|
AMITRIPTYLINE 50 MG TABLET
|
Facility
|
IP
|
$254.88
|
|
|
Service Code
|
NDC 00603221421
|
| Hospital Charge Code |
436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.67 |
| Max. Negotiated Rate |
$229.39 |
| Rate for Payer: Aetna Commercial |
$216.65
|
| Rate for Payer: BCBS Trust/PPO |
$208.06
|
| Rate for Payer: BCN Commercial |
$196.97
|
| Rate for Payer: Cash Price |
$203.90
|
| Rate for Payer: Cofinity Commercial |
$219.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.90
|
| Rate for Payer: Healthscope Commercial |
$229.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.65
|
| Rate for Payer: Nomi Health Commercial |
$209.00
|
| Rate for Payer: PHP Commercial |
$216.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.67
|
| Rate for Payer: Priority Health HMO/PPO |
$221.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.29
|
| Rate for Payer: UHC Core |
$212.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.16
|
|
|
AMITRIPTYLINE 50 MG TABLET
|
Facility
|
OP
|
$232.75
|
|
|
Service Code
|
NDC 50268003915
|
| Hospital Charge Code |
436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.28 |
| Max. Negotiated Rate |
$209.48 |
| Rate for Payer: Aetna Commercial |
$197.84
|
| Rate for Payer: Aetna Medicare |
$60.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.73
|
| Rate for Payer: BCBS Complete |
$93.10
|
| Rate for Payer: BCBS MAPPO |
$58.19
|
| Rate for Payer: BCBS Trust/PPO |
$191.34
|
| Rate for Payer: BCN Commercial |
$180.96
|
| Rate for Payer: BCN Medicare Advantage |
$58.19
|
| Rate for Payer: Cash Price |
$186.20
|
| Rate for Payer: Cofinity Commercial |
$200.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.19
|
| Rate for Payer: Healthscope Commercial |
$209.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.84
|
| Rate for Payer: Nomi Health Commercial |
$190.86
|
| Rate for Payer: PACE Senior Care Partners |
$55.28
|
| Rate for Payer: PACE SWMI |
$58.19
|
| Rate for Payer: PHP Commercial |
$197.84
|
| Rate for Payer: PHP Medicare Advantage |
$58.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.29
|
| Rate for Payer: Priority Health HMO/PPO |
$202.49
|
| Rate for Payer: Priority Health Medicare |
$58.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$155.94
|
| Rate for Payer: Railroad Medicare Medicare |
$58.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.82
|
| Rate for Payer: UHC Core |
$194.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.19
|
| Rate for Payer: UHC Exchange |
$58.19
|
| Rate for Payer: UHC Medicare Advantage |
$58.19
|
| Rate for Payer: VA VA |
$58.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.56
|
|
|
AMITRIPTYLINE 50 MG TABLET
|
Facility
|
IP
|
$232.75
|
|
|
Service Code
|
NDC 50268003915
|
| Hospital Charge Code |
436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.29 |
| Max. Negotiated Rate |
$209.48 |
| Rate for Payer: Aetna Commercial |
$197.84
|
| Rate for Payer: BCBS Trust/PPO |
$189.99
|
| Rate for Payer: BCN Commercial |
$179.87
|
| Rate for Payer: Cash Price |
$186.20
|
| Rate for Payer: Cofinity Commercial |
$200.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.20
|
| Rate for Payer: Healthscope Commercial |
$209.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.84
|
| Rate for Payer: Nomi Health Commercial |
$190.86
|
| Rate for Payer: PHP Commercial |
$197.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.29
|
| Rate for Payer: Priority Health HMO/PPO |
$202.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$155.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.82
|
| Rate for Payer: UHC Core |
$194.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.56
|
|
|
AMITRIPTYLINE 50 MG TABLET
|
Facility
|
OP
|
$409.45
|
|
|
Service Code
|
NDC 00904020261
|
| Hospital Charge Code |
436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.24 |
| Max. Negotiated Rate |
$368.50 |
| Rate for Payer: Aetna Commercial |
$348.03
|
| Rate for Payer: Aetna Medicare |
$106.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$127.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$127.95
|
| Rate for Payer: BCBS Complete |
$163.78
|
| Rate for Payer: BCBS MAPPO |
$102.36
|
| Rate for Payer: BCBS Trust/PPO |
$336.61
|
| Rate for Payer: BCN Commercial |
$318.35
|
| Rate for Payer: BCN Medicare Advantage |
