|
DONEPEZIL 10 MG TABLET
|
Facility
|
IP
|
$2.92
|
|
|
Service Code
|
NDC 60687030311
|
| Hospital Charge Code |
18787
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$2.63 |
| Rate for Payer: Aetna Commercial |
$2.48
|
| Rate for Payer: BCBS Trust/PPO |
$2.41
|
| Rate for Payer: BCN Commercial |
$2.41
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cofinity Commercial |
$2.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.34
|
| Rate for Payer: Healthscope Commercial |
$2.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.48
|
| Rate for Payer: Nomi Health Commercial |
$2.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.19
|
| Rate for Payer: PHP Commercial |
$2.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.57
|
| Rate for Payer: UHC Core |
$2.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.19
|
|
|
DONEPEZIL 10 MG TABLET
|
Facility
|
OP
|
$71.91
|
|
|
Service Code
|
NDC 43547027609
|
| Hospital Charge Code |
18787
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.68 |
| Max. Negotiated Rate |
$64.72 |
| Rate for Payer: Aetna Commercial |
$61.12
|
| Rate for Payer: Aetna Medicare |
$18.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.47
|
| Rate for Payer: BCBS Complete |
$13.31
|
| Rate for Payer: BCBS MAPPO |
$17.98
|
| Rate for Payer: BCBS Trust/PPO |
$59.12
|
| Rate for Payer: BCN Commercial |
$59.12
|
| Rate for Payer: BCN Medicare Advantage |
$17.98
|
| Rate for Payer: Cash Price |
$57.53
|
| Rate for Payer: Cofinity Commercial |
$61.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.98
|
| Rate for Payer: Healthscope Commercial |
$64.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.93
|
| Rate for Payer: Mclaren Medicaid |
$12.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.88
|
| Rate for Payer: Meridian Medicaid |
$13.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.12
|
| Rate for Payer: Nomi Health Commercial |
$58.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.93
|
| Rate for Payer: PACE Senior Care Partners |
$17.08
|
| Rate for Payer: PACE SWMI |
$17.98
|
| Rate for Payer: PHP Commercial |
$61.12
|
| Rate for Payer: PHP Medicare Advantage |
$17.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$62.56
|
| Rate for Payer: Priority Health Medicare |
$18.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.05
|
| Rate for Payer: Railroad Medicare Medicare |
$17.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.28
|
| Rate for Payer: UHC Core |
$60.04
|
| Rate for Payer: UHC Exchange |
$17.98
|
| Rate for Payer: UHC Medicaid |
$12.68
|
| Rate for Payer: UHC Medicare Advantage |
$17.98
|
| Rate for Payer: UHCCP Medicaid |
$12.68
|
| Rate for Payer: VA VA |
$17.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.93
|
|
|
DONEPEZIL 10 MG TABLET
|
Facility
|
IP
|
$71.91
|
|
|
Service Code
|
NDC 43547027609
|
| Hospital Charge Code |
18787
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.05 |
| Max. Negotiated Rate |
$64.72 |
| Rate for Payer: Aetna Commercial |
$61.12
|
| Rate for Payer: BCBS Trust/PPO |
$59.39
|
| Rate for Payer: BCN Commercial |
$59.39
|
| Rate for Payer: Cash Price |
$57.53
|
| Rate for Payer: Cofinity Commercial |
$61.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.53
|
| Rate for Payer: Healthscope Commercial |
$64.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.12
|
| Rate for Payer: Nomi Health Commercial |
$58.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.93
|
| Rate for Payer: PHP Commercial |
$61.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$62.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.28
|
| Rate for Payer: UHC Core |
$60.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.93
|
|
|
DONEPEZIL 10 MG TABLET
|
Facility
|
OP
|
$265.55
|
|
|
Service Code
|
NDC 00904647861
|
| Hospital Charge Code |
18787
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.82 |
| Max. Negotiated Rate |
$239.00 |
| Rate for Payer: Aetna Commercial |
$225.72
|
| Rate for Payer: Aetna Medicare |
