|
ATORVASTATIN 40 MG TABLET
|
Facility
|
OP
|
$219.45
|
|
|
Service Code
|
NDC 00904629261
|
| Hospital Charge Code |
19177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.12 |
| Max. Negotiated Rate |
$197.50 |
| Rate for Payer: Aetna Commercial |
$186.53
|
| Rate for Payer: Aetna Medicare |
$57.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.58
|
| Rate for Payer: BCBS Complete |
$87.78
|
| Rate for Payer: BCBS MAPPO |
$54.86
|
| Rate for Payer: BCBS Trust/PPO |
$180.41
|
| Rate for Payer: BCN Commercial |
$170.62
|
| Rate for Payer: BCN Medicare Advantage |
$54.86
|
| Rate for Payer: Cash Price |
$175.56
|
| Rate for Payer: Cofinity Commercial |
$188.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.86
|
| Rate for Payer: Healthscope Commercial |
$197.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.53
|
| Rate for Payer: Nomi Health Commercial |
$179.95
|
| Rate for Payer: PACE Senior Care Partners |
$52.12
|
| Rate for Payer: PACE SWMI |
$54.86
|
| Rate for Payer: PHP Commercial |
$186.53
|
| Rate for Payer: PHP Medicare Advantage |
$54.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.64
|
| Rate for Payer: Priority Health HMO/PPO |
$190.92
|
| Rate for Payer: Priority Health Medicare |
$55.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$147.03
|
| Rate for Payer: Railroad Medicare Medicare |
$54.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.12
|
| Rate for Payer: UHC Core |
$183.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.86
|
| Rate for Payer: UHC Exchange |
$54.86
|
| Rate for Payer: UHC Medicare Advantage |
$54.86
|
| Rate for Payer: VA VA |
$54.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.59
|
|
|
ATORVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$219.45
|
|
|
Service Code
|
NDC 00904629261
|
| Hospital Charge Code |
19177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.64 |
| Max. Negotiated Rate |
$197.50 |
| Rate for Payer: Aetna Commercial |
$186.53
|
| Rate for Payer: BCBS Trust/PPO |
$179.14
|
| Rate for Payer: BCN Commercial |
$169.59
|
| Rate for Payer: Cash Price |
$175.56
|
| Rate for Payer: Cofinity Commercial |
$188.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.56
|
| Rate for Payer: Healthscope Commercial |
$197.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.53
|
| Rate for Payer: Nomi Health Commercial |
$179.95
|
| Rate for Payer: PHP Commercial |
$186.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.64
|
| Rate for Payer: Priority Health HMO/PPO |
$190.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$147.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.12
|
| Rate for Payer: UHC Core |
$183.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.59
|
|
|
ATROPINE 0.1 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$42.99
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
730
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.94 |
| Max. Negotiated Rate |
$38.69 |
| Rate for Payer: Aetna Commercial |
$36.54
|
| Rate for Payer: Aetna Commercial |
$30.80
|
| Rate for Payer: Aetna Commercial |
$23.99
|
| Rate for Payer: Aetna Commercial |
$58.46
|
| Rate for Payer: BCBS Trust/PPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$56.15
|
| Rate for Payer: BCBS Trust/PPO |
$29.57
|
| Rate for Payer: BCBS Trust/PPO |
$23.04
|
| Rate for Payer: BCN Commercial |
$33.22
|
| Rate for Payer: BCN Commercial |
$21.81
|
| Rate for Payer: BCN Commercial |
$53.15
|
| Rate for Payer: BCN Commercial |
$28.00
|
| Rate for Payer: Cash Price |
$28.98
|
| Rate for Payer: Cash Price |
$34.39
|
| Rate for Payer: Cash Price |
$55.02
|
| Rate for Payer: Cash Price |
$22.58
|
| Rate for Payer: Cofinity Commercial |
$24.27
|
| Rate for Payer: Cofinity Commercial |
$59.15
|
| Rate for Payer: Cofinity Commercial |
$36.97
|
| Rate for Payer: Cofinity Commercial |
$31.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.02
|
| Rate for Payer: Healthscope Commercial |
$61.90
|
| Rate for Payer: Healthscope Commercial |
$32.61
|
| Rate for Payer: Healthscope Commercial |
$38.69
|
| Rate for Payer: Healthscope Commercial |
$25.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.46
|
| Rate for Payer: Nomi Health Commercial |
$23.14
|
| Rate for Payer: Nomi Health Commercial |
$29.71
|
| Rate for Payer: Nomi Health Commercial |
$56.40
|
| Rate for Payer: Nomi Health Commercial |
$35.25
|
| Rate for Payer: PHP Commercial |
$30.80
|
| Rate for Payer: PHP Commercial |
$23.99
|
| Rate for Payer: PHP Commercial |
$36.54
|
| Rate for Payer: PHP Commercial |
$58.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.94
|
| Rate for Payer: Priority Health HMO/PPO |
$37.40
|
| Rate for Payer: Priority Health HMO/PPO |
$59.84
|
| Rate for Payer: Priority Health HMO/PPO |
$24.55
|
| Rate for Payer: Priority Health HMO/PPO |
