|
| Rate for Payer: BCN Commercial |
$5.26
|
| Rate for Payer: BCN Medicare Advantage |
$1.69
|
| Rate for Payer: Cash Price |
$5.42
|
| Rate for Payer: Cofinity Commercial |
$5.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.69
|
| Rate for Payer: Healthscope Commercial |
$6.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.75
|
| Rate for Payer: Nomi Health Commercial |
$5.55
|
| Rate for Payer: PACE Senior Care Partners |
$1.61
|
| Rate for Payer: PACE SWMI |
$1.69
|
| Rate for Payer: PHP Commercial |
$5.75
|
| Rate for Payer: PHP Medicare Advantage |
$1.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.40
|
| Rate for Payer: Priority Health HMO/PPO |
$5.89
|
| Rate for Payer: Priority Health Medicare |
$1.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.96
|
| Rate for Payer: UHC Core |
$5.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.69
|
| Rate for Payer: UHC Exchange |
$1.69
|
| Rate for Payer: UHC Medicare Advantage |
$1.69
|
| Rate for Payer: VA VA |
$1.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.08
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$156.96
|
|
|
Service Code
|
NDC 00904693176
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.28 |
| Max. Negotiated Rate |
$141.26 |
| Rate for Payer: Aetna Commercial |
$133.42
|
| Rate for Payer: Aetna Medicare |
$40.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.05
|
| Rate for Payer: BCBS Complete |
$62.78
|
| Rate for Payer: BCBS MAPPO |
$39.24
|
| Rate for Payer: BCBS Trust/PPO |
$129.04
|
| Rate for Payer: BCN Commercial |
$122.04
|
| Rate for Payer: BCN Medicare Advantage |
$39.24
|
| Rate for Payer: Cash Price |
$125.57
|
| Rate for Payer: Cofinity Commercial |
$134.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.24
|
| Rate for Payer: Healthscope Commercial |
$141.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.42
|
| Rate for Payer: Nomi Health Commercial |
$128.71
|
| Rate for Payer: PACE Senior Care Partners |
$37.28
|
| Rate for Payer: PACE SWMI |
$39.24
|
| Rate for Payer: PHP Commercial |
$133.42
|
| Rate for Payer: PHP Medicare Advantage |
$39.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.02
|
| Rate for Payer: Priority Health HMO/PPO |
$136.56
|
| Rate for Payer: Priority Health Medicare |
$39.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$105.16
|
| Rate for Payer: Railroad Medicare Medicare |
$39.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.12
|
| Rate for Payer: UHC Core |
$131.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.24
|
| Rate for Payer: UHC Exchange |
$39.24
|
| Rate for Payer: UHC Medicare Advantage |
$39.24
|
| Rate for Payer: VA VA |
$39.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.72
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$205.20
|
|
|
Service Code
|
NDC 51079030630
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.74 |
| Max. Negotiated Rate |
$184.68 |
| Rate for Payer: Aetna Commercial |
$174.42
|
| Rate for Payer: Aetna Medicare |
$53.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.12
|
| Rate for Payer: BCBS Complete |
$82.08
|
| Rate for Payer: BCBS MAPPO |
$51.30
|
| Rate for Payer: BCBS Trust/PPO |
$168.69
|
| Rate for Payer: BCN Commercial |
$159.54
|
| Rate for Payer: BCN Medicare Advantage |
$51.30
|
| Rate for Payer: Cash Price |
$164.16
|
| Rate for Payer: Cofinity Commercial |
$176.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.30
|
| Rate for Payer: Healthscope Commercial |
$184.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.42
|
| Rate for Payer: Nomi Health Commercial |
$168.26
|
| Rate for Payer: PACE Senior Care Partners |
$48.74
|
| Rate for Payer: PACE SWMI |
$51.30
|
| Rate for Payer: PHP Commercial |
$174.42
|
| Rate for Payer: PHP Medicare Advantage |
$51.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.38
|
| Rate for Payer: Priority Health HMO/PPO |
$178.52
|
| Rate for Payer: Priority Health Medicare |
$51.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.48
|
| Rate for Payer: Railroad Medicare Medicare |
$51.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.58
|
| Rate for Payer: UHC Core |
$171.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.30
|
| Rate for Payer: UHC Exchange |
$51.30
|
| Rate for Payer: UHC Medicare Advantage |
$51.30
|
| Rate for Payer: VA VA |
$51.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.90
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$71.48
|
|
|
Service Code
|
NDC 11523726803
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.46 |
| Max. Negotiated Rate |
$64.33 |
| Rate for Payer: Aetna Commercial |
$60.76
|
| Rate for Payer: BCBS Trust/PPO |
$58.35
|
| Rate for Payer: BCN Commercial |
$55.24
|
| Rate for Payer: Cash Price |
$57.18
|
| Rate for Payer: Cofinity Commercial |
$61.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.18
|
| Rate for Payer: Healthscope Commercial |
$64.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.76
|
| Rate for Payer: Nomi Health Commercial |
$58.61
|
| Rate for Payer: PHP Commercial |
$60.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.46
|
| Rate for Payer: Priority Health HMO/PPO |
$62.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.90
|
| Rate for Payer: UHC Core |
$59.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.61
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$156.96
|
|
|
Service Code
|
NDC 00904693176
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.02 |
| Max. Negotiated Rate |
$141.26 |
| Rate for Payer: Aetna Commercial |
$133.42
|
| Rate for Payer: BCBS Trust/PPO |
$128.13
|
| Rate for Payer: BCN Commercial |
$121.30
|
| Rate for Payer: Cash Price |
$125.57
|
| Rate for Payer: Cofinity Commercial |
$134.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.57
|
| Rate for Payer: Healthscope Commercial |
$141.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.42
|
| Rate for Payer: Nomi Health Commercial |
$128.71
|
| Rate for Payer: PHP Commercial |
$133.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.02
|
| Rate for Payer: Priority Health HMO/PPO |
$136.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$105.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.12
|
| Rate for Payer: UHC Core |
$131.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.72
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$69.89
|
|
|
Service Code
|
NDC 68084043099
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.60 |
| Max. Negotiated Rate |
$62.90 |
| Rate for Payer: Aetna Commercial |
$59.41
|
| Rate for Payer: Aetna Medicare |
$18.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.84
|
| Rate for Payer: BCBS Complete |
$27.96
|
| Rate for Payer: BCBS MAPPO |
$17.47
|
| Rate for Payer: BCBS Trust/PPO |
$57.46
|
| Rate for Payer: BCN Commercial |
$54.34
|
| Rate for Payer: BCN Medicare Advantage |
$17.47
|
| Rate for Payer: Cash Price |
$55.91
|
| Rate for Payer: Cofinity Commercial |
$60.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.47
|
| Rate for Payer: Healthscope Commercial |
$62.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.41
|
| Rate for Payer: Nomi Health Commercial |
$57.31
|
| Rate for Payer: PACE Senior Care Partners |
$16.60
|
| Rate for Payer: PACE SWMI |
$17.47
|
| Rate for Payer: PHP Commercial |
$59.41
|
| Rate for Payer: PHP Medicare Advantage |
$17.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.43
|
| Rate for Payer: Priority Health HMO/PPO |
$60.80
|
| Rate for Payer: Priority Health Medicare |
$17.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.83
|
| Rate for Payer: Railroad Medicare Medicare |
$17.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.50
|
| Rate for Payer: UHC Core |
$58.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.47
|
| Rate for Payer: UHC Exchange |
$17.47
|
| Rate for Payer: UHC Medicare Advantage |
$17.47
|
| Rate for Payer: VA VA |
$17.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.42
|
|
