|
POISONING OF MEDICINAL AGENTS
|
Facility
|
IP
|
$5,060.16
|
|
|
Service Code
|
APR-DRG 8123
|
| Min. Negotiated Rate |
$4,819.20 |
| Max. Negotiated Rate |
$5,060.16 |
| Rate for Payer: BCBS Complete |
$5,060.16
|
| Rate for Payer: Mclaren Medicaid |
$4,819.20
|
| Rate for Payer: Meridian Medicaid |
$5,060.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,819.20
|
| Rate for Payer: UHC Medicaid |
$4,819.20
|
| Rate for Payer: UHCCP Medicaid |
$4,819.20
|
|
|
POISONING OF MEDICINAL AGENTS
|
Facility
|
IP
|
$2,357.87
|
|
|
Service Code
|
APR-DRG 8121
|
| Min. Negotiated Rate |
$2,245.59 |
| Max. Negotiated Rate |
$2,357.87 |
| Rate for Payer: BCBS Complete |
$2,357.87
|
| Rate for Payer: Mclaren Medicaid |
$2,245.59
|
| Rate for Payer: Meridian Medicaid |
$2,357.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,245.59
|
| Rate for Payer: UHC Medicaid |
$2,245.59
|
| Rate for Payer: UHCCP Medicaid |
$2,245.59
|
|
|
POISONING OF MEDICINAL AGENTS
|
Facility
|
IP
|
$9,886.84
|
|
|
Service Code
|
APR-DRG 8124
|
| Min. Negotiated Rate |
$9,416.04 |
| Max. Negotiated Rate |
$9,886.84 |
| Rate for Payer: BCBS Complete |
$9,886.84
|
| Rate for Payer: Mclaren Medicaid |
$9,416.04
|
| Rate for Payer: Meridian Medicaid |
$9,886.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,416.04
|
| Rate for Payer: UHC Medicaid |
$9,416.04
|
| Rate for Payer: UHCCP Medicaid |
$9,416.04
|
|
|
POISONING OF MEDICINAL AGENTS
|
Facility
|
IP
|
$3,587.81
|
|
|
Service Code
|
APR-DRG 8122
|
| Min. Negotiated Rate |
$3,416.96 |
| Max. Negotiated Rate |
$3,587.81 |
| Rate for Payer: BCBS Complete |
$3,587.81
|
| Rate for Payer: Mclaren Medicaid |
$3,416.96
|
| Rate for Payer: Meridian Medicaid |
$3,587.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,416.96
|
| Rate for Payer: UHC Medicaid |
$3,416.96
|
| Rate for Payer: UHCCP Medicaid |
$3,416.96
|
|
|
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 |
$48.64 |
| Max. Negotiated Rate |
$62.90 |
| Rate for Payer: Aetna Commercial |
$59.41
|
| Rate for Payer: BCBS Trust/PPO |
$57.72
|
| Rate for Payer: BCN Commercial |
$57.72
|
| 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: Opus (Opus Packaging Group) HMA |
$52.42
|
| Rate for Payer: PHP Commercial |
$59.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.64
|
| 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
|
$164.88
|
|
|
Service Code
|
NDC 00904693176
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.76 |
| Max. Negotiated Rate |
$148.39 |
| Rate for Payer: Aetna Commercial |
$140.15
|
| Rate for Payer: BCBS Trust/PPO |
$136.17
|
| Rate for Payer: BCN Commercial |
$136.17
|
| Rate for Payer: Cash Price |
$131.90
|
| Rate for Payer: Cofinity Commercial |
$141.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.90
|
| Rate for Payer: Healthscope Commercial |
$148.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.15
|
| Rate for Payer: Nomi Health Commercial |
$135.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.66
|
| Rate for Payer: PHP Commercial |
$140.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$143.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$114.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.09
|
| Rate for Payer: UHC Core |
$137.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.66
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$164.88
|
|
|
Service Code
|
NDC 00904693176
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.07 |
| Max. Negotiated Rate |
$148.39 |
| Rate for Payer: Aetna Commercial |
$140.15
|
| Rate for Payer: Aetna Medicare |
$42.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.52
|
| Rate for Payer: BCBS Complete |
$30.52
|
| Rate for Payer: BCBS MAPPO |
$41.22
|
| Rate for Payer: BCBS Trust/PPO |
$135.55
|
| Rate for Payer: BCN Commercial |
$135.55
|
| Rate for Payer: BCN Medicare Advantage |
$41.22
|
| Rate for Payer: Cash Price |
$131.90
|
| Rate for Payer: Cofinity Commercial |
$141.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.22
|
| Rate for Payer: Healthscope Commercial |
$148.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.66
|
| Rate for Payer: Mclaren Medicaid |
$29.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.28
|
| Rate for Payer: Meridian Medicaid |
$30.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$45.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.15
|
| Rate for Payer: Nomi Health Commercial |
$135.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.66
|
| Rate for Payer: PACE Senior Care Partners |
$39.16
|
| Rate for Payer: PACE SWMI |
$41.22
|
| Rate for Payer: PHP Commercial |
$140.15
|