$31.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.83
|
| Rate for Payer: UHC Core |
$35.90
|
| Rate for Payer: UHC Core |
$57.43
|
| Rate for Payer: UHC Core |
$30.25
|
| Rate for Payer: UHC Core |
$23.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.24
|
|
|
ATROPINE 0.1 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$28.22
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
730
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$25.40 |
| Rate for Payer: Aetna Commercial |
$23.99
|
| Rate for Payer: Aetna Commercial |
$58.46
|
| Rate for Payer: Aetna Commercial |
$36.54
|
| Rate for Payer: Aetna Commercial |
$30.80
|
| Rate for Payer: Aetna Medicare |
$9.42
|
| Rate for Payer: Aetna Medicare |
$7.34
|
| Rate for Payer: Aetna Medicare |
$11.18
|
| Rate for Payer: Aetna Medicare |
$17.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.82
|
| Rate for Payer: BCBS Complete |
$11.29
|
| Rate for Payer: BCBS Complete |
$14.49
|
| Rate for Payer: BCBS Complete |
$27.51
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS MAPPO |
$7.05
|
| Rate for Payer: BCBS MAPPO |
$9.06
|
| Rate for Payer: BCBS MAPPO |
$17.20
|
| Rate for Payer: BCBS MAPPO |
$10.75
|
| Rate for Payer: BCBS Trust/PPO |
$23.20
|
| Rate for Payer: BCBS Trust/PPO |
$56.54
|
| Rate for Payer: BCBS Trust/PPO |
$29.78
|
| Rate for Payer: BCBS Trust/PPO |
$35.34
|
| Rate for Payer: BCN Commercial |
$21.94
|
| Rate for Payer: BCN Commercial |
$33.42
|
| Rate for Payer: BCN Commercial |
$28.17
|
| Rate for Payer: BCN Commercial |
$53.48
|
| Rate for Payer: BCN Medicare Advantage |
$9.06
|
| Rate for Payer: BCN Medicare Advantage |
$17.20
|
| Rate for Payer: BCN Medicare Advantage |
$7.05
|
| Rate for Payer: BCN Medicare Advantage |
$10.75
|
| Rate for Payer: Cash Price |
$22.58
|
| Rate for Payer: Cash Price |
$55.02
|
| Rate for Payer: Cash Price |
$34.39
|
| Rate for Payer: Cash Price |
$28.98
|
| Rate for Payer: Cofinity Commercial |
$59.15
|
| Rate for Payer: Cofinity Commercial |
$31.16
|
| Rate for Payer: Cofinity Commercial |
$24.27
|
| Rate for Payer: Cofinity Commercial |
$36.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.75
|
| Rate for Payer: Healthscope Commercial |
$25.40
|
| Rate for Payer: Healthscope Commercial |
$61.90
|
| Rate for Payer: Healthscope Commercial |
$38.69
|
| Rate for Payer: Healthscope Commercial |
$32.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.54
|
| Rate for Payer: Nomi Health Commercial |
$35.25
|
| Rate for Payer: Nomi Health Commercial |
$56.40
|
| Rate for Payer: Nomi Health Commercial |
$23.14
|
| Rate for Payer: Nomi Health Commercial |
$29.71
|
| Rate for Payer: PACE Senior Care Partners |
$6.70
|
| Rate for Payer: PACE Senior Care Partners |
$10.21
|
| Rate for Payer: PACE Senior Care Partners |
$16.34
|
| Rate for Payer: PACE Senior Care Partners |
$8.60
|
| Rate for Payer: PACE SWMI |
$9.06
|
| Rate for Payer: PACE SWMI |
$7.05
|
| Rate for Payer: PACE SWMI |
$10.75
|
| Rate for Payer: PACE SWMI |
$17.20
|
| Rate for Payer: PHP Commercial |
$36.54
|
| Rate for Payer: PHP Commercial |
$58.46
|
| Rate for Payer: PHP Commercial |
$30.80
|
| Rate for Payer: PHP Commercial |
$23.99
|
| Rate for Payer: PHP Medicare Advantage |
$9.06
|
| Rate for Payer: PHP Medicare Advantage |
$7.05
|
| Rate for Payer: PHP Medicare Advantage |
$17.20
|
| Rate for Payer: PHP Medicare Advantage |
$10.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.34
|
| Rate for Payer: Priority Health HMO/PPO |
$31.52
|
| Rate for Payer: Priority Health HMO/PPO |
$59.84
|
| Rate for Payer: Priority Health HMO/PPO |
$37.40
|
| Rate for Payer: Priority Health HMO/PPO |
$24.55
|
| Rate for Payer: Priority Health Medicare |
$10.85
|
| Rate for Payer: Priority Health Medicare |
$7.13
|
| Rate for Payer: Priority Health Medicare |
$9.15
|
| Rate for Payer: Priority Health Medicare |
$17.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.91
|
| Rate for Payer: Railroad Medicare Medicare |
$9.06
|
| Rate for Payer: Railroad Medicare Medicare |
$10.75
|
| Rate for Payer: Railroad Medicare Medicare |
$7.05
|
| Rate for Payer: Railroad Medicare Medicare |
$17.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.88
|
| Rate for Payer: UHC Core |
$23.56
|
| Rate for Payer: UHC Core |
$57.43
|
| Rate for Payer: UHC Core |
$30.25
|
| Rate for Payer: UHC Core |
$35.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.06
|
| Rate for Payer: UHC Exchange |
$17.20
|
| Rate for Payer: UHC Exchange |
$9.06
|
| Rate for Payer: UHC Exchange |
$7.05
|
| Rate for Payer: UHC Exchange |
$10.75
|
| Rate for Payer: UHC Medicare Advantage |
$17.20
|
| Rate for Payer: UHC Medicare Advantage |
$7.05
|
| Rate for Payer: UHC Medicare Advantage |
$10.75
|
| Rate for Payer: UHC Medicare Advantage |
$9.06
|
| Rate for Payer: VA VA |