$102.36
|
| Rate for Payer: Cash Price |
$327.56
|
| Rate for Payer: Cofinity Commercial |
$352.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.36
|
| Rate for Payer: Healthscope Commercial |
$368.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$307.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$117.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.03
|
| Rate for Payer: Nomi Health Commercial |
$335.75
|
| Rate for Payer: PACE Senior Care Partners |
$97.24
|
| Rate for Payer: PACE SWMI |
$102.36
|
| Rate for Payer: PHP Commercial |
$348.03
|
| Rate for Payer: PHP Medicare Advantage |
$102.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.14
|
| Rate for Payer: Priority Health HMO/PPO |
$356.22
|
| Rate for Payer: Priority Health Medicare |
$103.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$274.33
|
| Rate for Payer: Railroad Medicare Medicare |
$102.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$360.32
|
| Rate for Payer: UHC Core |
$341.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.36
|
| Rate for Payer: UHC Exchange |
$102.36
|
| Rate for Payer: UHC Medicare Advantage |
$102.36
|
| Rate for Payer: VA VA |
$102.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$307.09
|
|
|
AMITRIPTYLINE 50 MG TABLET
|
Facility
|
IP
|
$409.45
|
|
|
Service Code
|
NDC 00904020261
|
| Hospital Charge Code |
436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$266.14 |
| Max. Negotiated Rate |
$368.50 |
| Rate for Payer: Aetna Commercial |
$348.03
|
| Rate for Payer: BCBS Trust/PPO |
$334.23
|
| Rate for Payer: BCN Commercial |
$316.42
|
| Rate for Payer: Cash Price |
$327.56
|
| Rate for Payer: Cofinity Commercial |
$352.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.56
|
| Rate for Payer: Healthscope Commercial |
$368.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$307.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.03
|
| Rate for Payer: Nomi Health Commercial |
$335.75
|
| Rate for Payer: PHP Commercial |
$348.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.14
|
| Rate for Payer: Priority Health HMO/PPO |
$356.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$274.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$360.32
|
| Rate for Payer: UHC Core |
$341.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$307.09
|
|
|
AMITRIPTYLINE 50 MG TABLET
|
Facility
|
OP
|
$336.30
|
|
|
Service Code
|
NDC 00904718561
|
| Hospital Charge Code |
436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.87 |
| Max. Negotiated Rate |
$302.67 |
| Rate for Payer: Aetna Commercial |
$285.86
|
| Rate for Payer: Aetna Medicare |
$87.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$105.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$105.09
|
| Rate for Payer: BCBS Complete |
$134.52
|
| Rate for Payer: BCBS MAPPO |
$84.08
|
| Rate for Payer: BCBS Trust/PPO |
$276.47
|
| Rate for Payer: BCN Commercial |
$261.47
|
| Rate for Payer: BCN Medicare Advantage |
$84.08
|
| Rate for Payer: Cash Price |
$269.04
|
| Rate for Payer: Cofinity Commercial |
$289.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.08
|
| Rate for Payer: Healthscope Commercial |
$302.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.86
|
| Rate for Payer: Nomi Health Commercial |
$275.77
|
| Rate for Payer: PACE Senior Care Partners |
$79.87
|
| Rate for Payer: PACE SWMI |
$84.08
|
| Rate for Payer: PHP Commercial |
$285.86
|
| Rate for Payer: PHP Medicare Advantage |
$84.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.60
|
| Rate for Payer: Priority Health HMO/PPO |
$292.58
|
| Rate for Payer: Priority Health Medicare |
$84.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$225.32
|
| Rate for Payer: Railroad Medicare Medicare |
$84.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$295.94
|
| Rate for Payer: UHC Core |
$280.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$84.08
|
| Rate for Payer: UHC Exchange |
$84.08
|
| Rate for Payer: UHC Medicare Advantage |
$84.08
|
| Rate for Payer: VA VA |
$84.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.22
|
|
|
AMITRIPTYLINE 50 MG TABLET
|
Facility
|
OP
|
$254.88
|
|
|
Service Code
|
NDC 00603221421
|
| Hospital Charge Code |
436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.53 |
| Max. Negotiated Rate |
$229.39 |