$69.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$82.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$82.98
|
| Rate for Payer: BCBS Complete |
$49.15
|
| Rate for Payer: BCBS MAPPO |
$66.39
|
| Rate for Payer: BCBS Trust/PPO |
$218.31
|
| Rate for Payer: BCN Commercial |
$218.31
|
| Rate for Payer: BCN Medicare Advantage |
$66.39
|
| Rate for Payer: Cash Price |
$212.44
|
| Rate for Payer: Cofinity Commercial |
$228.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.39
|
| Rate for Payer: Healthscope Commercial |
$239.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.16
|
| Rate for Payer: Mclaren Medicaid |
$46.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.71
|
| Rate for Payer: Meridian Medicaid |
$49.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$73.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.72
|
| Rate for Payer: Nomi Health Commercial |
$217.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.16
|
| Rate for Payer: PACE Senior Care Partners |
$63.07
|
| Rate for Payer: PACE SWMI |
$66.39
|
| Rate for Payer: PHP Commercial |
$225.72
|
| Rate for Payer: PHP Medicare Advantage |
$66.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$231.03
|
| Rate for Payer: Priority Health Medicare |
$67.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.82
|
| Rate for Payer: Railroad Medicare Medicare |
$66.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$233.68
|
| Rate for Payer: UHC Core |
$221.73
|
| Rate for Payer: UHC Exchange |
$66.39
|
| Rate for Payer: UHC Medicaid |
$46.82
|
| Rate for Payer: UHC Medicare Advantage |
$66.39
|
| Rate for Payer: UHCCP Medicaid |
$46.82
|
| Rate for Payer: VA VA |
$66.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.16
|
|
|
DONEPEZIL 10 MG TABLET
|
Facility
|
IP
|
$265.55
|
|
|
Service Code
|
NDC 00904647861
|
| Hospital Charge Code |
18787
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.82 |
| Max. Negotiated Rate |
$239.00 |
| Rate for Payer: Aetna Commercial |
$225.72
|
| Rate for Payer: BCBS Trust/PPO |
$219.32
|
| Rate for Payer: BCN Commercial |
$219.32
|
| Rate for Payer: Cash Price |
$212.44
|
| Rate for Payer: Cofinity Commercial |
$228.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.44
|
| Rate for Payer: Healthscope Commercial |
$239.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.72
|
| Rate for Payer: Nomi Health Commercial |
$217.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.16
|
| Rate for Payer: PHP Commercial |
$225.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$231.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$233.68
|
| Rate for Payer: UHC Core |
$221.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.16
|
|
|
DONEPEZIL 10 MG TABLET
|
Facility
|
OP
|
$291.40
|
|
|
Service Code
|
NDC 60687030301
|
| Hospital Charge Code |
18787
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.37 |
| Max. Negotiated Rate |
$262.26 |
| Rate for Payer: Aetna Commercial |
$247.69
|
| Rate for Payer: Aetna Medicare |
$75.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$91.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$91.06
|
| Rate for Payer: BCBS Complete |
$53.94
|
| Rate for Payer: BCBS MAPPO |
$72.85
|
| Rate for Payer: BCBS Trust/PPO |
$239.56
|
| Rate for Payer: BCN Commercial |
$239.56
|
| Rate for Payer: BCN Medicare Advantage |
$72.85
|
| Rate for Payer: Cash Price |
$233.12
|
| Rate for Payer: Cofinity Commercial |
$250.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.85
|
| Rate for Payer: Healthscope Commercial |
$262.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.55
|
| Rate for Payer: Mclaren Medicaid |
$51.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.49
|
| Rate for Payer: Meridian Medicaid |
$53.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$80.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.69
|
| Rate for Payer: Nomi Health Commercial |
$238.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.55
|
| Rate for Payer: PACE Senior Care Partners |