$9.06
|
| Rate for Payer: VA VA |
$17.20
|
| Rate for Payer: VA VA |
$10.75
|
| Rate for Payer: VA VA |
$7.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.24
|
|
|
ATROPINE 0.1 MG/ML SYRINGE (CODE)
|
Facility
|
IP
|
$68.78
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
163701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.71 |
| Max. Negotiated Rate |
$61.90 |
| Rate for Payer: Aetna Commercial |
$58.46
|
| Rate for Payer: BCBS Trust/PPO |
$56.15
|
| Rate for Payer: BCN Commercial |
$53.15
|
| Rate for Payer: Cash Price |
$55.02
|
| Rate for Payer: Cofinity Commercial |
$59.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.02
|
| Rate for Payer: Healthscope Commercial |
$61.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.46
|
| Rate for Payer: Nomi Health Commercial |
$56.40
|
| Rate for Payer: PHP Commercial |
$58.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.71
|
| Rate for Payer: Priority Health HMO/PPO |
$59.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.53
|
| Rate for Payer: UHC Core |
$57.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.59
|
|
|
ATROPINE 0.1 MG/ML SYRINGE (CODE)
|
Facility
|
OP
|
$68.78
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
163701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.34 |
| Max. Negotiated Rate |
$61.90 |
| Rate for Payer: Aetna Commercial |
$58.46
|
| Rate for Payer: Aetna Medicare |
$17.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.49
|
| Rate for Payer: BCBS Complete |
$27.51
|
| Rate for Payer: BCBS MAPPO |
$17.20
|
| Rate for Payer: BCBS Trust/PPO |
$56.54
|
| Rate for Payer: BCN Commercial |
$53.48
|
| Rate for Payer: BCN Medicare Advantage |
$17.20
|
| Rate for Payer: Cash Price |
$55.02
|
| Rate for Payer: Cofinity Commercial |
$59.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.20
|
| Rate for Payer: Healthscope Commercial |
$61.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.46
|
| Rate for Payer: Nomi Health Commercial |
$56.40
|
| Rate for Payer: PACE Senior Care Partners |
$16.34
|
| Rate for Payer: PACE SWMI |
$17.20
|
| Rate for Payer: PHP Commercial |
$58.46
|
| Rate for Payer: PHP Medicare Advantage |
$17.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.71
|
| Rate for Payer: Priority Health HMO/PPO |
$59.84
|
| Rate for Payer: Priority Health Medicare |
$17.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.08
|
| Rate for Payer: Railroad Medicare Medicare |
$17.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.53
|
| Rate for Payer: UHC Core |
$57.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.20
|
| Rate for Payer: UHC Exchange |
$17.20
|
| Rate for Payer: UHC Medicare Advantage |
$17.20
|
| Rate for Payer: VA VA |
$17.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.59
|
|
|
ATROPINE 1 % EYE DROPS
|
Facility
|
OP
|
$122.08
|
|
|
Service Code
|
NDC 17478021505
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.99 |
| Max. Negotiated Rate |
$109.87 |
| Rate for Payer: Aetna Commercial |
$103.77
|
| Rate for Payer: Aetna Medicare |
$31.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.15
|
| Rate for Payer: BCBS Complete |
$48.83
|
| Rate for Payer: BCBS MAPPO |
$30.52
|
| Rate for Payer: BCBS Trust/PPO |
$100.36
|
| Rate for Payer: BCN Commercial |
$94.92
|
| Rate for Payer: BCN Medicare Advantage |
$30.52
|
| Rate for Payer: Cash Price |
$97.66
|
| Rate for Payer: Cofinity Commercial |
$104.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.52
|
| Rate for Payer: Healthscope Commercial |
$109.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.77
|
| Rate for Payer: Nomi Health Commercial |
$100.11
|
| Rate for Payer: PACE Senior Care Partners |
$28.99
|
| Rate for Payer: PACE SWMI |
$30.52
|
| Rate for Payer: PHP Commercial |
$103.77
|
| Rate for Payer: PHP Medicare Advantage |
$30.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.35
|
| Rate for Payer: Priority Health HMO/PPO |
$106.21
|
| Rate for Payer: Priority Health Medicare |
$30.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.79
|
| Rate for Payer: Railroad Medicare Medicare |
$30.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.43
|
| Rate for Payer: UHC Core |
$101.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.52
|
| Rate for Payer: UHC Exchange |
$30.52
|
| Rate for Payer: UHC Medicare Advantage |
$30.52
|
| Rate for Payer: VA VA |
$30.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.56
|
|
|
ATROPINE 1 % EYE DROPS
|
Facility
|
IP
|
$122.08
|
|
|
Service Code
|
NDC 17478021505
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.35 |
| Max. Negotiated Rate |
$109.87 |
| Rate for Payer: Aetna Commercial |
$103.77
|
| Rate for Payer: BCBS Trust/PPO |
$99.65
|
| Rate for Payer: BCN Commercial |
$94.34
|
| Rate for Payer: Cash Price |
$97.66