| Rate for Payer: Aetna Commercial |
$216.65
|
| Rate for Payer: Aetna Medicare |
$66.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.65
|
| Rate for Payer: BCBS Complete |
$101.95
|
| Rate for Payer: BCBS MAPPO |
$63.72
|
| Rate for Payer: BCBS Trust/PPO |
$209.54
|
| Rate for Payer: BCN Commercial |
$198.17
|
| Rate for Payer: BCN Medicare Advantage |
$63.72
|
| Rate for Payer: Cash Price |
$203.90
|
| Rate for Payer: Cofinity Commercial |
$219.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.72
|
| Rate for Payer: Healthscope Commercial |
$229.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.65
|
| Rate for Payer: Nomi Health Commercial |
$209.00
|
| Rate for Payer: PACE Senior Care Partners |
$60.53
|
| Rate for Payer: PACE SWMI |
$63.72
|
| Rate for Payer: PHP Commercial |
$216.65
|
| Rate for Payer: PHP Medicare Advantage |
$63.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.67
|
| Rate for Payer: Priority Health HMO/PPO |
$221.75
|
| Rate for Payer: Priority Health Medicare |
$64.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.77
|
| Rate for Payer: Railroad Medicare Medicare |
$63.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.29
|
| Rate for Payer: UHC Core |
$212.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.72
|
| Rate for Payer: UHC Exchange |
$63.72
|
| Rate for Payer: UHC Medicare Advantage |
$63.72
|
| Rate for Payer: VA VA |
$63.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.16
|
|
|
AMITRIPTYLINE 50 MG TABLET
|
Facility
|
IP
|
$4.66
|
|
|
Service Code
|
NDC 50268003911
|
| Hospital Charge Code |
436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$4.19 |
| Rate for Payer: Aetna Commercial |
$3.96
|
| Rate for Payer: BCBS Trust/PPO |
$3.80
|
| Rate for Payer: BCN Commercial |
$3.60
|
| Rate for Payer: Cash Price |
$3.73
|
| Rate for Payer: Cofinity Commercial |
$4.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.73
|
| Rate for Payer: Healthscope Commercial |
$4.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.96
|
| Rate for Payer: Nomi Health Commercial |
$3.82
|
| Rate for Payer: PHP Commercial |
$3.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.03
|
| Rate for Payer: Priority Health HMO/PPO |
$4.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.10
|
| Rate for Payer: UHC Core |
$3.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.50
|
|
|
AMITRIPTYLINE 50 MG TABLET
|
Facility
|
IP
|
$336.30
|
|
|
Service Code
|
NDC 00904718561
|
| Hospital Charge Code |
436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$218.60 |
| Max. Negotiated Rate |
$302.67 |
| Rate for Payer: Aetna Commercial |
$285.86
|
| Rate for Payer: BCBS Trust/PPO |
$274.52
|
| Rate for Payer: BCN Commercial |
$259.89
|
| Rate for Payer: Cash Price |
$269.04
|
| Rate for Payer: Cofinity Commercial |
$289.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.04
|
| Rate for Payer: Healthscope Commercial |
$302.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.86
|
| Rate for Payer: Nomi Health Commercial |
$275.77
|
| Rate for Payer: PHP Commercial |
$285.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.60
|
| Rate for Payer: Priority Health HMO/PPO |
$292.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$225.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$295.94
|
| Rate for Payer: UHC Core |
$280.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.22
|
|
|
AMLODIPINE 10 MG TABLET
|
Facility
|
OP
|
$159.80
|
|
|
Service Code
|
NDC 00904637161
|
| Hospital Charge Code |
9069
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.95 |
| Max. Negotiated Rate |
$143.82 |
| Rate for Payer: Aetna Commercial |
$135.83
|
| Rate for Payer: Aetna Medicare |
$41.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.94
|
| Rate for Payer: BCBS Complete |
$63.92
|
| Rate for Payer: BCBS MAPPO |
$39.95
|
| Rate for Payer: BCBS Trust/PPO |
$131.37
|
| Rate for Payer: BCN Commercial |
$124.24
|
| Rate for Payer: BCN Medicare Advantage |
$39.95
|
| Rate for Payer: Cash Price |
$127.84
|
| Rate for Payer: Cofinity Commercial |
$137.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.95
|
| Rate for Payer: Healthscope Commercial |
$143.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.83
|
| Rate for Payer: Nomi Health Commercial |
$131.04
|
| Rate for Payer: PACE Senior Care Partners |
