|
PR ZOSTER VACCINE HZV LIVE FOR SUBCUTANEOUS USE
|
Professional
|
Both
|
$254.00
|
|
|
Service Code
|
HCPCS 90736
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$221.01 |
| Rate for Payer: Aetna Commercial |
$216.92
|
| Rate for Payer: Aetna Medicare |
$127.00
|
| Rate for Payer: BCBS Complete |
$101.60
|
| Rate for Payer: BCBS Trust/PPO |
$221.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.50
|
|
|
PSEUDOEPHEDRINE 30 MG TABLET
|
Facility
|
IP
|
$56.40
|
|
|
Service Code
|
NDC 00904505359
|
| Hospital Charge Code |
6714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.25 |
| Max. Negotiated Rate |
$50.76 |
| Rate for Payer: Aetna Commercial |
$47.94
|
| Rate for Payer: BCBS Trust/PPO |
$46.58
|
| Rate for Payer: BCN Commercial |
$46.58
|
| 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: Opus (Opus Packaging Group) HMA |
$42.30
|
| Rate for Payer: PHP Commercial |
$47.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$49.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.25
|
| 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
|
|
|
PSEUDOEPHEDRINE 30 MG TABLET
|
Facility
|
OP
|
$25.95
|
|
|
Service Code
|
NDC 00904633724
|
| Hospital Charge Code |
6714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$23.36 |
| Rate for Payer: Aetna Commercial |
$22.06
|
| Rate for Payer: Aetna Medicare |
$6.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.11
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: BCBS MAPPO |
$6.49
|
| Rate for Payer: BCBS Trust/PPO |
$21.33
|
| Rate for Payer: BCN Commercial |
$21.33
|
| Rate for Payer: BCN Medicare Advantage |
$6.49
|
| Rate for Payer: Cash Price |
$20.76
|
| Rate for Payer: Cofinity Commercial |
$22.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.49
|
| Rate for Payer: Healthscope Commercial |
$23.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.46
|
| Rate for Payer: Mclaren Medicaid |
$4.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.81
|
| Rate for Payer: Meridian Medicaid |
$4.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.06
|
| Rate for Payer: Nomi Health Commercial |
$21.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.46
|
| Rate for Payer: PACE Senior Care Partners |
$6.16
|
| Rate for Payer: PACE SWMI |
$6.49
|
| Rate for Payer: PHP Commercial |
$22.06
|
| Rate for Payer: PHP Medicare Advantage |
$6.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.58
|
| Rate for Payer: Priority Health Medicare |
$6.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.06
|
| Rate for Payer: Railroad Medicare Medicare |
$6.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.84
|
| Rate for Payer: UHC Core |
$21.67
|
| Rate for Payer: UHC Exchange |
$6.49
|
| Rate for Payer: UHC Medicaid |
$4.57
|
| Rate for Payer: UHC Medicare Advantage |
$6.49
|
| Rate for Payer: UHCCP Medicaid |
$4.57
|
| Rate for Payer: VA VA |
$6.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.46
|
|
|
PSEUDOEPHEDRINE 30 MG TABLET
|
Facility
|
IP
|
$25.95
|
|
|
Service Code
|
NDC 00904633724
|
| Hospital Charge Code |
6714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.06 |
| Max. Negotiated Rate |
$23.36 |
| Rate for Payer: Aetna Commercial |
$22.06
|
| Rate for Payer: BCBS Trust/PPO |
$21.43
|
| Rate for Payer: BCN Commercial |
$21.43
|
| Rate for Payer: Cash Price |
$20.76
|
| Rate for Payer: Cofinity Commercial |
$22.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.76
|
| Rate for Payer: Healthscope Commercial |
$23.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.06
|
| Rate for Payer: Nomi Health Commercial |
$21.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.46
|
| Rate for Payer: PHP Commercial |
$22.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.84
|
| Rate for Payer: UHC Core |
$21.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.46
|
|
|
PSEUDOEPHEDRINE 30 MG TABLET
|
Facility
|
OP
|
$56.40
|
|
|
Service Code
|
NDC 00904505359
|
| Hospital Charge Code |
6714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$50.76 |
| Rate for Payer: Aetna Commercial |
$47.94
|
| Rate for Payer: Aetna Medicare |
$14.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.62
|
| Rate for Payer: BCBS Complete |
$10.44
|
| Rate for Payer: BCBS MAPPO |
$14.10
|
| Rate for Payer: BCBS Trust/PPO |
$46.37
|