$69.21
|
| Rate for Payer: PACE SWMI |
$72.85
|
| Rate for Payer: PHP Commercial |
$247.69
|
| Rate for Payer: PHP Medicare Advantage |
$72.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$253.52
|
| Rate for Payer: Priority Health Medicare |
$73.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.81
|
| Rate for Payer: Railroad Medicare Medicare |
$72.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$256.43
|
| Rate for Payer: UHC Core |
$243.32
|
| Rate for Payer: UHC Exchange |
$72.85
|
| Rate for Payer: UHC Medicaid |
$51.37
|
| Rate for Payer: UHC Medicare Advantage |
$72.85
|
| Rate for Payer: UHCCP Medicaid |
$51.37
|
| Rate for Payer: VA VA |
$72.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.55
|
|
|
DONEPEZIL 10 MG TABLET
|
Facility
|
OP
|
$2.92
|
|
|
Service Code
|
NDC 60687030311
|
| Hospital Charge Code |
18787
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$2.63 |
| Rate for Payer: Aetna Commercial |
$2.48
|
| Rate for Payer: Aetna Medicare |
$0.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.91
|
| Rate for Payer: BCBS Complete |
$0.54
|
| Rate for Payer: BCBS MAPPO |
$0.73
|
| Rate for Payer: BCBS Trust/PPO |
$2.40
|
| Rate for Payer: BCN Commercial |
$2.40
|
| Rate for Payer: BCN Medicare Advantage |
$0.73
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cofinity Commercial |
$2.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.73
|
| Rate for Payer: Healthscope Commercial |
$2.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.19
|
| Rate for Payer: Mclaren Medicaid |
$0.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.77
|
| Rate for Payer: Meridian Medicaid |
$0.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.48
|
| Rate for Payer: Nomi Health Commercial |
$2.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.19
|
| Rate for Payer: PACE Senior Care Partners |
$0.69
|
| Rate for Payer: PACE SWMI |
$0.73
|
| Rate for Payer: PHP Commercial |
$2.48
|
| Rate for Payer: PHP Medicare Advantage |
$0.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.54
|
| Rate for Payer: Priority Health Medicare |
$0.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.03
|
| Rate for Payer: Railroad Medicare Medicare |
$0.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.57
|
| Rate for Payer: UHC Core |
$2.44
|
| Rate for Payer: UHC Exchange |
$0.73
|
| Rate for Payer: UHC Medicaid |
$0.51
|
| Rate for Payer: UHC Medicare Advantage |
$0.73
|
| Rate for Payer: UHCCP Medicaid |
$0.51
|
| Rate for Payer: VA VA |
$0.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.19
|
|
|
DONEPEZIL 10 MG TABLET
|
Facility
|
IP
|
$291.40
|
|
|
Service Code
|
NDC 60687030301
|
| Hospital Charge Code |
18787
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$202.81 |
| Max. Negotiated Rate |
$262.26 |
| Rate for Payer: Aetna Commercial |
$247.69
|
| Rate for Payer: BCBS Trust/PPO |
$240.67
|
| Rate for Payer: BCN Commercial |
$240.67
|
| Rate for Payer: Cash Price |
$233.12
|
| Rate for Payer: Cofinity Commercial |
$250.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.12
|
| Rate for Payer: Healthscope Commercial |
$262.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.69
|
| Rate for Payer: Nomi Health Commercial |
$238.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.55
|
| Rate for Payer: PHP Commercial |
$247.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$253.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$256.43
|
| Rate for Payer: UHC Core |
$243.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.55
|
|
|
DONEPEZIL 5 MG TABLET
|
Facility
|
IP
|
$43.71
|
|
|
Service Code
|
NDC 43547027503
|
| Hospital Charge Code |
18786
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.42 |
| Max. Negotiated Rate |
$39.34 |
| Rate for Payer: Aetna Commercial |
$37.15
|
| Rate for Payer: BCBS Trust/PPO |
$36.10
|
| Rate for Payer: BCN Commercial |
$36.10
|
| Rate for Payer: Cash Price |
$34.97
|
| Rate for Payer: Cofinity Commercial |