$37.95
|
| Rate for Payer: PACE SWMI |
$39.95
|
| Rate for Payer: PHP Commercial |
$135.83
|
| Rate for Payer: PHP Medicare Advantage |
$39.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.87
|
| Rate for Payer: Priority Health HMO/PPO |
$139.03
|
| Rate for Payer: Priority Health Medicare |
$40.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$107.07
|
| Rate for Payer: Railroad Medicare Medicare |
$39.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.62
|
| Rate for Payer: UHC Core |
$133.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.95
|
| Rate for Payer: UHC Exchange |
$39.95
|
| Rate for Payer: UHC Medicare Advantage |
$39.95
|
| Rate for Payer: VA VA |
$39.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.85
|
|
|
AMLODIPINE 10 MG TABLET
|
Facility
|
IP
|
$3,996.37
|
|
|
Service Code
|
NDC 00069154041
|
| Hospital Charge Code |
9069
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,597.64 |
| Max. Negotiated Rate |
$3,596.73 |
| Rate for Payer: Aetna Commercial |
$3,396.91
|
| Rate for Payer: BCBS Trust/PPO |
$3,262.24
|
| Rate for Payer: BCN Commercial |
$3,088.39
|
| Rate for Payer: Cash Price |
$3,197.10
|
| Rate for Payer: Cofinity Commercial |
$3,436.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,197.10
|
| Rate for Payer: Healthscope Commercial |
$3,596.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,997.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,396.91
|
| Rate for Payer: Nomi Health Commercial |
$3,277.02
|
| Rate for Payer: PHP Commercial |
$3,396.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,597.64
|
| Rate for Payer: Priority Health HMO/PPO |
$3,476.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,677.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,516.81
|
| Rate for Payer: UHC Core |
$3,336.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,997.28
|
|
|
AMLODIPINE 10 MG TABLET
|
Facility
|
IP
|
$159.80
|
|
|
Service Code
|
NDC 00904637161
|
| Hospital Charge Code |
9069
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$143.82 |
| Rate for Payer: Aetna Commercial |
$135.83
|
| Rate for Payer: BCBS Trust/PPO |
$130.44
|
| Rate for Payer: BCN Commercial |
$123.49
|
| Rate for Payer: Cash Price |
$127.84
|
| Rate for Payer: Cofinity Commercial |
$137.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.84
|
| Rate for Payer: Healthscope Commercial |
$143.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.83
|
| Rate for Payer: Nomi Health Commercial |
$131.04
|
| Rate for Payer: PHP Commercial |
$135.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.87
|
| Rate for Payer: Priority Health HMO/PPO |
$139.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$107.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.62
|
| Rate for Payer: UHC Core |
$133.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.85
|
|
|
AMLODIPINE 10 MG TABLET
|
Facility
|
OP
|
$3,996.37
|
|
|
Service Code
|
NDC 00069154041
|
| Hospital Charge Code |
9069
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$949.14 |
| Max. Negotiated Rate |
$3,596.73 |
| Rate for Payer: Aetna Commercial |
$3,396.91
|
| Rate for Payer: Aetna Medicare |
$1,039.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,248.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,248.87
|
| Rate for Payer: BCBS Complete |
$1,598.55
|
| Rate for Payer: BCBS MAPPO |
$999.09
|
| Rate for Payer: BCBS Trust/PPO |
$3,285.42
|
| Rate for Payer: BCN Commercial |
$3,107.18
|
| Rate for Payer: BCN Medicare Advantage |
$999.09
|
| Rate for Payer: Cash Price |
$3,197.10
|
| Rate for Payer: Cofinity Commercial |
$3,436.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,197.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$999.09
|
| Rate for Payer: Healthscope Commercial |
$3,596.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,997.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,049.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,148.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,396.91
|
| Rate for Payer: Nomi Health Commercial |
$3,277.02
|
| Rate for Payer: PACE Senior Care Partners |
$949.14
|
| Rate for Payer: PACE SWMI |
$999.09
|
| Rate for Payer: PHP Commercial |
$3,396.91
|
| Rate for Payer: PHP Medicare Advantage |