| Rate for Payer: BCN Commercial |
$46.37
|
| Rate for Payer: BCN Medicare Advantage |
$14.10
|
| 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: Health Alliance Plan Medicare Advantage |
$14.10
|
| Rate for Payer: Healthscope Commercial |
$50.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.30
|
| Rate for Payer: Mclaren Medicaid |
$9.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.80
|
| Rate for Payer: Meridian Medicaid |
$10.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.94
|
| Rate for Payer: Nomi Health Commercial |
$46.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.30
|
| Rate for Payer: PACE Senior Care Partners |
$13.39
|
| Rate for Payer: PACE SWMI |
$14.10
|
| Rate for Payer: PHP Commercial |
$47.94
|
| Rate for Payer: PHP Medicare Advantage |
$14.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$49.07
|
| Rate for Payer: Priority Health Medicare |
$14.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.25
|
| Rate for Payer: Railroad Medicare Medicare |
$14.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.63
|
| Rate for Payer: UHC Core |
$47.09
|
| Rate for Payer: UHC Exchange |
$14.10
|
| Rate for Payer: UHC Medicaid |
$9.94
|
| Rate for Payer: UHC Medicare Advantage |
$14.10
|
| Rate for Payer: UHCCP Medicaid |
$9.94
|
| Rate for Payer: VA VA |
$14.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.30
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$37.05
|
|
|
Service Code
|
NDC 45802010752
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.79 |
| Max. Negotiated Rate |
$33.34 |
| Rate for Payer: Aetna Commercial |
$31.49
|
| Rate for Payer: BCBS Trust/PPO |
$30.60
|
| Rate for Payer: BCN Commercial |
$30.60
|
| Rate for Payer: Cash Price |
$29.64
|
| Rate for Payer: Cofinity Commercial |
$31.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.64
|
| Rate for Payer: Healthscope Commercial |
$33.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.49
|
| Rate for Payer: Nomi Health Commercial |
$30.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.79
|
| Rate for Payer: PHP Commercial |
$31.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$32.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.60
|
| Rate for Payer: UHC Core |
$30.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.79
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$31.83
|
|
|
Service Code
|
NDC 00904675415
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$28.65 |
| Rate for Payer: Aetna Commercial |
$27.06
|
| Rate for Payer: Aetna Medicare |
$8.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.95
|
| Rate for Payer: BCBS Complete |
$5.89
|
| Rate for Payer: BCBS MAPPO |
$7.96
|
| Rate for Payer: BCBS Trust/PPO |
$26.17
|
| Rate for Payer: BCN Commercial |
$26.17
|
| Rate for Payer: BCN Medicare Advantage |
$7.96
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$27.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.96
|
| Rate for Payer: Healthscope Commercial |
$28.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.87
|
| Rate for Payer: Mclaren Medicaid |
$5.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.36
|
| Rate for Payer: Meridian Medicaid |
$5.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Nomi Health Commercial |
$26.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.87
|
| Rate for Payer: PACE Senior Care Partners |
$7.56
|
| Rate for Payer: PACE SWMI |
$7.96
|
| Rate for Payer: PHP Commercial |
$27.06
|
| Rate for Payer: PHP Medicare Advantage |
$7.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$27.69
|
| Rate for Payer: Priority Health Medicare |
$8.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.15
|
| Rate for Payer: Railroad Medicare Medicare |
$7.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.01
|
| Rate for Payer: UHC Core |
$26.58
|
| Rate for Payer: UHC Exchange |
$7.96
|
| Rate for Payer: UHC Medicaid |
$5.61
|
| Rate for Payer: UHC Medicare Advantage |
$7.96
|
| Rate for Payer: UHCCP Medicaid |
$5.61
|
| Rate for Payer: VA VA |
$7.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.87
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$37.05
|
|
|
Service Code
|
NDC 45802010752
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$33.34 |
| Rate for Payer: Aetna Commercial |
$31.49
