|
ALLOGENEIC BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$59,119.67
|
|
|
Service Code
|
APR-DRG 0073
|
| Min. Negotiated Rate |
$56,304.44 |
| Max. Negotiated Rate |
$59,119.67 |
| Rate for Payer: BCBS Complete |
$59,119.67
|
| Rate for Payer: Mclaren Medicaid |
$56,304.44
|
| Rate for Payer: Meridian Medicaid |
$59,119.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$56,304.44
|
| Rate for Payer: UHC Medicaid |
$56,304.44
|
| Rate for Payer: UHCCP Medicaid |
$56,304.44
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
IP
|
$2.56
|
|
|
Service Code
|
NDC 51079020501
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: BCBS Trust/PPO |
$2.11
|
| Rate for Payer: BCN Commercial |
$2.11
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cofinity Commercial |
$2.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.05
|
| Rate for Payer: Healthscope Commercial |
$2.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.18
|
| Rate for Payer: Nomi Health Commercial |
$2.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.92
|
| Rate for Payer: PHP Commercial |
$2.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.25
|
| Rate for Payer: UHC Core |
$2.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.92
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
IP
|
$249.10
|
|
|
Service Code
|
NDC 53489015601
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.37 |
| Max. Negotiated Rate |
$224.19 |
| Rate for Payer: Aetna Commercial |
$211.74
|
| Rate for Payer: BCBS Trust/PPO |
$205.73
|
| Rate for Payer: BCN Commercial |
$205.73
|
| Rate for Payer: Cash Price |
$199.28
|
| Rate for Payer: Cofinity Commercial |
$214.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.28
|
| Rate for Payer: Healthscope Commercial |
$224.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.74
|
| Rate for Payer: Nomi Health Commercial |
$204.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$186.82
|
| Rate for Payer: PHP Commercial |
$211.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$216.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$173.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.21
|
| Rate for Payer: UHC Core |
$208.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.82
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
OP
|
$195.70
|
|
|
Service Code
|
NDC 00904704161
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$176.13 |
| Rate for Payer: Aetna Commercial |
$166.34
|
| Rate for Payer: Aetna Medicare |
$50.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.16
|
| Rate for Payer: BCBS Complete |
$36.22
|
| Rate for Payer: BCBS MAPPO |
$48.92
|
| Rate for Payer: BCBS Trust/PPO |
$160.88
|
| Rate for Payer: BCN Commercial |
$160.88
|
| Rate for Payer: BCN Medicare Advantage |
$48.92
|
| Rate for Payer: Cash Price |
$156.56
|
| Rate for Payer: Cofinity Commercial |
$168.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.92
|
| Rate for Payer: Healthscope Commercial |
$176.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.78
|
| Rate for Payer: Mclaren Medicaid |
$34.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.37
|
| Rate for Payer: Meridian Medicaid |
$36.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$53.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.34
|
| Rate for Payer: Nomi Health Commercial |
$160.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.78
|
| Rate for Payer: PACE Senior Care Partners |
$46.48
|
| Rate for Payer: PACE SWMI |
$48.92
|
| Rate for Payer: PHP Commercial |
$166.34
|
| Rate for Payer: PHP Medicare Advantage |
$48.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$170.26
|
| Rate for Payer: Priority Health Medicare |
$49.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$136.21
|
| Rate for Payer: Railroad Medicare Medicare |
$48.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.22
|
| Rate for Payer: UHC Core |
$163.41
|
| Rate for Payer: UHC Exchange |
$48.92
|
| Rate for Payer: UHC Medicaid |
$34.50
|
| Rate for Payer: UHC Medicare Advantage |
$48.92
|
| Rate for Payer: UHCCP Medicaid |
$34.50
|
| Rate for Payer: VA VA |
$48.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.78
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
IP
|
$195.70
|
|
|
Service Code
|
NDC 00904704161
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.21 |
| Max. Negotiated Rate |
$176.13 |
| Rate for Payer: Aetna Commercial |
$166.34
|