| Rate for Payer: PHP Medicare Advantage |
$41.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$143.45
|
| Rate for Payer: Priority Health Medicare |
$41.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$114.76
|
| Rate for Payer: Railroad Medicare Medicare |
$41.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.09
|
| Rate for Payer: UHC Core |
$137.67
|
| Rate for Payer: UHC Exchange |
$41.22
|
| Rate for Payer: UHC Medicaid |
$29.07
|
| Rate for Payer: UHC Medicare Advantage |
$41.22
|
| Rate for Payer: UHCCP Medicaid |
$29.07
|
| Rate for Payer: VA VA |
$41.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.66
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$192.39
|
|
|
Service Code
|
NDC 51079030630
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.90 |
| Max. Negotiated Rate |
$173.15 |
| Rate for Payer: Aetna Commercial |
$163.53
|
| Rate for Payer: BCBS Trust/PPO |
$158.89
|
| Rate for Payer: BCN Commercial |
$158.89
|
| Rate for Payer: Cash Price |
$153.91
|
| Rate for Payer: Cofinity Commercial |
$165.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.91
|
| Rate for Payer: Healthscope Commercial |
$173.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.53
|
| Rate for Payer: Nomi Health Commercial |
$157.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.29
|
| Rate for Payer: PHP Commercial |
$163.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$167.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$133.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.30
|
| Rate for Payer: UHC Core |
$160.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.29
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$6.05
|
|
|
Service Code
|
NDC 60687043199
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.21 |
| Max. Negotiated Rate |
$5.45 |
| Rate for Payer: Aetna Commercial |
$5.14
|
| Rate for Payer: BCBS Trust/PPO |
$5.00
|
| Rate for Payer: BCN Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$4.84
|
| Rate for Payer: Cofinity Commercial |
$5.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.84
|
| Rate for Payer: Healthscope Commercial |
$5.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.14
|
| Rate for Payer: Nomi Health Commercial |
$4.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.54
|
| Rate for Payer: PHP Commercial |
$5.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.32
|
| Rate for Payer: UHC Core |
$5.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.54
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$520.80
|
|
|
Service Code
|
NDC 00904693181
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$362.48 |
| Max. Negotiated Rate |
$468.72 |
| Rate for Payer: Aetna Commercial |
$442.68
|
| Rate for Payer: BCBS Trust/PPO |
$430.13
|
| Rate for Payer: BCN Commercial |
$430.13
|
| Rate for Payer: Cash Price |
$416.64
|
| Rate for Payer: Cofinity Commercial |
$447.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.64
|
| Rate for Payer: Healthscope Commercial |
$468.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$390.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.68
|
| Rate for Payer: Nomi Health Commercial |
$427.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.60
|
| Rate for Payer: PHP Commercial |
$442.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$453.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$362.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$458.30
|
| Rate for Payer: UHC Core |
$434.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$390.60
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$572.64
|
|
|
Service Code
|
NDC 60687043192
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.96 |
| Max. Negotiated Rate |
$515.38 |
| Rate for Payer: Aetna Commercial |
$486.74
|
| Rate for Payer: Aetna Medicare |
$148.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$178.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$178.95
|
| Rate for Payer: BCBS Complete |
$106.00
|
| Rate for Payer: BCBS MAPPO |
$143.16
|
| Rate for Payer: BCBS Trust/PPO |
$470.77
|
| Rate for Payer: BCN Commercial |
$470.77
|
| Rate for Payer: BCN Medicare Advantage |
$143.16
|
| Rate for Payer: Cash Price |
$458.11
|
| Rate for Payer: Cofinity Commercial |
$492.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$143.16
|
| Rate for Payer: Healthscope Commercial |
$515.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$429.48
|
| Rate for Payer: Mclaren Medicaid |
$100.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$150.32
|
| Rate for Payer: Meridian Medicaid |
$106.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$157.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$486.74