$999.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,597.64
|
| Rate for Payer: Priority Health HMO/PPO |
$3,476.84
|
| Rate for Payer: Priority Health Medicare |
$1,009.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,677.57
|
| Rate for Payer: Railroad Medicare Medicare |
$999.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,516.81
|
| Rate for Payer: UHC Core |
$3,336.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$999.09
|
| Rate for Payer: UHC Exchange |
$999.09
|
| Rate for Payer: UHC Medicare Advantage |
$999.09
|
| Rate for Payer: VA VA |
$999.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,997.28
|
|
|
AMLODIPINE 2.5 MG TABLET
|
Facility
|
OP
|
$197.40
|
|
|
Service Code
|
NDC 00904636961
|
| Hospital Charge Code |
9070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.88 |
| Max. Negotiated Rate |
$177.66 |
| Rate for Payer: Aetna Commercial |
$167.79
|
| Rate for Payer: Aetna Medicare |
$51.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.69
|
| Rate for Payer: BCBS Complete |
$78.96
|
| Rate for Payer: BCBS MAPPO |
$49.35
|
| Rate for Payer: BCBS Trust/PPO |
$162.28
|
| Rate for Payer: BCN Commercial |
$153.48
|
| Rate for Payer: BCN Medicare Advantage |
$49.35
|
| Rate for Payer: Cash Price |
$157.92
|
| Rate for Payer: Cofinity Commercial |
$169.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.35
|
| Rate for Payer: Healthscope Commercial |
$177.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.79
|
| Rate for Payer: Nomi Health Commercial |
$161.87
|
| Rate for Payer: PACE Senior Care Partners |
$46.88
|
| Rate for Payer: PACE SWMI |
$49.35
|
| Rate for Payer: PHP Commercial |
$167.79
|
| Rate for Payer: PHP Medicare Advantage |
$49.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.31
|
| Rate for Payer: Priority Health HMO/PPO |
$171.74
|
| Rate for Payer: Priority Health Medicare |
$49.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$132.26
|
| Rate for Payer: Railroad Medicare Medicare |
$49.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.71
|
| Rate for Payer: UHC Core |
$164.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.35
|
| Rate for Payer: UHC Exchange |
$49.35
|
| Rate for Payer: UHC Medicare Advantage |
$49.35
|
| Rate for Payer: VA VA |
$49.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.05
|
|
|
AMLODIPINE 2.5 MG TABLET
|
Facility
|
IP
|
$197.40
|
|
|
Service Code
|
NDC 00904636961
|
| Hospital Charge Code |
9070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.31 |
| Max. Negotiated Rate |
$177.66 |
| Rate for Payer: Aetna Commercial |
$167.79
|
| Rate for Payer: BCBS Trust/PPO |
$161.14
|
| Rate for Payer: BCN Commercial |
$152.55
|
| Rate for Payer: Cash Price |
$157.92
|
| Rate for Payer: Cofinity Commercial |
$169.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.92
|
| Rate for Payer: Healthscope Commercial |
$177.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.79
|
| Rate for Payer: Nomi Health Commercial |
$161.87
|
| Rate for Payer: PHP Commercial |
$167.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.31
|
| Rate for Payer: Priority Health HMO/PPO |
$171.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$132.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.71
|
| Rate for Payer: UHC Core |
$164.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.05
|
|
|
AMLODIPINE 5 MG TABLET
|
Facility
|
IP
|
$173.90
|
|
|
Service Code
|
NDC 00904637061
|
| Hospital Charge Code |
9071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.04 |
| Max. Negotiated Rate |
$156.51 |
| Rate for Payer: Aetna Commercial |
$147.82
|
| Rate for Payer: BCBS Trust/PPO |
$141.95
|
| Rate for Payer: BCN Commercial |
$134.39
|
| Rate for Payer: Cash Price |
$139.12
|
| Rate for Payer: Cofinity Commercial |
$149.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.12
|
| Rate for Payer: Healthscope Commercial |
$156.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.82
|
| Rate for Payer: Nomi Health Commercial |
$142.60
|
| Rate for Payer: PHP Commercial |
$147.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.04
|
| Rate for Payer: Priority Health HMO/PPO |
$151.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$116.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.03
|
| Rate for Payer: UHC Core |
$145.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.42