|
| Rate for Payer: Aetna Medicare |
$9.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.58
|
| Rate for Payer: BCBS Complete |
$6.86
|
| Rate for Payer: BCBS MAPPO |
$9.26
|
| Rate for Payer: BCBS Trust/PPO |
$30.46
|
| Rate for Payer: BCN Commercial |
$30.46
|
| Rate for Payer: BCN Medicare Advantage |
$9.26
|
| Rate for Payer: Cash Price |
$29.64
|
| Rate for Payer: Cofinity Commercial |
$31.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.26
|
| Rate for Payer: Healthscope Commercial |
$33.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.79
|
| Rate for Payer: Mclaren Medicaid |
$6.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.73
|
| Rate for Payer: Meridian Medicaid |
$6.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.49
|
| Rate for Payer: Nomi Health Commercial |
$30.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.79
|
| Rate for Payer: PACE Senior Care Partners |
$8.80
|
| Rate for Payer: PACE SWMI |
$9.26
|
| Rate for Payer: PHP Commercial |
$31.49
|
| Rate for Payer: PHP Medicare Advantage |
$9.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$32.23
|
| Rate for Payer: Priority Health Medicare |
$9.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.79
|
| Rate for Payer: Railroad Medicare Medicare |
$9.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.60
|
| Rate for Payer: UHC Core |
$30.94
|
| Rate for Payer: UHC Exchange |
$9.26
|
| Rate for Payer: UHC Medicaid |
$6.53
|
| Rate for Payer: UHC Medicare Advantage |
$9.26
|
| Rate for Payer: UHCCP Medicaid |
$6.53
|
| Rate for Payer: VA VA |
$9.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.79
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$31.83
|
|
|
Service Code
|
NDC 00904675415
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.15 |
| Max. Negotiated Rate |
$28.65 |
| Rate for Payer: Aetna Commercial |
$27.06
|
| Rate for Payer: BCBS Trust/PPO |
$26.29
|
| Rate for Payer: BCN Commercial |
$26.29
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$27.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Healthscope Commercial |
$28.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Nomi Health Commercial |
$26.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.87
|
| Rate for Payer: PHP Commercial |
$27.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$27.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.01
|
| Rate for Payer: UHC Core |
$26.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.87
|
|
|
PSYLLIUM ORAL PACKET
|
Facility
|
IP
|
$8.85
|
|
|
Service Code
|
NDC 37000002410
|
| Hospital Charge Code |
11218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$7.96 |
| Rate for Payer: Aetna Commercial |
$7.52
|
| Rate for Payer: BCBS Trust/PPO |
$7.31
|
| Rate for Payer: BCN Commercial |
$7.31
|
| Rate for Payer: Cash Price |
$7.08
|
| Rate for Payer: Cofinity Commercial |
$7.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.08
|
| Rate for Payer: Healthscope Commercial |
$7.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.52
|
| Rate for Payer: Nomi Health Commercial |
$7.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.64
|
| Rate for Payer: PHP Commercial |
$7.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.79
|
| Rate for Payer: UHC Core |
$7.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.64
|
|
|
PSYLLIUM ORAL PACKET
|
Facility
|
OP
|
$8.85
|
|
|
Service Code
|
NDC 37000002410
|
| Hospital Charge Code |
11218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$7.96 |
| Rate for Payer: Aetna Commercial |
$7.52
|
| Rate for Payer: Aetna Medicare |
$2.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.77
|
| Rate for Payer: BCBS Complete |
$1.64
|
| Rate for Payer: BCBS MAPPO |
$2.21
|
| Rate for Payer: BCBS Trust/PPO |
$7.28
|
| Rate for Payer: BCN Commercial |
$7.28
|
| Rate for Payer: BCN Medicare Advantage |
$2.21
|
| Rate for Payer: Cash Price |
$7.08
|
| Rate for Payer: Cofinity Commercial |
$7.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.21
|
| Rate for Payer: Healthscope Commercial |
$7.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.64
|
| Rate for Payer: Mclaren Medicaid |
$1.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.32
|
| Rate for Payer: Meridian Medicaid |
$1.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.52