|
| Rate for Payer: Nomi Health Commercial |
$469.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$429.48
|
| Rate for Payer: PACE Senior Care Partners |
$136.00
|
| Rate for Payer: PACE SWMI |
$143.16
|
| Rate for Payer: PHP Commercial |
$486.74
|
| Rate for Payer: PHP Medicare Advantage |
$143.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$100.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$498.20
|
| Rate for Payer: Priority Health Medicare |
$144.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$398.56
|
| Rate for Payer: Railroad Medicare Medicare |
$143.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$503.92
|
| Rate for Payer: UHC Core |
$478.15
|
| Rate for Payer: UHC Exchange |
$143.16
|
| Rate for Payer: UHC Medicaid |
$100.96
|
| Rate for Payer: UHC Medicare Advantage |
$143.16
|
| Rate for Payer: UHCCP Medicaid |
$100.96
|
| Rate for Payer: VA VA |
$143.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$429.48
|
|
|
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 |
$49.75 |
| Max. Negotiated Rate |
$64.33 |
| Rate for Payer: Aetna Commercial |
$60.76
|
| Rate for Payer: BCBS Trust/PPO |
$59.04
|
| Rate for Payer: BCN Commercial |
$59.04
|
| 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: Opus (Opus Packaging Group) HMA |
$53.61
|
| Rate for Payer: PHP Commercial |
$60.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$62.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.75
|
| 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
|
OP
|
$6.38
|
|
|
Service Code
|
NDC 00904693186
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$5.74 |
| Rate for Payer: Aetna Commercial |
$5.42
|
| Rate for Payer: Aetna Medicare |
$1.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.99
|
| Rate for Payer: BCBS Complete |
$1.18
|
| Rate for Payer: BCBS MAPPO |
$1.59
|
| Rate for Payer: BCBS Trust/PPO |
$5.24
|
| Rate for Payer: BCN Commercial |
$5.24
|
| Rate for Payer: BCN Medicare Advantage |
$1.59
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Cofinity Commercial |
$5.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.59
|
| Rate for Payer: Healthscope Commercial |
$5.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.79
|
| Rate for Payer: Mclaren Medicaid |
$1.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.67
|
| Rate for Payer: Meridian Medicaid |
$1.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.42
|
| Rate for Payer: Nomi Health Commercial |
$5.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.79
|
| Rate for Payer: PACE Senior Care Partners |
$1.52
|
| Rate for Payer: PACE SWMI |
$1.59
|
| Rate for Payer: PHP Commercial |
$5.42
|
| Rate for Payer: PHP Medicare Advantage |
$1.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.55
|
| Rate for Payer: Priority Health Medicare |
$1.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.44
|
| Rate for Payer: Railroad Medicare Medicare |
$1.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.61
|
| Rate for Payer: UHC Core |
$5.33
|
| Rate for Payer: UHC Exchange |
$1.59
|
| Rate for Payer: UHC Medicaid |
$1.12
|
| Rate for Payer: UHC Medicare Advantage |
$1.59
|
| Rate for Payer: UHCCP Medicaid |
$1.12
|
| Rate for Payer: VA VA |
$1.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.79
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$520.80
|
|
|
Service Code
|
NDC 00904693181
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.82 |
| Max. Negotiated Rate |
$468.72 |
| Rate for Payer: Aetna Commercial |
$442.68
|
| Rate for Payer: Aetna Medicare |
$135.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$162.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$162.75
|
| Rate for Payer: BCBS Complete |
$96.40
|
| Rate for Payer: BCBS MAPPO |
$130.20
|
| Rate for Payer: BCBS Trust/PPO |
$428.15
|
| Rate for Payer: BCN Commercial |
$428.15
|
| Rate for Payer: BCN Medicare Advantage |
$130.20
|
| Rate for Payer: Cash Price |
$416.64
|
| Rate for Payer: Cofinity Commercial |
$447.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.20
|
| Rate for Payer: Healthscope Commercial |
$468.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$390.60
|
| Rate for Payer: Mclaren Medicaid |
$91.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.71
|
| Rate for Payer: Meridian Medicaid |
$96.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$143.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.68
|
| Rate for Payer: Nomi Health Commercial |
$427.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.60
|
| Rate for Payer: PACE Senior Care Partners |
$123.69
|