|
| Rate for Payer: Cofinity Commercial |
$104.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.66
|
| Rate for Payer: Healthscope Commercial |
$109.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.77
|
| Rate for Payer: Nomi Health Commercial |
$100.11
|
| Rate for Payer: PHP Commercial |
$103.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.35
|
| Rate for Payer: Priority Health HMO/PPO |
$106.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.43
|
| Rate for Payer: UHC Core |
$101.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.56
|
|
|
ATROPINE 1 % EYE DROPS
|
Facility
|
OP
|
$161.25
|
|
|
Service Code
|
NDC 00065030355
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.30 |
| Max. Negotiated Rate |
$145.12 |
| Rate for Payer: Aetna Commercial |
$137.06
|
| Rate for Payer: Aetna Medicare |
$41.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.39
|
| Rate for Payer: BCBS Complete |
$64.50
|
| Rate for Payer: BCBS MAPPO |
$40.31
|
| Rate for Payer: BCBS Trust/PPO |
$132.56
|
| Rate for Payer: BCN Commercial |
$125.37
|
| Rate for Payer: BCN Medicare Advantage |
$40.31
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cofinity Commercial |
$138.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.31
|
| Rate for Payer: Healthscope Commercial |
$145.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.06
|
| Rate for Payer: Nomi Health Commercial |
$132.22
|
| Rate for Payer: PACE Senior Care Partners |
$38.30
|
| Rate for Payer: PACE SWMI |
$40.31
|
| Rate for Payer: PHP Commercial |
$137.06
|
| Rate for Payer: PHP Medicare Advantage |
$40.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.81
|
| Rate for Payer: Priority Health HMO/PPO |
$140.29
|
| Rate for Payer: Priority Health Medicare |
$40.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.04
|
| Rate for Payer: Railroad Medicare Medicare |
$40.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.90
|
| Rate for Payer: UHC Core |
$134.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.31
|
| Rate for Payer: UHC Exchange |
$40.31
|
| Rate for Payer: UHC Medicare Advantage |
$40.31
|
| Rate for Payer: VA VA |
$40.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.94
|
|
|
ATROPINE 1 % EYE DROPS
|
Facility
|
IP
|
$161.25
|
|
|
Service Code
|
NDC 00065030355
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.81 |
| Max. Negotiated Rate |
$145.12 |
| Rate for Payer: Aetna Commercial |
$137.06
|
| Rate for Payer: BCBS Trust/PPO |
$131.63
|
| Rate for Payer: BCN Commercial |
$124.61
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cofinity Commercial |
$138.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.00
|
| Rate for Payer: Healthscope Commercial |
$145.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.06
|
| Rate for Payer: Nomi Health Commercial |
$132.22
|
| Rate for Payer: PHP Commercial |
$137.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.81
|
| Rate for Payer: Priority Health HMO/PPO |
$140.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.90
|
| Rate for Payer: UHC Core |
$134.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.94
|
|
|
ATROPINE 1 MG/ML INJECTION SOLUTION WRAPPER
|
Facility
|
IP
|
$30.29
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
301597
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.69 |
| Max. Negotiated Rate |
$27.26 |
| Rate for Payer: Aetna Commercial |
$25.75
|
| Rate for Payer: Aetna Commercial |
$25.80
|
| Rate for Payer: BCBS Trust/PPO |
$24.73
|
| Rate for Payer: BCBS Trust/PPO |
$24.77
|
| Rate for Payer: BCN Commercial |
$23.41
|
| Rate for Payer: BCN Commercial |
$23.45
|
| Rate for Payer: Cash Price |
$24.23
|
| Rate for Payer: Cash Price |
$24.28
|
| Rate for Payer: Cofinity Commercial |
$26.10
|
| Rate for Payer: Cofinity Commercial |
$26.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.23
|
| Rate for Payer: Healthscope Commercial |
$27.26
|
| Rate for Payer: Healthscope Commercial |
$27.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.80
|
| Rate for Payer: Nomi Health Commercial |
$24.84
|
| Rate for Payer: Nomi Health Commercial |
$24.89
|
| Rate for Payer: PHP Commercial |
$25.75
|
| Rate for Payer: PHP Commercial |
$25.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.69
|
| Rate for Payer: Priority Health HMO/PPO |
$26.40
|
| Rate for Payer: Priority Health HMO/PPO |
$26.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.71
|
| Rate for Payer: UHC Core |
$25.29
|
| Rate for Payer: UHC Core |
$25.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.76
|
|
|
ATROPINE 1 MG/ML INJECTION SOLUTION WRAPPER
|
Facility
|
OP
|
$30.35
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
301597
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.21 |
| Max. Negotiated Rate |
$27.32 |
| Rate for Payer: Aetna Commercial |
