|
BUSPIRONE 5 MG TABLET
|
Facility
|
OP
|
$105.75
|
|
|
Service Code
|
NDC 68382018001
|
| Hospital Charge Code |
9324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.12 |
| Max. Negotiated Rate |
$95.18 |
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Aetna Medicare |
$27.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.05
|
| Rate for Payer: BCBS Complete |
$42.30
|
| Rate for Payer: BCBS MAPPO |
$26.44
|
| Rate for Payer: BCBS Trust/PPO |
$86.94
|
| Rate for Payer: BCN Commercial |
$82.22
|
| Rate for Payer: BCN Medicare Advantage |
$26.44
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cofinity Commercial |
$90.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.44
|
| Rate for Payer: Healthscope Commercial |
$95.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.89
|
| Rate for Payer: Nomi Health Commercial |
$86.72
|
| Rate for Payer: PACE Senior Care Partners |
$25.12
|
| Rate for Payer: PACE SWMI |
$26.44
|
| Rate for Payer: PHP Commercial |
$89.89
|
| Rate for Payer: PHP Medicare Advantage |
$26.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.74
|
| Rate for Payer: Priority Health HMO/PPO |
$92.00
|
| Rate for Payer: Priority Health Medicare |
$26.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.85
|
| Rate for Payer: Railroad Medicare Medicare |
$26.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.06
|
| Rate for Payer: UHC Core |
$88.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.44
|
| Rate for Payer: UHC Exchange |
$26.44
|
| Rate for Payer: UHC Medicare Advantage |
$26.44
|
| Rate for Payer: VA VA |
$26.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.31
|
|
|
BUSPIRONE 5 MG TABLET
|
Facility
|
IP
|
$105.75
|
|
|
Service Code
|
NDC 68382018001
|
| Hospital Charge Code |
9324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.74 |
| Max. Negotiated Rate |
$95.18 |
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: BCBS Trust/PPO |
$86.32
|
| Rate for Payer: BCN Commercial |
$81.72
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cofinity Commercial |
$90.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.60
|
| Rate for Payer: Healthscope Commercial |
$95.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.89
|
| Rate for Payer: Nomi Health Commercial |
$86.72
|
| Rate for Payer: PHP Commercial |
$89.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.74
|
| Rate for Payer: Priority Health HMO/PPO |
$92.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.06
|
| Rate for Payer: UHC Core |
$88.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.31
|
|
|
BUSPIRONE 5 MG TABLET
|
Facility
|
OP
|
$251.45
|
|
|
Service Code
|
NDC 51079098520
|
| Hospital Charge Code |
9324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.72 |
| Max. Negotiated Rate |
$226.30 |
| Rate for Payer: Aetna Commercial |
$213.73
|
| Rate for Payer: Aetna Medicare |
$65.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.58
|
| Rate for Payer: BCBS Complete |
$100.58
|
| Rate for Payer: BCBS MAPPO |
$62.86
|
| Rate for Payer: BCBS Trust/PPO |
$206.72
|
| Rate for Payer: BCN Commercial |
$195.50
|
| Rate for Payer: BCN Medicare Advantage |
$62.86
|
| Rate for Payer: Cash Price |
$201.16
|
| Rate for Payer: Cofinity Commercial |
$216.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.86
|
| Rate for Payer: Healthscope Commercial |
$226.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.73
|
| Rate for Payer: Nomi Health Commercial |
$206.19
|
| Rate for Payer: PACE Senior Care Partners |
$59.72
|
| Rate for Payer: PACE SWMI |
$62.86
|
| Rate for Payer: PHP Commercial |
$213.73
|
| Rate for Payer: PHP Medicare Advantage |
$62.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.44
|
| Rate for Payer: Priority Health HMO/PPO |
$218.76
|
| Rate for Payer: Priority Health Medicare |
$63.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$168.47
|
| Rate for Payer: Railroad Medicare Medicare |
$62.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.28
|
| Rate for Payer: UHC Core |
$209.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.86
|
| Rate for Payer: UHC Exchange |
$62.86
|
| Rate for Payer: UHC Medicare Advantage |
$62.86
|
| Rate for Payer: VA VA |
$62.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.59
|
|
|
BUSPIRONE 5 MG TABLET
|
Facility
|
OP
|
$2.52
|
|
|
Service Code
|
NDC 51079098501
|
| Hospital Charge Code |