| Rate for Payer: PACE SWMI |
$130.20
|
| Rate for Payer: PHP Commercial |
$442.68
|
| Rate for Payer: PHP Medicare Advantage |
$130.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$453.10
|
| Rate for Payer: Priority Health Medicare |
$131.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$362.48
|
| Rate for Payer: Railroad Medicare Medicare |
$130.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$458.30
|
| Rate for Payer: UHC Core |
$434.87
|
| Rate for Payer: UHC Exchange |
$130.20
|
| Rate for Payer: UHC Medicaid |
$91.82
|
| Rate for Payer: UHC Medicare Advantage |
$130.20
|
| Rate for Payer: UHCCP Medicaid |
$91.82
|
| Rate for Payer: VA VA |
$130.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$390.60
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$572.64
|
|
|
Service Code
|
NDC 60687043192
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$398.56 |
| Max. Negotiated Rate |
$515.38 |
| Rate for Payer: Aetna Commercial |
$486.74
|
| Rate for Payer: BCBS Trust/PPO |
$472.94
|
| Rate for Payer: BCN Commercial |
$472.94
|
| Rate for Payer: Cash Price |
$458.11
|
| Rate for Payer: Cofinity Commercial |
$492.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.11
|
| Rate for Payer: Healthscope Commercial |
$515.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$429.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$486.74
|
| Rate for Payer: Nomi Health Commercial |
$469.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$429.48
|
| Rate for Payer: PHP Commercial |
$486.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$498.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$398.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$503.92
|
| Rate for Payer: UHC Core |
$478.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$429.48
|
|
|
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 |
$12.32 |
| 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 |
$12.94
|
| Rate for Payer: BCBS MAPPO |
$17.47
|
| Rate for Payer: BCBS Trust/PPO |
$57.46
|
| Rate for Payer: BCN Commercial |
$57.46
|
| 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: Mclaren Medicaid |
$12.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.35
|
| Rate for Payer: Meridian Medicaid |
$12.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.41
|
| Rate for Payer: Nomi Health Commercial |
$57.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.42
|
| 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 Choice Medicaid |
$12.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.80
|
| Rate for Payer: Priority Health Medicare |
$17.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.64
|
| 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 Exchange |
$17.47
|
| Rate for Payer: UHC Medicaid |
$12.32
|
| Rate for Payer: UHC Medicare Advantage |
$17.47
|
| Rate for Payer: UHCCP Medicaid |
$12.32
|
| 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
|
$6.42
|
|
|
Service Code
|
NDC 51079030601
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.47 |
| Max. Negotiated Rate |
$5.78 |
| Rate for Payer: Aetna Commercial |
$5.46
|
| Rate for Payer: BCBS Trust/PPO |
$5.30
|
| Rate for Payer: BCN Commercial |
$5.30
|
| Rate for Payer: Cash Price |
$5.14
|
| Rate for Payer: Cofinity Commercial |
$5.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.14
|
| Rate for Payer: Healthscope Commercial |
$5.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.46
|
| Rate for Payer: Nomi Health Commercial |
$5.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.82
|
| Rate for Payer: PHP Commercial |
$5.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.65
|
| Rate for Payer: UHC Core |
$5.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.82
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$6.05
|
|
|
Service Code
|
NDC 60687043199
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$5.45 |
| Rate for Payer: Aetna Commercial |
$5.14
|
| Rate for Payer: Aetna Medicare |
$1.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.89
|
| Rate for Payer: BCBS Complete |
$1.12
|
| Rate for Payer: BCBS MAPPO |
$1.51
|
| Rate for Payer: BCBS Trust/PPO |
$4.97
|
| Rate for Payer: BCN Commercial |
$4.97
|
| Rate for Payer: BCN Medicare Advantage |
$1.51
|
| Rate for Payer: Cash Price |
$4.84
|
| Rate for Payer: Cofinity Commercial |
$5.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.51
|
| Rate for Payer: Healthscope Commercial |
$5.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.54
|
| Rate for Payer: Mclaren Medicaid |
$1.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.59
|
| Rate for Payer: Meridian Medicaid |