$25.80
|
| Rate for Payer: Aetna Commercial |
$25.75
|
| Rate for Payer: Aetna Medicare |
$7.89
|
| Rate for Payer: Aetna Medicare |
$7.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.47
|
| Rate for Payer: BCBS Complete |
$12.12
|
| Rate for Payer: BCBS Complete |
$12.14
|
| Rate for Payer: BCBS MAPPO |
$7.57
|
| Rate for Payer: BCBS MAPPO |
$7.59
|
| Rate for Payer: BCBS Trust/PPO |
$24.95
|
| Rate for Payer: BCBS Trust/PPO |
$24.90
|
| Rate for Payer: BCN Commercial |
$23.60
|
| Rate for Payer: BCN Commercial |
$23.55
|
| Rate for Payer: BCN Medicare Advantage |
$7.59
|
| Rate for Payer: BCN Medicare Advantage |
$7.57
|
| Rate for Payer: Cash Price |
$24.28
|
| Rate for Payer: Cash Price |
$24.23
|
| Rate for Payer: Cofinity Commercial |
$26.05
|
| Rate for Payer: Cofinity Commercial |
$26.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.59
|
| Rate for Payer: Healthscope Commercial |
$27.26
|
| Rate for Payer: Healthscope Commercial |
$27.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.75
|
| Rate for Payer: Nomi Health Commercial |
$24.89
|
| Rate for Payer: Nomi Health Commercial |
$24.84
|
| Rate for Payer: PACE Senior Care Partners |
$7.21
|
| Rate for Payer: PACE Senior Care Partners |
$7.19
|
| Rate for Payer: PACE SWMI |
$7.59
|
| Rate for Payer: PACE SWMI |
$7.57
|
| Rate for Payer: PHP Commercial |
$25.80
|
| Rate for Payer: PHP Commercial |
$25.75
|
| Rate for Payer: PHP Medicare Advantage |
$7.57
|
| Rate for Payer: PHP Medicare Advantage |
$7.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.69
|
| Rate for Payer: Priority Health HMO/PPO |
$26.35
|
| Rate for Payer: Priority Health HMO/PPO |
$26.40
|
| Rate for Payer: Priority Health Medicare |
$7.66
|
| Rate for Payer: Priority Health Medicare |
$7.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.29
|
| Rate for Payer: Railroad Medicare Medicare |
$7.57
|
| Rate for Payer: Railroad Medicare Medicare |
$7.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.71
|
| Rate for Payer: UHC Core |
$25.34
|
| Rate for Payer: UHC Core |
$25.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.57
|
| Rate for Payer: UHC Exchange |
$7.57
|
| Rate for Payer: UHC Exchange |
$7.59
|
| Rate for Payer: UHC Medicare Advantage |
$7.57
|
| Rate for Payer: UHC Medicare Advantage |
$7.59
|
| Rate for Payer: VA VA |
$7.57
|
| Rate for Payer: VA VA |
$7.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.72
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$96.62
|
|
|
Service Code
|
NDC 42806015134
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.95 |
| Max. Negotiated Rate |
$86.96 |
| Rate for Payer: Aetna Commercial |
$82.13
|
| Rate for Payer: Aetna Medicare |
$25.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.19
|
| Rate for Payer: BCBS Complete |
$38.65
|
| Rate for Payer: BCBS MAPPO |
$24.16
|
| Rate for Payer: BCBS Trust/PPO |
$79.43
|
| Rate for Payer: BCN Commercial |
$75.12
|
| Rate for Payer: BCN Medicare Advantage |
$24.16
|
| Rate for Payer: Cash Price |
$77.30
|
| Rate for Payer: Cofinity Commercial |
$83.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.16
|
| Rate for Payer: Healthscope Commercial |
$86.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.13
|
| Rate for Payer: Nomi Health Commercial |
$79.23
|
| Rate for Payer: PACE Senior Care Partners |
$22.95
|
| Rate for Payer: PACE SWMI |
$24.16
|
| Rate for Payer: PHP Commercial |
$82.13
|
| Rate for Payer: PHP Medicare Advantage |
$24.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.80
|
| Rate for Payer: Priority Health HMO/PPO |
$84.06
|
| Rate for Payer: Priority Health Medicare |
$24.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.74
|
| Rate for Payer: Railroad Medicare Medicare |
$24.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.03
|
| Rate for Payer: UHC Core |
$80.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.16
|
| Rate for Payer: UHC Exchange |
$24.16
|
| Rate for Payer: UHC Medicare Advantage |
$24.16
|
| Rate for Payer: VA VA |
$24.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.47
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$19.08
|
|
|
Service Code
|
NDC 09900000333
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$17.17 |
| Rate for Payer: Aetna Commercial |
$16.22
|
| Rate for Payer: Aetna Medicare |
$4.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.96
|
| Rate for Payer: BCBS Complete |
$7.63
|
| Rate for Payer: BCBS MAPPO |
$4.77
|
| Rate for Payer: BCBS Trust/PPO |
$15.69
|
| Rate for Payer: BCN Commercial |
$14.83
|
| Rate for Payer: BCN Medicare Advantage |
$4.77
|
| Rate for Payer: Cash Price |
$15.26
|
| Rate for Payer: Cofinity Commercial |
$16.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.77
|
| Rate for Payer: Healthscope Commercial |