9324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2.27 |
| Rate for Payer: Aetna Commercial |
$2.14
|
| Rate for Payer: Aetna Medicare |
$0.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.79
|
| Rate for Payer: BCBS Complete |
$1.01
|
| Rate for Payer: BCBS MAPPO |
$0.63
|
| Rate for Payer: BCBS Trust/PPO |
$2.07
|
| Rate for Payer: BCN Commercial |
$1.96
|
| Rate for Payer: BCN Medicare Advantage |
$0.63
|
| Rate for Payer: Cash Price |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.63
|
| Rate for Payer: Healthscope Commercial |
$2.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.14
|
| Rate for Payer: Nomi Health Commercial |
$2.07
|
| Rate for Payer: PACE Senior Care Partners |
$0.60
|
| Rate for Payer: PACE SWMI |
$0.63
|
| Rate for Payer: PHP Commercial |
$2.14
|
| Rate for Payer: PHP Medicare Advantage |
$0.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.64
|
| Rate for Payer: Priority Health HMO/PPO |
$2.19
|
| Rate for Payer: Priority Health Medicare |
$0.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.69
|
| Rate for Payer: Railroad Medicare Medicare |
$0.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.22
|
| Rate for Payer: UHC Core |
$2.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.63
|
| Rate for Payer: UHC Exchange |
$0.63
|
| Rate for Payer: UHC Medicare Advantage |
$0.63
|
| Rate for Payer: VA VA |
$0.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.89
|
|
|
BUSPIRONE 5 MG TABLET
|
Facility
|
OP
|
$65.80
|
|
|
Service Code
|
NDC 16729020001
|
| Hospital Charge Code |
9324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.63 |
| Max. Negotiated Rate |
$59.22 |
| Rate for Payer: Aetna Commercial |
$55.93
|
| Rate for Payer: Aetna Medicare |
$17.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.56
|
| Rate for Payer: BCBS Complete |
$26.32
|
| Rate for Payer: BCBS MAPPO |
$16.45
|
| Rate for Payer: BCBS Trust/PPO |
$54.09
|
| Rate for Payer: BCN Commercial |
$51.16
|
| Rate for Payer: BCN Medicare Advantage |
$16.45
|
| Rate for Payer: Cash Price |
$52.64
|
| Rate for Payer: Cofinity Commercial |
$56.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.45
|
| Rate for Payer: Healthscope Commercial |
$59.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.93
|
| Rate for Payer: Nomi Health Commercial |
$53.96
|
| Rate for Payer: PACE Senior Care Partners |
$15.63
|
| Rate for Payer: PACE SWMI |
$16.45
|
| Rate for Payer: PHP Commercial |
$55.93
|
| Rate for Payer: PHP Medicare Advantage |
$16.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.77
|
| Rate for Payer: Priority Health HMO/PPO |
$57.25
|
| Rate for Payer: Priority Health Medicare |
$16.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.09
|
| Rate for Payer: Railroad Medicare Medicare |
$16.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.90
|
| Rate for Payer: UHC Core |
$54.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.45
|
| Rate for Payer: UHC Exchange |
$16.45
|
| Rate for Payer: UHC Medicare Advantage |
$16.45
|
| Rate for Payer: VA VA |
$16.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.35
|
|
|
BUSPIRONE 7.5 MG TABLET
|
Facility
|
IP
|
$7.31
|
|
|
Service Code
|
NDC 60687080111
|
| Hospital Charge Code |
29967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$6.58 |
| Rate for Payer: Aetna Commercial |
$6.21
|
| Rate for Payer: BCBS Trust/PPO |
$5.97
|
| Rate for Payer: BCN Commercial |
$5.65
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cofinity Commercial |
$6.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.85
|
| Rate for Payer: Healthscope Commercial |
$6.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.21
|
| Rate for Payer: Nomi Health Commercial |
$5.99
|
| Rate for Payer: PHP Commercial |
$6.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.75
|
| Rate for Payer: Priority Health HMO/PPO |
$6.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.43
|
| Rate for Payer: UHC Core |
$6.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.48
|
|
|
BUSPIRONE 7.5 MG TABLET
|
Facility
|
IP
|
$368.95
|
|
|
Service Code
|
NDC 72888006301
|
| Hospital Charge Code |
29967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$239.82 |
| Max. Negotiated Rate |
$332.06 |
| Rate for Payer: Aetna Commercial |
$313.61
|
| Rate for Payer: BCBS Trust/PPO |
$301.17
|
| Rate for Payer: BCN Commercial |