$37.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.97
|
| Rate for Payer: Healthscope Commercial |
$39.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.15
|
| Rate for Payer: Nomi Health Commercial |
$35.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.78
|
| Rate for Payer: PHP Commercial |
$37.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$38.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.46
|
| Rate for Payer: UHC Core |
$36.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.78
|
|
|
DONEPEZIL 5 MG TABLET
|
Facility
|
OP
|
$43.71
|
|
|
Service Code
|
NDC 43547027503
|
| Hospital Charge Code |
18786
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.71 |
| Max. Negotiated Rate |
$39.34 |
| Rate for Payer: Aetna Commercial |
$37.15
|
| Rate for Payer: Aetna Medicare |
$11.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.66
|
| Rate for Payer: BCBS Complete |
$8.09
|
| Rate for Payer: BCBS MAPPO |
$10.93
|
| Rate for Payer: BCBS Trust/PPO |
$35.93
|
| Rate for Payer: BCN Commercial |
$35.93
|
| Rate for Payer: BCN Medicare Advantage |
$10.93
|
| Rate for Payer: Cash Price |
$34.97
|
| Rate for Payer: Cofinity Commercial |
$37.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.93
|
| Rate for Payer: Healthscope Commercial |
$39.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.78
|
| Rate for Payer: Mclaren Medicaid |
$7.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.47
|
| Rate for Payer: Meridian Medicaid |
$8.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.15
|
| Rate for Payer: Nomi Health Commercial |
$35.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.78
|
| Rate for Payer: PACE Senior Care Partners |
$10.38
|
| Rate for Payer: PACE SWMI |
$10.93
|
| Rate for Payer: PHP Commercial |
$37.15
|
| Rate for Payer: PHP Medicare Advantage |
$10.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$38.03
|
| Rate for Payer: Priority Health Medicare |
$11.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.42
|
| Rate for Payer: Railroad Medicare Medicare |
$10.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.46
|
| Rate for Payer: UHC Core |
$36.50
|
| Rate for Payer: UHC Exchange |
$10.93
|
| Rate for Payer: UHC Medicaid |
$7.71
|
| Rate for Payer: UHC Medicare Advantage |
$10.93
|
| Rate for Payer: UHCCP Medicaid |
$7.71
|
| Rate for Payer: VA VA |
$10.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.78
|
|
|
DONEPEZIL 5 MG TABLET
|
Facility
|
OP
|
$260.85
|
|
|
Service Code
|
NDC 00904647761
|
| Hospital Charge Code |
18786
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.99 |
| Max. Negotiated Rate |
$234.76 |
| Rate for Payer: Aetna Commercial |
$221.72
|
| Rate for Payer: Aetna Medicare |
$67.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.52
|
| Rate for Payer: BCBS Complete |
$48.28
|
| Rate for Payer: BCBS MAPPO |
$65.21
|
| Rate for Payer: BCBS Trust/PPO |
$214.44
|
| Rate for Payer: BCN Commercial |
$214.44
|
| Rate for Payer: BCN Medicare Advantage |
$65.21
|
| Rate for Payer: Cash Price |
$208.68
|
| Rate for Payer: Cofinity Commercial |
$224.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.21
|
| Rate for Payer: Healthscope Commercial |
$234.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.64
|
| Rate for Payer: Mclaren Medicaid |
$45.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.47
|
| Rate for Payer: Meridian Medicaid |
$48.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$71.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.72
|
| Rate for Payer: Nomi Health Commercial |
$213.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.64
|
| Rate for Payer: PACE Senior Care Partners |
$61.95
|
| Rate for Payer: PACE SWMI |
$65.21
|
| Rate for Payer: PHP Commercial |
$221.72
|
| Rate for Payer: PHP Medicare Advantage |
$65.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$226.94
|
| Rate for Payer: Priority Health Medicare |
$65.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.55
|
| Rate for Payer: Railroad Medicare Medicare |