|
| Rate for Payer: Nomi Health Commercial |
$7.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.64
|
| Rate for Payer: PACE Senior Care Partners |
$2.10
|
| Rate for Payer: PACE SWMI |
$2.21
|
| Rate for Payer: PHP Commercial |
$7.52
|
| Rate for Payer: PHP Medicare Advantage |
$2.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7.70
|
| Rate for Payer: Priority Health Medicare |
$2.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.16
|
| Rate for Payer: Railroad Medicare Medicare |
$2.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.79
|
| Rate for Payer: UHC Core |
$7.39
|
| Rate for Payer: UHC Exchange |
$2.21
|
| Rate for Payer: UHC Medicaid |
$1.56
|
| Rate for Payer: UHC Medicare Advantage |
$2.21
|
| Rate for Payer: UHCCP Medicaid |
$1.56
|
| Rate for Payer: VA VA |
$2.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.64
|
|
|
PULMONARY EMBOLISM
|
Facility
|
IP
|
$3,958.00
|
|
|
Service Code
|
APR-DRG 1342
|
| Min. Negotiated Rate |
$3,769.52 |
| Max. Negotiated Rate |
$3,958.00 |
| Rate for Payer: BCBS Complete |
$3,958.00
|
| Rate for Payer: Mclaren Medicaid |
$3,769.52
|
| Rate for Payer: Meridian Medicaid |
$3,958.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,769.52
|
| Rate for Payer: UHC Medicaid |
$3,769.52
|
| Rate for Payer: UHCCP Medicaid |
$3,769.52
|
|
|
PULMONARY EMBOLISM
|
Facility
|
IP
|
$10,373.77
|
|
|
Service Code
|
APR-DRG 1344
|
| Min. Negotiated Rate |
$9,879.78 |
| Max. Negotiated Rate |
$10,373.77 |
| Rate for Payer: BCBS Complete |
$10,373.77
|
| Rate for Payer: Mclaren Medicaid |
$9,879.78
|
| Rate for Payer: Meridian Medicaid |
$10,373.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,879.78
|
| Rate for Payer: UHC Medicaid |
$9,879.78
|
| Rate for Payer: UHCCP Medicaid |
$9,879.78
|
|
|
PULMONARY EMBOLISM
|
Facility
|
IP
|
$6,254.34
|
|
|
Service Code
|
APR-DRG 1343
|
| Min. Negotiated Rate |
$5,956.52 |
| Max. Negotiated Rate |
$6,254.34 |
| Rate for Payer: BCBS Complete |
$6,254.34
|
| Rate for Payer: Mclaren Medicaid |
$5,956.52
|
| Rate for Payer: Meridian Medicaid |
$6,254.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,956.52
|
| Rate for Payer: UHC Medicaid |
$5,956.52
|
| Rate for Payer: UHCCP Medicaid |
$5,956.52
|
|
|
PULMONARY EMBOLISM
|
Facility
|
IP
|
$3,130.33
|
|
|
Service Code
|
APR-DRG 1341
|
| Min. Negotiated Rate |
$2,981.26 |
| Max. Negotiated Rate |
$3,130.33 |
| Rate for Payer: BCBS Complete |
$3,130.33
|
| Rate for Payer: Mclaren Medicaid |
$2,981.26
|
| Rate for Payer: Meridian Medicaid |
$3,130.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,981.26
|
| Rate for Payer: UHC Medicaid |
$2,981.26
|
| Rate for Payer: UHCCP Medicaid |
$2,981.26
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG TABLET
|
Facility
|
IP
|
$494.88
|
|
|
Service Code
|
NDC 00904662261
|
| Hospital Charge Code |
11239
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$344.44 |
| Max. Negotiated Rate |
$445.39 |
| Rate for Payer: Aetna Commercial |
$420.65
|
| Rate for Payer: BCBS Trust/PPO |
$408.72
|
| Rate for Payer: BCN Commercial |
$408.72
|
| Rate for Payer: Cash Price |
$395.90
|
| Rate for Payer: Cofinity Commercial |
$425.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.90
|
| Rate for Payer: Healthscope Commercial |
$445.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$371.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.65
|
| Rate for Payer: Nomi Health Commercial |
$405.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$371.16
|
| Rate for Payer: PHP Commercial |
$420.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$430.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$344.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$435.49
|
| Rate for Payer: UHC Core |
$413.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$371.16
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG TABLET
|
Facility
|
OP
|
$494.88
|
|
|
Service Code
|
NDC 00904662261
|
| Hospital Charge Code |
11239
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.25 |
| Max. Negotiated Rate |
$445.39 |
| Rate for Payer: Aetna Commercial |
$420.65
|
| Rate for Payer: Aetna Medicare |
$128.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$154.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$154.65