$285.12
|
| Rate for Payer: Cash Price |
$295.16
|
| Rate for Payer: Cofinity Commercial |
$317.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.16
|
| Rate for Payer: Healthscope Commercial |
$332.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$276.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.61
|
| Rate for Payer: Nomi Health Commercial |
$302.54
|
| Rate for Payer: PHP Commercial |
$313.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.82
|
| Rate for Payer: Priority Health HMO/PPO |
$320.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$247.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$324.68
|
| Rate for Payer: UHC Core |
$308.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$276.71
|
|
|
BUSPIRONE 7.5 MG TABLET
|
Facility
|
IP
|
$219.03
|
|
|
Service Code
|
NDC 60687080121
|
| Hospital Charge Code |
29967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.37 |
| Max. Negotiated Rate |
$197.13 |
| Rate for Payer: Aetna Commercial |
$186.18
|
| Rate for Payer: BCBS Trust/PPO |
$178.79
|
| Rate for Payer: BCN Commercial |
$169.27
|
| Rate for Payer: Cash Price |
$175.22
|
| Rate for Payer: Cofinity Commercial |
$188.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.22
|
| Rate for Payer: Healthscope Commercial |
$197.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.18
|
| Rate for Payer: Nomi Health Commercial |
$179.60
|
| Rate for Payer: PHP Commercial |
$186.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.37
|
| Rate for Payer: Priority Health HMO/PPO |
$190.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$146.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.75
|
| Rate for Payer: UHC Core |
$182.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.27
|
|
|
BUSPIRONE 7.5 MG TABLET
|
Facility
|
OP
|
$368.95
|
|
|
Service Code
|
NDC 72888006301
|
| Hospital Charge Code |
29967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.63 |
| Max. Negotiated Rate |
$332.06 |
| Rate for Payer: Aetna Commercial |
$313.61
|
| Rate for Payer: Aetna Medicare |
$95.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$115.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$115.30
|
| Rate for Payer: BCBS Complete |
$147.58
|
| Rate for Payer: BCBS MAPPO |
$92.24
|
| Rate for Payer: BCBS Trust/PPO |
$303.31
|
| Rate for Payer: BCN Commercial |
$286.86
|
| Rate for Payer: BCN Medicare Advantage |
$92.24
|
| Rate for Payer: Cash Price |
$295.16
|
| Rate for Payer: Cofinity Commercial |
$317.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.24
|
| Rate for Payer: Healthscope Commercial |
$332.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$276.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$106.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.61
|
| Rate for Payer: Nomi Health Commercial |
$302.54
|
| Rate for Payer: PACE Senior Care Partners |
$87.63
|
| Rate for Payer: PACE SWMI |
$92.24
|
| Rate for Payer: PHP Commercial |
$313.61
|
| Rate for Payer: PHP Medicare Advantage |
$92.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.82
|
| Rate for Payer: Priority Health HMO/PPO |
$320.99
|
| Rate for Payer: Priority Health Medicare |
$93.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$247.20
|
| Rate for Payer: Railroad Medicare Medicare |
$92.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$324.68
|
| Rate for Payer: UHC Core |
$308.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.24
|
| Rate for Payer: UHC Exchange |
$92.24
|
| Rate for Payer: UHC Medicare Advantage |
$92.24
|
| Rate for Payer: VA VA |
$92.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$276.71
|
|
|
BUSPIRONE 7.5 MG TABLET
|
Facility
|
OP
|
$219.03
|
|
|
Service Code
|
NDC 60687080121
|
| Hospital Charge Code |
29967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.02 |
| Max. Negotiated Rate |
$197.13 |
| Rate for Payer: Aetna Commercial |
$186.18
|
| Rate for Payer: Aetna Medicare |
$56.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.45
|
| Rate for Payer: BCBS Complete |
$87.61
|
| Rate for Payer: BCBS MAPPO |
$54.76
|
| Rate for Payer: BCBS Trust/PPO |
$180.06
|
| Rate for Payer: BCN Commercial |
$170.30
|
| Rate for Payer: BCN Medicare Advantage |
$54.76
|
| Rate for Payer: Cash Price |
$175.22
|
| Rate for Payer: Cofinity Commercial |
$188.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.76
|