$65.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$229.55
|
| Rate for Payer: UHC Core |
$217.81
|
| Rate for Payer: UHC Exchange |
$65.21
|
| Rate for Payer: UHC Medicaid |
$45.99
|
| Rate for Payer: UHC Medicare Advantage |
$65.21
|
| Rate for Payer: UHCCP Medicaid |
$45.99
|
| Rate for Payer: VA VA |
$65.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.64
|
|
|
DONEPEZIL 5 MG TABLET
|
Facility
|
IP
|
$82.49
|
|
|
Service Code
|
NDC 43547027509
|
| Hospital Charge Code |
18786
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.41 |
| Max. Negotiated Rate |
$74.24 |
| Rate for Payer: Aetna Commercial |
$70.12
|
| Rate for Payer: BCBS Trust/PPO |
$68.13
|
| Rate for Payer: BCN Commercial |
$68.13
|
| Rate for Payer: Cash Price |
$65.99
|
| Rate for Payer: Cofinity Commercial |
$70.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.99
|
| Rate for Payer: Healthscope Commercial |
$74.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.12
|
| Rate for Payer: Nomi Health Commercial |
$67.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.87
|
| Rate for Payer: PHP Commercial |
$70.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$71.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.59
|
| Rate for Payer: UHC Core |
$68.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.87
|
|
|
DONEPEZIL 5 MG TABLET
|
Facility
|
IP
|
$260.85
|
|
|
Service Code
|
NDC 00904647761
|
| Hospital Charge Code |
18786
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$181.55 |
| Max. Negotiated Rate |
$234.76 |
| Rate for Payer: Aetna Commercial |
$221.72
|
| Rate for Payer: BCBS Trust/PPO |
$215.44
|
| Rate for Payer: BCN Commercial |
$215.44
|
| Rate for Payer: Cash Price |
$208.68
|
| Rate for Payer: Cofinity Commercial |
$224.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.68
|
| Rate for Payer: Healthscope Commercial |
$234.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.72
|
| Rate for Payer: Nomi Health Commercial |
$213.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.64
|
| Rate for Payer: PHP Commercial |
$221.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$226.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$229.55
|
| Rate for Payer: UHC Core |
$217.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.64
|
|
|
DONEPEZIL 5 MG TABLET
|
Facility
|
OP
|
$82.49
|
|
|
Service Code
|
NDC 43547027509
|
| Hospital Charge Code |
18786
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.54 |
| Max. Negotiated Rate |
$74.24 |
| Rate for Payer: Aetna Commercial |
$70.12
|
| Rate for Payer: Aetna Medicare |
$21.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.78
|
| Rate for Payer: BCBS Complete |
$15.27
|
| Rate for Payer: BCBS MAPPO |
$20.62
|
| Rate for Payer: BCBS Trust/PPO |
$67.82
|
| Rate for Payer: BCN Commercial |
$67.82
|
| Rate for Payer: BCN Medicare Advantage |
$20.62
|
| Rate for Payer: Cash Price |
$65.99
|
| Rate for Payer: Cofinity Commercial |
$70.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.62
|
| Rate for Payer: Healthscope Commercial |
$74.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.87
|
| Rate for Payer: Mclaren Medicaid |
$14.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.65
|
| Rate for Payer: Meridian Medicaid |
$15.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.12
|
| Rate for Payer: Nomi Health Commercial |
$67.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.87
|
| Rate for Payer: PACE Senior Care Partners |
$19.59
|
| Rate for Payer: PACE SWMI |
$20.62
|
| Rate for Payer: PHP Commercial |
$70.12
|
| Rate for Payer: PHP Medicare Advantage |
$20.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$71.77
|
| Rate for Payer: Priority Health Medicare |
$20.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.41
|
| Rate for Payer: Railroad Medicare Medicare |
$20.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.59
|
| Rate for Payer: UHC Core |
$68.88
|
| Rate for Payer: UHC Exchange |
$20.62
|