| Rate for Payer: BCBS Trust/PPO |
$161.63
|
| Rate for Payer: BCN Commercial |
$161.63
|
| Rate for Payer: Cash Price |
$156.56
|
| Rate for Payer: Cofinity Commercial |
$168.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.56
|
| Rate for Payer: Healthscope Commercial |
$176.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.34
|
| Rate for Payer: Nomi Health Commercial |
$160.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.78
|
| Rate for Payer: PHP Commercial |
$166.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$170.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$136.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.22
|
| Rate for Payer: UHC Core |
$163.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.78
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
OP
|
$2.56
|
|
|
Service Code
|
NDC 51079020501
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: Aetna Medicare |
$0.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.80
|
| Rate for Payer: BCBS Complete |
$0.47
|
| Rate for Payer: BCBS MAPPO |
$0.64
|
| Rate for Payer: BCBS Trust/PPO |
$2.10
|
| Rate for Payer: BCN Commercial |
$2.10
|
| Rate for Payer: BCN Medicare Advantage |
$0.64
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cofinity Commercial |
$2.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.64
|
| Rate for Payer: Healthscope Commercial |
$2.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.92
|
| Rate for Payer: Mclaren Medicaid |
$0.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.67
|
| Rate for Payer: Meridian Medicaid |
$0.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.18
|
| Rate for Payer: Nomi Health Commercial |
$2.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.92
|
| Rate for Payer: PACE Senior Care Partners |
$0.61
|
| Rate for Payer: PACE SWMI |
$0.64
|
| Rate for Payer: PHP Commercial |
$2.18
|
| Rate for Payer: PHP Medicare Advantage |
$0.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.23
|
| Rate for Payer: Priority Health Medicare |
$0.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.78
|
| Rate for Payer: Railroad Medicare Medicare |
$0.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.25
|
| Rate for Payer: UHC Core |
$2.14
|
| Rate for Payer: UHC Exchange |
$0.64
|
| Rate for Payer: UHC Medicaid |
$0.45
|
| Rate for Payer: UHC Medicare Advantage |
$0.64
|
| Rate for Payer: UHCCP Medicaid |
$0.45
|
| Rate for Payer: VA VA |
$0.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.92
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
OP
|
$249.10
|
|
|
Service Code
|
NDC 53489015601
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.92 |
| Max. Negotiated Rate |
$224.19 |
| Rate for Payer: Aetna Commercial |
$211.74
|
| Rate for Payer: Aetna Medicare |
$64.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.84
|
| Rate for Payer: BCBS Complete |
$46.11
|
| Rate for Payer: BCBS MAPPO |
$62.27
|
| Rate for Payer: BCBS Trust/PPO |
$204.79
|
| Rate for Payer: BCN Commercial |
$204.79
|
| Rate for Payer: BCN Medicare Advantage |
$62.27
|
| Rate for Payer: Cash Price |
$199.28
|
| Rate for Payer: Cofinity Commercial |
$214.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.27
|
| Rate for Payer: Healthscope Commercial |
$224.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.82
|
| Rate for Payer: Mclaren Medicaid |
$43.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.39
|
| Rate for Payer: Meridian Medicaid |
$46.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$68.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.74
|
| Rate for Payer: Nomi Health Commercial |
$204.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$186.82
|
| Rate for Payer: PACE Senior Care Partners |
$59.16
|
| Rate for Payer: PACE SWMI |
$62.27
|
| Rate for Payer: PHP Commercial |
$211.74
|
| Rate for Payer: PHP Medicare Advantage |
$62.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$216.72
|
| Rate for Payer: Priority Health Medicare |
$62.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$173.37
|
| Rate for Payer: Railroad Medicare Medicare |
$62.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.21
|
| Rate for Payer: UHC Core |
$208.00
|
| Rate for Payer: UHC Exchange |
$62.27
|
| Rate for Payer: UHC Medicaid |
$43.92
|
| Rate for Payer: UHC Medicare Advantage |
$62.27
|
| Rate for Payer: UHCCP Medicaid |
$43.92
|
| Rate for Payer: VA VA |
$62.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.82