|
|
|
AMLODIPINE 5 MG TABLET
|
Facility
|
OP
|
$173.90
|
|
|
Service Code
|
NDC 00904637061
|
| Hospital Charge Code |
9071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.30 |
| Max. Negotiated Rate |
$156.51 |
| Rate for Payer: Aetna Commercial |
$147.82
|
| Rate for Payer: Aetna Medicare |
$45.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$54.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$54.34
|
| Rate for Payer: BCBS Complete |
$69.56
|
| Rate for Payer: BCBS MAPPO |
$43.48
|
| Rate for Payer: BCBS Trust/PPO |
$142.96
|
| Rate for Payer: BCN Commercial |
$135.21
|
| Rate for Payer: BCN Medicare Advantage |
$43.48
|
| Rate for Payer: Cash Price |
$139.12
|
| Rate for Payer: Cofinity Commercial |
$149.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.48
|
| Rate for Payer: Healthscope Commercial |
$156.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.82
|
| Rate for Payer: Nomi Health Commercial |
$142.60
|
| Rate for Payer: PACE Senior Care Partners |
$41.30
|
| Rate for Payer: PACE SWMI |
$43.48
|
| Rate for Payer: PHP Commercial |
$147.82
|
| Rate for Payer: PHP Medicare Advantage |
$43.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.04
|
| Rate for Payer: Priority Health HMO/PPO |
$151.29
|
| Rate for Payer: Priority Health Medicare |
$43.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$116.51
|
| Rate for Payer: Railroad Medicare Medicare |
$43.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.03
|
| Rate for Payer: UHC Core |
$145.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.48
|
| Rate for Payer: UHC Exchange |
$43.48
|
| Rate for Payer: UHC Medicare Advantage |
$43.48
|
| Rate for Payer: VA VA |
$43.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.42
|
|
|
AMMONIUM LACTATE 12 % LOTION
|
Facility
|
OP
|
$16.20
|
|
|
Service Code
|
NDC 00904598426
|
| Hospital Charge Code |
10380
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$14.58 |
| Rate for Payer: Aetna Commercial |
$13.77
|
| Rate for Payer: Aetna Medicare |
$4.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.06
|
| Rate for Payer: BCBS Complete |
$6.48
|
| Rate for Payer: BCBS MAPPO |
$4.05
|
| Rate for Payer: BCBS Trust/PPO |
$13.32
|
| Rate for Payer: BCN Commercial |
$12.60
|
| Rate for Payer: BCN Medicare Advantage |
$4.05
|
| Rate for Payer: Cash Price |
$12.96
|
| Rate for Payer: Cofinity Commercial |
$13.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.05
|
| Rate for Payer: Healthscope Commercial |
$14.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.77
|
| Rate for Payer: Nomi Health Commercial |
$13.28
|
| Rate for Payer: PACE Senior Care Partners |
$3.85
|
| Rate for Payer: PACE SWMI |
$4.05
|
| Rate for Payer: PHP Commercial |
$13.77
|
| Rate for Payer: PHP Medicare Advantage |
$4.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.53
|
| Rate for Payer: Priority Health HMO/PPO |
$14.09
|
| Rate for Payer: Priority Health Medicare |
$4.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.85
|
| Rate for Payer: Railroad Medicare Medicare |
$4.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.26
|
| Rate for Payer: UHC Core |
$13.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.05
|
| Rate for Payer: UHC Exchange |
$4.05
|
| Rate for Payer: UHC Medicare Advantage |
$4.05
|
| Rate for Payer: VA VA |
$4.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.15
|
|
|
AMMONIUM LACTATE 12 % LOTION
|
Facility
|
IP
|
$16.20
|
|
|
Service Code
|
NDC 00904598426
|
| Hospital Charge Code |
10380
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.53 |
| Max. Negotiated Rate |
$14.58 |
| Rate for Payer: Aetna Commercial |
$13.77
|
| Rate for Payer: BCBS Trust/PPO |
$13.22
|
| Rate for Payer: BCN Commercial |
$12.52
|
| Rate for Payer: Cash Price |
$12.96
|
| Rate for Payer: Cofinity Commercial |
$13.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.96
|
| Rate for Payer: Healthscope Commercial |
$14.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.77
|
| Rate for Payer: Nomi Health Commercial |
$13.28
|
| Rate for Payer: PHP Commercial |
$13.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.53
|
| Rate for Payer: Priority Health HMO/PPO |
$14.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.26
|
| Rate for Payer: UHC Core |