| Rate for Payer: UHC Medicaid |
$14.54
|
| Rate for Payer: UHC Medicare Advantage |
$20.62
|
| Rate for Payer: UHCCP Medicaid |
$14.54
|
| Rate for Payer: VA VA |
$20.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.87
|
|
|
DOPAMINE 400 MG/250 ML (1,600 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS SOLN
|
Facility
|
OP
|
$73.44
|
|
|
Service Code
|
HCPCS J1265
|
| Hospital Charge Code |
14845
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$66.10 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna Medicare |
$19.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.95
|
| Rate for Payer: BCBS Complete |
$13.59
|
| Rate for Payer: BCBS MAPPO |
$18.36
|
| Rate for Payer: BCBS Trust/PPO |
$60.38
|
| Rate for Payer: BCN Commercial |
$60.38
|
| Rate for Payer: BCN Medicare Advantage |
$18.36
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$63.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.36
|
| Rate for Payer: Healthscope Commercial |
$66.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.08
|
| Rate for Payer: Mclaren Medicaid |
$12.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.28
|
| Rate for Payer: Meridian Medicaid |
$13.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: Nomi Health Commercial |
$60.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.08
|
| Rate for Payer: PACE Senior Care Partners |
$17.44
|
| Rate for Payer: PACE SWMI |
$18.36
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: PHP Medicare Advantage |
$18.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$63.89
|
| Rate for Payer: Priority Health Medicare |
$18.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.11
|
| Rate for Payer: Railroad Medicare Medicare |
$18.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.63
|
| Rate for Payer: UHC Core |
$61.32
|
| Rate for Payer: UHC Exchange |
$18.36
|
| Rate for Payer: UHC Medicaid |
$12.95
|
| Rate for Payer: UHC Medicare Advantage |
$18.36
|
| Rate for Payer: UHCCP Medicaid |
$12.95
|
| Rate for Payer: VA VA |
$18.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.08
|
|
|
DOPAMINE 400 MG/250 ML (1,600 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS SOLN
|
Facility
|
IP
|
$73.44
|
|
|
Service Code
|
HCPCS J1265
|
| Hospital Charge Code |
14845
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.11 |
| Max. Negotiated Rate |
$66.10 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: BCBS Trust/PPO |
$60.65
|
| Rate for Payer: BCN Commercial |
$60.65
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$63.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Healthscope Commercial |
$66.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: Nomi Health Commercial |
$60.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.08
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$63.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.63
|
| Rate for Payer: UHC Core |
$61.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.08
|
|
|
DORSAL AND LUMBAR FUSION PROCEDURE EXCEPT FOR CURVATURE OF BACK
|
Facility
|
IP
|
$30,114.33
|
|
|
Service Code
|
APR-DRG 3044
|
| Min. Negotiated Rate |
$28,680.32 |
| Max. Negotiated Rate |
$30,114.33 |
| Rate for Payer: BCBS Complete |
$30,114.33
|
| Rate for Payer: Mclaren Medicaid |
$28,680.32
|
| Rate for Payer: Meridian Medicaid |
$30,114.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$28,680.32
|
| Rate for Payer: UHC Medicaid |
$28,680.32
|
| Rate for Payer: UHCCP Medicaid |
$28,680.32
|
|
|
DORSAL AND LUMBAR FUSION PROCEDURE EXCEPT FOR CURVATURE OF BACK
|
Facility
|
IP
|
$15,956.09
|
|
|
Service Code
|
APR-DRG 3042
|
| Min. Negotiated Rate |
$15,196.28 |
| Max. Negotiated Rate |
$15,956.09 |
| Rate for Payer: BCBS Complete |
$15,956.09
|
| Rate for Payer: Mclaren Medicaid |
$15,196.28
|
| Rate for Payer: Meridian Medicaid |
$15,956.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,196.28
|
| Rate for Payer: UHC Medicaid |
$15,196.28
|
| Rate for Payer: UHCCP Medicaid |
$15,196.28
|
|
|