|
|
|
ALLOPURINOL 300 MG TABLET
|
Facility
|
IP
|
$371.30
|
|
|
Service Code
|
NDC 00603211621
|
| Hospital Charge Code |
311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$258.42 |
| Max. Negotiated Rate |
$334.17 |
| Rate for Payer: Aetna Commercial |
$315.61
|
| Rate for Payer: BCBS Trust/PPO |
$306.66
|
| Rate for Payer: BCN Commercial |
$306.66
|
| Rate for Payer: Cash Price |
$297.04
|
| Rate for Payer: Cofinity Commercial |
$319.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.04
|
| Rate for Payer: Healthscope Commercial |
$334.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.61
|
| Rate for Payer: Nomi Health Commercial |
$304.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$278.48
|
| Rate for Payer: PHP Commercial |
$315.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$323.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$258.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.74
|
| Rate for Payer: UHC Core |
$310.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.48
|
|
|
ALLOPURINOL 300 MG TABLET
|
Facility
|
IP
|
$254.40
|
|
|
Service Code
|
NDC 00378018101
|
| Hospital Charge Code |
311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.06 |
| Max. Negotiated Rate |
$228.96 |
| Rate for Payer: Aetna Commercial |
$216.24
|
| Rate for Payer: BCBS Trust/PPO |
$210.11
|
| Rate for Payer: BCN Commercial |
$210.11
|
| Rate for Payer: Cash Price |
$203.52
|
| Rate for Payer: Cofinity Commercial |
$218.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.52
|
| Rate for Payer: Healthscope Commercial |
$228.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.24
|
| Rate for Payer: Nomi Health Commercial |
$208.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.80
|
| Rate for Payer: PHP Commercial |
$216.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$221.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$177.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.87
|
| Rate for Payer: UHC Core |
$212.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.80
|
|
|
ALLOPURINOL 300 MG TABLET
|
Facility
|
IP
|
$377.15
|
|
|
Service Code
|
NDC 00904657261
|
| Hospital Charge Code |
311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$339.44 |
| Rate for Payer: Aetna Commercial |
$320.58
|
| Rate for Payer: BCBS Trust/PPO |
$311.49
|
| Rate for Payer: BCN Commercial |
$311.49
|
| Rate for Payer: Cash Price |
$301.72
|
| Rate for Payer: Cofinity Commercial |
$324.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$301.72
|
| Rate for Payer: Healthscope Commercial |
$339.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$282.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$320.58
|
| Rate for Payer: Nomi Health Commercial |
$309.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$282.86
|
| Rate for Payer: PHP Commercial |
$320.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$328.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$262.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$331.89
|
| Rate for Payer: UHC Core |
$314.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$282.86
|
|
|
ALLOPURINOL 300 MG TABLET
|
Facility
|
IP
|
$267.84
|
|
|
Service Code
|
NDC 00591554401
|
| Hospital Charge Code |
311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$186.42 |
| Max. Negotiated Rate |
$241.06 |
| Rate for Payer: Aetna Commercial |
$227.66
|
| Rate for Payer: BCBS Trust/PPO |
$221.21
|
| Rate for Payer: BCN Commercial |
$221.21
|
| Rate for Payer: Cash Price |
$214.27
|
| Rate for Payer: Cofinity Commercial |
$230.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.27
|
| Rate for Payer: Healthscope Commercial |
$241.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.66
|
| Rate for Payer: Nomi Health Commercial |
$219.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.88
|
| Rate for Payer: PHP Commercial |
$227.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$233.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$186.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.70
|
| Rate for Payer: UHC Core |
$223.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.88
|
|
|
ALLOPURINOL 300 MG TABLET
|
Facility
|
OP
|
$267.84
|
|
|
Service Code
|
NDC 00591554401
|
| Hospital Charge Code |
311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.22 |
| Max. Negotiated Rate |
$241.06 |
| Rate for Payer: Aetna Commercial |
$227.66
|