$1.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.14
|
| Rate for Payer: Nomi Health Commercial |
$4.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.54
|
| Rate for Payer: PACE Senior Care Partners |
$1.44
|
| Rate for Payer: PACE SWMI |
$1.51
|
| Rate for Payer: PHP Commercial |
$5.14
|
| Rate for Payer: PHP Medicare Advantage |
$1.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.26
|
| Rate for Payer: Priority Health Medicare |
$1.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.21
|
| Rate for Payer: Railroad Medicare Medicare |
$1.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.32
|
| Rate for Payer: UHC Core |
$5.05
|
| Rate for Payer: UHC Exchange |
$1.51
|
| Rate for Payer: UHC Medicaid |
$1.07
|
| Rate for Payer: UHC Medicare Advantage |
$1.51
|
| Rate for Payer: UHCCP Medicaid |
$1.07
|
| Rate for Payer: VA VA |
$1.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.54
|
|
|
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 |
$48.64 |
| Max. Negotiated Rate |
$62.90 |
| Rate for Payer: Aetna Commercial |
$59.41
|
| Rate for Payer: BCBS Trust/PPO |
$57.72
|
| Rate for Payer: BCN Commercial |
$57.72
|
| 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: Opus (Opus Packaging Group) HMA |
$52.42
|
| Rate for Payer: PHP Commercial |
$59.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.64
|
| 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
|
$6.38
|
|
|
Service Code
|
NDC 00904693186
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$5.74 |
| Rate for Payer: Aetna Commercial |
$5.42
|
| Rate for Payer: BCBS Trust/PPO |
$5.27
|
| Rate for Payer: BCN Commercial |
$5.27
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Cofinity Commercial |
$5.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.10
|
| Rate for Payer: Healthscope Commercial |
$5.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.42
|
| Rate for Payer: Nomi Health Commercial |
$5.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.79
|
| Rate for Payer: PHP Commercial |
$5.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.61
|
| Rate for Payer: UHC Core |
$5.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.79
|
|
|
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 |
$12.60 |
| 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 |
$13.23
|
| Rate for Payer: BCBS MAPPO |
$17.87
|
| Rate for Payer: BCBS Trust/PPO |
$58.76
|
| Rate for Payer: BCN Commercial |
$58.76
|
| 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: Mclaren Medicaid |
$12.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.76
|
| Rate for Payer: Meridian Medicaid |
$13.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.76
|
| Rate for Payer: Nomi Health Commercial |
$58.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.61
|
| 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 Choice Medicaid |
$12.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$62.19
|
| Rate for Payer: Priority Health Medicare |
$18.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.75
|
| 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 Exchange |
$17.87
|
| Rate for Payer: UHC Medicaid |
$12.60
|
| Rate for Payer: UHC Medicare Advantage |
$17.87
|
| Rate for Payer: UHCCP Medicaid |
$12.60
|
| 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
|
OP
|
$6.77
|
|
|
Service Code
|
NDC 11523723401
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.19 |
| 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 |
$1.25
|
| Rate for Payer: BCBS MAPPO |
$1.69
|
| Rate for Payer: BCBS Trust/PPO |
$5.57
|
| Rate for Payer: BCN Commercial |
$5.57
|
| 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: Mclaren Medicaid |
$1.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.78
|
| Rate for Payer: Meridian Medicaid |
$1.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.75
|
| Rate for Payer: Nomi Health Commercial |
$5.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.08
|
| 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 Choice Medicaid |
$1.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.89
|
| Rate for Payer: Priority Health Medicare |
$1.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.71
|
| 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 Exchange |
$1.69
|
| Rate for Payer: UHC Medicaid |
$1.19
|
| Rate for Payer: UHC Medicare Advantage |
$1.69
|
| Rate for Payer: UHCCP Medicaid |
$1.19
|
| 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
|
$192.39
|
|
|
Service Code
|
NDC 51079030630
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.92 |
| Max. Negotiated Rate |
$173.15 |
| Rate for Payer: Aetna Commercial |