| Rate for Payer: Healthscope Commercial |
$197.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.18
|
| Rate for Payer: Nomi Health Commercial |
$179.60
|
| Rate for Payer: PACE Senior Care Partners |
$52.02
|
| Rate for Payer: PACE SWMI |
$54.76
|
| Rate for Payer: PHP Commercial |
$186.18
|
| Rate for Payer: PHP Medicare Advantage |
$54.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.37
|
| Rate for Payer: Priority Health HMO/PPO |
$190.56
|
| Rate for Payer: Priority Health Medicare |
$55.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$146.75
|
| Rate for Payer: Railroad Medicare Medicare |
$54.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.75
|
| Rate for Payer: UHC Core |
$182.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.76
|
| Rate for Payer: UHC Exchange |
$54.76
|
| Rate for Payer: UHC Medicare Advantage |
$54.76
|
| Rate for Payer: VA VA |
$54.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.27
|
|
|
BUSPIRONE 7.5 MG TABLET
|
Facility
|
OP
|
$225.15
|
|
|
Service Code
|
NDC 16729020101
|
| Hospital Charge Code |
29967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.47 |
| Max. Negotiated Rate |
$202.64 |
| Rate for Payer: Aetna Commercial |
$191.38
|
| Rate for Payer: Aetna Medicare |
$58.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70.36
|
| Rate for Payer: BCBS Complete |
$90.06
|
| Rate for Payer: BCBS MAPPO |
$56.29
|
| Rate for Payer: BCBS Trust/PPO |
$185.10
|
| Rate for Payer: BCN Commercial |
$175.05
|
| Rate for Payer: BCN Medicare Advantage |
$56.29
|
| Rate for Payer: Cash Price |
$180.12
|
| Rate for Payer: Cofinity Commercial |
$193.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.29
|
| Rate for Payer: Healthscope Commercial |
$202.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.38
|
| Rate for Payer: Nomi Health Commercial |
$184.62
|
| Rate for Payer: PACE Senior Care Partners |
$53.47
|
| Rate for Payer: PACE SWMI |
$56.29
|
| Rate for Payer: PHP Commercial |
$191.38
|
| Rate for Payer: PHP Medicare Advantage |
$56.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.35
|
| Rate for Payer: Priority Health HMO/PPO |
$195.88
|
| Rate for Payer: Priority Health Medicare |
$56.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$150.85
|
| Rate for Payer: Railroad Medicare Medicare |
$56.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.13
|
| Rate for Payer: UHC Core |
$188.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.29
|
| Rate for Payer: UHC Exchange |
$56.29
|
| Rate for Payer: UHC Medicare Advantage |
$56.29
|
| Rate for Payer: VA VA |
$56.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.86
|
|
|
BUSPIRONE 7.5 MG TABLET
|
Facility
|
IP
|
$225.15
|
|
|
Service Code
|
NDC 16729020101
|
| Hospital Charge Code |
29967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.35 |
| Max. Negotiated Rate |
$202.64 |
| Rate for Payer: Aetna Commercial |
$191.38
|
| Rate for Payer: BCBS Trust/PPO |
$183.79
|
| Rate for Payer: BCN Commercial |
$174.00
|
| Rate for Payer: Cash Price |
$180.12
|
| Rate for Payer: Cofinity Commercial |
$193.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.12
|
| Rate for Payer: Healthscope Commercial |
$202.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.38
|
| Rate for Payer: Nomi Health Commercial |
$184.62
|
| Rate for Payer: PHP Commercial |
$191.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.35
|
| Rate for Payer: Priority Health HMO/PPO |
$195.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$150.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.13
|
| Rate for Payer: UHC Core |
$188.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.86
|
|
|
BUSPIRONE 7.5 MG TABLET
|
Facility
|
OP
|
$7.31
|
|
|
Service Code
|
NDC 60687080111
|
| Hospital Charge Code |
29967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$6.58 |
| Rate for Payer: Aetna Commercial |
$6.21
|
| Rate for Payer: Aetna Medicare |
$1.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.28
|
| Rate for Payer: BCBS Complete |
$2.92
|
| Rate for Payer: BCBS MAPPO |
$1.83
|
| Rate for Payer: BCBS Trust/PPO |
$6.01
|
| Rate for Payer: BCN Commercial |
$5.68
|
| Rate for Payer: BCN Medicare Advantage |
$1.83
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cofinity Commercial |
$6.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.83
|
| Rate for Payer: Healthscope Commercial |