$17.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.22
|
| Rate for Payer: Nomi Health Commercial |
$15.65
|
| Rate for Payer: PACE Senior Care Partners |
$4.53
|
| Rate for Payer: PACE SWMI |
$4.77
|
| Rate for Payer: PHP Commercial |
$16.22
|
| Rate for Payer: PHP Medicare Advantage |
$4.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.40
|
| Rate for Payer: Priority Health HMO/PPO |
$16.60
|
| Rate for Payer: Priority Health Medicare |
$4.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.78
|
| Rate for Payer: Railroad Medicare Medicare |
$4.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.79
|
| Rate for Payer: UHC Core |
$15.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.77
|
| Rate for Payer: UHC Exchange |
$4.77
|
| Rate for Payer: UHC Medicare Advantage |
$4.77
|
| Rate for Payer: VA VA |
$4.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.31
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$96.62
|
|
|
Service Code
|
NDC 42806015134
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.80 |
| Max. Negotiated Rate |
$86.96 |
| Rate for Payer: Aetna Commercial |
$82.13
|
| Rate for Payer: BCBS Trust/PPO |
$78.87
|
| Rate for Payer: BCN Commercial |
$74.67
|
| Rate for Payer: Cash Price |
$77.30
|
| Rate for Payer: Cofinity Commercial |
$83.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.30
|
| Rate for Payer: Healthscope Commercial |
$86.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.13
|
| Rate for Payer: Nomi Health Commercial |
$79.23
|
| Rate for Payer: PHP Commercial |
$82.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.80
|
| Rate for Payer: Priority Health HMO/PPO |
$84.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.03
|
| Rate for Payer: UHC Core |
$80.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.47
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$19.08
|
|
|
Service Code
|
NDC 09900000333
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$17.17 |
| Rate for Payer: Aetna Commercial |
$16.22
|
| Rate for Payer: BCBS Trust/PPO |
$15.58
|
| Rate for Payer: BCN Commercial |
$14.75
|
| Rate for Payer: Cash Price |
$15.26
|
| Rate for Payer: Cofinity Commercial |
$16.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.26
|
| Rate for Payer: Healthscope Commercial |
$17.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.22
|
| Rate for Payer: Nomi Health Commercial |
$15.65
|
| Rate for Payer: PHP Commercial |
$16.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.40
|
| Rate for Payer: Priority Health HMO/PPO |
$16.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.79
|
| Rate for Payer: UHC Core |
$15.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.31
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$116.79
|
|
|
Service Code
|
NDC 00093202631
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.74 |
| Max. Negotiated Rate |
$105.11 |
| Rate for Payer: Aetna Commercial |
$99.27
|
| Rate for Payer: Aetna Medicare |
$30.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.50
|
| Rate for Payer: BCBS Complete |
$46.72
|
| Rate for Payer: BCBS MAPPO |
$29.20
|
| Rate for Payer: BCBS Trust/PPO |
$96.01
|
| Rate for Payer: BCN Commercial |
$90.80
|
| Rate for Payer: BCN Medicare Advantage |
$29.20
|
| Rate for Payer: Cash Price |
$93.43
|
| Rate for Payer: Cofinity Commercial |
$100.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.20
|
| Rate for Payer: Healthscope Commercial |
$105.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.27
|
| Rate for Payer: Nomi Health Commercial |
$95.77
|
| Rate for Payer: PACE Senior Care Partners |
$27.74
|
| Rate for Payer: PACE SWMI |
$29.20
|
| Rate for Payer: PHP Commercial |
$99.27
|
| Rate for Payer: PHP Medicare Advantage |
$29.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.91
|
| Rate for Payer: Priority Health HMO/PPO |
$101.61
|
| Rate for Payer: Priority Health Medicare |
$29.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.25
|
| Rate for Payer: Railroad Medicare Medicare |
$29.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.78
|
| Rate for Payer: UHC Core |
$97.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.20
|
| Rate for Payer: UHC Exchange |
$29.20
|
| Rate for Payer: UHC Medicare Advantage |
$29.20
|
| Rate for Payer: VA VA |
$29.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.59
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$116.79
|
|
|
Service Code
|
NDC 00093202631
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.91 |
| Max. Negotiated Rate |
$105.11 |
| Rate for Payer: Aetna Commercial |
$99.27
|
| Rate for Payer: BCBS Trust/PPO |
$95.34
|
| Rate for Payer: BCN Commercial |
$90.26
|
| Rate for Payer: Cash Price |
$93.43
|
| Rate for Payer: Cofinity Commercial |
$100.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.43