$163.53
|
| Rate for Payer: Aetna Medicare |
$50.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.12
|
| Rate for Payer: BCBS Complete |
$35.61
|
| Rate for Payer: BCBS MAPPO |
$48.10
|
| Rate for Payer: BCBS Trust/PPO |
$158.16
|
| Rate for Payer: BCN Commercial |
$158.16
|
| Rate for Payer: BCN Medicare Advantage |
$48.10
|
| Rate for Payer: Cash Price |
$153.91
|
| Rate for Payer: Cofinity Commercial |
$165.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.10
|
| Rate for Payer: Healthscope Commercial |
$173.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.29
|
| Rate for Payer: Mclaren Medicaid |
$33.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.50
|
| Rate for Payer: Meridian Medicaid |
$35.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$52.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.53
|
| Rate for Payer: Nomi Health Commercial |
$157.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.29
|
| Rate for Payer: PACE Senior Care Partners |
$45.69
|
| Rate for Payer: PACE SWMI |
$48.10
|
| Rate for Payer: PHP Commercial |
$163.53
|
| Rate for Payer: PHP Medicare Advantage |
$48.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$167.38
|
| Rate for Payer: Priority Health Medicare |
$48.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$133.90
|
| Rate for Payer: Railroad Medicare Medicare |
$48.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.30
|
| Rate for Payer: UHC Core |
$160.65
|
| Rate for Payer: UHC Exchange |
$48.10
|
| Rate for Payer: UHC Medicaid |
$33.92
|
| Rate for Payer: UHC Medicare Advantage |
$48.10
|
| Rate for Payer: UHCCP Medicaid |
$33.92
|
| Rate for Payer: VA VA |
$48.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.29
|
|
|
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 |
$12.32 |
| 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 |
$12.94
|
| Rate for Payer: BCBS MAPPO |
$17.47
|
| Rate for Payer: BCBS Trust/PPO |
$57.46
|
| Rate for Payer: BCN Commercial |
$57.46
|
| 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: Mclaren Medicaid |
$12.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.35
|
| Rate for Payer: Meridian Medicaid |
$12.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.41
|
| Rate for Payer: Nomi Health Commercial |
$57.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.42
|
| 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 Choice Medicaid |
$12.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.80
|
| Rate for Payer: Priority Health Medicare |
$17.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.64
|
| 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 Exchange |
$17.47
|
| Rate for Payer: UHC Medicaid |
$12.32
|
| Rate for Payer: UHC Medicare Advantage |
$17.47
|
| Rate for Payer: UHCCP Medicaid |
$12.32
|
| 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
|
OP
|
$6.42
|
|
|
Service Code
|
NDC 51079030601
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$5.78 |
| Rate for Payer: Aetna Commercial |
$5.46
|
| Rate for Payer: Aetna Medicare |
$1.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.01
|
| Rate for Payer: BCBS Complete |
$1.19
|
| Rate for Payer: BCBS MAPPO |
$1.60
|
| Rate for Payer: BCBS Trust/PPO |
$5.28
|
| Rate for Payer: BCN Commercial |
$5.28
|
| Rate for Payer: BCN Medicare Advantage |
$1.60
|
| Rate for Payer: Cash Price |
$5.14
|
| Rate for Payer: Cofinity Commercial |
$5.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.60
|
| Rate for Payer: Healthscope Commercial |
$5.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.82
|
| Rate for Payer: Mclaren Medicaid |
$1.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.69
|
| Rate for Payer: Meridian Medicaid |
$1.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.46
|
| Rate for Payer: Nomi Health Commercial |
$5.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.82
|
| Rate for Payer: PACE Senior Care Partners |
$1.52
|
| Rate for Payer: PACE SWMI |
$1.60
|
| Rate for Payer: PHP Commercial |
$5.46
|
| Rate for Payer: PHP Medicare Advantage |
$1.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.59
|
| Rate for Payer: Priority Health Medicare |
$1.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.47
|
| Rate for Payer: Railroad Medicare Medicare |
$1.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.65
|
| Rate for Payer: UHC Core |
$5.36
|
| Rate for Payer: UHC Exchange |
$1.60
|
| Rate for Payer: UHC Medicaid |
$1.13
|
| Rate for Payer: UHC Medicare Advantage |
$1.60
|
| Rate for Payer: UHCCP Medicaid |
$1.13
|
| Rate for Payer: VA VA |
$1.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.82
|
|