$6.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.21
|
| Rate for Payer: Nomi Health Commercial |
$5.99
|
| Rate for Payer: PACE Senior Care Partners |
$1.74
|
| Rate for Payer: PACE SWMI |
$1.83
|
| Rate for Payer: PHP Commercial |
$6.21
|
| Rate for Payer: PHP Medicare Advantage |
$1.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.75
|
| Rate for Payer: Priority Health HMO/PPO |
$6.36
|
| Rate for Payer: Priority Health Medicare |
$1.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.90
|
| Rate for Payer: Railroad Medicare Medicare |
$1.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.43
|
| Rate for Payer: UHC Core |
$6.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.83
|
| Rate for Payer: UHC Exchange |
$1.83
|
| Rate for Payer: UHC Medicare Advantage |
$1.83
|
| Rate for Payer: VA VA |
$1.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.48
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
OP
|
$371.35
|
|
|
Service Code
|
NDC 00904693806
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$334.22 |
| Rate for Payer: Aetna Commercial |
$315.65
|
| Rate for Payer: Aetna Medicare |
$96.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$116.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$116.05
|
| Rate for Payer: BCBS Complete |
$148.54
|
| Rate for Payer: BCBS MAPPO |
$92.84
|
| Rate for Payer: BCBS Trust/PPO |
$305.29
|
| Rate for Payer: BCN Commercial |
$288.72
|
| Rate for Payer: BCN Medicare Advantage |
$92.84
|
| Rate for Payer: Cash Price |
$297.08
|
| Rate for Payer: Cofinity Commercial |
$319.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.84
|
| Rate for Payer: Healthscope Commercial |
$334.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$97.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$106.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.65
|
| Rate for Payer: Nomi Health Commercial |
$304.51
|
| Rate for Payer: PACE Senior Care Partners |
$88.20
|
| Rate for Payer: PACE SWMI |
$92.84
|
| Rate for Payer: PHP Commercial |
$315.65
|
| Rate for Payer: PHP Medicare Advantage |
$92.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.38
|
| Rate for Payer: Priority Health HMO/PPO |
$323.07
|
| Rate for Payer: Priority Health Medicare |
$93.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$248.80
|
| Rate for Payer: Railroad Medicare Medicare |
$92.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.79
|
| Rate for Payer: UHC Core |
$310.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.84
|
| Rate for Payer: UHC Exchange |
$92.84
|
| Rate for Payer: UHC Medicare Advantage |
$92.84
|
| Rate for Payer: VA VA |
$92.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.51
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
IP
|
$371.35
|
|
|
Service Code
|
NDC 00904693806
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$241.38 |
| Max. Negotiated Rate |
$334.22 |
| Rate for Payer: Aetna Commercial |
$315.65
|
| Rate for Payer: BCBS Trust/PPO |
$303.13
|
| Rate for Payer: BCN Commercial |
$286.98
|
| Rate for Payer: Cash Price |
$297.08
|
| Rate for Payer: Cofinity Commercial |
$319.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.08
|
| Rate for Payer: Healthscope Commercial |
$334.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.65
|
| Rate for Payer: Nomi Health Commercial |
$304.51
|
| Rate for Payer: PHP Commercial |
$315.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.38
|
| Rate for Payer: Priority Health HMO/PPO |
$323.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$248.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.79
|
| Rate for Payer: UHC Core |
$310.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.51
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
IP
|
$302.75
|
|
|
Service Code
|
NDC 00527169501
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.79 |
| Max. Negotiated Rate |
$272.48 |
| Rate for Payer: Aetna Commercial |
$257.34
|
| Rate for Payer: BCBS Trust/PPO |
$247.13
|
| Rate for Payer: BCN Commercial |
$233.97
|
| Rate for Payer: Cash Price |
$242.20
|
| Rate for Payer: Cofinity Commercial |
$260.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.20
|
| Rate for Payer: Healthscope Commercial |
$272.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.34
|
| Rate for Payer: Nomi Health Commercial |
$248.26
|