| Rate for Payer: Aetna Medicare |
$69.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$83.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$83.70
|
| Rate for Payer: BCBS Complete |
$49.58
|
| Rate for Payer: BCBS MAPPO |
$66.96
|
| Rate for Payer: BCBS Trust/PPO |
$220.19
|
| Rate for Payer: BCN Commercial |
$220.19
|
| Rate for Payer: BCN Medicare Advantage |
$66.96
|
| Rate for Payer: Cash Price |
$214.27
|
| Rate for Payer: Cofinity Commercial |
$230.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.96
|
| Rate for Payer: Healthscope Commercial |
$241.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.88
|
| Rate for Payer: Mclaren Medicaid |
$47.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.31
|
| Rate for Payer: Meridian Medicaid |
$49.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$73.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.66
|
| Rate for Payer: Nomi Health Commercial |
$219.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.88
|
| Rate for Payer: PACE Senior Care Partners |
$63.61
|
| Rate for Payer: PACE SWMI |
$66.96
|
| Rate for Payer: PHP Commercial |
$227.66
|
| Rate for Payer: PHP Medicare Advantage |
$66.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$233.02
|
| Rate for Payer: Priority Health Medicare |
$67.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$186.42
|
| Rate for Payer: Railroad Medicare Medicare |
$66.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.70
|
| Rate for Payer: UHC Core |
$223.65
|
| Rate for Payer: UHC Exchange |
$66.96
|
| Rate for Payer: UHC Medicaid |
$47.22
|
| Rate for Payer: UHC Medicare Advantage |
$66.96
|
| Rate for Payer: UHCCP Medicaid |
$47.22
|
| Rate for Payer: VA VA |
$66.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.88
|
|
|
ALLOPURINOL 300 MG TABLET
|
Facility
|
OP
|
$371.30
|
|
|
Service Code
|
NDC 00603211621
|
| Hospital Charge Code |
311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.46 |
| Max. Negotiated Rate |
$334.17 |
| Rate for Payer: Aetna Commercial |
$315.61
|
| Rate for Payer: Aetna Medicare |
$96.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$116.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$116.03
|
| Rate for Payer: BCBS Complete |
$68.73
|
| Rate for Payer: BCBS MAPPO |
$92.83
|
| Rate for Payer: BCBS Trust/PPO |
$305.25
|
| Rate for Payer: BCN Commercial |
$305.25
|
| Rate for Payer: BCN Medicare Advantage |
$92.83
|
| Rate for Payer: Cash Price |
$297.04
|
| Rate for Payer: Cofinity Commercial |
$319.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.83
|
| Rate for Payer: Healthscope Commercial |
$334.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.48
|
| Rate for Payer: Mclaren Medicaid |
$65.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$97.47
|
| Rate for Payer: Meridian Medicaid |
$68.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$106.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$102.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.61
|
| Rate for Payer: Nomi Health Commercial |
$304.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$278.48
|
| Rate for Payer: PACE Senior Care Partners |
$88.18
|
| Rate for Payer: PACE SWMI |
$92.83
|
| Rate for Payer: PHP Commercial |
$315.61
|
| Rate for Payer: PHP Medicare Advantage |
$92.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$323.03
|
| Rate for Payer: Priority Health Medicare |
$93.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$258.42
|
| Rate for Payer: Railroad Medicare Medicare |
$92.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.74
|
| Rate for Payer: UHC Core |
$310.04
|
| Rate for Payer: UHC Exchange |
$92.83
|
| Rate for Payer: UHC Medicaid |
$65.46
|
| Rate for Payer: UHC Medicare Advantage |
$92.83
|
| Rate for Payer: UHCCP Medicaid |
$65.46
|
| Rate for Payer: VA VA |
$92.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.48
|
|
|
ALLOPURINOL 300 MG TABLET
|
Facility
|
OP
|
$254.40
|
|
|
Service Code
|
NDC 00378018101
|
| Hospital Charge Code |
311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$228.96 |
| Rate for Payer: Aetna Commercial |
$216.24
|
| Rate for Payer: Aetna Medicare |
$66.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.50
|
| Rate for Payer: BCBS Complete |
$47.09
|
| Rate for Payer: BCBS MAPPO |
$63.60
|
| Rate for Payer: BCBS Trust/PPO |
$209.14
|
| Rate for Payer: BCN Commercial |
$209.14
|
| Rate for Payer: BCN Medicare Advantage |
$63.60