|
| Rate for Payer: BCBS Complete |
$91.60
|
| Rate for Payer: BCBS MAPPO |
$123.72
|
| Rate for Payer: BCBS Trust/PPO |
$406.84
|
| Rate for Payer: BCN Commercial |
$406.84
|
| Rate for Payer: BCN Medicare Advantage |
$123.72
|
| Rate for Payer: Cash Price |
$395.90
|
| Rate for Payer: Cofinity Commercial |
$425.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.72
|
| Rate for Payer: Healthscope Commercial |
$445.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$371.16
|
| Rate for Payer: Mclaren Medicaid |
$87.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.91
|
| Rate for Payer: Meridian Medicaid |
$91.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.65
|
| Rate for Payer: Nomi Health Commercial |
$405.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$371.16
|
| Rate for Payer: PACE Senior Care Partners |
$117.53
|
| Rate for Payer: PACE SWMI |
$123.72
|
| Rate for Payer: PHP Commercial |
$420.65
|
| Rate for Payer: PHP Medicare Advantage |
$123.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$430.55
|
| Rate for Payer: Priority Health Medicare |
$124.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$344.44
|
| Rate for Payer: Railroad Medicare Medicare |
$123.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$435.49
|
| Rate for Payer: UHC Core |
$413.22
|
| Rate for Payer: UHC Exchange |
$123.72
|
| Rate for Payer: UHC Medicaid |
$87.25
|
| Rate for Payer: UHC Medicare Advantage |
$123.72
|
| Rate for Payer: UHCCP Medicaid |
$87.25
|
| Rate for Payer: VA VA |
$123.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$371.16
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
OP
|
$144.10
|
|
|
Service Code
|
NDC 77333094010
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.40 |
| Max. Negotiated Rate |
$129.69 |
| Rate for Payer: Aetna Commercial |
$122.48
|
| Rate for Payer: Aetna Medicare |
$37.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.03
|
| Rate for Payer: BCBS Complete |
$26.67
|
| Rate for Payer: BCBS MAPPO |
$36.02
|
| Rate for Payer: BCBS Trust/PPO |
$118.46
|
| Rate for Payer: BCN Commercial |
$118.46
|
| Rate for Payer: BCN Medicare Advantage |
$36.02
|
| Rate for Payer: Cash Price |
$115.28
|
| Rate for Payer: Cofinity Commercial |
$123.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.02
|
| Rate for Payer: Healthscope Commercial |
$129.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.08
|
| Rate for Payer: Mclaren Medicaid |
$25.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.83
|
| Rate for Payer: Meridian Medicaid |
$26.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$39.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.48
|
| Rate for Payer: Nomi Health Commercial |
$118.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.08
|
| Rate for Payer: PACE Senior Care Partners |
$34.22
|
| Rate for Payer: PACE SWMI |
$36.02
|
| Rate for Payer: PHP Commercial |
$122.48
|
| Rate for Payer: PHP Medicare Advantage |
$36.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$125.37
|
| Rate for Payer: Priority Health Medicare |
$36.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.29
|
| Rate for Payer: Railroad Medicare Medicare |
$36.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.81
|
| Rate for Payer: UHC Core |
$120.32
|
| Rate for Payer: UHC Exchange |
$36.02
|
| Rate for Payer: UHC Medicaid |
$25.40
|
| Rate for Payer: UHC Medicare Advantage |
$36.02
|
| Rate for Payer: UHCCP Medicaid |
$25.40
|
| Rate for Payer: VA VA |
$36.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.08
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
IP
|
$157.50
|
|
|
Service Code
|
NDC 57896085301
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.62 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Aetna Commercial |
$133.88
|
| Rate for Payer: BCBS Trust/PPO |
$130.08
|
| Rate for Payer: BCN Commercial |
$130.08
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cofinity Commercial |
$135.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.00
|
| Rate for Payer: Healthscope Commercial |
$141.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.88
|
| Rate for Payer: Nomi Health Commercial |
$129.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.12
|
| Rate for Payer: PHP Commercial |