| Rate for Payer: PHP Commercial |
$257.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.79
|
| Rate for Payer: Priority Health HMO/PPO |
$263.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.42
|
| Rate for Payer: UHC Core |
$252.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.06
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
OP
|
$302.75
|
|
|
Service Code
|
NDC 00527169501
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.90 |
| Max. Negotiated Rate |
$272.48 |
| Rate for Payer: Aetna Commercial |
$257.34
|
| Rate for Payer: Aetna Medicare |
$78.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$94.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$94.61
|
| Rate for Payer: BCBS Complete |
$121.10
|
| Rate for Payer: BCBS MAPPO |
$75.69
|
| Rate for Payer: BCBS Trust/PPO |
$248.89
|
| Rate for Payer: BCN Commercial |
$235.39
|
| Rate for Payer: BCN Medicare Advantage |
$75.69
|
| Rate for Payer: Cash Price |
$242.20
|
| Rate for Payer: Cofinity Commercial |
$260.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.69
|
| Rate for Payer: Healthscope Commercial |
$272.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.34
|
| Rate for Payer: Nomi Health Commercial |
$248.26
|
| Rate for Payer: PACE Senior Care Partners |
$71.90
|
| Rate for Payer: PACE SWMI |
$75.69
|
| Rate for Payer: PHP Commercial |
$257.34
|
| Rate for Payer: PHP Medicare Advantage |
$75.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.79
|
| Rate for Payer: Priority Health HMO/PPO |
$263.39
|
| Rate for Payer: Priority Health Medicare |
$76.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.84
|
| Rate for Payer: Railroad Medicare Medicare |
$75.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.42
|
| Rate for Payer: UHC Core |
$252.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.69
|
| Rate for Payer: UHC Exchange |
$75.69
|
| Rate for Payer: UHC Medicare Advantage |
$75.69
|
| Rate for Payer: VA VA |
$75.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.06
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
IP
|
$735.70
|
|
|
Service Code
|
NDC 00603254421
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$478.20 |
| Max. Negotiated Rate |
$662.13 |
| Rate for Payer: Aetna Commercial |
$625.34
|
| Rate for Payer: BCBS Trust/PPO |
$600.55
|
| Rate for Payer: BCN Commercial |
$568.55
|
| Rate for Payer: Cash Price |
$588.56
|
| Rate for Payer: Cofinity Commercial |
$632.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$588.56
|
| Rate for Payer: Healthscope Commercial |
$662.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$551.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$625.34
|
| Rate for Payer: Nomi Health Commercial |
$603.27
|
| Rate for Payer: PHP Commercial |
$625.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$478.20
|
| Rate for Payer: Priority Health HMO/PPO |
$640.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$492.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$647.42
|
| Rate for Payer: UHC Core |
$614.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$551.78
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
OP
|
$735.70
|
|
|
Service Code
|
NDC 00603254421
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.73 |
| Max. Negotiated Rate |
$662.13 |
| Rate for Payer: Aetna Commercial |
$625.34
|
| Rate for Payer: Aetna Medicare |
$191.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$229.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$229.91
|
| Rate for Payer: BCBS Complete |
$294.28
|
| Rate for Payer: BCBS MAPPO |
$183.92
|
| Rate for Payer: BCBS Trust/PPO |
$604.82
|
| Rate for Payer: BCN Commercial |
$572.01
|
| Rate for Payer: BCN Medicare Advantage |
$183.92
|
| Rate for Payer: Cash Price |
$588.56
|
| Rate for Payer: Cofinity Commercial |
$632.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$588.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$183.92
|
| Rate for Payer: Healthscope Commercial |
$662.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$551.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$193.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$211.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$625.34
|
| Rate for Payer: Nomi Health Commercial |
$603.27
|
| Rate for Payer: PACE Senior Care Partners |
$174.73
|
| Rate for Payer: PACE SWMI |
$183.92
|