|
| Rate for Payer: Cash Price |
$203.52
|
| Rate for Payer: Cofinity Commercial |
$218.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.60
|
| Rate for Payer: Healthscope Commercial |
$228.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.80
|
| Rate for Payer: Mclaren Medicaid |
$44.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.78
|
| Rate for Payer: Meridian Medicaid |
$47.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$69.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.24
|
| Rate for Payer: Nomi Health Commercial |
$208.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.80
|
| Rate for Payer: PACE Senior Care Partners |
$60.42
|
| Rate for Payer: PACE SWMI |
$63.60
|
| Rate for Payer: PHP Commercial |
$216.24
|
| Rate for Payer: PHP Medicare Advantage |
$63.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$221.33
|
| Rate for Payer: Priority Health Medicare |
$64.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$177.06
|
| Rate for Payer: Railroad Medicare Medicare |
$63.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.87
|
| Rate for Payer: UHC Core |
$212.42
|
| Rate for Payer: UHC Exchange |
$63.60
|
| Rate for Payer: UHC Medicaid |
$44.85
|
| Rate for Payer: UHC Medicare Advantage |
$63.60
|
| Rate for Payer: UHCCP Medicaid |
$44.85
|
| Rate for Payer: VA VA |
$63.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.80
|
|
|
ALLOPURINOL 300 MG TABLET
|
Facility
|
OP
|
$377.15
|
|
|
Service Code
|
NDC 00904657261
|
| Hospital Charge Code |
311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.49 |
| Max. Negotiated Rate |
$339.44 |
| Rate for Payer: Aetna Commercial |
$320.58
|
| Rate for Payer: Aetna Medicare |
$98.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$117.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$117.86
|
| Rate for Payer: BCBS Complete |
$69.81
|
| Rate for Payer: BCBS MAPPO |
$94.29
|
| Rate for Payer: BCBS Trust/PPO |
$310.06
|
| Rate for Payer: BCN Commercial |
$310.06
|
| Rate for Payer: BCN Medicare Advantage |
$94.29
|
| Rate for Payer: Cash Price |
$301.72
|
| Rate for Payer: Cofinity Commercial |
$324.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$301.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.29
|
| Rate for Payer: Healthscope Commercial |
$339.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$282.86
|
| Rate for Payer: Mclaren Medicaid |
$66.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.00
|
| Rate for Payer: Meridian Medicaid |
$69.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$103.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$320.58
|
| Rate for Payer: Nomi Health Commercial |
$309.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$282.86
|
| Rate for Payer: PACE Senior Care Partners |
$89.57
|
| Rate for Payer: PACE SWMI |
$94.29
|
| Rate for Payer: PHP Commercial |
$320.58
|
| Rate for Payer: PHP Medicare Advantage |
$94.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$328.12
|
| Rate for Payer: Priority Health Medicare |
$95.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$262.50
|
| Rate for Payer: Railroad Medicare Medicare |
$94.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$331.89
|
| Rate for Payer: UHC Core |
$314.92
|
| Rate for Payer: UHC Exchange |
$94.29
|
| Rate for Payer: UHC Medicaid |
$66.49
|
| Rate for Payer: UHC Medicare Advantage |
$94.29
|
| Rate for Payer: UHCCP Medicaid |
$66.49
|
| Rate for Payer: VA VA |
$94.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$282.86
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
OP
|
$64.75
|
|
|
Service Code
|
NDC 65862067601
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.42 |
| Max. Negotiated Rate |
$58.27 |
| Rate for Payer: Aetna Commercial |
$55.04
|
| Rate for Payer: Aetna Medicare |
$16.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.23
|
| Rate for Payer: BCBS Complete |
$11.99
|
| Rate for Payer: BCBS MAPPO |
$16.19
|
| Rate for Payer: BCBS Trust/PPO |
$53.23
|
| Rate for Payer: BCN Commercial |
$53.23
|
| Rate for Payer: BCN Medicare Advantage |
$16.19
|
| Rate for Payer: Cash Price |
$51.80
|
| Rate for Payer: Cofinity Commercial |
$55.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.19
|
| Rate for Payer: Healthscope Commercial |
$58.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.56
|
| Rate for Payer: Mclaren Medicaid |
$11.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.00
|