|
| Rate for Payer: Healthscope Commercial |
$105.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.27
|
| Rate for Payer: Nomi Health Commercial |
$95.77
|
| Rate for Payer: PHP Commercial |
$99.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.91
|
| Rate for Payer: Priority Health HMO/PPO |
$101.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.78
|
| Rate for Payer: UHC Core |
$97.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.59
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$51.62
|
|
|
Service Code
|
NDC 50111078751
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.26 |
| Max. Negotiated Rate |
$46.46 |
| Rate for Payer: Aetna Commercial |
$43.88
|
| Rate for Payer: Aetna Medicare |
$13.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.13
|
| Rate for Payer: BCBS Complete |
$20.65
|
| Rate for Payer: BCBS MAPPO |
$12.90
|
| Rate for Payer: BCBS Trust/PPO |
$42.44
|
| Rate for Payer: BCN Commercial |
$40.13
|
| Rate for Payer: BCN Medicare Advantage |
$12.90
|
| Rate for Payer: Cash Price |
$41.30
|
| Rate for Payer: Cofinity Commercial |
$44.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.90
|
| Rate for Payer: Healthscope Commercial |
$46.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.88
|
| Rate for Payer: Nomi Health Commercial |
$42.33
|
| Rate for Payer: PACE Senior Care Partners |
$12.26
|
| Rate for Payer: PACE SWMI |
$12.90
|
| Rate for Payer: PHP Commercial |
$43.88
|
| Rate for Payer: PHP Medicare Advantage |
$12.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.55
|
| Rate for Payer: Priority Health HMO/PPO |
$44.91
|
| Rate for Payer: Priority Health Medicare |
$13.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.59
|
| Rate for Payer: Railroad Medicare Medicare |
$12.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.43
|
| Rate for Payer: UHC Core |
$43.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.90
|
| Rate for Payer: UHC Exchange |
$12.90
|
| Rate for Payer: UHC Medicare Advantage |
$12.90
|
| Rate for Payer: VA VA |
$12.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.72
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$775.20
|
|
|
Service Code
|
NDC 60687028201
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$503.88 |
| Max. Negotiated Rate |
$697.68 |
| Rate for Payer: Aetna Commercial |
$658.92
|
| Rate for Payer: BCBS Trust/PPO |
$632.80
|
| Rate for Payer: BCN Commercial |
$599.07
|
| Rate for Payer: Cash Price |
$620.16
|
| Rate for Payer: Cofinity Commercial |
$666.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$620.16
|
| Rate for Payer: Healthscope Commercial |
$697.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$581.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$658.92
|
| Rate for Payer: Nomi Health Commercial |
$635.66
|
| Rate for Payer: PHP Commercial |
$658.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$503.88
|
| Rate for Payer: Priority Health HMO/PPO |
$674.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$519.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$682.18
|
| Rate for Payer: UHC Core |
$647.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$581.40
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$513.60
|
|
|
Service Code
|
NDC 00904735061
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$333.84 |
| Max. Negotiated Rate |
$462.24 |
| Rate for Payer: Aetna Commercial |
$436.56
|
| Rate for Payer: BCBS Trust/PPO |
$419.25
|
| Rate for Payer: BCN Commercial |
$396.91
|
| Rate for Payer: Cash Price |
$410.88
|
| Rate for Payer: Cofinity Commercial |
$441.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$410.88
|
| Rate for Payer: Healthscope Commercial |
$462.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$385.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$436.56
|
| Rate for Payer: Nomi Health Commercial |
$421.15
|
| Rate for Payer: PHP Commercial |
$436.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.84
|
| Rate for Payer: Priority Health HMO/PPO |
$446.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$344.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$451.97
|
| Rate for Payer: UHC Core |
$428.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$385.20
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$37.68
|
|
|
Service Code
|
NDC 50111078766
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.95 |
| Max. Negotiated Rate |
$33.91 |
| Rate for Payer: Aetna Commercial |
$32.03
|
| Rate for Payer: Aetna Medicare |
$9.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.78
|
| Rate for Payer: BCBS Complete |
$15.07
|
| Rate for Payer: BCBS MAPPO |
$9.42
|
| Rate for Payer: BCBS Trust/PPO |
$30.98
|
| Rate for Payer: BCN Commercial |
$29.30
|
| Rate for Payer: BCN Medicare Advantage |