| Rate for Payer: PHP Commercial |
$625.34
|
| Rate for Payer: PHP Medicare Advantage |
$183.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$478.20
|
| Rate for Payer: Priority Health HMO/PPO |
$640.06
|
| Rate for Payer: Priority Health Medicare |
$185.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$492.92
|
| Rate for Payer: Railroad Medicare Medicare |
$183.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$647.42
|
| Rate for Payer: UHC Core |
$614.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$183.92
|
| Rate for Payer: UHC Exchange |
$183.92
|
| Rate for Payer: UHC Medicare Advantage |
$183.92
|
| Rate for Payer: VA VA |
$183.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$551.78
|
|
|
CALAMINE 8 %-ZINC OXIDE 8 % LOTION
|
Facility
|
OP
|
$14.34
|
|
|
Service Code
|
NDC 00395041396
|
| Hospital Charge Code |
78879
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$12.91 |
| Rate for Payer: Aetna Commercial |
$12.19
|
| Rate for Payer: Aetna Medicare |
$3.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.48
|
| Rate for Payer: BCBS Complete |
$5.74
|
| Rate for Payer: BCBS MAPPO |
$3.58
|
| Rate for Payer: BCBS Trust/PPO |
$11.79
|
| Rate for Payer: BCN Commercial |
$11.15
|
| Rate for Payer: BCN Medicare Advantage |
$3.58
|
| Rate for Payer: Cash Price |
$11.47
|
| Rate for Payer: Cofinity Commercial |
$12.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.58
|
| Rate for Payer: Healthscope Commercial |
$12.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.19
|
| Rate for Payer: Nomi Health Commercial |
$11.76
|
| Rate for Payer: PACE Senior Care Partners |
$3.41
|
| Rate for Payer: PACE SWMI |
$3.58
|
| Rate for Payer: PHP Commercial |
$12.19
|
| Rate for Payer: PHP Medicare Advantage |
$3.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.32
|
| Rate for Payer: Priority Health HMO/PPO |
$12.48
|
| Rate for Payer: Priority Health Medicare |
$3.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.61
|
| Rate for Payer: Railroad Medicare Medicare |
$3.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.62
|
| Rate for Payer: UHC Core |
$11.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.58
|
| Rate for Payer: UHC Exchange |
$3.58
|
| Rate for Payer: UHC Medicare Advantage |
$3.58
|
| Rate for Payer: VA VA |
$3.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.76
|
|
|
CALAMINE 8 %-ZINC OXIDE 8 % LOTION
|
Facility
|
IP
|
$14.34
|
|
|
Service Code
|
NDC 00395041396
|
| Hospital Charge Code |
78879
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.32 |
| Max. Negotiated Rate |
$12.91 |
| Rate for Payer: Aetna Commercial |
$12.19
|
| Rate for Payer: BCBS Trust/PPO |
$11.71
|
| Rate for Payer: BCN Commercial |
$11.08
|
| Rate for Payer: Cash Price |
$11.47
|
| Rate for Payer: Cofinity Commercial |
$12.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.47
|
| Rate for Payer: Healthscope Commercial |
$12.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.19
|
| Rate for Payer: Nomi Health Commercial |
$11.76
|
| Rate for Payer: PHP Commercial |
$12.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.32
|
| Rate for Payer: Priority Health HMO/PPO |
$12.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.62
|
| Rate for Payer: UHC Core |
$11.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.76
|
|
|
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY
|
Facility
|
OP
|
$243.71
|
|
|
Service Code
|
NDC 60505082306
|
| Hospital Charge Code |
15738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.88 |
| Max. Negotiated Rate |
$219.34 |
| Rate for Payer: Aetna Commercial |
$207.15
|
| Rate for Payer: Aetna Medicare |
$63.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.16
|
| Rate for Payer: BCBS Complete |
$97.48
|
| Rate for Payer: BCBS MAPPO |
$60.93
|
| Rate for Payer: BCBS Trust/PPO |
$200.35
|
| Rate for Payer: BCN Commercial |
$189.48
|
| Rate for Payer: BCN Medicare Advantage |
$60.93
|
| Rate for Payer: Cash Price |
$194.97
|
| Rate for Payer: Cofinity Commercial |
$209.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.93
|
| Rate for Payer: Healthscope Commercial |
$219.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.15
|
| Rate for Payer: Nomi Health Commercial |
$199.84
|
| Rate for Payer: PACE Senior Care Partners |
$57.88
|
| Rate for Payer: PACE SWMI |
$60.93
|
| Rate for Payer: PHP Commercial |