| Rate for Payer: Meridian Medicaid |
$11.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.04
|
| Rate for Payer: Nomi Health Commercial |
$53.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.56
|
| Rate for Payer: PACE Senior Care Partners |
$15.38
|
| Rate for Payer: PACE SWMI |
$16.19
|
| Rate for Payer: PHP Commercial |
$55.04
|
| Rate for Payer: PHP Medicare Advantage |
$16.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$56.33
|
| Rate for Payer: Priority Health Medicare |
$16.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.07
|
| Rate for Payer: Railroad Medicare Medicare |
$16.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.98
|
| Rate for Payer: UHC Core |
$54.07
|
| Rate for Payer: UHC Exchange |
$16.19
|
| Rate for Payer: UHC Medicaid |
$11.42
|
| Rate for Payer: UHC Medicare Advantage |
$16.19
|
| Rate for Payer: UHCCP Medicaid |
$11.42
|
| Rate for Payer: VA VA |
$16.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.56
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
NDC 00781106101
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.40 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Aetna Commercial |
$35.70
|
| Rate for Payer: Aetna Medicare |
$10.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.12
|
| Rate for Payer: BCBS Complete |
$7.77
|
| Rate for Payer: BCBS MAPPO |
$10.50
|
| Rate for Payer: BCBS Trust/PPO |
$34.53
|
| Rate for Payer: BCN Commercial |
$34.53
|
| Rate for Payer: BCN Medicare Advantage |
$10.50
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$36.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.50
|
| Rate for Payer: Healthscope Commercial |
$37.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.50
|
| Rate for Payer: Mclaren Medicaid |
$7.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.03
|
| Rate for Payer: Meridian Medicaid |
$7.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.70
|
| Rate for Payer: Nomi Health Commercial |
$34.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.50
|
| Rate for Payer: PACE Senior Care Partners |
$9.97
|
| Rate for Payer: PACE SWMI |
$10.50
|
| Rate for Payer: PHP Commercial |
$35.70
|
| Rate for Payer: PHP Medicare Advantage |
$10.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$36.54
|
| Rate for Payer: Priority Health Medicare |
$10.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.23
|
| Rate for Payer: Railroad Medicare Medicare |
$10.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.96
|
| Rate for Payer: UHC Core |
$35.07
|
| Rate for Payer: UHC Exchange |
$10.50
|
| Rate for Payer: UHC Medicaid |
$7.40
|
| Rate for Payer: UHC Medicare Advantage |
$10.50
|
| Rate for Payer: UHCCP Medicaid |
$7.40
|
| Rate for Payer: VA VA |
$10.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.50
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
IP
|
$64.75
|
|
|
Service Code
|
NDC 65862067601
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.07 |
| Max. Negotiated Rate |
$58.27 |
| Rate for Payer: Aetna Commercial |
$55.04
|
| Rate for Payer: BCBS Trust/PPO |
$53.48
|
| Rate for Payer: BCN Commercial |
$53.48
|
| Rate for Payer: Cash Price |
$51.80
|
| Rate for Payer: Cofinity Commercial |
$55.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.80
|
| Rate for Payer: Healthscope Commercial |
$58.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.04
|
| Rate for Payer: Nomi Health Commercial |
$53.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.56
|
| Rate for Payer: PHP Commercial |
$55.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$56.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.98
|
| Rate for Payer: UHC Core |
$54.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.56
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
NDC 00781106101
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.23 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Aetna Commercial |
$35.70
|
| Rate for Payer: BCBS Trust/PPO |
$34.69
|
| Rate for Payer: BCN Commercial |
$34.69
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$36.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.60
|
| Rate for Payer: Healthscope Commercial |
$37.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.70
|
| Rate for Payer: Nomi Health Commercial |
$34.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.50
|
| Rate for Payer: PHP Commercial |
$35.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$36.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.96