$13.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.15
|
|
|
AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$2.59
|
|
|
Service Code
|
NDC 09900000421
|
| Hospital Charge Code |
454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.33 |
| Rate for Payer: Aetna Commercial |
$2.20
|
| Rate for Payer: Aetna Medicare |
$0.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.81
|
| Rate for Payer: BCBS Complete |
$1.04
|
| Rate for Payer: BCBS MAPPO |
$0.65
|
| Rate for Payer: BCBS Trust/PPO |
$2.13
|
| Rate for Payer: BCN Commercial |
$2.01
|
| Rate for Payer: BCN Medicare Advantage |
$0.65
|
| Rate for Payer: Cash Price |
$2.07
|
| Rate for Payer: Cofinity Commercial |
$2.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.65
|
| Rate for Payer: Healthscope Commercial |
$2.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.20
|
| Rate for Payer: Nomi Health Commercial |
$2.12
|
| Rate for Payer: PACE Senior Care Partners |
$0.62
|
| Rate for Payer: PACE SWMI |
$0.65
|
| Rate for Payer: PHP Commercial |
$2.20
|
| Rate for Payer: PHP Medicare Advantage |
$0.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.68
|
| Rate for Payer: Priority Health HMO/PPO |
$2.25
|
| Rate for Payer: Priority Health Medicare |
$0.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.74
|
| Rate for Payer: Railroad Medicare Medicare |
$0.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.28
|
| Rate for Payer: UHC Core |
$2.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.65
|
| Rate for Payer: UHC Exchange |
$0.65
|
| Rate for Payer: UHC Medicare Advantage |
$0.65
|
| Rate for Payer: VA VA |
$0.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.94
|
|
|
AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$88.13
|
|
|
Service Code
|
NDC 00781604155
|
| Hospital Charge Code |
454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.93 |
| Max. Negotiated Rate |
$79.32 |
| Rate for Payer: Aetna Commercial |
$74.91
|
| Rate for Payer: Aetna Medicare |
$22.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.54
|
| Rate for Payer: BCBS Complete |
$35.25
|
| Rate for Payer: BCBS MAPPO |
$22.03
|
| Rate for Payer: BCBS Trust/PPO |
$72.45
|
| Rate for Payer: BCN Commercial |
$68.52
|
| Rate for Payer: BCN Medicare Advantage |
$22.03
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cofinity Commercial |
$75.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.03
|
| Rate for Payer: Healthscope Commercial |
$79.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.91
|
| Rate for Payer: Nomi Health Commercial |
$72.27
|
| Rate for Payer: PACE Senior Care Partners |
$20.93
|
| Rate for Payer: PACE SWMI |
$22.03
|
| Rate for Payer: PHP Commercial |
$74.91
|
| Rate for Payer: PHP Medicare Advantage |
$22.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.28
|
| Rate for Payer: Priority Health HMO/PPO |
$76.67
|
| Rate for Payer: Priority Health Medicare |
$22.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.05
|
| Rate for Payer: Railroad Medicare Medicare |
$22.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.55
|
| Rate for Payer: UHC Core |
$73.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.03
|
| Rate for Payer: UHC Exchange |
$22.03
|
| Rate for Payer: UHC Medicare Advantage |
$22.03
|
| Rate for Payer: VA VA |
$22.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.10
|
|
|
AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$56.40
|
|
|
Service Code
|
NDC 00143988980
|
| Hospital Charge Code |
454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.66 |
| Max. Negotiated Rate |
$50.76 |
| Rate for Payer: Aetna Commercial |
$47.94
|
| Rate for Payer: BCBS Trust/PPO |
$46.04
|
| Rate for Payer: BCN Commercial |
$43.59
|
| Rate for Payer: Cash Price |
$45.12
|
| Rate for Payer: Cofinity Commercial |
$48.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.12
|
| Rate for Payer: Healthscope Commercial |
$50.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.94
|
| Rate for Payer: Nomi Health Commercial |
$46.25
|
| Rate for Payer: PHP Commercial |
$47.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.66
|
| Rate for Payer: Priority Health HMO/PPO |
$49.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.63
|
| Rate for Payer: UHC Core |
$47.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.30
|
|
|
AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$77.55
|
|
|
Service Code
|
NDC 00781604146
|
| Hospital Charge Code |
454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.41 |
| Max. Negotiated Rate |
$69.80 |
| Rate for Payer: Aetna Commercial |
$65.92
|
| Rate for Payer: BCBS Trust/PPO |
$63.30
|
| Rate for Payer: BCN Commercial |
$59.93
|
| Rate for Payer: Cash Price |
$62.04
|
| Rate for Payer: Cofinity Commercial |
$66.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.04
|
| Rate for Payer: Healthscope Commercial |
$69.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.92
|
| Rate for Payer: Nomi Health Commercial |
$63.59
|
| Rate for Payer: PHP Commercial |
$65.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.41
|
| Rate for Payer: Priority Health HMO/PPO |
$67.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.24
|
| Rate for Payer: UHC Core |
$64.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.16
|
|
|
AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$71.44
|
|
|
Service Code
|
NDC 00093415579
|
| Hospital Charge Code |
454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.97 |
| Max. Negotiated Rate |
$64.30 |
| Rate for Payer: Aetna Commercial |
$60.72
|
| Rate for Payer: Aetna Medicare |
$18.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.32
|
| Rate for Payer: BCBS Complete |
$28.58
|
| Rate for Payer: BCBS MAPPO |
$17.86
|
| Rate for Payer: BCBS Trust/PPO |
$58.73
|
| Rate for Payer: BCN Commercial |
$55.54
|
| Rate for Payer: BCN Medicare Advantage |
$17.86
|
| Rate for Payer: Cash Price |
$57.15
|
| Rate for Payer: Cofinity Commercial |
$61.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.86
|
| Rate for Payer: Healthscope Commercial |
$64.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.72
|
| Rate for Payer: Nomi Health Commercial |
$58.58
|
| Rate for Payer: PACE Senior Care Partners |
$16.97
|
| Rate for Payer: PACE SWMI |
$17.86
|
| Rate for Payer: PHP Commercial |
$60.72
|
| Rate for Payer: PHP Medicare Advantage |
$17.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.44
|
| Rate for Payer: Priority Health HMO/PPO |
$62.15
|
| Rate for Payer: Priority Health Medicare |
$18.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.86
|
| Rate for Payer: Railroad Medicare Medicare |
$17.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.87
|
| Rate for Payer: UHC Core |
$59.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.86
|
| Rate for Payer: UHC Exchange |
$17.86
|
| Rate for Payer: UHC Medicare Advantage |
$17.86
|
| Rate for Payer: VA VA |
$17.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.58
|
|
|
AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$77.55
|
|
|
Service Code
|
NDC 00781604146
|
| Hospital Charge Code |
454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.42 |
| Max. Negotiated Rate |
$69.80 |
| Rate for Payer: Aetna Commercial |
$65.92
|
| Rate for Payer: Aetna Medicare |
$20.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.23
|
| Rate for Payer: BCBS Complete |
$31.02
|
| Rate for Payer: BCBS MAPPO |
$19.39
|
| Rate for Payer: BCBS Trust/PPO |
$63.75
|
| Rate for Payer: BCN Commercial |
$60.30
|
| Rate for Payer: BCN Medicare Advantage |
$19.39
|
| Rate for Payer: Cash Price |
$62.04
|
| Rate for Payer: Cofinity Commercial |
$66.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.39
|
| Rate for Payer: Healthscope Commercial |
$69.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.92
|
| Rate for Payer: Nomi Health Commercial |
$63.59
|
| Rate for Payer: PACE Senior Care Partners |
$18.42
|
| Rate for Payer: PACE SWMI |
$19.39
|
| Rate for Payer: PHP Commercial |
$65.92
|
| Rate for Payer: PHP Medicare Advantage |
$19.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.41
|
| Rate for Payer: Priority Health HMO/PPO |
$67.47
|
| Rate for Payer: Priority Health Medicare |
$19.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.96
|
| Rate for Payer: Railroad Medicare Medicare |
$19.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.24
|
| Rate for Payer: UHC Core |
$64.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.39
|
| Rate for Payer: UHC Exchange |
$19.39
|
| Rate for Payer: UHC Medicare Advantage |
$19.39
|
| Rate for Payer: VA VA |
$19.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.16
|
|