$207.15
|
| Rate for Payer: PHP Medicare Advantage |
$60.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.41
|
| Rate for Payer: Priority Health HMO/PPO |
$212.03
|
| Rate for Payer: Priority Health Medicare |
$61.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.29
|
| Rate for Payer: Railroad Medicare Medicare |
$60.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.46
|
| Rate for Payer: UHC Core |
$203.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.93
|
| Rate for Payer: UHC Exchange |
$60.93
|
| Rate for Payer: UHC Medicare Advantage |
$60.93
|
| Rate for Payer: VA VA |
$60.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.78
|
|
|
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY
|
Facility
|
OP
|
$137.24
|
|
|
Service Code
|
NDC 49884016111
|
| Hospital Charge Code |
15738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.59 |
| Max. Negotiated Rate |
$123.52 |
| Rate for Payer: Aetna Commercial |
$116.65
|
| Rate for Payer: Aetna Medicare |
$35.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.89
|
| Rate for Payer: BCBS Complete |
$54.90
|
| Rate for Payer: BCBS MAPPO |
$34.31
|
| Rate for Payer: BCBS Trust/PPO |
$112.83
|
| Rate for Payer: BCN Commercial |
$106.70
|
| Rate for Payer: BCN Medicare Advantage |
$34.31
|
| Rate for Payer: Cash Price |
$109.79
|
| Rate for Payer: Cofinity Commercial |
$118.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.31
|
| Rate for Payer: Healthscope Commercial |
$123.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.65
|
| Rate for Payer: Nomi Health Commercial |
$112.54
|
| Rate for Payer: PACE Senior Care Partners |
$32.59
|
| Rate for Payer: PACE SWMI |
$34.31
|
| Rate for Payer: PHP Commercial |
$116.65
|
| Rate for Payer: PHP Medicare Advantage |
$34.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.21
|
| Rate for Payer: Priority Health HMO/PPO |
$119.40
|
| Rate for Payer: Priority Health Medicare |
$34.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.95
|
| Rate for Payer: Railroad Medicare Medicare |
$34.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.77
|
| Rate for Payer: UHC Core |
$114.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.31
|
| Rate for Payer: UHC Exchange |
$34.31
|
| Rate for Payer: UHC Medicare Advantage |
$34.31
|
| Rate for Payer: VA VA |
$34.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.93
|
|
|
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY
|
Facility
|
IP
|
$137.24
|
|
|
Service Code
|
NDC 49884016111
|
| Hospital Charge Code |
15738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.21 |
| Max. Negotiated Rate |
$123.52 |
| Rate for Payer: Aetna Commercial |
$116.65
|
| Rate for Payer: BCBS Trust/PPO |
$112.03
|
| Rate for Payer: BCN Commercial |
$106.06
|
| Rate for Payer: Cash Price |
$109.79
|
| Rate for Payer: Cofinity Commercial |
$118.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.79
|
| Rate for Payer: Healthscope Commercial |
$123.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.65
|
| Rate for Payer: Nomi Health Commercial |
$112.54
|
| Rate for Payer: PHP Commercial |
$116.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.21
|
| Rate for Payer: Priority Health HMO/PPO |
$119.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.77
|
| Rate for Payer: UHC Core |
$114.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.93
|
|
|
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY
|
Facility
|
IP
|
$243.71
|
|
|
Service Code
|
NDC 60505082306
|
| Hospital Charge Code |
15738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.41 |
| Max. Negotiated Rate |
$219.34 |
| Rate for Payer: Aetna Commercial |
$207.15
|
| Rate for Payer: BCBS Trust/PPO |
$198.94
|
| Rate for Payer: BCN Commercial |
$188.34
|
| Rate for Payer: Cash Price |
$194.97
|
| Rate for Payer: Cofinity Commercial |
$209.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.97
|
| Rate for Payer: Healthscope Commercial |
$219.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.15
|
| Rate for Payer: Nomi Health Commercial |
$199.84
|
| Rate for Payer: PHP Commercial |
$207.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.41
|
| Rate for Payer: Priority Health HMO/PPO |
$212.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.46
|
| Rate for Payer: UHC Core |
$203.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.78
|
|