|
| Rate for Payer: UHC Core |
$35.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.50
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
OP
|
$6.67
|
|
|
Service Code
|
NDC 60687038811
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Aetna Commercial |
$5.67
|
| Rate for Payer: Aetna Medicare |
$1.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.08
|
| Rate for Payer: BCBS Complete |
$1.23
|
| Rate for Payer: BCBS MAPPO |
$1.67
|
| Rate for Payer: BCBS Trust/PPO |
$5.48
|
| Rate for Payer: BCN Commercial |
$5.48
|
| Rate for Payer: BCN Medicare Advantage |
$1.67
|
| Rate for Payer: Cash Price |
$5.34
|
| Rate for Payer: Cofinity Commercial |
$5.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.67
|
| Rate for Payer: Healthscope Commercial |
$6.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.00
|
| Rate for Payer: Mclaren Medicaid |
$1.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.75
|
| Rate for Payer: Meridian Medicaid |
$1.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.67
|
| Rate for Payer: Nomi Health Commercial |
$5.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.00
|
| Rate for Payer: PACE Senior Care Partners |
$1.58
|
| Rate for Payer: PACE SWMI |
$1.67
|
| Rate for Payer: PHP Commercial |
$5.67
|
| Rate for Payer: PHP Medicare Advantage |
$1.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.80
|
| Rate for Payer: Priority Health Medicare |
$1.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.64
|
| Rate for Payer: Railroad Medicare Medicare |
$1.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.87
|
| Rate for Payer: UHC Core |
$5.57
|
| Rate for Payer: UHC Exchange |
$1.67
|
| Rate for Payer: UHC Medicaid |
$1.18
|
| Rate for Payer: UHC Medicare Advantage |
$1.67
|
| Rate for Payer: UHCCP Medicaid |
$1.18
|
| Rate for Payer: VA VA |
$1.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.00
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
IP
|
$666.75
|
|
|
Service Code
|
NDC 60687038801
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$464.06 |
| Max. Negotiated Rate |
$600.08 |
| Rate for Payer: Aetna Commercial |
$566.74
|
| Rate for Payer: BCBS Trust/PPO |
$550.67
|
| Rate for Payer: BCN Commercial |
$550.67
|
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cofinity Commercial |
$573.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$533.40
|
| Rate for Payer: Healthscope Commercial |
$600.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$500.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$566.74
|
| Rate for Payer: Nomi Health Commercial |
$546.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$500.06
|
| Rate for Payer: PHP Commercial |
$566.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$580.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$464.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$586.74
|
| Rate for Payer: UHC Core |
$556.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$500.06
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
OP
|
$666.75
|
|
|
Service Code
|
NDC 60687038801
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.55 |
| Max. Negotiated Rate |
$600.08 |
| Rate for Payer: Aetna Commercial |
$566.74
|
| Rate for Payer: Aetna Medicare |
$173.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$208.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$208.36
|
| Rate for Payer: BCBS Complete |
$123.42
|
| Rate for Payer: BCBS MAPPO |
$166.69
|
| Rate for Payer: BCBS Trust/PPO |
$548.14
|
| Rate for Payer: BCN Commercial |
$548.14
|
| Rate for Payer: BCN Medicare Advantage |
$166.69
|
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cofinity Commercial |
$573.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$533.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$166.69
|
| Rate for Payer: Healthscope Commercial |
$600.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$500.06
|
| Rate for Payer: Mclaren Medicaid |
$117.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$175.02
|
| Rate for Payer: Meridian Medicaid |
$123.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$191.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$183.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$566.74
|
| Rate for Payer: Nomi Health Commercial |
$546.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$500.06
|
| Rate for Payer: PACE Senior Care Partners |