DORSAL AND LUMBAR FUSION PROCEDURE EXCEPT FOR CURVATURE OF BACK
|
Facility
|
IP
|
$12,523.41
|
|
|
Service Code
|
APR-DRG 3041
|
| Min. Negotiated Rate |
$11,927.05 |
| Max. Negotiated Rate |
$12,523.41 |
| Rate for Payer: BCBS Complete |
$12,523.41
|
| Rate for Payer: Mclaren Medicaid |
$11,927.05
|
| Rate for Payer: Meridian Medicaid |
$12,523.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,927.05
|
| Rate for Payer: UHC Medicaid |
$11,927.05
|
| Rate for Payer: UHCCP Medicaid |
$11,927.05
|
|
|
DORSAL AND LUMBAR FUSION PROCEDURE EXCEPT FOR CURVATURE OF BACK
|
Facility
|
IP
|
$23,358.34
|
|
|
Service Code
|
APR-DRG 3043
|
| Min. Negotiated Rate |
$22,246.04 |
| Max. Negotiated Rate |
$23,358.34 |
| Rate for Payer: BCBS Complete |
$23,358.34
|
| Rate for Payer: Mclaren Medicaid |
$22,246.04
|
| Rate for Payer: Meridian Medicaid |
$23,358.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$22,246.04
|
| Rate for Payer: UHC Medicaid |
$22,246.04
|
| Rate for Payer: UHCCP Medicaid |
$22,246.04
|
|
|
DORSAL AND LUMBAR FUSION PROCEDURE FOR CURVATURE OF BACK
|
Facility
|
IP
|
$24,156.56
|
|
|
Service Code
|
APR-DRG 3032
|
| Min. Negotiated Rate |
$23,006.25 |
| Max. Negotiated Rate |
$24,156.56 |
| Rate for Payer: BCBS Complete |
$24,156.56
|
| Rate for Payer: Mclaren Medicaid |
$23,006.25
|
| Rate for Payer: Meridian Medicaid |
$24,156.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$23,006.25
|
| Rate for Payer: UHC Medicaid |
$23,006.25
|
| Rate for Payer: UHCCP Medicaid |
$23,006.25
|
|
|
DORSAL AND LUMBAR FUSION PROCEDURE FOR CURVATURE OF BACK
|
Facility
|
IP
|
$34,864.24
|
|
|
Service Code
|
APR-DRG 3033
|
| Min. Negotiated Rate |
$33,204.04 |
| Max. Negotiated Rate |
$34,864.24 |
| Rate for Payer: BCBS Complete |
$34,864.24
|
| Rate for Payer: Mclaren Medicaid |
$33,204.04
|
| Rate for Payer: Meridian Medicaid |
$34,864.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$33,204.04
|
| Rate for Payer: UHC Medicaid |
$33,204.04
|
| Rate for Payer: UHCCP Medicaid |
$33,204.04
|
|
|
DORSAL AND LUMBAR FUSION PROCEDURE FOR CURVATURE OF BACK
|
Facility
|
IP
|
$54,706.82
|
|
|
Service Code
|
APR-DRG 3034
|
| Min. Negotiated Rate |
$52,101.73 |
| Max. Negotiated Rate |
$54,706.82 |
| Rate for Payer: BCBS Complete |
$54,706.82
|
| Rate for Payer: Mclaren Medicaid |
$52,101.73
|
| Rate for Payer: Meridian Medicaid |
$54,706.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$52,101.73
|
| Rate for Payer: UHC Medicaid |
$52,101.73
|
| Rate for Payer: UHCCP Medicaid |
$52,101.73
|
|
|
DORSAL AND LUMBAR FUSION PROCEDURE FOR CURVATURE OF BACK
|
Facility
|
IP
|
$21,706.15
|
|
|
Service Code
|
APR-DRG 3031
|
| Min. Negotiated Rate |
$20,672.52 |
| Max. Negotiated Rate |
$21,706.15 |
| Rate for Payer: BCBS Complete |
$21,706.15
|
| Rate for Payer: Mclaren Medicaid |
$20,672.52
|
| Rate for Payer: Meridian Medicaid |
$21,706.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$20,672.52
|
| Rate for Payer: UHC Medicaid |
$20,672.52
|
| Rate for Payer: UHCCP Medicaid |
$20,672.52
|
|
|
DORZOLAMIDE 22.3 MG-TIMOLOL 6.8 MG/ML EYE DROPS
|
Facility
|
IP
|
$30.49
|
|
|
Service Code
|
NDC 24208048610
|
| Hospital Charge Code |
22982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.22 |
| Max. Negotiated Rate |
$27.44 |
| Rate for Payer: Aetna Commercial |
$25.92
|
| Rate for Payer: BCBS Trust/PPO |
$25.18
|
| Rate for Payer: BCN Commercial |
$25.18
|
| Rate for Payer: Cash Price |
$24.39
|
| Rate for Payer: Cofinity Commercial |
$26.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.39
|
| Rate for Payer: Healthscope Commercial |
$27.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.92
|
| Rate for Payer: Nomi Health Commercial |
$25.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.87
|
| Rate for Payer: PHP Commercial |
$25.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$26.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.83
|
| Rate for Payer: UHC Core |
$25.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.87
|
|