$9.42
|
| Rate for Payer: Cash Price |
$30.14
|
| Rate for Payer: Cofinity Commercial |
$32.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.42
|
| Rate for Payer: Healthscope Commercial |
$33.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.03
|
| Rate for Payer: Nomi Health Commercial |
$30.90
|
| Rate for Payer: PACE Senior Care Partners |
$8.95
|
| Rate for Payer: PACE SWMI |
$9.42
|
| Rate for Payer: PHP Commercial |
$32.03
|
| Rate for Payer: PHP Medicare Advantage |
$9.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.49
|
| Rate for Payer: Priority Health HMO/PPO |
$32.78
|
| Rate for Payer: Priority Health Medicare |
$9.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.25
|
| Rate for Payer: Railroad Medicare Medicare |
$9.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.16
|
| Rate for Payer: UHC Core |
$31.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.42
|
| Rate for Payer: UHC Exchange |
$9.42
|
| Rate for Payer: UHC Medicare Advantage |
$9.42
|
| Rate for Payer: VA VA |
$9.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.26
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$384.80
|
|
|
Service Code
|
NDC 59762306003
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.39 |
| Max. Negotiated Rate |
$346.32 |
| Rate for Payer: Aetna Commercial |
$327.08
|
| Rate for Payer: Aetna Medicare |
$100.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$120.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$120.25
|
| Rate for Payer: BCBS Complete |
$153.92
|
| Rate for Payer: BCBS MAPPO |
$96.20
|
| Rate for Payer: BCBS Trust/PPO |
$316.34
|
| Rate for Payer: BCN Commercial |
$299.18
|
| Rate for Payer: BCN Medicare Advantage |
$96.20
|
| Rate for Payer: Cash Price |
$307.84
|
| Rate for Payer: Cofinity Commercial |
$330.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.20
|
| Rate for Payer: Healthscope Commercial |
$346.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$288.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.08
|
| Rate for Payer: Nomi Health Commercial |
$315.54
|
| Rate for Payer: PACE Senior Care Partners |
$91.39
|
| Rate for Payer: PACE SWMI |
$96.20
|
| Rate for Payer: PHP Commercial |
$327.08
|
| Rate for Payer: PHP Medicare Advantage |
$96.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.12
|
| Rate for Payer: Priority Health HMO/PPO |
$334.78
|
| Rate for Payer: Priority Health Medicare |
$97.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$257.82
|
| Rate for Payer: Railroad Medicare Medicare |
$96.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$338.62
|
| Rate for Payer: UHC Core |
$321.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.20
|
| Rate for Payer: UHC Exchange |
$96.20
|
| Rate for Payer: UHC Medicare Advantage |
$96.20
|
| Rate for Payer: VA VA |
$96.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$288.60
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$409.92
|
|
|
Service Code
|
NDC 00904670861
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$266.45 |
| Max. Negotiated Rate |
$368.93 |
| Rate for Payer: Aetna Commercial |
$348.43
|
| Rate for Payer: BCBS Trust/PPO |
$334.62
|
| Rate for Payer: BCN Commercial |
$316.79
|
| Rate for Payer: Cash Price |
$327.94
|
| Rate for Payer: Cofinity Commercial |
$352.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.94
|
| Rate for Payer: Healthscope Commercial |
$368.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$307.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.43
|
| Rate for Payer: Nomi Health Commercial |
$336.13
|
| Rate for Payer: PHP Commercial |
$348.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.45
|
| Rate for Payer: Priority Health HMO/PPO |
$356.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$274.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$360.73
|
| Rate for Payer: UHC Core |
$342.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$307.44
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$3.12
|
|
|
Service Code
|
NDC 50268009811
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Aetna Commercial |
$2.65
|
| Rate for Payer: BCBS Trust/PPO |
$2.55
|
| Rate for Payer: BCN Commercial |
$2.41
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cofinity Commercial |
$2.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.50
|
| Rate for Payer: Healthscope Commercial |
$2.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.65
|
| Rate for Payer: Nomi Health Commercial |
$2.56
|
| Rate for Payer: PHP Commercial |
$2.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.03
|
| Rate for Payer: Priority Health HMO/PPO |
$2.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.75
|
| Rate for Payer: UHC Core |
$2.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.34
|
|