$158.35
|
| Rate for Payer: PACE SWMI |
$166.69
|
| Rate for Payer: PHP Commercial |
$566.74
|
| Rate for Payer: PHP Medicare Advantage |
$166.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$117.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$580.07
|
| Rate for Payer: Priority Health Medicare |
$168.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$464.06
|
| Rate for Payer: Railroad Medicare Medicare |
$166.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$586.74
|
| Rate for Payer: UHC Core |
$556.74
|
| Rate for Payer: UHC Exchange |
$166.69
|
| Rate for Payer: UHC Medicaid |
$117.55
|
| Rate for Payer: UHC Medicare Advantage |
$166.69
|
| Rate for Payer: UHCCP Medicaid |
$117.55
|
| Rate for Payer: VA VA |
$166.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$500.06
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
IP
|
$6.67
|
|
|
Service Code
|
NDC 60687038811
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Aetna Commercial |
$5.67
|
| Rate for Payer: BCBS Trust/PPO |
$5.51
|
| Rate for Payer: BCN Commercial |
$5.51
|
| Rate for Payer: Cash Price |
$5.34
|
| Rate for Payer: Cofinity Commercial |
$5.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.34
|
| Rate for Payer: Healthscope Commercial |
$6.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.67
|
| Rate for Payer: Nomi Health Commercial |
$5.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.00
|
| Rate for Payer: PHP Commercial |
$5.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.87
|
| Rate for Payer: UHC Core |
$5.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.00
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
IP
|
$68.25
|
|
|
Service Code
|
NDC 65862067701
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.50 |
| Max. Negotiated Rate |
$61.42 |
| Rate for Payer: Aetna Commercial |
$58.01
|
| Rate for Payer: BCBS Trust/PPO |
$56.37
|
| Rate for Payer: BCN Commercial |
$56.37
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cofinity Commercial |
$58.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.60
|
| Rate for Payer: Healthscope Commercial |
$61.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.01
|
| Rate for Payer: Nomi Health Commercial |
$55.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.19
|
| Rate for Payer: PHP Commercial |
$58.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$59.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.06
|
| Rate for Payer: UHC Core |
$56.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.19
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
OP
|
$68.25
|
|
|
Service Code
|
NDC 65862067701
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.03 |
| Max. Negotiated Rate |
$61.42 |
| Rate for Payer: Aetna Commercial |
$58.01
|
| Rate for Payer: Aetna Medicare |
$17.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.33
|
| Rate for Payer: BCBS Complete |
$12.63
|
| Rate for Payer: BCBS MAPPO |
$17.06
|
| Rate for Payer: BCBS Trust/PPO |
$56.11
|
| Rate for Payer: BCN Commercial |
$56.11
|
| Rate for Payer: BCN Medicare Advantage |
$17.06
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cofinity Commercial |
$58.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.06
|
| Rate for Payer: Healthscope Commercial |
$61.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.19
|
| Rate for Payer: Mclaren Medicaid |
$12.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.92
|
| Rate for Payer: Meridian Medicaid |
$12.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.01
|
| Rate for Payer: Nomi Health Commercial |
$55.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.19
|
| Rate for Payer: PACE Senior Care Partners |
$16.21
|
| Rate for Payer: PACE SWMI |
$17.06
|
| Rate for Payer: PHP Commercial |
$58.01
|
| Rate for Payer: PHP Medicare Advantage |
$17.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$59.38
|
| Rate for Payer: Priority Health Medicare |
$17.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.50
|
| Rate for Payer: Railroad Medicare Medicare |
$17.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.06
|
| Rate for Payer: UHC Core |
$56.99
|
| Rate for Payer: UHC Exchange |
$17.06
|
| Rate for Payer: UHC Medicaid |
$12.03
|
| Rate for Payer: UHC Medicare Advantage |
$17.06
|
| Rate for Payer: UHCCP Medicaid |
$12.03
|
| Rate for Payer: VA VA |
$17.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.19
|
|