$133.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$137.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$109.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.60
|
| Rate for Payer: UHC Core |
$131.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.12
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
IP
|
$144.10
|
|
|
Service Code
|
NDC 77333094010
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.29 |
| Max. Negotiated Rate |
$129.69 |
| Rate for Payer: Aetna Commercial |
$122.48
|
| Rate for Payer: BCBS Trust/PPO |
$119.01
|
| Rate for Payer: BCN Commercial |
$119.01
|
| Rate for Payer: Cash Price |
$115.28
|
| Rate for Payer: Cofinity Commercial |
$123.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.28
|
| Rate for Payer: Healthscope Commercial |
$129.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.48
|
| Rate for Payer: Nomi Health Commercial |
$118.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.08
|
| Rate for Payer: PHP Commercial |
$122.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$125.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.81
|
| Rate for Payer: UHC Core |
$120.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.08
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
OP
|
$1.45
|
|
|
Service Code
|
NDC 77333094025
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Aetna Commercial |
$1.23
|
| Rate for Payer: Aetna Medicare |
$0.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.45
|
| Rate for Payer: BCBS Complete |
$0.27
|
| Rate for Payer: BCBS MAPPO |
$0.36
|
| Rate for Payer: BCBS Trust/PPO |
$1.19
|
| Rate for Payer: BCN Commercial |
$1.19
|
| Rate for Payer: BCN Medicare Advantage |
$0.36
|
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: Cofinity Commercial |
$1.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.36
|
| Rate for Payer: Healthscope Commercial |
$1.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.09
|
| Rate for Payer: Mclaren Medicaid |
$0.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.38
|
| Rate for Payer: Meridian Medicaid |
$0.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.23
|
| Rate for Payer: Nomi Health Commercial |
$1.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.09
|
| Rate for Payer: PACE Senior Care Partners |
$0.34
|
| Rate for Payer: PACE SWMI |
$0.36
|
| Rate for Payer: PHP Commercial |
$1.23
|
| Rate for Payer: PHP Medicare Advantage |
$0.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.26
|
| Rate for Payer: Priority Health Medicare |
$0.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.01
|
| Rate for Payer: Railroad Medicare Medicare |
$0.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.28
|
| Rate for Payer: UHC Core |
$1.21
|
| Rate for Payer: UHC Exchange |
$0.36
|
| Rate for Payer: UHC Medicaid |
$0.26
|
| Rate for Payer: UHC Medicare Advantage |
$0.36
|
| Rate for Payer: UHCCP Medicaid |
$0.26
|
| Rate for Payer: VA VA |
$0.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.09
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
IP
|
$1.45
|
|
|
Service Code
|
NDC 77333094025
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Aetna Commercial |
$1.23
|
| Rate for Payer: BCBS Trust/PPO |
$1.20
|
| Rate for Payer: BCN Commercial |
$1.20
|
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: Cofinity Commercial |
$1.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.16
|
| Rate for Payer: Healthscope Commercial |
$1.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.23
|
| Rate for Payer: Nomi Health Commercial |
$1.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.09
|
| Rate for Payer: PHP Commercial |
$1.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.28
|
| Rate for Payer: UHC Core |
$1.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.09
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
OP
|
$157.50
|
|
|
Service Code
|
NDC 57896085301
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.77 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Aetna Commercial |
$133.88
|
| Rate for Payer: Aetna Medicare |
$40.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.22
|
| Rate for Payer: BCBS Complete |
$29.15
|
| Rate for Payer: BCBS MAPPO |
$39.38
|
| Rate for Payer: BCBS Trust/PPO |
$129.48
|
| Rate for Payer: BCN Commercial |
$129.48
|
| Rate for Payer: BCN Medicare Advantage |
$39.38
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cofinity Commercial |
$135.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.38
|
| Rate for Payer: Healthscope Commercial |
$141.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.12
|
| Rate for Payer: Mclaren Medicaid |
$27.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.34
|
| Rate for Payer: Meridian Medicaid |
$29.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$43.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.88
|
| Rate for Payer: Nomi Health Commercial |
$129.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.12
|
| Rate for Payer: PACE Senior Care Partners |
$37.41
|
| Rate for Payer: PACE SWMI |
$39.38
|
| Rate for Payer: PHP Commercial |
$133.88
|
| Rate for Payer: PHP Medicare Advantage |
$39.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$137.03
|
| Rate for Payer: Priority Health Medicare |
$39.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$109.62
|
| Rate for Payer: Railroad Medicare Medicare |
$39.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.60
|
| Rate for Payer: UHC Core |
$131.51
|
| Rate for Payer: UHC Exchange |
$39.38
|
| Rate for Payer: UHC Medicaid |
$27.77
|
| Rate for Payer: UHC Medicare Advantage |
$39.38
|
| Rate for Payer: UHCCP Medicaid |
$27.77
|
| Rate for Payer: VA VA |
$39.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.12
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
OP
|
$138.65
|
|
|
Service Code
|
NDC 16729014701
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.44 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna Commercial |
$117.85
|
| Rate for Payer: Aetna Medicare |
$36.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.33
|
| Rate for Payer: BCBS Complete |
$25.66
|
| Rate for Payer: BCBS MAPPO |
$34.66
|
| Rate for Payer: BCBS Trust/PPO |
$113.98
|
| Rate for Payer: BCN Commercial |
$113.98
|
| Rate for Payer: BCN Medicare Advantage |
$34.66
|
| Rate for Payer: Cash Price |
$110.92
|
| Rate for Payer: Cofinity Commercial |
$119.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.66
|
| Rate for Payer: Healthscope Commercial |
$124.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.99
|
| Rate for Payer: Mclaren Medicaid |
$24.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.40
|
| Rate for Payer: Meridian Medicaid |
$25.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.85
|
| Rate for Payer: Nomi Health Commercial |
$113.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.99
|
| Rate for Payer: PACE Senior Care Partners |
$32.93
|
| Rate for Payer: PACE SWMI |
$34.66
|
| Rate for Payer: PHP Commercial |
$117.85
|
| Rate for Payer: PHP Medicare Advantage |
$34.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$120.63
|
| Rate for Payer: Priority Health Medicare |
$35.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.50
|
| Rate for Payer: Railroad Medicare Medicare |
$34.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.01
|
| Rate for Payer: UHC Core |
$115.77
|
| Rate for Payer: UHC Exchange |
$34.66
|
| Rate for Payer: UHC Medicaid |
$24.44
|
| Rate for Payer: UHC Medicare Advantage |
$34.66
|
| Rate for Payer: UHCCP Medicaid |
$24.44
|
| Rate for Payer: VA VA |
$34.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.99
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
IP
|
$138.65
|
|
|
Service Code
|
NDC 16729014701
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.50 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna Commercial |
$117.85
|
| Rate for Payer: BCBS Trust/PPO |
$114.51
|
| Rate for Payer: BCN Commercial |
$114.51
|
| Rate for Payer: Cash Price |
$110.92
|
| Rate for Payer: Cofinity Commercial |
$119.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.92
|
| Rate for Payer: Healthscope Commercial |
$124.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.85
|
| Rate for Payer: Nomi Health Commercial |
$113.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.99
|
| Rate for Payer: PHP Commercial |
$117.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$120.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.01
|
| Rate for Payer: UHC Core |
$115.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.99
|
|
